How is rehabilitation after an ischemic stroke. Treatment and recovery after cerebral ischemic stroke: effective approaches and methods. Methods and means of rehabilitation

A stroke is a very dangerous disease associated with impaired blood circulation in the brain, which leads to severe ones, including loss of memory and movements, paralysis and others.

Depressing statistics

According to medicine, after a stroke during the first month, death occurs in 15-25% of people. In half of these cases, death occurs due to secondary cerebral edema. In other cases, death occurs due to many severe complications, such as:

A lot of people are wondering what is the life expectancy after a stroke, it is impossible to answer this question unambiguously, because there are no such statistics and everything is very individual. The prognosis depends on a number of factors.

According to statistics, the mortality rate after is 65%. Of those who have suffered an apoplexy, 35% of people can live more than one year.

With a more favorable prognosis. The survival rate is 75%.

Regardless of its type, the mortality rate will be much higher than after the first brain damage.

The duration and quality of life of a post-stroke patient depends on the physical health of the person, and the lifestyle that the patient led, as well as the presence of any serious chronic diseases.

A lot depends on the rehabilitation regimen and whether the causes of the pathology have been completely eliminated.

Proper nutrition and adequate drug treatment, refraining from smoking and drinking alcohol, as well as constantly working to improve the functioning of your body, are guaranteed to increase the chances of maximum recovery and a good life expectancy.

According to experts, about 30% of patients in the case of a favorable course of the disease gradually partially or completely restore impaired functions.

More than 30% of people due to a stroke have a complete or partial loss of important skills, which leads to disability. Such a person needs constant care.

If it happens, it will be much harder than the first one. At the same time, the patient's condition periodically worsens, the treatment process is delayed, and very rarely it is possible to completely restore the impaired functions.

The likelihood of a second stroke in the first year is very high. Secondary impact in almost 70% of cases leads to death. That is why strict measures should be observed in order to prevent the risk of recurrence of the pathology.

Favorable factors and not so ...

Speaking of, it should be noted favorable and unfavorable factors that play an important role.

Unfavorable factors include:

a large focus of brain damage;
localization of the lesion in the areas responsible for speech and motor skills;
poor circulation around the lesion;
elderly age;
emotional disturbances.

Favorable factors:

timely start of restoration activities;
previously spontaneous recovery of functions.

The first days after the attack

First of all, after a stroke, a complex of therapeutic measures is carried out, the purpose of which is to maintain the cardiovascular and respiratory systems. In the first few days, the patient should be in the intensive neurology unit or acute stroke unit.

Here, measures will be taken to control the work of the heart, blood vessels and respiratory organs. First of all, the following is done:

correction of water and electrolyte balance;
elimination of cerebral edema.

The patient must comply with strict bed rest. To prevent the formation of bedsores from prolonged lying, it is necessary that the mattress is even, and the sheet does not form wrinkles. The body must be treated with camphor alcohol and talc, which absorbs moisture well.

If it is impossible to swallow food, feeding is done using a probe. If a person is able to swallow, on the first day they are given juices and sweet tea. From the second day, the diet expands and you can eat light foods, such as yoghurts, broths, vegetable and fruit purees.

The duration and quality of life will depend on how many intact nerve cells remain around the lesion in the early period after a stroke, and the speed and professionalism of doctors will determine how effective the further recovery and rehabilitation of the patient will be.

To limit the size of the focus, the following drugs are prescribed:

diuretics: Mannitol, Furosemide - reduce swelling in the area of the affected tissue;
neuroprotectors: Actovegin, Cerebrolysin.

Therapeutic exercise as a way of life

- This is one of the main methods after a stroke. The goal of therapy is to return the limbs to their former strength, range of motion, restore the skills of standing, walking, maintaining balance, and self-service. The selection of exercises is performed by a specialist, taking into account the severity of the patient's condition:

With deep violations, rehabilitation starts with passive gymnastics. The movements of arms and legs are carried out by relatives or an instructor. At the same time, blood flow in the muscles is restored, and joints are developed. In no case should such rotational movements cause discomfort or pain.
At first the patient is put on the bed for several minutes, gradually this time should increase. Then he is taught to stand. When the condition begins to improve, the patient learns to sit, get up and walk without assistance. If necessary, you can use a support - a chair or a stick.
The function of the hands is restored with the help of special simulators and hand expanders. Such devices have a good effect on the functions of the muscles of the hand and the return of the skills to perform simple small movements and even writing. It will be very useful in combination with gymnastics, which helps to improve muscle tone and reduce spasticity.

