Therapeutic gymnastics after. Massage after a stroke. Passive hand exercises

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Rehabilitation after a stroke at home is an important component of the complex therapy of the disease. After an attack, the patient must follow all the recommendations of the doctor.

Medical indications

Stroke is a complex dangerous disease, which occurs during blocking (by a plaque, thrombus - ischemic stroke) or rupture (hemorrhagic stroke) of the blood vessels of the brain.

In this case, an acute disturbance of blood flow in the organ is noted, causing damage and death of the cells of the nervous series.

The treatment of such an ailment is a long process consisting of many successive stages. Primary medical measures necessarily carried out in intensive care, then in therapeutic departments, where the emphasis is on recovery. At the end of inpatient treatment, a rehabilitation period necessarily follows. It minimizes the deficit left after the hospital.

This stroke treatment helps the body get used to living off the remaining intact neurons. All questions about recovery after a stroke are decided individually with each patient, since there are no unified data on such a condition. In this case, the doctor takes into account:

• area of ​​change;
• localization of the disease;
• kind of illness;
• timeliness of medical care.

Estimated survival times:

1. With minimal neurological changes, partial recovery occurs after a few months, complete recovery within 2-3 months.
2. With a pronounced neurological deficit, partial recovery occurs after six months, complete recovery rarely occurs, lasting for years.
3. In severe violations, partial recovery occurs within a year.

Recovery after an ischemic disease occurs faster.

Rarely after a stroke, the patient recovers completely and in as soon as possible. Therefore, rehabilitation after a stroke at home usually lasts for life. Often use the technique of short courses or daily exercises after a stroke at home. It has been proven that such exercises not only restore lost functions, but also prevent the development of new stroke attacks.

During rehabilitation, stroke recovery exercises are aimed at restoring limb function.

• decrease in the tone of the body (with a stroke, paralysis occurs with hypertonicity);
• effect on microcirculation (the disease disrupts blood circulation);
• prevention of contractures - charging should fight muscle stiffening;
• protection of the skin, exercise (the rehabilitation complex should protect the areas of greatest pressure);
• resumption of subtle movements (these are important functions of the body and nervous structures).

Healing procedures

It is better to treat a stroke with exercise after consulting with your doctor. With it, you can choose a set of exercises and learn how to perform them correctly, effectively. The peculiarity of such complexes is that they start with simple movements and gradually become more complex.
Before performing, warm up the tissues. Suitable for this water procedures. In the presence of contraindications or other reasons, instead of baths, a massage lasting up to a quarter of an hour is used. For the rehabilitation after a stroke of severe patients with gross lesions, assistance is important, they cannot do such tasks on their own. Each exercise should be performed easily, not cause fatigue and overwork.

If such a clinic occurs, it is important to suspend classes or reduce the load, since there is a discrepancy between the loads and the patient's abilities at a particular stage of the rehabilitation and recovery period.

Exercise

For a quick recovery, physiotherapy exercises after a stroke must be performed strictly according to certain rules.

When in bed, it is quite difficult to perform a large amount of exercise. In this state, the functionality of a weakened organism is very limited. Exercises are performed with outside help.

Therapeutic gymnastics begins to be performed in the acute period of the disease in the presence of spastic paralysis, increased tone muscles. At the same time, patients are not able to straighten their limbs, since they are firmly fixed in bent position. Exercise reduces tone and increases range of motion. An example of gymnastics for rehabilitation:

1. Extension, flexion of fingers and hands, forearms and elbows, feet and knees.
2. Rotational movements with damaged segments, performed with outside help. There is an imitation of movements that healthy people are able to perform.
3. Hand recovery exercises. Spastic limbs are stretched with the help of splints or other devices. Similar exercises are indicated for persistent forms of paralysis. The bent limbs gradually unbend, they are fixed to special devices for at least half an hour.
4. Often used exercises for a stroke with a towel. It is attached above the bed, grasped with the affected hand and made various movements.
5. Exercises with a rubber ring. It is made with a diameter of 40 cm, thrown between the hands, forearms and stretched by spreading the arms.
6. Exercise after an attack to minimize muscle spasm in the legs. A rigid roller is placed under the knee, the thickness of which is gradually increased. This is how the muscles are stretched.
7. If a stroke occurs, rehabilitation at home includes grasping the shins over the joint, flexing and extending the legs at the knees by sliding the feet on the bed.
8. Lying in bed, you should try to grab her back with your hands. It is necessary to perform a series of incomplete pull-ups with simultaneous stretching of the feet.
9. Recovery after a stroke at home necessarily includes eye training. At the same time, the emphasis is on restoring the mobility of the eyeballs, on adapting vision. They often move their eyes in different sides, circular motion. Exercise is done with closed and open eyelids.
10. Stroke treatment at home often includes eye exercises with gaze fixation followed by various head movements without breaking away from this fixation point.

Physical activity in different positions

Exercise therapy in a sitting position for neurological patients is aimed at resuming precise movements of the hands, strengthening the back and legs. Exercise is usually performed after a stroke at home. An example of such a technique:

1. In a sitting position, patients on inspiration bend in the back and stretch the torso. On exhalation, relaxation occurs. The exercise is performed up to 10 times.
2. In a sitting position, raise and lower legs alternately.
3. Treatment after a stroke includes such an exercise. Starting position sitting in bed. On inspiration, the shoulder blades are brought as close as possible to each other, throwing the head back. On the exhale, you need to relax.

How to treat a stroke with exercises in a standing position? Such gymnastics is shown after the expansion of the patient's motor regimen. Usually it can be carried out after its partial recovery. The purpose of the classes is the resumption of movements, the elimination of the pathology of the neurological plan.

Similar healing gymnastics:

1. Picking up a small item from the floor or table. Therapeutic exercise of such a plan after a stroke helps to work out subtle movements.
2. While inhaling, raise your arms, stand on your toes. As you exhale, you need to relax, bend your torso and lower yourself. The exercise is repeated up to 5 times.
3. Using an expander to bend the hands into a fist, spreading the arms to the sides.
4. Body tilts to the side.
5. Performing the exercise "scissors" with your hands.
6. Slow squats. You need to keep your back straight.

For a long time, the method of combined training has been used. When performing new gymnastic techniques, you can continue the gymnastics of the previous stages. It is allowed to use healing physical education with elements of strength exercises. It is recommended to use light dumbbells during training.

Violation of the patient's speech activity

Often the disease affects the speech centers of the brain. Their recovery is much slower than the motor areas of the brain. It usually takes years. Therefore, the recovery of patients is necessarily carried out continuously from the first day of the stability of the condition. It is strictly forbidden to stop classes. Over time, there will be an improvement in speech function.

Clear recommendations have been developed for speech restoration classes. All efforts are aimed at restoring the structure and functions of damaged cells. For this, constant training of speech and hearing is carried out. An important element healing is listening to speech. It is necessary to talk more with patients, describe the room, nature, appearance of people and objects. This will allow the patient to start playing sounds faster.

Patients first learn to repeat individual sounds, syllables. Gradually increase the number of reproduced words. At the last stage, the patient is taught to repeat rhymes, tongue twisters. It has been proven that singing has a positive effect on the speech abilities of stroke patients. Frequent listening to songs contributes to the speedy healing.

For the active development of facial muscles, apply:

• protrusion of the tongue;
• slight biting of the lips;
• licking the lips with the tongue in different directions.

Memory after an attack

Memory is affected in a stroke in the first place. To restore it, doctors usually use a medical method of supporting structures.

Often used nootropic drugs that improve metabolic processes(memory, attention, speech). Popular nootropics are:

• Piracetam;
• Lucetam;
• Nootropil.

Memory recovery

A feature of their action is considered to be a rather slow effect from their use. Therefore, such medicines are used for at least 3 months. Then a short pause in therapy necessarily follows, and the course of treatment is repeated.

Against the background of medication, functional and restorative therapy is carried out. It consists in memorizing words, rhymes. Patients benefit from playing Board games with which you can re-learn to concentrate.

Medical methods of therapy

An indispensable element of the rehabilitation therapy of stroke patients is the drug treatment of brain dysfunction. Medicines are taken in courses. It is recommended to take parenterally twice a year cerebral medicines that improve blood flow and brain function. After a hemorrhagic stroke, blood-thinning medications should not be used.

The main groups of drugs used for the rehabilitation of stroke patients:

1. Improving blood flow (Cerebrolysin, products containing aspirin).
2. Increasing metabolism (Ceraxon, Actovegil, Solcoseryl).
3. Other medicines (Glycine, Sirdalud, Gidazepam, Adaptol, medicinal herbs, herbal teas).

Drug therapy usually has a stepwise approach. It involves the step-by-step administration of medications (first parenteral, and then tablet). It must be understood that the appointment, cancellation or replacement of medicines is carried out exclusively by the attending doctor, who constantly monitors the condition of his patient.

