Exercise and massage after a stroke. Are there any contraindications for exercise therapy? Complexes from a sitting position

Rehabilitation after a stroke involves performing restoration activities in a complex - drug therapy, physical therapy, physiotherapeutic procedures, massages and non-traditional methods of influencing nerve cells. Physical therapy (physical therapy) after a stroke occupies a predetermining place in this entire list, since through physical impact on atrophied muscles it can make immobilized limbs, speech apparatus, and visual organs “work.” The condition for the effectiveness of the recovery process is the rational distribution of the load on the muscles and regular performance of the exercises recommended by the attending physician.

The role of exercise therapy in the recovery of the patient

Physical therapy is an integral part of the recovery program after. Its benefits are as follows:

• the ability to restore mobility of limb joints and return tense muscles to normal;
• prevention of complications such as bedsores on the back, buttocks and feet in bedridden patients;
• restoration of sensitivity and mobility of paralyzed limbs;
• relieving muscle hypertonicity and preventing the formation of contractures;
• elimination of speech disorders by influencing facial and linguistic muscles;
• restoration of hand motor skills, writing and drawing skills;
• improved vision;
• restoration of the functioning of the entire body.

For exercise therapy to be effective after a stroke, physical exercise must be combined with other recovery methods - taking medications, physiotherapy, and measures for social and psychological adaptation.

The post-stroke recovery period begins 3-4 days after the attack with passive gymnastics. Medical personnel or trained relatives perform the exercises instead of the patient, making their own efforts to restore sensitivity and strength in the limbs.

Passive exercise therapy begins with a massage, which includes the following manipulations:

• stroking movements in a circle;
• impact on muscle tissue, starting from the upper back and ending with the legs;
• tapping on the back;
• impact on the chest muscles - from the chest to the armpits;
• massaging the arms from the shoulder joint to the fingers, and the legs from the buttocks to the foot.

Initially, the healthy side of the body is massaged, then the one affected by the stroke.

Passive gymnastics can be performed both in a medical facility and at home. To do this, up to 3 times a day for half an hour, a health worker or person caring for the patient helps to perform the following exercises:

• development of the hand - flexion of the fingers followed by extension, rotation of the hand, flexion-extension of the elbow joint, raising and lowering the shoulder;
• development of a paralyzed leg - flexion followed by extension of the fingers, circular rotation of the feet, bending of the leg at the knee and hip joint;
• restoration of motor skills and grasp reflex– a round object is placed in the patient’s affected hand;
• development of limbs in a suspended state - with a leg or arm suspended on a towel, rotational and pendulum movements are performed.

Is something bothering you? Illness or life situation?

Active exercise therapy after a stroke, when the patient begins to perform gymnastics on his own, is switched to after the doctor’s recommendation. Initially, the emphasis is on exercises in a supine position, then they include the development of limbs while sitting. If the described exercises are performed confidently, the patient is allowed to practice physical therapy standing.

Exercises while lying down

1. Straightening the affected limb - with force, the limb in the joints is straightened as far as possible (arm - at the elbow and wrist, leg - at the knee) and fixed for half an hour using a splint.
2. Head turns - slowly turn the head first to the left, then to the right, while fixing the gaze in front of you.
3. Flexion and extension of the limbs - in a flat position on the back, first bend the arm at the elbow, fix it for a few seconds, then extend it to its original position. A similar exercise is performed with the legs when bending them at the knee joint.
4. Bending the fingers into a fist - the exercise is performed up to 10 times per approach, alternately with both hands, first with the sick one, then with the healthy one.
5. Pull-up of the torso - lying on your back, you need to grab the headboard of the bed with both hands and pull yourself towards it, as if on a horizontal bar. In this case, the legs should be straightened as much as possible, and the toes should be extended.
6. Leg sliding - lying on your back with your legs straight, you need to bend them at the knees and pull them towards you, while your feet should not leave the bed.

Exercises while sitting

1. Rotate your head to the sides and bend over.
2. Leg swings - while sitting on a hard surface with your legs extended, you need to slowly lift one limb first, then the other.
3. Reduction of the shoulder blades - while sitting with your legs straight, you need to inhale and place your hands behind your back, clasp them for a few seconds and then slowly return to the original position as you exhale.
4. Exercise with a gymnastic stick - sitting on a chair, grasp the sports equipment with both hands and rest it on the floor. Breathing evenly, you need to swing your body different sides while leaning on a stick.
5. Throwing a tennis ball from one hand to another.

Exercises while standing

1. Raising your legs - resting your hand on the back of the chair, you need to lift your legs one by one and place them on the chair, and then return to the starting position.
2. Taking the leg to the side - in the same position, first one leg is moved to the side and fixed for 3-5 seconds, then the other.
3. Raising your arms - placing your legs at shoulder level, you need to slowly raise your arms up as you inhale, clasp them together above your head, and then lower them down as you exhale.
4. Torso turns - standing with your arms spread to the sides, you perform torso turns, first in one direction, then in the other.
5. Tilts - with your hands on your belt and your feet shoulder-width apart, you need to inhale, bend forward, hold for 3-5 seconds and then straighten up with an exhalation.
6. Squats - standing with a straight back, you need to inhale, stretch your arms in front of you and squat as you exhale. After that in sitting position inhale and exhale after standing up.
7. Walking in place - the exercise is performed for 20 seconds, after which a break is required to restore breathing.