Speech restoration

Speech disorders are very common with strokes. A person may experience difficulty in pronunciation, remembering words, and also in understanding someone else's speech. Violations can be completely different. The process takes place with the participation of a qualified speech therapist, and can take several years.

After a stroke, the functions of the muscles of the face and tongue may be impaired. The speech of such a person becomes slow, deaf and illegible.

The speech therapist conducts exercises during which the tongue and muscles are trained. They are best done in front of a mirror. Classes should be regular.

The patient can also do the following:

roll lips into a tube;
imitate a grin;
stick out the tongue to the maximum length;
bite the lower and upper lip in turn.

Relatives and friends need to take into account the limited capabilities of the post-stroke patient, so you should speak slowly, in simple phrases, giving him time to comprehend what he heard. You need to ask questions in such a way that he answers “Yes” or “No”.

In addition to speech disorders, very often a person experiences difficulties in the process of swallowing and chewing food due to damage to the facial muscles. That is, a person may simply not feel food in his mouth.

Special exercises help to restore the swallowing function, which activate muscle strength and improve the motor skills of the lips and tongue.

To make the swallowing process less painful, it should be easy to chew and swallow. It should not be too hot or cold. When eating, the patient should be in a sitting position.

Memory recovery

Memory recovery occurs through constant training with simple exercises. For example:

Memorizing easy children's poems. First you need to remember the line, then the stanza. Gradually, the size of the poem can increase. It is good that in the process of memorization the patient bends his fingers, so additional associations will be formed.
Replaying past events. The patient may describe the events of the past day or older events. It is imperative that the memories are only positive.
As memory is restored, you can move on to solving crossword puzzles and memorizing small texts.. Exercise can be done in any setting, such as at lunch or while walking.

The question of nutrition

Plays a huge role. If a person has excess weight, or a high level of glucose in the blood is detected, dietary nutrition is prescribed.

It is very important to limit the intake of salt, sugar, fats and cholesterol, which negatively affect the state of blood vessels. Food should be rich in fiber, minerals and vitamins. It is very important to eat small meals and at least four times a day.

What not to eat:

Time for healing

This is very actual question, which occupies both the victim himself and his relatives. Time is determined by many factors, which include:

the degree of brain damage;
the individual ability of the body to recover;
the program of rehabilitation measures that have been applied;
the patient's desire for recovery.

Very often, the treatment gives a good result after a couple of months. However, it is possible that it will be possible to restore the simplest skills only after a few years.

What to do after a stroke

It is very important to follow these simple rules:

regularly examined by your doctor;
give up all bad habits and unhealthy food;
in no case stop performing exercises in therapeutic gymnastics;
visit sanatoriums and resorts;
walk more;
avoid stress and heavy physical exertion.

A stroke is not a death sentence. Adequate treatment, a properly selected rehabilitation technique and the implementation of all medical prescriptions can speed up the recovery process and return to a full life.

It is also necessary to once again recall the importance of the positive attitude of the victim himself and the provision of psychological assistance from relatives.

Successful recovery and effectiveness of treatment for the consequences of a stroke largely depend on the severity of the disease and on how timely therapy is started. An important factor is the psychological mood of the patient, his motivation for a speedy and full recovery.

The disease proceeds in several stages, during which various changes occur in the functional structures of the brain:

Time is the main factor in successful recovery after a stroke! Rehabilitation will be more effective if it is carried out in the early stages and the consequences of the disease are not neglected.

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Causes

The occurrence of a stroke depends on several factors, on the basis of which it is accepted to distinguish between two types of the disease:

The nature of the course of any type of stroke is heterogeneous and cyclical, accompanied by a change in positive dynamics to crisis states.

General signs

To avoid serious complications and difficulties in the recovery period, you need to know the signs of a stroke:

blurred consciousness of the patient, fainting;
redness of the face;
increase in body temperature;
violation of the motor functions of the limbs;
tactile sensitivity decreases or completely disappears;
on the affected side, the corner of the mouth drops, the eye does not close, the face becomes asymmetrical.

It is those around who should notice the changes that occur with the patient. He himself can objectively notice such violations in the state due to the specifics of the course of the disease.

What is the most dangerous period after a stroke?

Medical science recognizes the most dangerous two periods of stroke - the most acute and acute.

It is at these stages that serious complications may occur, such as a recurrent stroke, the formation of blood clots and blockage of the lumen of blood vessels, and an increase in cerebral edema.