Survival, the degree of resumption of brain function depends on:

• the extent of organ damage;
• the quality of primary care;
• the speed of delivery of the patient to the medical institution;
• timeliness and adequacy of therapeutic measures.

Since such an ailment is much easier to prevent, it is necessary to take care of your health, lead correct image life, periodically examined by a doctor in the presence of aggravating factors (risk factors).

Relatives and friends of a post-stroke patient are required to show maximum patience, endurance, understanding and diligence. This can provide the patient with proper care for the entire period of rehabilitation, accelerate his healing.

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Many patients after a stroke manage to return to working capacity and lead a normal life. The main condition is activity, perseverance, self-confidence. And most importantly - movement, movement, movement. Even a bedridden patient can and should exercise. And if he cannot, due to complete immobility, then those who care for him should do passive gymnastics for him.
Here are a few examples of how paralyzed bedridden patients after a stroke were able to fully recover from disabled people to full-fledged people. As well as advice on rehabilitation after a stroke with the help of massage and gymnastics.

Rubbing for those who have had a stroke:
This tool helps to restore body mobility to bedridden patients after a stroke. To prepare the rub, you need to take the following dry crushed ingredients: half a glass of black radish peel, 1/2 cup horseradish leaves, 2-3 pods of hot pepper, 1/4 cup partitions walnut, 1/4 cup pine nut peel. Put all this in a jar and pour 500 ml of alcohol or triple cologne. Infuse the mixture for 7-9 days. Rub the entire body of the patient dry from head to toe. (HLS 2000, No. 14, p. 12)

You can limit yourself in tincture to only black radish peel and hot capsicum (HLS 2010, No. 14, p. 19)

Massage after a stroke:
A man at work had a stroke. The right side of the body was taken away, swallowing functions disappeared. Hospital, injections, tube feeding... 10 days have passed, and there was no improvement. Then the wife, who decided to use folk remedies. Daily gave 8 teaspoons of blue iodine on jelly during feeding. As a result, 4 days after that, he began to swallow on his own. From Gavaa Luvsana's book "Essays on Oriental Reflexology Methods," she wrote out points on the meridians that should be massaged in case of a stroke. First, the right foot warmed up, which was icy, then the right side began to function. As a result, the man again went to work (HLS 2000, No. 24, p. 7)

Care of the bedridden patient after a stroke:
In the first days after a stroke, the patient is doomed to complete immobility. To prevent pulmonary edema, a bedridden patient should be turned in bed every 2 hours. When the condition improves, sit him in bed for a few minutes. If the patient is conscious, it is necessary to force him to do breathing exercises, most often they are allowed to inflate inflatable toys.
So that a paralyzed bedridden patient does not form bedsores after a stroke, it is necessary to wipe the skin daily with camphor alcohol or a mixture of vodka and shampoo. If the patient still has skin damage, it is necessary to wipe them with a solution of potassium permanganate and lubricate with rosehip oil.
With a bedridden patient after a stroke, even if he is completely immobilized, it is necessary to carry out passive gymnastics, this prevents blood stasis and thrombophlebitis. The patient's arms and legs must be bent, unbent, lifted and massaged.
It is necessary to constantly talk with the patient, even if it seems to you that he does not understand the speech addressed to him. This will allow faster recovery logical thinking and speech. (HLS 2001, No. 3, p. 8-, from a conversation with Dr. MN Kadykov A. S.)

Exercise after a stroke:
A 65-year-old woman suffered a stroke, her right side was paralyzed. At first she fell into depression, she did not want to live, so as not to be a burden on the family, but her daughters convinced her to fight for life. And she began to fight.
At the hospital, doctors taught the patient to walk, moving a chair in front of her, at home she continued these classes, and as a result she was able to move independently.
Every day he does exercises for paralyzed hands and feet: gymnastics, counting, rolling with sticks (smooth and spiked), rolling a tennis ball and rubber balls. also collects right hand pyramids, puts 100 pencils from the table into a box, collects dominoes, squeezes the carpal expander, sorts through the knuckles of the beads with his fingers, shakes right foot"frog" (foot pump for inflating the chambers) 120 times, pulls the expander with his right hand - 200 times, sits down and stands on high chair, holding the handrail - 50 times, reads aloud to restore speech.
There is a desire to reduce the number of exercises, but every time a woman pulls herself up and tries to increase them every month. Everyone is happy to celebrate small victories: the hand has already begun to clench into a fist, now it turns out to eat with a spoon in the right hand, etc ... (HLS 2002, No. 10, p. 3)

Exercises to restore the hands and fingers.

Consider how to develop fingers after a stroke:
1. Drum your fingers on the table
2. Do finger splits
3. Widely spread, and then squeeze your fingers
4. Put the brush on the table or on the bed. Raise each finger in turn, then raise the whole palm.
5. Holding a paralyzed hand with a healthy hand, raise a sick hand
6. Putting your elbow on the table, hold your hand vertically, reach your palm with your fingers
7. thumb hands to press on each other finger of the same hand.
8. Putting your palms together, rest each finger in turn on the opposite
9. Elbows on the table, palms together. Raise and lower your elbows, sliding them on the table
10. Roll the rolling pin on the table with your palm.
11. Roll up the foam with your fingers.
12. Take a stick in both outstretched hands and twist it, intercepting, clockwise and counterclockwise
13. Throw a stick from one hand to another.
14. Roll the ball with your fingers away from you and towards you.
15. Like spinning a light bulb, spin the ball clockwise and back
16. Squeeze the ball between the palms and put pressure on it
17. Toss the ball from hand to hand.

Exercises after a stroke for the arms and development of the shoulder joint:
1. Stretch your arms forward and put the diseased healthy arm, bending at the elbows. A "frame" is formed. We make turns, moving the "frame" to the left and right.
2. Lower and raise hands in the lock, helping a paralyzed healthy hand
3. With hands clasped in a lock, make circular movements.
4. Without disengaging your hands, rotate your shoulders back and forth
5. Raise the hands clasped in the lock up, spread apart and lower

Exercises after a stroke for the legs:
1. Sit on the floor, unbend and bend your knees, sliding your feet along the floor.
2. Sitting on the floor, legs extended forward. Move your legs in turn to the side, sliding your feet on the floor
3. Raise a straight leg and put it on the other.
4. Pull one knee to the chest, then the other.
5. Lying on your stomach, toes rest on the floor, tear your knees off the floor.
6. Crawl
7. Sitting on a chair, roll your feet from heel to toe and back
8. Sitting on a chair, spread and flatten your heels. Then lower your legs to your heels and bring them together - spread your socks
9. Put the affected leg on the healthy one and rotate the ankle joint.

Massage and exercises for stroke prevention:
In Russia, 400,000 strokes occur annually. The reasons are stress, deterioration of blood circulation in the vessels of the brain.
To manage yourself and resist stressful situations, a relaxation exercise will help: you need to sit comfortably, close your eyes and be alone with yourself for 10-15 minutes. Do this exercise 2-3 times a day.
To increase cerebral circulation and avoid a stroke, it is useful to do a head massage.
1. With fingers clenched into a fist, you need to stroke your head from the forehead to the back of the head and neck, and then to reverse direction(2-3 times)
2. Beat the whole head with fingertips for 1-2 minutes
3. With fingertips, beat whiskey and cheeks for 1-2 minutes
4. Rub your ears with your palms.
5. Rub the left shoulder with the right hand
6. Rubbing the right shoulder with the left hand

For improvement cerebral circulation it is useful to perform vibro-gymnastics. Stand on tiptoe and drop sharply, hitting the heels on the floor. 20 concussion-lifts with the vertical position of the head, 20 - with the head tilted to the right, 20 - with the tilt to the left and 20 - with the head tilted forward. (HLS 2002, No. 24, p. 12)

Mental exercises after a stroke:
"Mental gymnastics" helps patients recover, even bedridden patients after a stroke can do it. It is possible to restore the central nervous regulation that controls the motor activity of the affected areas of the body by creating a mental image of a particular exercise.
Imagine that you clench your fingers into a fist, raise your feet up, lower them down. The clearer the “picture”, the faster connections are formed with other parts of the brain, which will take over the functions of nervous regulation of the parts of the body affected by paralysis.
Each mental exercise leaves its mark in the brain; when repeated, a chain of such traces is created and a new center nerve connections that control movement.
Depending on the severity of brain damage, the will of the patient, patience and perseverance, the process of building new connections can take a month or a year. And you also need unconditional faith in the power of mental training. Whether this faith is true or false, it will work wonders. Set goals and go for them. (HLS 2002, No. 13, p. 19. Boris Goryachev, doctor)

