Rehabilitation And Recovery After A Stroke At Home - A Set Of Exercises

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Rehabilitation and recovery after a stroke at home

Treatment of stroke patients is a very long and gradual process that must go through a number of successive stages. First, such patients are treated in the intensive care unit, where the struggle for their lives is being waged, then in the neurological hospital, where they are engaged in the restoration of the affected cells.

But no less important is the recovery stage after discharge from the hospital. After all, the neurological deficit that the patient has can no longer be restored by medication, since the brain cells are destroyed.

But it is possible to adapt a person to life as much as possible at the expense of other neurons that remained unharmed. It will take a long time to achieve this. Naturally, this is possible only thanks to independent recovery from a stroke at home, when both the patient and his relatives are actively interested in this process.

Content:

• How long does it take to recover from a stroke?
• Stroke recovery exercises
• Recovery of speech after a stroke
• Recovering memory after a stroke
• Stroke recovery drugs

How long does it take to recover from a stroke?

In deciding the question of the recovery time after a stroke period, there can be no unambiguous indicator. It all depends on the size and location of the lesion in the brain, the type of stroke, the time from the onset of the disease to the direct provision of specialized medical care. The higher the values of these indicators, the worse the prognosis for the patient's complete recovery. You have to work with such people for a very long time, practically for life, if only in order not to aggravate the existing neurological deficit. Tentative dates and forecasts can be shown in the form of such a table.

Duration of the recovery period
Ischemic stroke with minimal neurological deficit (mild paralysis of the limbs and face, impaired coordination, vision, dizziness)	Partial recovery 1-2 months Full recovery 2-3 months
Any type of stroke with severe neurological deficits (severe paralysis of the limbs and face, persistent discoordination disorders)	Partial recovery with self-service 6 months. Full recovery is rare and takes years
Severe massive ischemic and hemorrhagic strokes with persistent neurological deficit (disability due to paralysis of one side and other defects)	Partial recovery with the ability to sit on their own - 1-2 years; Full recovery is not possible

From the above table, it becomes obvious that the more severe the stroke was, the longer rehabilitation treatment should be. Patients who have had an ischemic stroke recover a little faster than after a hemorrhagic stroke.

With the existing gross neurological deficit against the background of any stroke, there is not always the possibility of complete recovery of a person, which is determined by the necrosis of those important clusters of brain neurons, the function of which is not able to take on neighboring healthy cells. Therefore, the recovery period after any stroke never ends. It is necessary to engage in recovery procedures for life as short-term courses or daily. This will not only help in the restoration of lost abilities, but also prevent new stroke attacks.

You should never lose heart, no matter what type of stroke is suffered, and despite the obvious predictions. After all, the life resource of each person is different, especially in relation to the brain. Only constant self-improvement can help to recover more fully and as shortly as possible after a stroke.

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Stroke recovery exercises

One of the primary tasks of the recovery period after a stroke is the resumption of the motor function of the limbs. It is on them that the neurological deficit in this disease is mostly closed. It is necessary to start restoring movements almost from the first day after the onset of a stroke.

The general features of the exercises are characterized by the following points:

1. Decreased muscle tone and tension. Any stroke causes paralysis, characterized by muscle hypertonicity and increased excitability;
2. Improving microcirculation. A stroke disrupts the innervation of all tissues. As a result - a violation of their blood supply;
3. Prevention of contracture. Against the background of prolonged neurological deficit and spastic paralysis, additional freezing of muscles occurs, which are in a state of constant tension;
4. Protection of the skin of the extremities from bedsores. This is especially true for the legs. In places of greatest pressure and contact, which are the heel areas, bedsores most often occur;
5. Renewal of fine movements. They belong to the most important functions of the limbs, which, in fact, characterize the complete restoration of the nervous system. This is most true in relation to the hands and upper limbs in general.

Before starting any exercise after a stroke, it is advisable to consult with your doctor, and even better with a narrow specialist - a rehabilitation therapist. He will help not only to choose the right set of exercises, but also to tell about all the subtleties and stages of their implementation. In general terms, it is worth pointing out such a feature: all exercises should start from simpler ones with a gradual expansion of their volume, depending on the patient's functional abilities.

Against the background of physiotherapy exercises, even patients with an identical problem and the severity of a stroke can recover in different ways. Therefore, you should not overload a person greatly. This is as harmful as the absence of remedial gymnastics in general. Before performing any set of exercises, it is better to warm up the tissues to which their action will be directed. If possible, warm water procedures are suitable for these purposes. If there are contraindications or other reasons why this action is not feasible, a light massage for 15 minutes immediately before the exercises will be sufficient. As a last resort, you can use a heating pad to warm the affected limbs.

All patients after severe strokes with a gross neurological deficit must be helped by someone close to them, since they are unable to cope with this task on their own. It is better if the set of exercises is performed 2-3 times a day in a kind of short courses that take about one hour. They should not cause severe fatigue and overwork in the patient. If any arise, this indicates the incompatibility of the loads and the actual abilities of the patient at a particular stage of the rehabilitation and recovery period.