This state of affairs is more typical for severe strokes, accompanied by paralysis and impaired consciousness.

Actions in a given period of time

Patients in the acute period of a stroke should be immediately hospitalized. The first 3 hours from the onset of the disease - sensitive period for effective recovery.

Hospitalization is excluded only in one case - if the patient is in a state of agony.

The best option for hospitalization is placement in a multidisciplinary hospital, where it is possible to carry out the maximum number of diagnostic measures and get advice from a neurosurgeon.

The emergency actions carried out by the ambulance team or other persons delivering the patient to the hospital include:

correction of oxygenation, i.e. an increase in the amount of oxygen supplied to the brain cells;
maintaining normal blood pressure;
exclusion of seizures.

Upon admission to the hospital, urgent measures are as follows:

diagnostics of the level of oxygenation;
assessment of blood pressure;
examination by a neurologist;
conducting a minimum set of laboratory tests;
the use of MRI in order to build an adequate treatment and recovery program;
making a decision about the further place of stay of the patient.

Treatment in a hospital can take from several days to several months. In any case, after discharge, rehabilitation measures must be continued at home or by visiting specialized centers.

Recovery period

Restoration of motor functions primarily involves the elimination of defects on the part of neurology.
The patient is invited to undergo a full examination, on the basis of which he is assigned physical methods of rehabilitation, including:

therapeutic exercises and;
physiotherapy;
manual therapy;
reflexology;
biofeedback with the possibility of applying feedback.

Additional methods for restoring motor functions include electrical stimulation of nerve and muscle fibers.

Rehabilitation for speech disorders

Speech disorders are an equally common problem caused by strokes. Often, such functional changes are associated with motor defects.

The main types of speech disorders after a stroke include:

aphasia, which are versatile functional speech disorders caused by local left hemisphere lesions of special zones;
dysarthria associated with a violation of the pronunciation of speech, contained in the articulatory, rhythmic and tempo properties of speech.

Corrective action for the purpose involves the use of drugs that activate the metabolism in nerve cells and start the recovery process in the necessary areas of the brain.

Cerebellar injury and features of rehabilitation

Symptoms of a stroke with damage to the cerebellum and bridge are as follows:

the appearance of dizziness;
nausea and vomiting;
tinnitus;
paresis of mimic muscles;
cerebellar ataxia (disorder of coordination of movements).

Measures aimed at recovery after a stroke of this kind are reduced to active therapy and the selection of a complex, including massage, kinesitherapy and balance training, as well as a feedback method using a stabilogram.

Rehabilitation for astheno-depressive disorders

The course of the disease in this case is accompanied by depression, associated with rapid fatigue, low activity level, exhaustion and reduced ability to long-term mental and physical stress.

Rehabilitation of patients with astheno-depressive disorders is carried out according to the program of individual lessons, the specifics of which are as follows:

classes in therapeutic gymnastics and exercise therapy are carried out with frequent breaks;
included sessions with a psychologist;
drug therapy includes nootropics and antidepressants.

AT special occasions treatment of patients with this kind of pathology is carried out under the supervision of a neurologist and a psychiatrist.

The recovery period after a stroke in the elderly

The recovery period for them has a number of features:

classes, including elements of physical activity, are held with additional breaks and massages;
classes are held with a psychologist;
active therapy is underway medicines supporting the cardiovascular system;
for a long time, neurotrophic and anti-sclerotic dosage forms are prescribed;
a course of vitamin therapy is required.

Classes for such patients have a low level of intensity, but are prolonged in time.

Results of restoration work

Upon reaching the patient of the late recovery stage, it is possible to sum up the results of rehabilitation, differentiated by classes:

Class	Characteristic
The first	Characterized by full return and restoration of lost functions
Second	When there has been a significant, but not complete recovery, there is no dependence on others, but the ability to work is reduced.
Third	In which the ability to work is lost, a partial dependence on others is formed.
Fourth	It is characterized by a significant degree of dependence on others, all types of adaptation are violated.
Fifth	Which is characterized by a complete loss of self-service skills, there is a complete dependence on others.

Strokes became real social problem modern world. This disease affects people of all age groups. and are the most common sequelae of stroke.

Every year, about 6 million strokes occur in the world, so it is so important to inform the population about the disease: its causes, periods and features of recovery.

One of the biggest problems in modern neurology are diseases caused by pathological changes in cerebral vessels and disruption of normal blood circulation in the main organ of the human body. As a rule, they develop after a cerebral infarction. At the same time, the statistics remain disappointing. Despite the fact that in modern medicine there are many effective methods treatment, about 35 percent of cases are fatal.