For visual disturbances caused by a cerebral stroke, the patient is prescribed drug treatment and performing exercise therapy. The program is tailored individually for each patient, but there are a number of basic eye exercises suitable for each of them:

1. “Palm Press.” Cover your eyes with your palms, then take several deep breaths through your nose and exhale through your mouth. Next, use your palms to lightly press first on the upper and then on the lower part of the eye socket. At the initial stage, the exercise is performed 3-5 times, gradually increasing the number to 15 repetitions.
2. "Closing your eyes." Both eyes close tightly, hold the position for up to 5 seconds, after which they sharply relax the eye muscles.
3. "Massaging the eyeballs." Closed eyes are massaged with fingers in a circle through the eyelids, while the pressure should be light.
4. "Exercise with a pencil." The pencil is placed in front of the eyes, after which they begin to move it in a circle, in different directions, bringing it closer and further away. When performing this exercise, the head should remain motionless.

Mandatory exercises when restoring vision after a stroke are eye movements - left and right, bevel diagonally, up and down, in a circle, bringing the pupils to the bridge of the nose.

Exercise therapy for legs after a stroke

1. Finger movements - flexion, extension, fingering.
2. Leg abduction - in a lying position, the leg slides along the surface to the side, while the arms should be located along the body. When performing the exercise while standing, a chair is used instead of a support, and the leg is moved up and to the side with the back straight.
3. Pulling up your socks – you need to pull your socks towards you as much as possible, resting your heels on a hard surface.
4. Leg bending at the knees - performed in all body positions.
5. Raising the heels - sitting on a chair, the patient raises the heels, thus emphasizing the force of gravity on the toes. After being in this position for 10-15 seconds, you need to return your legs to their original position and rest your heels on the floor.
6. Jumping – you need to jump up for a minute.

Articulation and speech

To restore speech and articulation, a patient who has suffered a stroke must, from the first days after the attack, perform exercises that may seem too simple for a healthy person:

1. "Smile". Smile widely, exposing as many teeth as possible, hold in this position for 5-10 seconds, then close your lips.
2. "Swing". Stick your tongue out of your mouth, lift it up and try to reach the tip of your nose. After this, lower your tongue down, trying to reach your chin.
3. "Spatula". Stick your tongue out as far as possible, while lowering its tip down. Stay in this position for 7-10 seconds.
4. "Tube". The lips are rolled into a tube and pulled forward as much as possible.
5. "Groove". The tongue is stuck out and folded into a groove for 5-10 seconds.
6. "Nitting." The lips are bitten alternately with the teeth - first the upper jaw, lifting the lower jaw upward, then vice versa.

The exercise therapy program, which restores speech and articulation after a stroke, also includes pronouncing letters of the alphabet, words (from simple to complex) and tongue twisters.

After the patient has come to his senses and his basic vital systems begin to work stably, he needs to perform breathing exercises. Regular training of the respiratory system will strengthen it, normalize lung function and eliminate congestion, as well as reduce hypertonicity of the facial muscles.

Before starting the workout, you need to sit down, lean on a hard surface, put your feet on the floor or stretch them out on the bed, and put your hands on your knees. Exercises are performed from 4 to 8 repetitions depending on the patient’s well-being.

Exercise No. 1.

Hands are spread to the sides. At the entrance through the nose, bend forward, bringing your arms together in the form of hugging yourself by the shoulders. After holding this position for a few seconds, the arms are moved back to their original position, while exhaling through the mouth.

Exercise No. 2.

The palms are located on the thighs in the first third. While inhaling through the nose, the arms are straightened at the elbows, the chest is pulled up. After a few seconds, you exhale through your mouth, your arms relax and your torso leans forward.

Exercise No. 3.

The palms are located on the belt. While inhaling through the nose, the palms slide along the belt and close in front of the body with their backs as tightly as possible to each other, after which they lower down in this position. The chin at this moment should be pressed to chest. As you exhale through your mouth, your arms are moved behind your back as much as possible, and your head rises up.

When performing breathing exercises, the eyes should be open. If dizziness, shortness of breath or nausea occurs, exercise should be stopped and further actions should be discussed with a doctor.

For the efficiency and speed of restoration of movement functions after a stroke, the following simulators are used:

• Walkers are the simplest exercise equipment used to restore walking function.
• An exercise bike is necessary to restore the functions of movement of the lower extremities, strengthen the cardiovascular system and improve the health of the body as a whole.
• The “Bud” simulator is used to develop the hand, restore the grasping reflex, and the “clench-unclench” function.
• The “Shagonog” exercise machine helps strengthen the muscle tissue of the legs in bedridden patients.
• Verticalizer – helps restore the functioning of the vestibular apparatus, giving a vertical position to the body.
• Robotic simulators are machines programmed to carry out commands from the brain with parts of the body.
• Step platform – helps restore the function of walking up stairs and strengthens the calf muscles.

Before using any exercise equipment, you should consult your doctor. Only a specialist can recommend an effective model and degree of load on the body, taking into account the nature of motor dysfunction.

Contraindications to exercise therapy classes

Despite the effectiveness of using exercise therapy in the recovery period after a stroke, there are a number of pathological conditions, in which classes are contraindicated:

If there is a history of the described diseases, the attending physician draws up an individual program, selecting gentle exercises to restore motor functions. In case of acute conditions (for example, high temperature or hypertensive crisis), it is necessary to wait until your state of health returns to normal and only then begin physical therapy.