A strict individual approach with strict adherence to the general rules of physiotherapy exercises can be called the only correct step on the way to the rapid recovery of patients after a stroke.

Exercises in bed rest

Of course, in this case it is extremely difficult to do something on a large scale, since the functional abilities of patients are very limited. Therefore, it is necessary to help people around such patients. This set of exercises should be performed by all persons in the acute period after any stroke, as well as by those who have severe spastic paralysis of the limbs with a pronounced increase in muscle tone. Such patients are not able to straighten the limbs, as they are firmly fixed in a bent position. Exercises should be aimed at reducing tone and gradually increasing the range of motion.

Typical gymnastics looks like this:

1. Simple extension and flexion of fingers and hands, forearms and elbows, feet and knees, movement of limbs in the shoulder and hip joints;
2. Rotational movements by the indicated segments. Performed with the help of caregivers. They must imitate those movements that a healthy person is capable of performing;
3. Exercise to restore the arm. Stretching spasmodic limbs with splints and other devices. Indicated for persistent paralysis. To do this, the bent limb is gradually unbent from the fingers and fixed with a bandage to a hard flat board or other device. Step by step, the same actions are performed with the overlying parts of the hand (hand and forearm). In this position, the limb is fixed for half an hour, but it can be longer if the patient does not cause discomfort;
4. A towel is hung over the bed. The following exercise can be performed by persons with restored hand function. To do this, grab the towel with it and perform all possible movements (abduction and adduction, lifting-lowering in the shoulder, flexion-extension at the elbow). Gradually, the towel is raised higher and the exercise is hampered by the patient's own weight;
5. From a strip of rubber of medium thickness and width, it is necessary to make a ring with a diameter of 40 cm. With this device, you can perform a large number of exercises. It is thrown between the hands, forearms, arm and leg, hand and any object. In this case, the elastic is stretched by separating its ends from each other;
6. To eliminate the muscle spasm of the lower limb, a hard roller is placed in the popliteal region, the thickness of which gradually increases. Thus, muscle stretching and an increase in the range of motion are achieved;
7. Grasping the lower legs over the ankle joint with further flexion-extension of the legs in the knee joints by sliding the feet along the bed;
8. Lying in bed, you need to gently raise your arms above your head and try to grab onto its back. After that, incomplete pull-ups are performed with simultaneous stretching of the feet and fingers (as if stretching);
9. Exercises for the eyes. They restore the function of eyeball mobility and vision adaptation. To do this, you need to make eye movements in different directions several times. Circular movements. Repeat the procedure with the eyelids closed;
10. Fixation of the gaze at one point with subsequent rotational, nodding and circular movements of the head without detaching from this fixation point;

Sitting exercise

They are aimed at restoring targeted arm movements, strengthening the back and preparing the legs for walking. Their technique is as follows:

1. The patient is transferred to a sitting position, hands grabbing the edges of the bed. On inhalation, flexion in the back is performed while stretching the trunk in a state of tension. On exhalation, relaxation follows. The cycle consists of 8-10 repetitions;
2. Starting position is sitting on the bed, legs at body level (do not fall). Alternately raise and lower the left and then the right leg several times;
3. The starting position is sitting in bed. Hands are laid back. On inspiration, the shoulder blades are brought closer to each other while the head is thrown back. On exhalation, relaxation follows;

Standing exercises

Shown after the expansion of the motor regime and partial recovery of the patient. Their main goal is to restore fine movements to maximize the elimination of neurological disorders. Typical examples look like this:

1. Lifting a matchbox off the floor or table. Works out purposeful subtle movements;
2. The starting position is standing with hands down. As you inhale, raise your hands up above your head, while simultaneously stretching and standing on your fingers. On exhalation, they relax, bending the torso down and lowering. Repeat several times;
3. Flexion-extension of the hand into a fist with the help of an expander with simultaneous removal of the arms from the body;
4. In a standing position, feet shoulder-width apart, hands are placed on the waist. Tilts of the body are made to the right-left, back and forth;
5. From the previous starting position, perform the scissors exercise (alternate movement of crossed arms extended in front of you, to the opposite side;
6. Squats from a standing position with joined feet. During the exercise, it is necessary to keep your back as straight as possible and not to tear your heels off the floor;

During the performance of exercises related to the stage of restoring fine movements, you can continue gymnastics from the previous stages, especially if it strengthens the muscles and expands the range of motion in general. Physiotherapy exercises using light dumbbells and strength exercises are allowed.

In order for physiotherapy exercises to really be of a restorative nature, it must become part of the patient's lifestyle.