A large number of patients do not fully recover from a heart attack and remain disabled. They develop various neurotic and psychological defects that make normal life impossible. Let's try to figure out if recovery is possible after ischemic stroke, as well as what medical, educational, economic and professional measures will help patients to at least partially recover from the disease.

A few words about disability

Before we talk about what recovery after ischemic stroke at home can be like, let's first understand the main consequences that patients face. According to profiled experts, due to circulatory disorders, the brain begins to experience an acute shortage of oxygen and nutrients, as a result of which a person begins to develop various neurological and mental disorders. In addition, the patient ceases to independently cope even with elementary daily tasks, so constant care is required for him.

Among the most commonly diagnosed defects are the following:

decrease in strength caused by damage to the motor pathway nervous system;
paralysis;
ataxia;
memory loss;
violation of the speech apparatus;
deterioration of mental performance;
hypoesthesia;
visual disturbances;
disorder of the act of swallowing;
violation of pronunciation and voice function;
violation of the functioning of the organs of the genitourinary system;
epileptic seizures;
Dejerine-Roussy syndrome.

To minimize the likelihood of developing the disorders listed above, a person needs to recover from an ischemic stroke. Most of the activities are aimed at improving such basic abilities as walking, talking and self-care, since many patients are almost helpless at first after a cerebral infarction. However, they cannot cope with everything on their own, so they need help and moral support from loved ones.

Principles and goals of rehabilitation

As a rule, recovery after an ischemic stroke at home is aimed at normalizing impaired functions, treating and preventing concomitant diseases and complications caused by a violation of the normal blood circulation of the brain, as well as teaching walking, speech and self-fulfillment the main tasks so that the patient can continue to live, not depending on others.

The main principles include the complete or partial return of lost functions to the patient, assistance in psychological and social adaptation, differentiated therapy and various measures aimed at preventing relapses. Thus, recovery from a massive ischemic stroke is very important, as it aims not only to return the patient to normal life, but also to help him cope better with mental pressure.

Key factors influencing the success of rehabilitation

Let's dwell on this in more detail. Even profiled specialists cannot name the exact recovery time after ischemic stroke, since everything here depends on a number of factors, the main ones being the severity of the syndrome and the characteristics of the body of each person. The success of rehabilitation largely depends on how quickly hospitalization was carried out and treatment started.

At the same time, the key factors are not only the consistency, systematicity and duration of rehabilitation, but also the physical assistance of relatives and friends, their moral support, faith and involvement in the entire process of the patient himself. Of no small importance is an integrated approach to recovery and the participation of qualified specialists in various fields, the leading among which are a neuropathologist, physiotherapist, neuropsychologist, speech therapist-aphasiologist, massage therapists, social workers, a specialist in exercise therapy and representatives of many other areas of modern medicine. Only when joint work a number of specialists recovery after ischemic stroke can be productive and will achieve positive results.

Stages of rehabilitation

So what do you need to know about it? The program of therapy and recovery after a cerebral stroke is compiled for each patient on an individual basis. When developing it, the features of the underlying pathology, the intensity and degree of manifestation of concomitant syndromes and disorders, the age category and many other factors are taken into account.

There are the following periods of recovery after ischemic stroke:

First stage. It is considered the most difficult and takes place during the first 3-4 weeks after the manifestation of the syndrome, when violations and lesions make themselves felt in the most acute form.
Second phase. First 6 months after hospitalization.
Third stage. Late stage recovery extending over a period of 6 to 12 months.
Fourth stage. The period of residual effects, starting after a year of illness.

The above terms of recovery after ischemic stroke are conditional. This pathology is very serious and often ends in the death of the patient, so it is impossible to give exact numbers and the effectiveness of rehabilitation.

Features of the course of the recovery period

According to doctors, the rehabilitation of patients can last from 2-3 months to several years. At first, the patient must be hospitalized under the strict supervision of qualified doctors so that they can monitor the patient's condition and, if necessary, make appropriate adjustments to the therapy program. At the same time, recovery after an ischemic stroke of the brain should take place in specially equipped wards equipped with modern equipment, with which you can carry out certain activities aimed at returning lost functions to a person, perform physiotherapy and gymnastic exercises, do therapeutic massage, and also use other modern methods highly effective treatments.