Exercise "Kalmyk yoga":
Many senile diseases are associated with impaired cerebral circulation. Patients fight these diseases with the help of breathing exercises according to the methods of Strelnikova, Budeiko, Frolov. These systems have one thing in common: the content of carbon dioxide in the blood increases, and this increases the blood flow to the brain and heart, dilates blood vessels. The exercise “Kalmyk yoga” works on the same principle.
There are cases when the exercise "Kalmyk yoga" completely removed the diagnosis " diabetes”, many people significantly lower their blood pressure levels (from 190/100 to 140/90). But you need to practice every day for 2-3 years. This is a long time, but this exercise will not only save you from recurrent stroke and heart attack, but also completely rejuvenate and strengthen the body.
“Kalmyk yoga” is squats with breath holding and the torso tilted parallel to the floor. When doing the foundation exercise thumbs close the nostrils. You should do 10-15 sets of 20-60 squats.
The man suffered a heart attack, his wife showed him an article about Kalmyk yoga. He began to do exercises daily, gradually gave up all medications, the pressure returned to normal, his health became perfect. (Healthy lifestyle 2003 No. 3, p. 23)

Simple gymnastics for bedridden patients after a stroke:
A 58-year-old man suffered a stroke. He knew that the only way so that a bedridden patient after a stroke turns into a full-fledged person - these are daily physical exercise. There is no time to waste, you need to start exercising immediately, while still lying in bed, in order to overcome the consequences of a brain stroke.
You can start with the simplest exercises (1) and move on to more complex ones (10):
1. Raising a paralyzed hand, first you can help with a healthy hand, and even earlier, those who care for the paralyzed patient should raise the sick hand for the paralyzed patient.
2. Squeeze a clothespin with the affected hand, it will not work the first time, but it will work out on the tenth or hundredth attempt.
3. Lying down, squeeze the mattress with a sick hand and make circular movements on it.
4. After you get stronger and start to sit down, learn to write with your left hand.
5. Dip in water and wring out a rag. Over time, wipe the tiles in the kitchen and bathroom.
6. Squeeze a rubber ball with your hand to make it more pleasant to do - pierce it. Perform 100 repetitions.
7. Sculpt balls from plasticine.
8. To develop the legs, use a rubber ball, round sticks - you need to roll them with your foot on the floor, gradually increasing the pressure.
9. Rest against the wall with your hands (if the sick hand does not rise, help her with a healthy one), shift from one foot to the other.
10. Lean forward, touching the floor with your fingers.
The most important thing is to defeat apathy, laziness, the belief that you are no longer good for anything and will not be able to return to normal life.
The man has been doing these exercises for three years, as a result, he learned to serve himself, walks around the apartment freely, and on the street with a stick, he learned to write with his right hand, on which, after a stroke, he could not even move his fingers. (Healthy lifestyle 2003 No. 17, p. 10)

Exercise after a stroke:
After a stroke, the son took the woman to his home, she began to do exercises in the hospital - the doctors showed the complex. They soon seemed too simple. She asked her son to find more large buttons, there were 17 pieces. They were dumped into a pile, and the woman carried them with one paralyzed hand to another pile at a distance of 30-50 cm. Then she did the same exercise with matches, then she learned to put the spilled matches into a box.
A table was placed near the patient's bed so that she could learn to get up and walk leaning on it. Over time, she was able to walk around the apartment, holding on to the wall.
The paralyzed arm after a stroke was very swollen, the woman bandaged aspen pegs to it, and the swelling went away. Also, a paralyzed hand can be tied to the neck so that it is less below, so it almost does not swell.
The patient had a strict routine - exercises 3 times a day, exercises with buttons, exercises with matches, long walking around the apartment. Soon she learned how to peel potatoes and cook soup for the arrival of children. To develop strength in a paralyzed arm, she carried in a bag first half a loaf of bread, then a whole loaf.
Now, 4 years after the stroke, her main exercise is “Kalmyk yoga”, she does 30 squats daily. Previously, they called an ambulance 2-3 times a month, now the pressure has returned to normal, and I managed to give up the pills.
A wish for those who have experienced a stroke: work slowly and hard, work and work within your capabilities. Movement is life, while we move, we live. The main thing is not to lose heart, always set a goal and achieve it. (HLS 2006, No. 23, p. 18,)

Walking and exercise helped recover from a stroke:
A man in 19955 was in the hospital with a diagnosis of stroke. The left side was paralyzed. The memory was gone for 8 days. 41 days after the stroke was in the hospital. I couldn't sit, I couldn't hold a spoon, I couldn't eat, because my mouth hardly opened, I only drank, my head hurt a lot.
When the hands began to act a little, he began to rise on the bed with the help of a rope with knots tied to the headboard. Sat for two minutes. After some time, he began to lower his legs from the bed, immediately felt relieved, because the blood began to flow into his legs. I did this exercise several times a day. He began to roll the roller with his feet, plus a foot massage. Feel a little better, appetite appeared.
When he was discharged home, he began to learn to walk, first around the house, holding on to the wall and with a cane. A month later, he asked to go outside. There he decided to go alone to the next entrance, somehow he succeeded, sat there on a bench and on the way back. After that, his legs hurt all day, but the next day he walked 2 times more, and every day he increased the distance. A week later, I was already walking around the three-entrance house.
Then the patient asked to be taken to the village where he had a house built. There he every day 100 m to the farm and 100 m back. His legs became more obedient, but still he often fell. Soon he began to train his left paralyzed arm - he carried a bucket with 2 liters of water. At first with a rest, then he carried it to the end, without letting go of it, it was very hard - the fingers unbent and the bucket tried to slip out.
Gradually increased the distance - did 5 walkers daily - 1 km, then 2 km. Arms and legs got stronger, he began to work in the garden and at home, 12 years have passed since the stroke, the patient is now 70 years old, he emerged victorious from the fight with the disease. (HLS 2007, No. 8, p. 8,)

Massage after a stroke:
A woman who has been massaging people for 25 years wrote to the newspaper. Her main patients are bedridden patients paralyzed after a stroke. When she came to another patient for the first time, she decided that no massage would help here. The woman was very heavy - she did not speak, did not move, did not think, did not understand where she was and what had happened to her.
For the first six months after the stroke, the patient was massaged daily. And then courses 2 times a year.
3 years have passed after the stroke, her speech and memory have returned to her, now she is learning poems and reciting them by heart, knitting socks, planting flowers, doing everything around the house herself, doing gymnastics.
The masseuse did not have such patients yet, usually lazy patients who did little to heal themselves came across. In order to defeat the consequences of a stroke, one must simply not be lazy.
Employees of the editorial office of the newspaper "Herald Healthy Lifestyle" called this patient to find out the secret of the cure. It turned out that there is no secret, but there is an amazing fortitude and perseverance. “I don’t give myself a moment of rest, I do something all day long. Sometimes I get so tired that I have no strength, I want to lie down, but I can’t, I have to move, move and move. The only indulgence is to lie down after dinner for 15 minutes, ”the patient said by phone. (HLS 2009, No. 9, p. 9)

Breathing exercises after a stroke:
This breathing exercise helps with the most various diseases, in particular, cerebral sclerosis and stroke. Just a month of classes, and you will forget what sclerosis is, and stroke patients will gain hope for recovery. A 74-year-old woman, after reading an article about this gymnastics, practiced for almost 2 years. As a result, high blood pressure, which was not lowered by any medication, returned to normal, and her health improved significantly.

First you need to choose a position: either reclining in a chair or lying on your back. Relax and drop all thoughts. Close the left nostril with the left hand and inhale calmly, very slowly through the right nostril. Take a deep breath so that the chest rises. Then close the right nostril, freeing the left. Do not breathe as long as possible, endure with the last of your strength. This is the point of the exercise. Then begin to exhale through the left nostril. Repeat the exercise 5-7 times. Then we do the opposite: inhale through the left, exhale through the right nostril, also 5-7 times. This is 1 cycle. Such cycles should be done 3-5 times.
After about a week in the solar plexus area during the exercise, you will feel a slight tingling and warmth. After 2 months, your abdominals will become elastic like a drum. All this suggests that the exercises are going correctly and are beneficial (HLS 2011, No. 9, p. 19)

How to start exercises for a bedridden patient after a stroke - stages of rehabilitation:
1st stage:
From the first hours of the acute period of a stroke, positional treatment is applied to avoid contractures of the paralyzed limbs. They also do passive gymnastics.
2nd stage:
By the end of the first week, active gymnastics is prescribed, developed by exercise therapy instructors in a hospital. It is first performed in isometric mode, without movement in the joints. Sick limbs are lifted by an assistant, and the goal of the patient is to hold the raised arm or leg. The hand cannot be raised by the hand. If the sick hand is raised by the sick healthy hand, he must lift it by the elbow, turn the hand with the palm up, if the assistant raises the hand, then with one hand it is taken above the elbow from below, and with the other hand by the wrist from above.
3rd stage:
The patient is taught to sit. They begin with 3-5 minutes of reclining, putting pillows under the back and head, after 2-3 days the patient is transferred to a semi-vertical position.
Then they sit on the bed with their legs down, substituting a bench under them.
4th stage:
Strengthening the muscles of the legs. Exercises are carried out using an expander or a frog pump for inflating rubber mattresses. IN lying position do the exercise "imitation of walking" - the legs bend and unbend at the knees, the feet slide along the sheet.
5th stage:
Walking. The patient from a sitting position tries to get up, holding on to a stable support - the back of the bed, a nearby chair or armchair. When the patient learns to stand confidently, he should begin to shift from foot to foot. Having mastered this exercise, you can move on to walking in place, holding on to the headboard. Then they try to walk in place without support.
Hand exercises:
Simultaneously with exercises for the legs, it is necessary to develop the muscles of the hands. To do this, they assemble and disassemble pyramids, children's designers, cubes, and sculpt from plasticine. It is useful to shift objects with a sore hand, leafing through books, tightening nuts, fastening zippers, tying ribbons.
To relax the muscles, it is useful to lie on your back and dangle your paralyzed arm and swing it.
For the development of the shoulder joint:
1. hands in the lock, raise them up, tilt them left and right
2. take a stick with both hands, lift it up, lower it behind your head.
At the same time, the diseased hand is passive, it is pulled by a healthy hand.