Recovery of speech after a stroke

Recovery processes in the brain in relation to speech function are much slower than in motor disorders. They can last for several years. Therefore, it is necessary to deal with patients constantly, starting from the first day of the recovery period after stabilization of the general condition. The main task in this difficult process falls on the patients themselves and their relatives. Only persistent desire should guide them. You cannot stop exercising, despite the long absence of a pronounced effect. Sooner or later, all efforts will be rewarded with a gradual improvement in speech.

The recommendations for speech restoration exercises are clear enough. Their main focus is the involvement of nerve cells located in the area of the affected speech center to perform the function they have lost. This can be achieved through continuous training in speech and hearing. In order for the patient to regain the ability to speak independently, he must hear speech. Everyone should talk to him constantly. Thus, he will be able to reproduce sounds.

As for the direct pronunciation of words, in the event of a complete loss of speech ability, it is necessary to begin pronunciation of individual sounds and syllables. To do this, the patient is told part of a word or phrase without finishing the endings. The patient himself must pronounce them. The volume of the reproduced words should gradually increase. The very last step is to repeat the rhymes and tongue twisters.

Singing has a beneficial effect on the development of speech ability. If the patient hears singing, and subsequently tries to sing together with loved ones, then he will succeed much faster than ordinary speech. Therefore, it is imperative to include this method of rehabilitation of patients after a stroke to restore speech ability.

It is extremely important for the restoration of speech - to resume the ability to pronounce sounds. After all, a person can potentially be able to speak, but due to a prolonged violation of the innervation of the mimic and masticatory muscles, their peculiar solidification occurs.

In such cases, they should be actively developed by:

1. Folding the lips into a tube;
2. Bared teeth;
3. Maximum protrusion of the tongue forward;
4. Light biting of the upper and lower lips with the jaws;
5. Licking lips with tongue in both directions (from left to right and vice versa);

Recovering memory after a stroke

One of the brain functions that is impaired as a result of a stroke is memory. It is very important to correctly approach the recovery processes in this regard. Like all other abilities of higher nervous activity, work on it should be started as early as possible. This usually corresponds to the period after the elimination of a direct threat to human life and the phenomena of cerebral edema against the background of a stroke.

The first thing doctors are working on is medication support for the affected neurons. Patients are prescribed intravenous infusions of nootropics (drugs that improve metabolic processes in the brain and memory). Their reception must be continued at the stage of outpatient treatment, but already in tablet form. The most common and effective nootropics include piracetam, lucetam, nootropil, fezam, thiocetam. All of them act rather slowly, so it is important to observe the duration of admission, which should be at least 3 months. After a short break, the treatment course must be repeated.

In addition to drug correction, functional rehabilitation treatment should also be performed. It involves constantly training the brain's ability to remember. This process is one of the longest of all types of rehabilitation treatment after a stroke and takes many months and even years. It includes memorizing and constant repetition of numbers, certain words, rhymes, first short, and then longer. Board games and other activities with elements of the game, when the patient is simultaneously distracted from the outside world and concentrated on a certain action, also have a beneficial effect on memory.

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Stroke recovery drugs

An extremely important place in the rehabilitation treatment of stroke patients belongs to the drug treatment of cerebral dysfunction. It is imperative to adhere to their course intake with alternating periods of active treatment and breaks between them. It is advisable to intravenously inject cerebroprotectors twice a year (drugs that improve blood circulation and brain activity).

It is important to remember that you should not take blood thinners after hemorrhagic strokes. In this, not only is there no expediency, but it is also possible to provoke the recurrence of a stroke. All other drugs are prescribed not differentially, regardless of the type of stroke.

An approximate classification of medications for rehabilitation in the post-stroke period is given in the form of a table:

Specific representatives
Improving blood flow to the brain	Pentoxifylline; Cavinton; Cerebrolysin; Aspirin-based preparations;
Improving metabolic processes in brain cells	Ceraxon; Actovegin; Solcoseryl; Cinnarizine; Ginkgo Fort; Cortexin;
Nootropics	Piracetam; Noofen; Lucetam;
Combined products (consist of several drugs)	Phezam; Neuro-norms; Thiocetam;
Other drugs	Glycine - reduces the excitability of the nervous system; Sirdalud - eliminates muscle tension, muscle spasm and hypertonicity; Medicinal plants and herbal teas; Antidepressants (gidazepam, adaptol)

With medication rehabilitation of the brain and its functions, a clearly sequential tactic of stepwise therapy is used. It involves the step-by-step administration of drugs, starting with intravenous administration, and ending with taking tablets containing identical active ingredients. In this regard, modern pharmaceutical companies that are engaged in the production of cerebroprotectors have created various dosage forms of the most common active substances. This allows patients to take the same drug, which is especially important when it is ideal for the patient.

Only the attending physician or specialist who monitors the patient should prescribe or replace drugs with others. The patient and his relatives should only strictly adhere to the recommendations and not miss taking the drug at the appointed time.

Author of the article: Sokov Andrey Vladimirovich | Neurologist

Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".