Rehabilitation of patients with partial or complete loss of the ability to move

The main physical disorders are unilateral or bilateral damage to the motor pathway of the nervous system, paralysis, as well as impaired muscle tone and sensitivity. In this case, full recovery after ischemic stroke is possible only with adequate treatment started in a timely manner. However, in order to choose the most effective rehabilitation program, the doctor needs a detailed clinical picture of the patient's health, so a comprehensive examination by many specialists is required here. As the main activities, as a rule, massage, physiotherapy, physiotherapy exercises and gymnastics, acupressure on certain parts of the body and manual therapy are prescribed.

It should be noted that the most effective during rehabilitation is a set of gymnastic exercises and exercise therapy. With their help, doctors very often manage to restore normal walking skills to patients and teach them to perform basic tasks and functions on their own in order to be independent from others. To increase the effectiveness of therapy, neuromuscular electrical stimulation can be used.

Any method used at each stage of rehabilitation is aimed at restoring the patient's normal mobility. With the help of a set of special exercises, you can gradually increase the amount of motor activity, restore muscle tone and increase its ability to strain and relax. After that, specialists begin to teach basic skills - stand, walk and perform basic daily tasks: dress and undress independently, eat and perform water procedures.

At the initial stages, recovery after an ischemic stroke is carried out in a sparing mode. The patient is not assigned heavy loads, but measures are used that have a stimulating effect on the muscular apparatus, normalize blood circulation and the functioning of the lymph nodes, and prevent the development of contractures. The load increases gradually. At the later stages of rehabilitation, exercises are performed that contribute to the formation and improvement of walking skills, the development of the vestibular apparatus and training of vertical stability.

Speech disorders

What do you need to know about it? Speech recovery after ischemic stroke is very milestone, because if a person does not have the opportunity to communicate with others, he develops a sense of his own hopelessness, he fences himself off from everyone and becomes closed, which negatively affects the whole therapy.

Among the most common disorders are the following:

complete absence or violation of speech functions caused by damage to some parts of the brain;
violation of innervation manifested due to damage to the nervous system.

The rehabilitation program involves a course of drug therapy based on the use of drugs that improve metabolic processes in nerve cells and start recovery processes in the brain. These include amino acid drugs, such as Cerebrolysin, as well as neurometabolic drugs. Along the way, a speech therapist-aphasiologist and a neuropsychologist work with the patient.

The recovery time after an ischemic stroke in speech disorders depends on the degree of damage to certain departments and zones of the organ, as well as on how quickly the therapy was started. As practice shows, the rehabilitation program gives top scores at the initial stages. At the same time, the course of treatment requires constant adjustments, since its effectiveness depends on the localization of the lesion and the characteristics of the course of the pathology.

Rehabilitation in case of damage to the cerebellum

In most cases, cerebral infarction is accompanied by severe circulatory disorders. As a result, extensive lesions of the cerebellum occur. This kind of pathology is accompanied by the following clinical manifestations:

dizziness;
nausea and vomiting;
tinnitus;
violation of spatial orientation and coordination of movements;
paralysis of mimic muscles.

The main goal of recovery after an ischemic stroke, accompanied by damage to the cerebellum and brainstem, is to eliminate problems with coordination of movements, normalize the functioning of the vestibular apparatus and restore defects in facial muscles. The therapy program is based on individual sets of exercises, exercise therapy, selective massage and biofeedback according to the stabilogram.

Rehabilitation for astheno-depressive syndrome

This is a very common condition in which a person gets tired very quickly, and is also constantly depressed, close to depression. He ceases to withstand prolonged emotional and physical exercise which interferes with normal functioning. Recovery after ischemic stroke at home in this syndrome can bring results and achieve a significant breakthrough in treatment, but an integrated approach is very important here.

The patient must perform physiotherapy and gymnastic exercises. But at the same time, the load should not be too strong, and long breaks should be taken between them. Massage is prescribed to increase the tone of the muscular apparatus. In addition, to bring a person out of a depressed and depressive state, conversations with a psychologist and taking certain medications are required.

Rehabilitation of elderly patients

This category of patients requires a special approach in the course of therapy, since its representatives are the most difficult to treat. Rehabilitation is carried out in the form of short individual lessons, therapeutic exercises and psychotherapy sessions. Along the way, vitamin complexes and drugs that improve functioning are taken. of cardio-vascular system and enhancing memory. Prolonged physical activity is contraindicated, and instead of them, a course of general rehabilitation treatment is carried out.

The effectiveness of rehabilitation

If a person has had an ischemic stroke, recovery after a year, carried out at home under the close supervision of an experienced specialist, allows you to achieve positive results.