But the main thing in rehabilitation after a stroke is walking. Choose flat routes without climbs with benches for rest. Gradually increase the distance. The pace of walking is slow - 40-50 steps per minute. Rest every 5-10 minutes.
Do not spare the paralyzed side, because the muscles that are not working cannot be restored. (HLS 2011, No. 22, pp. 6-7)

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Post-stroke care

Acute circulatory disorders in the brain have serious consequences, even death, surviving patients often become disabled. In addition to loss of speech, deterioration of vision and memory, immobility, the patient can be tormented by:

• insomnia (about 60% of patients complain about it);
• hallucinations (more often in the elderly);
• dizziness, noise and pain in the head.

All these features of the patient's condition must be taken into account, try to understand what torments him. Often a person cannot express their problems in words until speech is restored at least partially. The possibilities of rehabilitation after a stroke at home are limited compared to treatment procedures in specialized centers. At home there is no way to install high-tech simulators, but caring care and presence nearby loved ones allow the patient to return to life.

After ischemic

Of all cases of stroke, 80-85%, according to statistics, are ischemic. It is divided into three types:

• thromboembolic, arising from thrombosis of cerebral vessels;
• hemodynamic, which leads to a prolonged spasm of cerebral vessels caused by a lack of nutrients;
• lacunar, manifests itself in the form of disturbances in the patient's sense organs, motor functions.

After a microstroke, a stroke of any severity, the patient needs a strict bed rest. An ischemic attack can cause a lesion of a left-sided or right-sided nature, a person is paralyzed. When caring for a bedridden patient, it is important not to let him stay in one position for a long time, you need to turn him over every 2-3 hours.

After hemorrhagic

In this type of stroke, a cerebral hemorrhage occurs. 30-60% of those who have undergone extensive cerebral hemorrhage fall into a coma and die. The main task at the first stage, when recovery from a stroke has just begun, is to avoid bedsores. It is important to learn how to properly turn over, seat the patient, shift and lift him. The patient's behavior is affected by which part of the brain is affected, left or right. The process of returning to a full life after the disease begins in the first weeks and lasts about 1.5 years.

Treatment after a stroke at home

After taking the victim of a brain stroke from the hospital, it is important to continue the prescribed medication. The patient must receive medication to improve blood circulation in the brain. For this, drugs such as Encephabol, Actovegin (in tablets and injections), Vinpocetine, Mexidol are prescribed. With the help of drug therapy, the brain is enriched with glucose and oxygen. In order to restore all functions, a set of measures is needed, a program aimed at the rapid rehabilitation of the patient, including diet, massage, gymnastics, and speech therapy classes.

Diet

Nutrition after a stroke in the first two weeks is carried out with a teaspoon. Bring food to a semi-liquid consistency, wipe. When the patient's swallowing is restored, more solid food can be fed. Eliminate foods that increase cholesterol: pastries, pastries, everything fatty. When compiling a menu, try to use the following products:

• Cereals half of them should be whole grains (wheat, rice, oats, corn, buckwheat).
• Vegetables beans, peas, dark green and orange foods.
• Fruit daily, fresh, dried, thawed.
• Dairy products (low fat).
• Protein lean poultry meat, not daily, sometimes replaced with fish, legumes.
• Fat nuts, fish. Do not cook with margarine, lard, butter give the minimum amount. Vegetable oils are preferred.

Massage

It is started to be done with ischemic stroke on day 2-4, with hemorrhagic stroke on day 6-8. The first procedures last from 5 to 10 minutes, gradually extended to half an hour. The course includes 20-30 daily sessions. After a break for a period of one and a half to two months, the massage is resumed. If it is impossible to invite a massage therapist, you need to perform the procedure yourself, take lessons from a professional or download a suitable technique and consult a doctor.

Stroke exercises at home

After 1-2 weeks, when the patient gets better, you can start doing physical exercises. During rehabilitation after a stroke at home, passive physical education is available and easy to do, all actions are carried out with the patient by the one who cares for him. The following exercises are helpful:

• Breathing exercises. The ward must be taught to slowly inhale and exhale through slightly parted lips, while saying “zhzh”. You can blow up a balloon.
• Rock action. Roll on its surface the feet, palms of the patient.
• Passive charging. Bend and unbend alternately the arms and legs of the patient lying on his back.

Physiotherapy

When the patient succeeds in the first movement of the paralyzed limb, sensitivity begins to recover, it is time to accustom the patient to physical activity, first in bed, sitting, then standing, and then you can move on to slow walks. During rehabilitation after a stroke, gymnastics should take 2-3 hours daily, not in a row, in small complexes: the first week 40 minutes twice, the second - three times a day.

Daily walking is necessary when the patient can get up. You can walk around the apartment with ski poles, as a load on your hands. The beneficial effect of yoga on the rehabilitation of the patient is noted, asanas eliminate disorders of the nervous system. Recovery of vision after a stroke is also accelerated with the help of special exercises for concentration and focus.

Speech restoration

The more the brain is damaged during a stroke, the slower speech is restored. Successful rehabilitation of speech occurs during the first year, then the process slows down. After a stroke, pronunciation defects remain, to which one has to adapt. The patient needs classes in a speech therapy program, constant verbal communication with loved ones, memorizing tongue twisters, reading texts aloud.

Find out a few ways to improve your memory.

Video about restoring movement after a stroke

14.09.2017

Stroke is a very dangerous and serious pathology, which, depending on the species, may occur as a result of thrombosis in the vessels or rupture of blood vessels in the brain. In any case, the gray matter of the brain is affected, and then various organs. Previously, stroke was considered a priority for mature people over the age of 50, but today this pathology also affects quite young people, aged 20-30 years. Stroke attacks are becoming more frequent every year, and the risk of death is still very high. And if not immediately, then within 1 year after the attack, many die.

And to prevent this from happening, it is necessary to produce not only emergency treatment for an attack, but alsostroke recovery at home. After a recent attack, a person is able to fully or partially restore their functional activity. But this is not possible without a proper home rehabilitation period. Recovery consists of many important points, one of which is exercise therapy. From this article you will find out why you needphysiotherapy after a strokeand how to do it the right way to get the best results.

Features of the development and treatment of stroke

A stroke is a pathology that is characterized by an acute violation of blood circulation in the brain, resulting in the death of nerve cells, accompanied by the manifestation of serious symptoms from the neurological system. As a result, this leads to the loss of vital functions, for which dead brain cells were responsible. That is, due to an attack of a stroke, a person may lose hearing, speech, vision, or he may be partially or completely paralyzed. Of course, everything can end quite favorably, but most cases of stroke still eventually lead to disability or death.

After a stroke, a person is able to recover

In many ways, the patient's condition and its further treatment and recovery depends on the type of stroke. All types of strokes are divided into 2 large groups:

1. ischemic. Cause ischemic stroke is the formation of blood clots, which then clog the arteries going to the brain. This leads to impaired blood supply to brain cells and hypoxia. This type of stroke usually does not develop immediately, but within a few hours, which gives the patient the opportunity to detect the problem in a timely manner and begin treatment. Symptoms such as problems with speech, hearing and vision, partial paralysis and dizziness can indicate the development of an ischemic stroke. These signs mean the pre-stroke period;
2. hemorrhagic. It can develop as a result of rupture of the vessel due to hemorrhage in the brain. This phenomenon can be provoked by a hypertensive crisis and a significant increase in blood pressure. A hemorrhagic stroke occurs suddenly, within a couple of minutes, or even seconds. This usually happens in the daytime, after physical overexertion. A person can observe a sharp headache, nausea, fever throughout the body, which is accompanied by redness and loss of consciousness. Even a quick reaction to the symptoms that have arisen will not prevent a hemorrhagic stroke. And the later the person is taken to the hospital, the more serious the consequences will be.