Nerve cells die and 80% of patients experience movement disorders. To restore functions, rehabilitation measures are necessary, including physical therapy.

Exercise therapy is an individually selected set of exercises taking into account the characteristics of the disease, its degree and stage of development, and the patient’s well-being. Dosed daily loads are indicated, starting 2-3 days after the attack.

About the benefits of exercise therapy

Physical exercise after a stroke speeds up the recovery process. Daily exercise improves blood circulation, prevents blood from stagnating, helps restore muscle memory, reduces muscle tone, prevents the development of contractures, bedsores, atrophy and spasms, and eliminates involuntary movements of the limb.

Physical activity leads to positive changes in the body:

• work improves of cardio-vascular system;
• breathing is normalized;
• metabolic processes are stimulated;
• is improving emotional condition sick.

Exercise therapy after a stroke includes compensatory mechanisms to restore function. Repeated repetitions of exercises contribute to the emergence of new conditioned reflex connections.

Contraindications to exercise therapy

Physiotherapy exercises are not prescribed for the following conditions:

• being in a coma;
• repeated people;
• epileptic seizures;
• mental disorders and aggressive behavior;
• the presence of diabetes mellitus, tuberculosis, malignant tumors.

For hemorrhagic stroke exercise therapy prescribed when the patient’s symptoms stop increasing and the functioning of the vascular system and internal organs improves. In the first 3 days from the start of classes, breathing exercises and superficial massage. Physical therapy is contraindicated if blood pressure exceeds 180/105 mmHg. Art.

Preparatory activities

Preparation for exercise therapy consists of the following stages:

1. Changing the patient's body position to prevent blood stagnation.
2. Passive loads for different joints and muscle groups by medical staff: circular movements and abduction of the limbs, flexion and extension.
3. Breathing exercises to improve lung function.
4. Mental gymnastics to restore muscle memory.
5. Massage to normalize blood circulation and prepare the body for more active activities.

Passive loads

When the patient regains consciousness, passive exercises are prescribed. In the early period, correction is carried out by position. Light stroking is used on affected muscles with increased tone. For other muscles, deeper massage techniques are used: gentle rubbing and kneading.

Gymnastics for bedridden patients is carried out carefully, the patient’s breathing should be free. In case of stiffness, classes begin with large joints, in the absence of contractures and increased muscle tone - with the distal parts of the arms and legs.

To regain muscle memory, use mental gymnastics. To restore memory, you need to perform mental exercises every day, during which the patient himself or his relative voices what movement he is making. For example: “I move my hand to the side.”

A person who has suffered a stroke is depressed, feels disabled, and does not believe in his own strength, so he needs to be encouraged and praised.

Paralysis often leads to speech impairment. It is important to do articulation exercises every day and not stop practicing. In order for the function to recover faster, you need to talk to the patient, he must hear speech. Classes begin with the reproduction of individual sounds, then gradually move on to syllables and words.

Passive exercises should be done 2-3 times a day, 10-15 repetitions for each joint. It is important to monitor the patient's reaction. Holding your breath, causing pain and increasing muscle tone should not be allowed.

Active physical activity

Active loads are aimed at restoring old and forming new conditioned reflexes.
The exercises include 2 phases - static and dynamic. Performed by a physical therapy methodologist. The first phase causes muscle tension and develops the ability to hold an arm or leg in the desired position. The second phase is the movement itself.

The goal of active exercises is to achieve isolated movements in the patient by providing light resistance.

When a person is paralyzed, the fine motor skills. Its recovery depends on the degree of loss of motor function. If the hand does not move at all, passive loads are needed. Then they move on to exercises in turning over cards, collecting scattered coins, writing letters, etc.

Patients are shown exercise on a stationary bike to train the cardiovascular system and restore motor skills of the lower extremities.

If there are no contraindications during the recovery period, you can use the yoga method, but not earlier than 6 months after the stroke.

Exercises while lying down

Gymnastics in bed is started in the early period of rehabilitation. Exercises after a stroke are performed in a lying position on your back, stomach, or healthy side.

Exercise 1. The patient lies on his back. You need to clasp his ankles with your hands and bend his knees so that his feet slide on the bed (imitation of walking).

Exercise 2. Hang the affected arm of the paralyzed person on a towel and rotate it in a circle. Exercise for up to 30 minutes with breaks of 2-3 minutes.

Exercise 3. To restore swallowing reflex, you need to do the following exercises:

1. strain your mouth, pretending to whistle without sound;
2. cough;
3. to yawn;
4. snore;
5. when pushing, pronounce “a” and “e”.

You can do exercises for your eyes and hands while lying down.

Gymnastics while lying down is preparation for the next stage, when the patient will be able to perform sitting and standing exercises for the vestibular system, restore coordination of movements and begin to learn to walk.

Complexes from a sitting position

When the acute period ends and the patient can sit down, they move on to sitting exercises.

Exercise 1. Lean your back against the pillow, stretch your legs, hold the edges of the bed with your hands. While inhaling, bend forward slightly, and as you exhale, return to the starting position. Repeat 5 times.

Exercise 2. Sit on the bed, keep your back straight, arms out to the sides. Bring your shoulder blades together. Repeat 5 times.