Assessment of the condition of patients is carried out in 5 classes:

The first. The highest degree of evaluation, implying that the doctors managed to completely eliminate the defects and return the person to normal life.
Second. Pathological processes were not completely eliminated, but disability was avoided, so the patient can engage in labor activity and cope with all matters without outside help.
Third. The treatment has failed to restore the patient's ability to work, leaving him dependent on outsiders for complex tasks such as dressing and undressing or taking a bath.
Fourth. People are able to perform any tasks and move around the apartment with the help of loved ones.
Fifth. Complete disability and, as a rule, paralysis.

It is worth noting that cerebral infarction is a serious syndrome in which, in very rare cases, significant results can be achieved. Unfortunately, most patients remain disabled and need outside help to perform even the simplest tasks. Therefore, if your loved ones have suffered an ischemic stroke, then you will have to stock up on great patience and become support and reliable support for them.

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In a stroke, cerebral circulation is disrupted, which leads to cell death. Rehabilitation after a stroke takes place at home. Recovery of the affected brain cells occurs gradually, the process can drag on for months. Early rehabilitation allows patients to quickly return to a full life. Measures to restore lost due to stroke functions should be carried out regularly until complete recovery. The use of rehabilitation equipment is mandatory.

After stabilization of the general condition of the patient, it is necessary to immediately begin recovery after a stroke. Speech stabilizes gradually. After partial or complete familiarization of the affected cells to normal functioning, the patient begins to pronounce individual sounds, which are converted into words. It is necessary to constantly talk with the patient - hearing training speeds up the recovery process.

Active development of the speech center is carried out with the help of a series of exercises. The patient should regularly stretch out the tongue, alternately bite the lower and upper lip, move the lower jaw, stretch the lips with a “tube” and expose the teeth. With a complete loss of speech at the initial stage, the patient is taught to pronounce individual letters and syllables. The stroke man is told part of the word, and he chooses the ending on his own. The volume of reproduced words increases - a person puts words into sentences, repeats tongue twisters and poems.

At the initial stage of the recovery period, the patient should try to play simple songs. Singing trains the ear and helps to restore memory.

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21.10.2019

Recovery of the brain after a stroke is aimed at normalizing cerebral circulation. Post-stroke rehabilitation is based on medical support for neurons affected by stroke. Solutions of nootropic drugs are administered intravenously. Medications are taken throughout the recovery period. Functional and restorative measures include regular memory training.

With complete memory loss, the patient is regularly shown photographs and talks about significant events from his life. Partial amnesia requires regular repetition and memorization of numbers, words, and tongue twisters. Measures to restore speech functions are often combined with exercises that allow you to restore memory.

Return of sight

The cause of partial or complete loss of vision can be a stroke, rehabilitation at home takes place in several stages. Against the background of intracranial hemorrhage, the ophthalmic and oculomotor nerves atrophy. Stroke recovery procedures include:

taking medications;
surgical intervention;
special exercises.

Surgery refers to radical ways which are used as a last resort. According to reviews, most effective tool consider gymnastics. A set of exercises:

The upper edges of the eyes are clamped with three fingers.
Fingers slowly move to the temples.
Return the fingers to their original position.
The skin of the upper edges of the eyes is moved to the nose.

It is necessary to perform 3-4 approaches. During gymnastics, it is recommended to lightly press on the eyeball. If all medical recommendations are followed, a complete restoration of vision is possible.

Psychological support

The patient after a rupture of a blood vessel becomes closed due to the inability to return to a full life. Psychological support is provided by specialists, relatives and friends of the patient, it helps a person to fully adapt socially. The main goal of psychological support is to teach a stroke patient to control behavior and actions. In the process of rehabilitation, the processes of perception of the surrounding world are improved.

The main tasks of psychological assistance:

to teach the patient to understand, accept and manage psychological patterns;
prevent depression;
morally prepare the patient for the upcoming difficulties.

Diet and food

During the rehabilitation period after a stroke, you must follow a diet. Rough, salty, sour, spicy and smoked foods are removed from the diet. The list of allowed foods includes rye bread, fresh vegetables and fruits, lean meats (turkey, rabbit, chicken). Vegetable oil consumed in minimal quantities. Dishes are steamed. Meat and vegetables are boiled or stewed, soups and cereals are cooked in water. The fat content of dairy and sour-milk products should not exceed 1%.