As mentioned earlier, after a stroke attack, a person is able to recover. Therefore, it is very important for the first 3 years after an attack to pay attention to rehabilitation measures, of which there are a huge number. And together they can significantly improve the patient's condition.Therapeutic exercise after a strokecan only helpwith ischemic stroke, because this type damages brain cells less and the body has a reserve for producing food.

Exercises after a stroke for the right side

Probability of Recoveryafter ischemic strokevery high with the right rehabilitation approach, including exercise therapy. But the physical therapy of hemorrhagic stroke consists only of preventing the development of a second attack, surgery and resorption of the hematoma. Mandatory stroke treatment consists of the following several stages:

• resuscitation measures to save the patient's life;
• in a positive outcome, the patient is transferred to the neurological department;
• the initial stage of rehabilitation in stationary conditions;
• rehabilitation after a stroke at home.

There are many methods of home rehabilitation after a stroke. But really positive effect they will only provide integrated approach. And it is from this stage of treatment that the usefulness of the patient's recovery after a stroke depends. The treatment is complex and consists of drug and physical therapy, diet and proper daily routine, as well as gymnasticexercise after a stroke.

What is the benefit of exercise therapy after a stroke?

Recovery after a stroke is a long process that requires a lot of strength and patience. Step-by-step treatment allows the body to get used to later life without the involvement of damaged brain neurons. What exactly will be included in the treatment process is decided individually in each case, taking into account multiple factors, for example, the area of ​​damage or the timeliness of medical care. Therapeuticgymnastics after a stroke at homeis an integral part to prevent the development of complications and restore lost functions.

Therapeutic gymnastics restores blood circulation

Many people become paralyzed after a stroke, so they have to spend all their time in bed. And such forced immobility for a long time will lead to serious complications. Therefore, to prevent this from happening, you need to exercise.Exercise therapy after a stroke at home, the purpose of which is:

• decrease in tone;
• the return of the functionality of the arms and legs, as well as fine movements;
• prevention of muscle stiffness;
• restoration of blood circulation;
• skin protection.

Also, a complex of restorative gymnastics helps to prevent the development of the following complications:

• bedsores on the body;
• heart failure;
• pneumonia;
• muscle atrophy;
• thrombosis and embolism;
• transformation of the shape of the arms and legs;
• spasm of muscle groups.

Practice after an illness

Undoubtedly, the main task that comes to the fore after an attack is the return of lost sensitivity and functionality of the limbs. Physical education during a stroke helps to improve microcirculation and metabolism in all parts of the body affected by an attack. Thanks to exercise therapy, the patient will return the opportunity to perform some active movements such as drawing or writing. Also, properly executedat home exerciseswill allow you to return the gift of speech and normalize work internal organs. But positive result will be only if all the exercises are performed correctly.

Features of performing exercise therapy for stroke

Rehabilitation mainly depends on which part of the brain is affected and on the actions and mood of the patient himself. A very important role in this case is decided by the person's mood for recovery. The more he believes in a positive outcome, the better the outcome will be. In medicine, there are many cases when, despite the skepticism of doctors, the patient coped with the disease. If the stroke was in a mild form, that is, there were only minor violations of coordination, then the restoration of some functions with the help of exercise therapy is possible after a couple of months, and a full recovery after 3 months of treatment.

Stroke with gross paralysis is distinguished by more serious discoordination disorders. In this case, gymnasticexercise after stroke at homeis aimed at maintaining the ability of surviving neurons to perform certain functions. Complete recovery is very rare long years rehabilitation activities. But thanks to the correct exercise therapy after an attack, six months later, the patient will be able to partially recover, returning the possibility of independent consumer services. If the stroke led to the development of persistent neurological disorders, that is, paralysis, coma, or a complete impairment of consciousness, then the prospects are extremely bleak. The only thing that can be achieved after a few years is the ability to sit.

Therapeutic exercises should be carried out after consultation with a doctor.

If the patient's consciousness after a stroke is preserved and he is not in a coma, then 3 days after the attack, it is recommended to perform breathing exercises, which prevents the development of congestion in the lungs. And on the fifth day it is already allowed to start passive and active exercise therapy. The gymnastic complex after a stroke consists of simple movements, from a series of banal morning exercises. But, despite its simplicity, the regular and correct implementation of these exercises will bring a positive result.

You can start exercise therapy after a stroke only after consulting a doctor who will select the most suitable gymnastic complex, based on individual features patient and degree of brain damage. This individual program, drawn up by a doctor, should be carried out with the patient at home, after being discharged from the hospital.

An important point in this difficult period is the support and help of loved ones. Also, do not overdo it, because excessive loads can be harmful, however, as well as their complete absence. And you need to understand that rehabilitation does not last 1-2 years, but throughout the rest of a person’s life after a stroke.

Breathing and passive gymnastics after a stroke

Respiratory gymnastics after strokeis that the patient must take deep breaths while lying down. Moreover, the number of breaths should only increase over time. If the patient can sit and the doctor does not forbid him, then the back should be straight, letting air into the lungs as much as possible. essence breathing exercises is slow deep breaths, a second breath holding and the same slow exhalation. After each such exercise, the patient should rest and make sure that severe dizziness does not begin.

Breathing exercises should be done very carefully

In the first days after a stroke, the patient must rest, so mobile gymnastics is prohibited. But you can safely do passive gymnastics, which consists in doing exercises by other people. It is necessary that someone from close people or a qualified worker bend and unbend the limbs of the patient. You need to start with the fingers of a paralyzed hand, and then a healthy one. Then you can start rotating the brush in both directions. After you can move to the elbows and at the very end to the shoulders. Movements should be smooth in different directions and in a circle. In the same way, passive gymnastics for the legs is performed.

Active exercise therapy after a stroke

If the patient can move himself or even sit and stand, then the doctor prescribes a set of active exercises that must be done with the help of relatives or on their own. The first period after the attack is the most acute and the patient is usually unable to extend the muscles of the limbs. While in a supine position, a person after a stroke can perform the following exercises:

• eye gymnastics;
• careful turns of the neck;

• a towel is attached above the bed, for which the patient clings and tries to work with his hand, bending and unbending it. Over time, I understand the towel higher, complicating the exercise;
• the patient should grab the headboard and try to rise and push off from it. Ideally, this exercise should also involve the lower limbs;
• warming up the fingers while lying in turn and at the same time;
• development of joints in the elbows. The patient lies on his back, arms are along the body. The right hand must be bent at the elbow and lowered to the bed in this position, then do the same with the left hand. Repeat the exercise 10 times;
• alternating bending of the legs at the knees, without taking your feet off the bed. Do this 10 times with each leg.

If the patient can sit and stand, then the doctor developsa set of exercises for strokein sitting and standing position. At the same time, at any moment of rehabilitation, the patient should think positively, directing all his energy to recovery. positive thinking and the support of loved ones, combined with drug treatment, physiotherapy and therapeutic exercises, will help you quickly return to normal life.

The terrible is over, relatives know that a loved one survived a stroke and is preparing to be discharged. At home, they are waiting and equipping the room, and the doctors are preparing a list of necessary for rehabilitation, which includes gymnastics after a stroke. Often, exercise therapy is perceived as something secondary and it seems that pills and massage are needed more, but this is an erroneous opinion. Let's see how important therapeutic movements are in the post-stroke period and the rules for conducting motor rehabilitation.

To understand why physical therapy is needed after a stroke, it should be remembered that motor disorders are caused by necrosis of part of the brain cells. Structures destroyed by ischemia cannot be restored, but other brain tissues can take over their functions. Exercise after a stroke will help get the brain working.

In addition to creating new neural circuits necessary for mobility, recovery gymnastics will help:

• avoid bedsores;
• normalize muscle tone (eliminate myospasms, reduce paresis);
• prevent congestive pneumonia;
• improve blood supply to internal organs.

The first exercise therapy for a stroke is carried out in a hospital, and then gymnastics must be continued at home. Relatives need to know the rules for preparing the patient for classes.

A little about preparation

You can not immediately give a load on fragile muscles. Before starting exercise therapy for a stroke, a person must first be prepared. This requires a massage.

It is not necessary to resort to the services of a massage therapist, the procedure can be carried out independently:

Massage movements are performed first on healthy parts of the body, then the affected side is massaged. After the massage, you can move on to exercise therapy after a stroke.

What is anaerobic exercise

From doctors you can hear the mysterious term "anaerobic gymnastics." But behind the name lies only physical education after a stroke, during which oxygen consumption by tissues increases. In addition to the exercises prescribed by the doctor, patients are recommended the following types of anaerobic exercise:

• hiking;
• cycling trips;
• swimming;
• dancing;
• moderate outdoor activities (caring for flowers, decorating a personal plot, etc.).

Exercise after a stroke extra classes, providing physical activity, are selected individually, taking into account the capabilities of a person.