Exercise 3. While sitting, hold onto the edge of the bed with your hands. Raise alternately the left one and then the right leg. Perform 4 times with each leg.

Complexes from a standing position

Exercise 1. Feet shoulder-width apart, hands on the waist. While inhaling, turn to the left, while exhaling, turn to the right. Perform slowly 5 times in each direction.

Exercise 2. Feet shoulder-width apart, arms down along the body. Raise your arms up, stretch slightly, inhale; lower your hands down, describe a circle with them, exhale. Repeat 5 times.

Exercise 3. Stand on your toes, raise your arms up and stretch as if trying to reach the ceiling.

Exercise 4. Walk in place for 30 seconds.

Eye complex

Motor function of the eyes is restored after a stroke using the following exercises:

1. Forcefully squeeze and unclench your eyelids 15 times.
2. Move your eyeballs up and down, right and left with your eyes open and closed.
3. Fix your gaze at one point.
4. Blink frequently.
5. Rotate your eyes clockwise and counterclockwise.

Hand loads

If the hand is affected, bend and straighten the fingers in any convenient position 10 times.

To strengthen the shoulder joint, perform the exercise while lying on your healthy side. The methodologist records right hand shoulder joint, slowly and smoothly removes the affected limb from the body with the left hand. The methodologist holds the patient’s elbow with the forearm in a state of pronation, and the hand in an extended position, then raises his arm up, moves it to the side, then back.

In the supine position, the methodologist extends the patient’s arm at the elbow and abducts it to the side.

When minimal voluntary movements appear in the paralyzed arm, they proceed to the exercise of raising and lowering the affected limb using a blocking device and a healthy arm.

Leg loads

To restore movement in the joints and muscles of the legs, use the following exercises:

1. Hip abduction and adduction.
2. Rotation in the hip joint.
3. Passive flexion and extension of the knee joints.
4. Passive knee extension while lying on your side with the hip extended.
5. Raising your leg with your healthy arm and using a pulley with a cord...
6. Passive movements in the ankle.

Exercises begin with healthy limbs, then alternate them with exercises for the paralyzed in combination with massage and muscle relaxation.

Active movements are done slowly, avoiding painful exercises.

Articulation complex

When cerebral circulation is impaired during a stroke, the facial muscles are paralyzed and the person loses the ability to pronounce sounds. The following complex helps restore articulation:

1. Roll your lips into a tube and stretch them out.
2. Stick out your tongue as much as possible.
3. Spread your lips wide, as if to pronounce “y”.
4. Bite your upper and lower lips alternately.

Daily exercises make it possible to quickly return to intelligible speech.

Breathing exercises

Exercises should be started when the patient regains consciousness and can control the facial muscles. The simplest action is to exhale through closed lips.

Gymnastics after a stroke consists of taking a deep breath, holding your breath for a few seconds and exhaling slowly.

The patient must see the result and believe that function will be restored. When he gets better, he will be able to inflate balloon or blow into a tube lowered into water. So he sees how the ball increases in size, or hears how the water gurgles.

Breathing exercises are performed often with rest breaks. You should not strain while holding your breath to avoid dizziness or headaches.

Exercise equipment

Exercising on exercise equipment, such as:

• The verticalizer gives the human body a vertical position.
• Rehabilitation exercise bike with electric or mechanical drive.
• The lokomat is intended for people who are learning to walk.
• Exercise machines for legs and arms. "Bud" develops his fingers. “Shagong” imitates walking and can be used for bedridden patients.

In order for the patient to recover faster, an integrated approach is needed. Drug therapy without exercise therapy will not give the desired result.

Stroke is an acute vascular accident that ranks first in the structure of disability and mortality. Despite the improvement medical care, a large percentage of people who have had a stroke remain disabled. In this case, it is very important to re-adapt such people, to adapt them to the new social status and restore self-service.

Brain stroke– acute cerebrovascular accident, accompanied by persistent deficits in brain function. Cerebral stroke has synonyms: acute cerebrovascular accident (ACVA), apoplexy, stroke (apoplexy). There are two main types of stroke: ischemic and hemorrhagic. In both types, the area of ​​the brain that was supplied by the affected vessel dies.

Ischemic stroke occurs due to the cessation of blood supply to an area of ​​the brain. The most common cause of this type of stroke is vascular atherosclerosis: with it, a plaque grows in the wall of the vessel, which increases over time until it blocks the lumen. Sometimes part of the plaque breaks off and clogs the vessel in the form of a blood clot. Blood clots also form during atrial fibrillation (especially in its chronic form). Other rarer causes ischemic stroke are blood diseases (thrombocytosis, erythremia, leukemia, etc.), vasculitis, some immunological disorders, taking oral contraceptives, hormone replacement therapy.

Hemorrhagic stroke occurs when a vessel ruptures, allowing blood to flow into the brain tissue. In 60% of cases, this type of stroke is a complication of hypertension against the background of vascular atherosclerosis. Modified vessels (with plaques on the walls) rupture. Another reason hemorrhagic stroke– rupture of an arteriovenous malformation (saccular aneurysm) – which is a feature of the structure of the blood vessels of the brain. Other causes: blood diseases, alcoholism, drug use. Hemorrhagic stroke is more severe and its prognosis is more serious.

How to recognize a stroke?

A characteristic sign of a stroke is a complaint of weakness in limbs. You need to ask the person to raise both hands up. If he really has a stroke, then one arm can rise well, but the other may either not rise, or the movement will be difficult.