Rehabilitation of patients after ischemic stroke can take from 3 months to several years. The degree of restoration of lost functions is determined by the site of brain destruction, the severity of neurological and cerebral disorders. Patients who have had a cerebral infarction are recommended a set of measures to improve movements, sensitivity, speech, memory, and self-care skills.

The success of the rehabilitation of patients after acute violation cerebral circulation depends on the location and extent of the brain lesion, the age of the patient, the presence of concomitant pathology.

The most favorable is with minor neurological symptoms - weakness in the limbs with preserved or slightly reduced sensitivity, transient visual impairment, and unsteady gait. In such cases, improvement occurs on average for 2 months, and a fairly complete restoration of functions by 3 months from the onset of a stroke.

An important role in the rehabilitation process is played by getting rid of the cause of the development of the disease (smoking, alcohol intake, malnutrition, overweight), as well as compensation for the course of hypertension, diabetes, elevated cholesterol levels in the blood.

As a rule, patients after a massive stroke lose the ability to self-care, independent movement, effective communication, and adequate behavior. This leads to a complete loss of ability to work, it determines the disability group. Most of them need the help of outsiders.

Full recovery usually does not occur. Rehabilitation takes one to two years, it is considered successful if the patient can sit in bed and eat, control the processes of urination and defecation.

If right/left side

Residual effects of hemispheric strokes are muscle weakness in the limbs or paralysis, it can also affect the facial muscles. There is a loss or decrease in sensitivity, as well as speech disorders. The patient pronounces words slowly, with impaired articulation, in severe cases, can only communicate with sounds.

The duration of partial rehabilitation with the return of the ability to self-service takes about six months, within a period of up to a year, lost functions are restored to the maximum, complete normalization of the condition is doubtful. In the future, only slight progress or stabilization of neurological disorders is possible.

If a cerebellar stroke

After a stroke, balance is disturbed in the cerebellar zone, patients complain of dizziness, unsteadiness when walking, falls, and difficulty in coordinating movements. The most difficult to recover is cerebellar ataxia. It is a set of symptoms:

violation of proportionality of movements - earlier or later termination;
inability to perform multidirectional actions at an accelerated pace (for example, hand up, then palm down);
when writing, the letters become large and distorted;
deviations to the side when walking and turning the body, gait like a drunk person;
speech becomes slurred.

Cerebellar stroke

The rehabilitation period usually lasts 9-12 months, a full recovery can be achieved in exceptional cases.

Recovery course

The rehabilitation program includes many methods of influencing paralyzed limbs, teaching walking, eating, maintaining personal hygiene, and self-service. It includes such areas as kinesiotherapy (treatment by movement), training, memory, dietary nutrition, medication, physiotherapy, and massage.

Watch a video about recovery after a stroke:

Motor program

You need to start moving as early as possible. At first, it can be flexion and extension of the fingers, hands and feet of the healthy side of the body. This speeds up the recovery of brain cells in the affected area. Subsequently, usually simultaneously with the massage, the physical therapy instructor conducts gentle flexion and extension, rotation sequentially in all joints of the arm and leg.

Restoring finger movement after a stroke

To restore the function of the upper limb, a towel is hung over the bed, and the patient grabs it and moves back and forth, sideways, up and down. After mastering these, the towel is hung higher.

Also, a rubber bandage is used as a training device, it is tied into a ring (the length of the strip is about 80 cm) and fixed on a fixed object or between the arms, legs, arm and leg. In the process of training, you need to stretch the ring.

The lower limbs in bed can be developed by passive movements in the ankle, knee and hip joints, and then the patient is invited to slide the heel along the bed. To eliminate spasm under the knee, you need to put a hard roller.

Exercise in bed

The next stage of training is classes in a sitting position on the bed, and then standing on the floor. The following exercises may be included in the rehabilitation complex:

pick up from the table, and then from the floor boxes of matches;
stand on your toes with your arms raised above your head;
expander compression;
torso inclinations;
hand movements like scissors;
squats.

Special simulators for recovery after a stroke significantly speed up the rehabilitation process and can be used from the first days

Speech training

Speech is restored later than movement in the limbs, it can even take several years. To restore the ability to speak, it is important that the patient constantly hear the conversation addressed to him, even if he is not yet able to answer. Even the perception of someone else's speech activates the corresponding centers of the brain, which contributes to their disinhibition. If speech is completely absent, then the following techniques can be applied for training:

the patient finishes the word (the part without the last letter, syllable is pronounced to him), then the sentence;
repetition of simple phrases;
well-known poems;
Tongue Twisters;
joint singing.