Recommended sets of exercises for recovery at home

After a stroke attack, it is necessary to train on all parts of the body, but exercise therapy after a stroke is selected so that the maximum correction of possible movement disorders occurs.

Improving the functioning of the vestibular apparatus

Balance and coordination exercises are essential for people who have difficulty maintaining vertical position while walking.

Exercise therapy for stroke for balance consists of relatively simple movements:

• Standing, lean your hands on the back of a chair. Stand on 1 leg for half a minute, then change the limb. Gradually, the duration of standing should be increased to 2 minutes and do not use your hands to maintain balance.
• The following coordination exercises will become a more complicated version of the previous movement - you must not only raise your leg, but also take it to the side, holding the raised limb for a couple of seconds, then slowly lower it to the floor.
• Walking in one line. You need to walk, placing the heel of the right foot close to the toe of the left.

At first, relatives help to do exercises to restore balance, and then the person begins to train on his own.

Troubleshoot facial expressions

Facial exercises after a stroke are necessary when paresis of the facial muscles persists and articulation is impaired.

• alternately frown and raise eyebrows;
• puff out cheeks;
• smile.

A useful gymnastics for the muscles of the face is to make faces in front of the mirror, trying to make the halves of the face look the same.

Almost always, a violation of facial expressions is accompanied by difficulty in articulation. Then a set of exercises for the tongue and lips will help:

• drive the tongue over the lips;
• grin showing teeth;
• stick out the tongue, trying to touch the chin;
• pucker your lips.

Such rehabilitation at home will allow not only to return facial expressions, but also to get rid of slurred speech.

Gymnastics for the eyes

Paresis of the oculomotor nerve interferes with focusing the gaze, causing double vision. To eliminate this, you will need a special exercise therapy complex:

• focus on one point and blink at regular intervals;
• change the direction of the gaze, first to the right-left, and then from top to bottom;
• rotate the pupils first clockwise and then counterclockwise;
• close your eyes tightly for a few seconds, and then slowly open your eyes.

An important rule: gymnastics for the eyes should not overwork the organ of vision. Eye physical education after a stroke is performed slowly, with a small number of repetitions, but movements must be done 3-4 times a day. This will help restore the working capacity of the oculomotor muscles and nerves.

Strengthening the muscles of the body

Restorative gymnastics after a stroke necessarily contains exercises for the body. This is necessary in order to build up a natural muscle corset that makes it easier to maintain balance:

• Body rotations. It is necessary to turn the body in the lumbar region to the right and left. First, physiotherapy exercises are carried out while sitting on a chair, and then, as the muscles strengthen, turns are done while standing.
• Tilts to the side. The situation is the same as described above. You need to lower your left shoulder and bend slightly to the left, then straighten up and repeat everything on the other side.
• Leaning forward. Raise your hands up and clasp from "to the castle." Slowly lean forward without changing the position of the upper limbs, and then return to the previous position.

Leg exercises at home

Restorative gymnastics for the legs at home has 2 goals: to restore muscle tone and increase the range of motion of the limb.

Exercise therapy for the legs includes the following movements:

• Walking. When doing walking exercises, you should march a little, raising your knees high, and then walk on your toes, heels and lateral surfaces of the foot. The proposed movements to restore walking will not only strengthen all leg muscles, but also improve coordination.
• Strengthening the ankle. The following leg recovery exercises should be done while sitting in a chair. It is necessary to rotate the ankles first outward and then inward. Another exercise for the ankle joint: stretch the toe as much as possible, “like a ballerina”, and then bend the foot, trying to pull the fingers to the lower leg.
• Stretching the ligaments under the knee. You need to sit on the floor and slowly lean forward, trying to touch your toes with your hands and feeling how the hamstrings are stretched. This is a good exercise for relieving spasticity in the lower leg, knee, and hip.
• Stretching of the femoral tendons. It is necessary to put a pillow or a small ball between the thighs and try to squeeze the legs, despite the resistance of the ball.

It is important to remember that exercises performed after a stroke should begin with leisurely movements. Exercises for the legs are first performed at a slow pace, and then, the rhythm of the movements gradually accelerates.

Exercises to restore hand strength and motor skills after a stroke

Patients complain of weakness of the paralyzed arm and the inability to perform precise movements. Hand exercises after a stroke are conditionally divided into 2 groups: restoring muscle strength and improving coordination.

Gymnastics for restoring muscle performance at home includes a set of exercises:

• Lie on your back and fold your arms over your chest. If the right hand does not work well, then the left palm should lie on top of the right and vice versa. Raise your arms to the ceiling, stretching the diseased limb with the help of a healthy one.
• Standing with your arms down, clasp your limbs into a lock. Slowly lift the clasped hands up.
• Starting position, as in the previous exercise. But the arms do not rise up, but bend and unbend at the elbow joints.

This passive arm recovery exercise helps improve blood flow to the limbs and prevent joint stiffness. But, in addition to passive movements, active actions are necessary to develop the hand. In addition to physical therapy, patients at home are recommended to perform the following actions with a sore hand:

• Open and close doors with turning handles. This is a good exercise for the hand, strengthening the muscles and restoring fine motor skills.
• Turn the key in the keyhole. This movement is good for the fingers: it increases strength and coordination.
• Take objects with your hand (choose unbreakable ones) and carry them around the room.

In addition to increasing muscle strength, it is necessary to restore fine motor skills, return the ability to perform accurate movements to the fingers. Doctors advise to draw, knit and perform another precise work. When choosing a training area for fine motor skills, one should take into account not only the capabilities of the limb, but also the personal preferences of the patient. When a person likes an activity, the recovery process will be successful.

Exercise therapy for ischemic stroke and hemorrhage in the brain tissue are carried out in the same way. It is necessary to remember only one rule: physical activity after a stroke increases gradually: patients should not overwork while performing therapeutic exercises.

Breathing exercises

Gymnastics for breathing is carried out depending on the capabilities of a person after a stroke:

• Violated the power of mobility on the right. At home, exercises are recommended for a stroke on the right side, when the movements of the affected limbs are done with assistance or using a healthy left hand. Gymnastics should be accompanied by measured deep breathing.
• Paresis on the left. Gymnastics for a stroke on the left side is carried out similarly previous option, but the person helps when performing movements with the right hand. Breathe deeply and evenly.
• Paralysis. If one or both sides of the body are completely paralyzed, then at home, the recommended exercises for recovery are performed by relatives, making movements with the limbs of the patient. At the same time, a paralyzed person is asked to take deep and even breaths during the procedure.

Breathing will make it possible to saturate the blood with oxygen and reduce tissue hypoxia, and this will favorably affect the subsequent rehabilitation.

In addition to charging, to improve respiratory function, stroke patients at home are recommended to inflate balloons and perform other activities accompanied by increased lung function.

Training on simulators

Developed various models stroke rehabilitation simulators: some are used at home, while others are used for recovery in hospitals. Let's see what exercise equipment after a stroke can help:

• Exercise bike. Simulates a bike ride. At the same time, the severity of pedaling and the frequency of revolutions are dosed. It is useful not only for the legs - the rotational movements of the lower extremities improve the muscle tone of the buttocks, lower back, abdominals and, partially, the arms. Suitable for home - cycling is useful at all stages of the recovery period.

Used for patients with severe muscle atrophy. The device is attached to human body, acting as an external skeleton.

• Machine. Exerciser for the hand after a stroke The machine improves the flexion-extensor ability of the fingers. The device has 2 modes for the hand: automatic (the rate of forced movements is set) and mechanical, when the device “works” by pressing with a healthy limb.
• Bud. The simulator after a stroke Bud in everyday life is called a glove simulator. Designed for the hand, allowing you to improve the work of the brush. The device looks like a glove with latches attached to a rigid frame. The limb is placed in a "glove", secured with straps and the device is driven by a portable electric motor. This finger trainer after a stroke is allowed to be used as a supplement to active exercise therapy.

Manual rehabilitation simulators are relatively inexpensive and are recommended for purchase if there is a stroke patient at home. They are suitable not only for the recovery period - passive development of the hands should be carried out for the disabled, who are forced to lie motionless in bed.

Are there contraindications for exercise therapy

Charging after a stroke is not always helpful. Exercise therapy is contraindicated in the following cases:

• coma;
• mental disorders accompanied by aggression;
• the appearance of muscle cramps or seizures of epilepsy;
• the presence of severe comorbidities (cancer with metastases, disseminated tuberculosis, etc.).

Relative stroke in old age will be a relative contraindication. The question of the need for therapeutic exercises in the post-stroke period, doctors decide after assessing the patient's condition.

Exercise therapy is necessary for a stroke patient. Individually selected exercises will allow you to quickly restore impaired motor functions.

After a stroke physiotherapy exercises are the most important means for recovery.. After all, destroyed nerve cells cannot be restored, their functions are taken over by other brain cells. This is what therapeutic exercises serve, but to get the desired effect, you must follow all the rules and recommendations.