With a stroke it is observed facial asymmetry. Ask a person to smile, and you will immediately notice an asymmetrical smile: one corner of the mouth will be lower than the other, and the smoothness of the nasolabial fold on one side will be noticeable.

Stroke is characterized by speech disorder. Sometimes it is obvious enough that there is no doubt about the presence of a stroke. To recognize less obvious speech disorders, ask the person to say, “333rd Artillery Brigade.” If he has a stroke, impaired articulation will become noticeable.

Even if all these signs appear in a mild form, do not expect that they will go away on their own. You need to call an ambulance using the universal number (both from a landline and a mobile phone) – 103.

Features of female stroke

Women are more susceptible to stroke, take longer to recover and are more likely to die from its consequences.

Increase the risk of stroke in women:

- smoking;

- use of hormonal contraceptives (especially over the age of 30);

— hormone replacement therapy for menopausal disorders.

Atypical signs of a female stroke:

• an attack of severe pain in one of the limbs;
• sudden attack of hiccups;
• an attack of severe nausea or abdominal pain;
• sudden fatigue;
• short-term loss of consciousness;
• sharp chest pain;
• attack of suffocation;
• suddenly increased heart rate;
• insomnia (insomnia).

Principles of treatment

Future prospects depend on the early start of stroke treatment. With regard to stroke (as with most diseases), there is a so-called “therapeutic window”, when therapeutic measures most effective. It lasts 2-4 hours, then the area of ​​the brain dies, unfortunately, completely.

The treatment system for patients with cerebral stroke includes three stages: prehospital, inpatient and recovery.

At the prehospital stage, a diagnosis of stroke is carried out and the patient is urgently transported by an ambulance to a specialized institution for inpatient treatment. At the stage of inpatient treatment, stroke therapy can begin in the intensive care unit, where emergency measures are carried out aimed at maintaining the vital functions of the body (cardiac and respiratory activity) and at preventing possible complications.

Consideration of the recovery period deserves special attention, because its provision and implementation often falls on the shoulders of the patient’s relatives. Since strokes occupy the first place in the structure of disability among neurological patients, and there is a tendency towards “rejuvenation” of this disease, each person should be familiar with the rehabilitation program after a cerebral stroke in order to help his relative adapt to his new life and restore self-care.

Rehabilitation of patients who have suffered a cerebral stroke

The World Health Organization (WHO) defines medical rehabilitation as follows.

Medical rehabilitation – this is an active process, the goal of which is to achieve complete restoration of functions impaired due to illness or injury, or, if this is not possible, the optimal realization of the physical, mental and social potential of a disabled person, his most adequate integration into society.

There are some patients who, after a stroke, experience partial (and sometimes complete) independent restoration of damaged functions. The speed and extent of this recovery depend on a number of factors: the period of the disease (duration of the stroke), the size and location of the lesion. Restoration of impaired functions occurs in the first 3-5 months from the onset of the disease. It is at this time that restoration measures should be carried out to the maximum extent - then they will have maximum benefit. By the way, it is also very important how actively the patient himself participates in the rehabilitation process, how much he understands the importance and necessity of rehabilitation measures and makes efforts to achieve the maximum effect.

Conventionally, there are five periods of stroke:

• acute (up to 3-5 days);
• acute (up to 3 weeks);
• early recovery (up to 6 months);
• late recovery (up to two years);
• period of persistent residual effects.

Basic principles of rehabilitation measures:

• earlier start;
• systematicity and duration;
• complexity;
• phasing.

Rehabilitation treatment begins already in the acute period of a stroke, during the patient’s treatment in a specialized neurological hospital. After 3-6 weeks, the patient is transferred to the rehabilitation department. If after discharge a person needs further rehabilitation, then it is carried out on an outpatient basis in the rehabilitation department of the clinic (if there is one) or in rehabilitation center. But most often such care is shifted onto the shoulders of relatives.

The objectives and means of rehabilitation vary depending on the period of the disease.

Rehabilitation in acute and early recovery periods of stroke

It is carried out in a hospital setting. At this time, all activities are aimed at saving lives. When there is a threat to life will pass, measures to restore functions begin. Positional treatment, massage, passive exercises and breathing exercises begin from the first days of a stroke, and the time for the start of active recovery measures (active exercises, transition to a vertical position, standing up, static loads) is individual and depends on the nature and degree of circulatory disorders in the brain, depending on availability concomitant diseases. Exercises are performed only on patients who are clearly conscious and in satisfactory condition. For small hemorrhages, small and medium-sized heart attacks - on average from 5-7 days of stroke, for extensive hemorrhages and heart attacks - on 7-14 days.

In the acute and early recovery periods, the main rehabilitation measures are the prescription of medications, kinesiotherapy, and massage.

Medications

IN pure form the use of medications cannot be classified as rehabilitation, because it is more of a treatment. However, drug therapy creates the background that provides the most effective recovery, stimulates the disinhibition of temporarily inactivated brain cells. Medicines are prescribed strictly by a doctor.

Kinesiotherapy

In the acute period, it is carried out in the form of therapeutic exercises. Kinesitherapy is based on positional treatment, passive and active movements, breathing exercises. On the basis of active movements, carried out relatively later, learning to walk and self-care is built. When performing gymnastics, the patient must not be overtired; efforts must be strictly measured and the load gradually increased. Treatment with position and passive exercises for uncomplicated ischemic stroke begin on the 2-4th day of illness, for hemorrhagic stroke - on the 6-8th day.