Speech therapist tips for restoring speech

In order to force the development of the muscles involved in articulation, the patient is asked to move the lower jaw daily, stick out the tongue, lick the lips in different directions, and roll them into a tube.

Memory recovery

Against the background of drug therapy (nootropic drugs), special memory development exercises:

repetition of the digital series with closed eyes;
learning proverbs, sayings, poems;
retelling of a read text or a song heard;
board games.

Board games to restore memory

The best results can be obtained if the sessions are combined with the patient's previous hobbies so that the training process is accompanied by positive emotions.

Food

It is most difficult to feed patients with impaired swallowing and sensitivity in one half of the oral cavity. They have to learn to eat again. To do this, you can use exercises to restore lost abilities:

the patient simulates coughing, swallowing and yawning;
puffs out cheeks;
rinse mouth and throat.

Cheek Puffing Exercise

When organizing the nutrition of patients with impaired chewing and swallowing functions, the following features should be taken into account:

food should only be warm and smell appetizing;
exclude viscous and hard dishes - rice, dry cottage cheese, dried bread, crackers;
the garnish should have the consistency of a thick puree, and soup or juice can be added to meat and fish;
eating takes at least 40 minutes, you can not rush the patient;
it is necessary to feed in such a way that food gets on the healthy side;
for drinks and water, it is convenient to use a drinking bowl or a straw for a cocktail.

The easiest foods for stroke patients with eating problems to swallow are:

boiled carrots, potatoes, mashed or cubed;
cauliflower, broccoli;
minced meat;
baked flounder, sardines;
omelette;
avocado, banana;
soft pear cubes;
baked or mashed apples;
jelly, pudding;
soft cheese;
porridge from flakes or grains (thoroughly boiled).

Pureed vegetable, meat, fish soups

It is unacceptable to include fatty meat, fats, fried and spicy foods, alcoholic and caffeinated drinks in the diet.

Preparations

The choice of medicines for rehabilitation is carried out exclusively by a neurologist. The following groups of drugs are used:

Groups	Medicines
Vasodilators (with caution, under pressure control)	Cavinton, Sermion, Instenon;
Neuroprotectors	Somazina, Semax, Cerebrolysin, Encephabol;
Antioxidants
Nootropic	Lucetam, Phenotropil.

If there are indications, antiplatelet agents (Tiklid, Aspirin), hypocholesterolemic agents (Atocor, Vasilip) are used.

Physiotherapy

The appointment of procedures can be no earlier than 1 - 2 months from the onset of a stroke. The following methods are shown in the recovery period:

electrophoresis on the collar zone;
sulfide baths for hands;
magnetotherapy on the neck area;
shared baths with sea salt, coniferous extract, carbonic and pearl;
ozocerite or paraffin, mud or galvanic mud on the affected limbs;
reflexology - acupressure or;
electrical stimulation with sinusoidally modulated currents;
darsonvalization of limbs.

Massage

Shown from the first week of illness daily, starting from 10 minutes to half an hour. All movements are slow and low-intensity, especially in the presence of muscle spasm. On the healthy side, the technique of massage movements can be classic. Massaging sequence:

Scapular region.
Shoulder.
Forearm and hand.
Pelvic, femoral region.
Leg and foot.

The course requires from 30 to 50 sessions, after which you need a break for a month, then for maintenance therapy, massage can be done 10 sessions 3-4 times a year.

Watch the video about massage and exercise therapy after a stroke:

Recovery time after ischemic stroke

After inpatient treatment, the patient is discharged for further treatment. The most productive recovery period is the interval from the onset of a stroke to 3 months, then the possibilities gradually decrease, and after one year it is quite difficult to make progress.

Nevertheless, cases are described when the lost functions with persistent treatment appeared after a few years.

Approximate terms for which partial improvement can be achieved:

Degree of damage	Recovery time
small stroke
Mild degree of neurological impairment	3 - 4 months;
Violation of cerebral circulation of moderate severity, severe neurological deficit	after six months;
Major stroke	from 1 year to 3 years.

With regard to complete recovery, the prognosis is worse - this can only be achieved with a small lesion, in relatively young patients without comorbidities, with early diagnosis and the beginning of treatment, complex rehabilitation.

Ischemic stroke has consequences in the form of a violation of the patient's ability to move, speak, remember events and information. This leads to a significant limitation of self-service, hinders social activity and professional activities.

The possibilities of rehabilitation are directly related to the place of brain damage, the severity of the stroke. For rehabilitation therapy, exercises, massage, physiotherapy, medicines, and special nutrition are used.