Healing takes place in several stages. First, a person ends up in the intensive care unit, where doctors are fighting for his life. If successful, the patient enters the neurology department, where the initial rehabilitation takes place, the final recovery takes place at home. The last stage is the longest, and it depends on it whether the rehabilitation will be full or partial.

Each type of stroke has its own exercises, but most of them are general and recommended for any type of stroke. The main thing you need to build on when choosing exercises is what part of the brain suffered as a result of a stroke.

When defeated left hemisphere occurs:

• Paralysis of the right side of the body;
• The problem with the perception of space;
• Motor memory deficit (the patient does not know how to tie shoelaces);
• Impulsive, quick behavior.

When defeated right hemisphere occurs:

• Paralysis of the left side of the body;
• Problem with speech
• Lack of language memory (the patient is aware of the idea he wants to convey, but cannot remember the word);
• Cautious, slow behavior.

To eliminate each problem, in addition to the basic exercises, they perform gymnastics aimed at training the impaired function.

How long does rehabilitation take

Recovery depends on two factors: the lesion and the actions of the patient. How more people believes in himself and carefully follows the recommendations of doctors, the higher the chance for full rehabilitation. Sometimes the will and aspiration of a person play a decisive role, contrary to the forecasts of specialists. Another factor is the location and volume of the affected area, as well as the time from a stroke to the arrival of an ambulance. With an increase in these indicators, the chance of an unfavorable prognosis and rehabilitation increases.

A stroke that causes slight paralysis of the body and face, moderate incoordination is the mildest form. With it, partial rehabilitation is predicted in 1-2 months. Full recovery occurs within 2-3 months.

Stroke with severe paralysis persistent discoordination disorders are already much more difficult to cure. Partial recovery to the level of household self-service at home is possible only after 6 months of training. The possibility of a full recovery is unlikely, and if it happens, then after years.

Stroke with persistent neurological impairment(disability due to complete paralysis of one side) has the worst prospects. Full recovery is not possible, partial will be limited to the ability to sit, and it will be only in a year or two.

It should be clarified that after any stroke, the treatment period lasts a lifetime and never ends. This is due to the fact that the cells that have taken over the functions of dead ones cannot replace them 100%.

A person in ordinary activities can behave like an absolutely healthy person, but in extreme situations he will lack reaction, coordination of movements.

Goals of gymnastic exercises after a stroke

The main task is the complete restoration of all functions. In addition, there are many secondary, no less important tasks:

• Removal of high muscle tone, with paralysis, the muscles are too tense, it is necessary to relieve excitability;
• Return of the accuracy of movements;
• When warming up, the blood supply to the tissues, which is reduced due to a violation of innervation, increases;
• Prevention of bedsores, with long-term preservation of one position of the body, the violation of blood circulation in places is inevitable high pressure, a change in body position prevents this.

How to do the exercises

First you need consult with a specialist and develop an individual program classes. The doctor can talk about the intricacies of any exercise and choose the most useful based on the type of stroke. Exercises are performed from simple tasks and a smooth transition to more complex tasks.

You can not overload a person, excessive therapeutic exercises are harmful, as well as its absence. Before starting the exercises, it is advisable to warm up the part of the body being trained by massage.

It is essential to have the help and support of loved ones, as well as a positive attitude towards the training process. At home, you need to help the patient, maintain faith in healing and optimism. It is important that close people constantly praise and emphasize the success of the patient. Gymnastic exercises should be performed throughout life to prevent recurrent stroke.

Stroke Exercises

Passive gymnastics

Immediately after a stroke in the first days, the patient is given complete rest, gymnastics is possible, but exclusively passive. It lies in the fact that gymnastic exercises for the patient are performed by other people, bending and unbending his limbs. Passive physiotherapy exercises begin with the fingers, first the paralyzed hand, after the healthy one.

After switching to rotation with the brush, movements should be carried out in both directions (clockwise and counterclockwise). Then they bend and unbend their arms at the elbows, and at the end they move to the shoulders, perform movements up and down, left and right, and make rotational movements. Passive gymnastics for the lower extremities follows the same principle.

To relieve muscle spasm can be fixed on a short time them in the unfolded state. The hand or fingers can be tied to a stick, securing them in an unbent position, as is done with other parts of the body. Fixation is permissible to carry out no more than 30 minutes a day and provided that the patient does not experience discomfort.

The patient himself "mental" gymnastics. These exercises accelerate the recovery of the motor center. All that is needed is to mentally imagine such gymnastics. Imagining how he squeezes and unclenches his palm, the patient forms a new motor center in the head. Important clearly present a picture and visualize it as often as possible. You have to believe that everything will work out.

Active gymnastics in a supine position

• A cloth (towel) is hung over the bed. A person grabs it with a brush and develops a hand on his own, bends and unbends, raises and lowers. The fabric is gradually hung higher, complicating the training process, stimulating the recovery process.
• The next device is a rubber ring with a diameter of 40 cm. The ring is thrown between the limbs, the task of a person is to stretch it. The ring for this is made of medium thickness, so that it was quite simple and difficult at the same time to spread the limbs to the sides.
• The patient with a smooth movement grabs the back of the bed and tries to pull himself up or push off from it. It is useful in this process to connect the legs.

Active gymnastics in a sitting position

• The patient sits on the bed, lowers his legs to the floor, holds on to the bed with his hands. The task is to bend in the back, sticking out the chest. Bend on the inhale, relax on the exhale.
• The patient sits on the bed with his feet also on the bed. The task is to raise straight legs, alternately, first one leg, then raise the second.
• Another exercise in the same position. To relax the back, put a pillow under it. The task is to reach your knee to your chest, clasping your leg with your hands. Raise the leg while inhaling, hold the movement and breath at the chest for a couple of seconds. Do it alternately for each leg.
• The person sits on the bed, the legs rest here, the arms are laid back, with the palms resting on the bed. The task is to try to connect the shoulder blades with each other while inhaling. At the same time, tilt your head back.

Active gymnastics standing

• Raise small object(box of matches, pencil) from the table, after successful completion, you can pick up the object from the floor.
• Raise your arms up and stretch, standing on your toes. Exercise on the inhale, relax on the exhale.
• Feet shoulder width apart, palms on the belt. Tilts forward-backward and left-right.
• Stand up straight, stretch your arms forward, exercise "scissors" for the hands.
• Connect the feet together, squat, trying to keep a straight posture and not tear your heels off the floor.
• Put your feet shoulder-width apart, put your hands on your belt, turn your torso clockwise and against it.
• Walking, standing still.
• Swing your leg, with a clap of hands under it.

In general, you can do any gymnastic exercises from the school curriculum.

Therapeutic exercises for the face, tongue

These exercises are provided for patients with impaired functions of the speech apparatus. Often the return of speech is slower than motor skills, and may take several years. The main condition for successful healing is a person should hear live human speech more often (not on TV). At home, relatives should constantly communicate with the sick.

Exercises for facial muscles and tongue

• Show the tongue, stretch it forward as much as possible;
• Lick lips, counterclockwise and along it;
• It is easy to bite alternately the upper and lower lip;
• Grin;
• Curl lips into a tube;
• Click your tongue.

Exercises to restore the ability to pronounce words

• We start with the pronunciation of individual sounds (in alphabetical order);
• After that, we learn to pronounce simple words (mom, dad) or the roots of complex words, without endings;
• After we train the correct pronunciation of full words;
• In conclusion, you can train to pronounce tongue twisters and rhymes.

How to plan workouts

There is no exact gymnastics plan to restore motor activity. Each person's recovery after a stroke is different. Start from successes in the present tense, if the patient performs the exercise accurately enough, then you can try to move on to the next stage. The number of movements and approaches for one exercise is also increased based on the patient's well-being. Classes begin with passive training, when the patient begins to move his fingers and hands, you can switch to active exercises in the prone position.

If a person performs all active exercises in a supine position with good accuracy, then move on to classes in a sitting position. Initially have to be present at such classes, support the patient so that he does not fall. Progress should not be artificially delayed. If the patient easily performs tasks in the prone position, but hardly copes with sitting exercises, then you need to train hard while sitting, and the result will definitely be.

In case of damage to the function of speech, tasks for its restoration should be performed from the first days of rehabilitation.

There is no need to distinguish between individual exercises. If the patient can move his arms, but is not able to do the same with his legs, then the arms should be developed with active gymnastics, and the legs with passive ones. If the patient performs one sitting exercise well, and gets too tired from the other, then only the resulting task can be included in the recumbent gymnastics, and wait with others.

During the first active training for any exercise, the number of arm movements is 1-2, legs - 3-5. Gradually increase the number to 5-6 for the arms and 14-16 for the legs. The amplitude and speed of movement also need to be increased in stages. The number of sessions at the beginning of rehabilitation is strictly once a day, after which you can increase up to 2 times, but only with good health.