Treatment by position. Purpose: to give paralyzed (paretic) limbs the correct position while the patient lies in bed. Make sure that your arms and legs do not remain in one position for a long time.

Dynamic exercises are performed primarily for muscles whose tone usually does not increase: for the abductor muscles of the shoulder, supinators, extensors of the forearm, hand and fingers, abductor muscles of the thigh, flexors of the leg and foot. With severe paresis, they begin with ideomotor exercises (the patient first mentally imagines the movement, then tries to perform it, while pronouncing the actions performed) and with movements in facilitated conditions. Lighter conditions imply the elimination different ways gravity and friction forces, which make it difficult to perform movements. To do this, active movements are performed in a horizontal plane on a smooth slippery surface, systems of blocks and hammocks are used, as well as the help of a methodologist who supports the limb segments below and above the working joint.

Towards the end of the acute period, the nature of active movements becomes more complex, the pace and number of repetitions gradually but noticeably increase, and exercises for the torso begin (light turns, bends to the sides, flexion and extension).

Starting from 8-10 days (ischemic stroke) and from 3-4 weeks (hemorrhagic stroke), when the patient feels well and is in satisfactory condition, they begin to teach sitting. Initially, he is helped 1-2 times a day for 3-5 minutes to take a semi-sitting position with a seating angle of about 30 0. Over the course of several days, monitoring the pulse, increase both the angle and time of sitting. When changing body position, the pulse should not increase by more than 20 beats per minute; if pronounced palpitations occur, then reduce the landing angle and duration of the exercise. Usually, after 3-6 days, the elevation angle is adjusted to 90 0, and the procedure time is up to 15 minutes, then they begin learning to sit with their legs down (the paretic arm is fixed with a scarf to prevent stretching of the joint capsule of the shoulder joint). When sitting healthy leg from time to time they are placed on the paretic side - this is how the patient is taught to distribute body weight on the paretic side.

Along with teaching the patient to walk, exercises are carried out to restore everyday skills: dressing, eating, and performing personal hygiene procedures. Exercises and techniques for restoring self-service are reflected in the table below.

Massage

Massage begins for uncomplicated ischemic stroke on days 2-4 of illness, and for hemorrhagic stroke - on days 6-8. The massage is carried out when the patient lies on his back and on his healthy side, daily, starting from 10 minutes and gradually increasing the duration of the massage to 20 minutes. Remember: vigorous tissue irritation, as well as a fast pace of massage movements, can increase muscle spasticity! With selective promotion muscle tone massage should be selective.

On muscles with increased tone, only continuous planar and grasping stroking is used. When massaging opposing muscles (antagonist muscles), stroking is used (deep planar, tong-like and intermittent grasping), gentle transverse, longitudinal and spiral rubbing, light shallow longitudinal, transverse and tong-like kneading.

Direction of massage: shoulder-scapular girdle → shoulder → forearm → hand; pelvic girdle → thigh → lower leg → foot. Special attention they massage the pectoralis major muscle, in which the tone is usually increased (slow stroking is used), and the deltoid muscle, in which the tone is usually reduced (stimulating methods in the form of kneading, rubbing and effleurage at a faster pace). Massage course 30-40 sessions.

In a hospital setting, rehabilitation measures are carried out no longer than 1.5-2 months. If it is necessary to continue rehabilitation treatment, the patient is transferred to an outpatient rehabilitation facility.

Outpatient rehabilitation measures in the recovery and residual periods of stroke

Patients are referred for outpatient rehabilitation treatment no earlier than 1.5 months after an ischemic stroke and 2.5 months after a hemorrhagic stroke. Patients with motor, speech, sensory, and coordination disorders are subject to outpatient rehabilitation. Outpatient rehabilitation provided to a patient who suffered a stroke a year or more ago will have a positive effect, provided there are signs of ongoing functional recovery.

Basic outpatient rehabilitation activities:

- drug therapy (prescribed strictly by a doctor);

— physiotherapy;

— kinesitherapy;

— psychotherapy (conducted by doctors of relevant specialties);

— restoration of higher cortical functions;

— occupational therapy.

Physiotherapy

It is carried out under the supervision of a physiotherapist. Physiotherapeutic procedures are prescribed no earlier than 1-1.5 months after an ischemic stroke and no earlier than 3-6 months after a hemorrhagic one.

Patients who have had a stroke are contraindicated:

— general darsonvalization;

— general inductometry;

— UHF and MVT on the cervical-collar area.

Allowed:

— electrophoresis of solutions of vasoactive drugs;

— local sulfide baths for the upper extremities;

— a constant magnetic field on the cervical-collar region in case of disturbances of venous outflow;

- general sea, coniferous, pearl, carbon dioxide baths;

— massage of the cervical-collar area daily, course of 12-15 procedures;

— paraffin or ozokerite applications on a paretic limb;

- acupressure;

— acupuncture;

- diadynamic or sinusoidally modulated currents;

— local application of d’Arsonval currents;

— electrical stimulation of paretic muscles.

Kinesiotherapy

Contraindications for kinesiotherapy are blood pressure above 165/90 mmHg, severe heart rhythm disturbances, acute inflammatory diseases.