Gymnastics after a stroke is an important part of the patient's rehabilitation from this serious condition. Only thanks to the implementation of all the recommendations of the doctor, drug treatment, physical therapy, the patient will gradually recover.

In a stroke, blood flow is disrupted in a specific area of ​​the brain. Oxygen access with nutritional components for the cellular structures of the brain is reduced. This leads to paralysis of the right or left side of the patient's body, facial numbness, impaired speech function.

A person who has undergone this disease requires careful attention to himself, constant care. It takes a long time to restore brain functions.

How to prepare for the recovery of the patient

Procedures should be carried out with a period of 2 to 3 hours. The physical rehabilitation of the patient requires great endurance and care of relatives caring for the patient.

To restore the lost functions of the patient, it is necessary to follow the recommendations of the treating neurologist:

• The change in the patient's posture should be constant for every 2-3 hours. It is required to change the position of the patient from one side to another in order to prevent congestion with bedsores.
• The patient is obliged to perform passive gymnastics in the form of movements during outside help to reduce muscle spasms.
• Perform breathing recovery exercises, combining with passive gymnastics on inhalation and exhalation. This will increase the supply of oxygen to the brain, the muscles will involuntarily tighten and relax.
• Active load consists in the fact that at the beginning of physical exercises the patient performs lying in bed, then walks, slowly walking. After an ischemic stroke, this will restore the health of the patient, reduce the likelihood of recurrent strokes.

In order for the muscles not to overstrain, each exercise must be performed with one or two approaches, with a gradual increase in them. The period between each lesson is 1 hour.

How to do passive gymnastics

Before you perform passive exercises to recover from a stroke, you need to prepare the patient's muscles for physical work. To do this, use massage.

Every massage rule must be observed:

• Perform movements gently, in a circular manner.
• The specialist is obliged to move from bottom to top: first massages the brush, goes to the shoulder. On the leg, the foot is massaged first, then the lower leg.
• The thoracic spine is massaged from behind with tapping and pinching techniques.
• Thoracic myofibers are kneaded from the central zone to the axillary regions.

After carrying out massage procedures, they begin exercise therapy after strokes at home. For rehabilitation after a stroke, exercise therapy is performed:

• They bend the lower limb so that it then becomes straight on its own, having passed along the bed. This exercise will help restore the lost memory of movements.
• Extend the lower limb in the same way. First, the leg is bent at the knee joint, and the patient tries to extend it.
• The upper or lower limb is hung with a stretch band and rotated in circles. Also, all limbs are bent, unbent, carried out to the side. The patient tries to twist or perform movements with fixed limbs. During the day, such gymnastics is performed once for 30 minutes.
• To restore the movements of the joint in the shoulder, it is necessary to raise and lower the arm, and also perform its flexion with extension.
• Wrist muscles are being developed. It is necessary to clench your fingers into a fist and unclench at least 10 times.
• To restore fine motor skills, small objects are placed in the patient's hand, they are helped to hold them with their fingers.

Typically, such a set of exercises for a stroke is performed at least two times. If improvements are achieved, then this restorative gymnastics after a stroke is performed no more than 3 times a day, for at least 33-37 minutes.

How to do it while sitting

Exercises after a stroke at home can be done while sitting. This requires:

• Sit the patient on the bed, lower the lower limbs to the floor, use the hands to hold on to the bed. The patient bends in the back, protruding the chest. When inhaling, perform a deflection, relaxation occurs when exhaling.
• The patient sits, the lower limbs are located on the bed. It is required to perform lifting of straight legs in turn. At the beginning, one limb is raised, then the next.
• To relax your back, you need to put a pillow under it. The patient reaches his knee to the chest, clasping the leg with his hands. Then you need to raise your leg while inhaling, the movement is delayed at the chest, you must not breathe for 2-3 seconds. Perform in turn for each lower limb.
• Sitting on the bed, the lower limbs lie horizontally, and the upper ones are retracted backwards, the palmar surfaces rest against the bed. During inhalation, the patient connects the scapular bones together with the tilting of the head backwards.

Performing such gymnastics after a stroke will gradually strengthen the back muscles and improve the patient's well-being.

What exercises are performed while standing

Physical therapy after a stroke is performed in the following order:

• The patient picks up a small object lying on the table; in the future, with an improvement in well-being, you can pick up a thing from the floor surface.
• Raise the upper limbs up and stretch, resting on the socks. Perform when inhaling, relax when exhaling.
• The lower limbs are shoulder-width apart, the palms are located on the belt. It is necessary to lean forward and backward, to the right and left sides.
• The patient is standing straight. The upper limbs are extended anteriorly. You need to wave your arms a little in a horizontal plane.
• The soles are joined together. The patient squats, keeps the back straight, the heels do not come off the floor.
• The lower limbs are shoulder-width apart. Palms at the waist. It is necessary to turn the body first in one direction, then in the other direction.
• Walk around a bit.
• Wave the lower limb, performing a clap with the palms under it.

How to develop language and face

Exercise therapy after a stroke is performed by patients with impaired speech function. More often, speech does not return as quickly as motor activity, sometimes it takes years to fully recover. The main factor for restoring speech is that stroke patients should listen to how any real person talks.

The patient needs communication, then the effectiveness of exercise therapy exercises to restore speech will be higher.

Therapeutic exercises for facial myofibers and tongue are as follows:

• The patient shows the tongue, fully stretching it anteriorly to its full length.
• Further licks lips in a circular motion first in one direction, then in the other direction.
• Lightly bites in turn, first the lower, then the upper lip.
• Performs grinning of teeth.
• Curls lips into a tube.
• Clicks tongue.

Gymnastics, aimed at pronunciation of words, takes place as follows:

• First, the patient pronounces some sounds in alphabetical order.
• Then learns to speak a few simple words or the roots are complex, the endings do not need to be pronounced.
• Then you need to practice pronouncing the full words correctly.
• At the last stage, you can try to say verses, a few tongue twisters.

What effect does exercise therapy have?

The work of the brain is restored with the help of exercise therapy for stroke in three ways:

• Defective neurons are restored. Some nerve cells after the disease are not damaged, but do not function, they do not send an impulse from the motor center to the muscle fibers. To resume their functions, commands must be sent in a different order, in other words, from the hand or foot to the brain, through exercise after a stroke. Progress will appear gradually.
• Dead nerve cells are replaced by new ones. Performing exercises at home, blood supply to functioning myofibers is provided. Oxygen supply with nutritional components is carried out to living neurons faster. This accelerates the growth of new cellular structures around the surviving neurons, they communicate with each other, and the motor activity is gradually controlled by the brain.
• The work of dead neurons is compensated by neighboring nerve cells. Thanks to gymnastics, commands go to neighboring brain areas that do the work of dead neurons.

In addition to gradually recovering brain functions in stroke, exercise therapy has a good effect on the entire body of the patient. Fortified the immune system, articular surfaces become mobile, muscle hypertonicity of the injured side decreases.

What gymnastics to perform at different periods of a stroke

In the acute (first 3 days) and acute (up to 28 days) period of the disease, respiratory and passive gymnastics are performed, and they are also treated with the help of the position:

• At breathing exercises the patient rhythmically inhales and exhales, accelerating or slowing down breathing, breathes with the stomach, then with the chest and vice versa.
• With the help of the position, muscle hypertonicity of the damaged limbs is removed. Pay attention to the shoulder muscles, flexors of the arm and sole, leading to the femoral myofibers and calf extensors.
• From 1.5 to 2 hours each bring the affected arm and leg to the correct position.
• The upper limb is placed on a pillow, horizontally placing it parallel to the body. Slowly retract until a 90° angle is formed. Then the hand turns outward, fixed with a splint.
• The injured lower limb is bent at an angle of 15 to 20°, a roller is placed.
• A passively performed type of exercise therapy begins only after the tone of the damaged muscle has decreased. Gymnastics is performed first on normal, then on the affected limbs.

With early recovery period(from 28-29 days to six months) the patient gradually moves from passive gymnastics to active exercise. Muscles begin to voluntarily contract.

The patient is able to be in a sitting position on the bed, so he performs gymnastics while sitting.

At this time, you need to prepare to walk. In the supine position, the patient walks, as it were, such exercises will help in the future when walking.

In the late recovery period (from six months to 2 years), in order to restore lost movement skills, exercise therapy is performed after a stroke, aimed at overcoming resistance:

• Sitting on a chair, the lower limbs are pressed against the floor surface. Without emphasis on the upper limbs, while inhaling, the patient gets up, exhaling, he sits down.
• In a sitting position on a chair, the patient raises the heel zone, pressing his socks to the floor. In a slow rhythm, the lower limbs rise, the ankles rotate for 20 seconds, then lower the legs to the starting position.
• Become straight, rest your hands on the back of the chair. The patient rises on his toes, stands for 5-6 seconds and falls to the opposite position.

IN rehabilitation period the patient and his relatives will face different problems. The more persistently they endure, the more actively motor skills will be restored.

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