In the early recovery period, the following types of kinesitherapy are used:

1) treatment by position;

2) active movements in healthy limbs;

3) passive, active-passive and active with the help, or in facilitated conditions of movement in paretic limbs;

4) relaxation exercises combined with acupressure.

Direction of exercises: shoulder-scapular girdle → shoulder → forearm → hand; pelvic girdle → thigh → lower leg → foot. All movements must be performed smoothly, slowly in each joint, in all planes, repeating them 10-15 times; all exercises must be combined with correct breathing(it should be slow, smooth, rhythmic, with an extended inhalation). Make sure that there is no pain during the exercises. Restoring proper walking skills is important special meaning: it is important to pay more attention to training the equal distribution of body weight on the diseased and healthy limbs, support on the entire foot, training in “triple shortening” (flexion at the hip, knee and extension at the ankle joints) of the paretic leg without moving it to the side.

In the late recovery period, there is often a pronounced increase in muscle tone. To reduce it you need to do special exercises. The peculiarity of these exercises: when treating with position, the paretic arm and leg are fixed more long time. Removable plaster splints are applied for 2-3 hours 2-4 times a day, and in case of significant spasticity they are left overnight.

For those who have suffered a stroke, there is always the possibility of partial or complete recovery. Doctors recommend rehabilitation activities for at least three years.

Usually it gives more hope, because... it causes less damage to brain cells. If we are talking about, then physical rehabilitation is difficult due to the period of resorption of the hematoma and the use of surgical intervention.

Physiotherapy after a stroke is considered one of the methods of recovery. She gives certain positive results, as well as medications, and physical therapy.

Physical therapy exercises are very important in order to prevent complications, adapt to self-care, and help. Due to the forced regime without movement, significant problems can arise.

With the help of physical therapy you can prevent:

1. the appearance of bedsores on the body;
2. congestive pneumonia;
3. heart failure;
4. muscle atrophy;
5. the appearance of blood clots;
6. spasms of some muscles.

Therapeutic exercise has a positive effect on metabolism and microcirculation in organs that have been impaired due to stroke. Therapeutic gymnastics after a stroke at home allows you to return to active movements, with its help you can more easily begin to write, draw, use dishes, etc. again.

Thanks to exercise internal organs function normally again and speech is restored.

When can you start exercising?

Specific exercises and their duration are at the discretion of the attending physician.

The choice in favor of gymnastics will depend on the following circumstances:

1. how severely the brain tissue is damaged;
2. How ready is the body for recovery?
3. treatment and whether it was started on time.

The most problematic period is considered the first six months. During this period, the indicators of the ischemic focus change: some cells die, others retain the ability to perform functions, but they need help. This is why gymnastics is needed after a stroke. There is a certain memory at the cellular level that is able to “remember” movements and resume the transmission of impulses.

If the patient is of sound consciousness and not in a coma, then after three days he is recommended to do breathing exercises. It is needed to prevent congestion in the lungs. After five days, it is recommended to begin physical therapy exercises. Exercises should include familiar movements, taking into account the patient's condition.

After about six months, the patient must be provided with a course of treatment in a sanatorium or specialized institution. It is better to conduct this course twice a year.

In addition to exercise therapy in a specialized institution, the patient will be provided with the following procedures:

1. acupuncture;
2. oxygen baths;
3. massage;
4. electrosleep;
5. magnetic therapy;
6. hardware electrical stimulation of certain muscles.

Exercise therapy should also be done at home, after discharge from a medical institution. For this purpose, relatives should know the recommended exercises and monitor their implementation by the patient, encouraging him. You need to try as hard as possible to maintain a positive mood, because... this greatly affects the speed of recovery.

Breathing exercises

It is necessary to take a lying position and take several deep breaths.

Such breaths must be repeated several times during the day, and the more, the better.

As soon as the doctor allows you to sit, you will need to monitor your posture: your back should be straight so that as much air can enter the lungs as possible and straighten them. Breathing exercises involve taking a deep breath, then holding your breath for a couple of seconds and exhaling slowly. You need to rest after performing each such exercise.

It is necessary to monitor your general condition in order to avoid severe dizziness; you should not strain too much while holding your breath.

This is important at any stage of rehabilitation

Effective physical activities cannot exist without mental support. Muscle memory is capable of giving commands, including to weak cortical structures. The patient must accompany all his physical efforts with mental instructions to move his arms and legs.

What exercises can you do lying down?

If doctors have not given permission to sit or stand, then the exercises should be performed in a lying position.

Gymnastic exercises after a stroke

Classes are based on movement in the joints of the limbs. First, it is recommended to perform passive exercises, which include rotation, flexion, and abduction. The amplitude is constantly increasing. You cannot immediately take maximum loads. It is recommended to start with small vibrations, ten movements in each joint. It is recommended to perform three such approaches per day.

We must not forget about a certain order: from the center to the periphery. That is, classes for the arm begin first from the shoulder, and then to the elbow, then the hand. Also with the leg exercise: first the hip, then the movements for the foot.

A set of active movements for the hands

Gymnastics for the arms can be performed in fifteen approaches:

1. clenching and unclenching fingers into a fist;
2. rotation of the arms in both directions;
3. flexion and extension at the elbows;
4. swing to the sides.

A set of active exercises for legs

It is advisable to start exercises for the legs from bed rest, then continue in a sitting position. Gymnastics should not be overly intense.

The exercises should be performed comfortably, and repetitions should be increased gradually.

Suitable exercises include:

1. the toes actively flex and extend;
2. socks are pulled towards themselves and returned to the opposite position;
3. knees bend and straighten;

How to develop the muscles of the torso?

To perform these exercises, you need to lie on your back and try to repeat ten approaches:

1. perform rolls from one side to the other;
2. try to raise your pelvis with the help of your shoulder blades, elbows and heels;
3. try to lift your upper body, while tensing your abdominal muscles.

What other movements need to be developed?

To prevent eyelids from drooping, you need to perform gymnastics in several approaches:

1. It is recommended to move your eyes in different directions;
2. you can rotate your eyes in a circle, also in different directions;
3. squeeze and unclench your eyelids.

You also need to work on strengthening your neck:

1. it is recommended to turn your head in different directions;
2. press the back of your head as deep as possible into the pillow, then relax.

After a stroke occurs, the patient loses the ability to perform small movements fingers. But this is extremely necessary if a person wants to serve himself.

To work effectively on your hands, you need to do the following exercises:

1. It is recommended to put it in a wide container various items: pens, erasers, pencils, felt-tip pens;
2. the patient is advised to transfer these items from one container to another.

In specialized institutions they can use lotto and mosaic.

Exercises while standing

If the patient can stand and move independently, then it is recommended that he gradually increase the amount of exercise per day. You need to work with simple exercises first and then add variety.

The following techniques can be called simple gymnastics:

1. smooth stretches with controlled breathing;
2. turns several times in each direction;
3. squats with your heels firmly pressed to the floor;
4. alternately raising legs;
5. bending the torso in different directions (with the arms alternately above the head).

The following exercises are considered advanced gymnastics:

1. clasp your hands and slowly stretch them;
2. boxing movements with hands;
3. circular rotation of the shoulder joints.

Gymnastics must be completed with slow breathing exercises.

Contraindications

Gymnastics cannot be done in some cases. Whether the patient does it or not depends on his condition.

1. the patient is in a coma;
2. some mental instability has been recorded (excessive irritability, aggression, etc.);
3. occurred and the patient is elderly;
4. seizures similar to epileptic ones, as well as convulsions, were recorded;
5. a stroke occurred in a patient who suffers additionally diabetes mellitus, tuberculosis, etc.

When performing a gymnastic complex, the patient should feel quite comfortable. If complaints are received about headache, excessive weakness (low blood pressure, etc.), then it is necessary to change the pace of physical activity and rest more.

As soon as the doctor allows you to walk, it is recommended to walk as much as possible, spend time fresh air. It is recommended to gradually increase the route when walking. The help of loved ones, their moral support and self-confidence will help a person cope with the disease as soon as possible.

Useful video

Therapeutic exercises after a stroke - video describing recommended exercises:

All recommendations in the article are for informational purposes only. Whether to engage in exercise therapy and how many times a day is decided solely by the patient’s attending physician! Self-prescribed physical activity after a stroke is unacceptable!

Exercise after a stroke - required condition successful rehabilitation after a brain accident. The set of exercises should be selected by the attending physician individually. Physical exercise create an optimistic mood in the patient’s psyche. This necessary condition to form an impulse of will. Before starting a set of exercises, you need to normalize your blood pressure and pulse. Remember that complete immobility of the body is dangerous for the development of congestive pneumonia. A patient after a stroke needs to perform the most basic exercises: turning over on his side, flexion and extension of the affected limbs. Remember that more complex exercises can be performed no earlier than six months after the stroke. If you experience discomfort during exercise, stop exercising until normal breathing is restored. Be sure to monitor your pulse and blood pressure.

Some effective exercises for exercise after a stroke:

- Awakening. You need to lie on your back on a hard mattress. Twist your pelvis so that one heel is as far forward as possible, and the other behind. At the same time, do not lift your feet from the surface. Your hands should repeat the movements at this time. Hold the pose for 10-15 seconds if possible. Do 3-4 repetitions. Then rest. Exercise awakens the body, normalizes blood pressure, and massages the kidneys.

- Explosion. Clench your fists. Hold it down bent arms to your chest and close your eyes. Take a deep breath. As you exhale, you need to open your eyes and unclench your fists. Straighten your arms with strength. Lie down for a while. Remember that when you exhale you need to try to reset all the accumulated negativity. As you inhale, imagine that your body is filled with positive energy. When you master the exercise, improve it: extend not only your arms, but also your legs as you inhale and exhale.

- Stretching. You will need outside help to complete the exercise. Take a sitting position on the bed. The head should move toward the knees, while the hands hold the shins. The assistant should press on your shoulders to bend you. Hold the position for a few seconds. Then restore your breathing. The exercise helps the patient stretch the spine; it stimulates the flow of neural impulses from the head to the feet.

- Bows. The exercise can only be done 6 months after the stroke. It needs to be done in bed. Sit on your knees. In this case, the tailbone should be at the heels. Keep your hands on your knees. Watch your breathing. It should be smooth, calm and deep. Close your eyes. Smoothly lower your torso as you exhale. Reach the extreme point and, while inhaling, slowly return to the starting position. Restore calm breathing. You need to do the exercise 5-6 times. This is a basic exercise that people with any vascular disorders of the brain should perform.