Is good consciousness restored after a stroke. How to recover from a stroke - the return of basic functions. alcohol withdrawal syndrome

Vascular dementia is one of the most unfavorable variants of the course of chronic ischemic brain disease. Our consultant: Nina Minuvalievna Khasanova, angioneurologist at the First City Hospital in Arkhangelsk.

It is noted that this disease occurs, as a rule, in old age. The cause of dementia after a stroke is associated with damage to the part of the brain that is responsible for memory or the performance of any skills.

Vascular dementia (dementia) is a combination of symptoms that are manifested by a deterioration in memory, thinking, a decrease in the ability to perform skills in ordinary life, which either stops or significantly complicates the independent life of the patient and his usual work.

Vascular dementia after a stroke is not necessarily an emerging symptom. This condition occurs when there is a pronounced lesion of the brain tissue or as a result of a repeated stroke against the background of uncontrolled arterial hypertension.

If a person after a stroke becomes apathetic, whiny, quickly emotionally exhausted, his mental capacity worsen, he ceases to be interested in the life of his family, friends, this may be the first sign of oncoming dementia, which requires a doctor's examination for timely treatment.

The onset of post-stroke dementia, unlike, for example, Alzheimer's disease, is acute. For example, even on Wednesday, a person behaved normally, and on Thursday morning he became aggressive, uncontrollable, his memory deteriorated sharply. It is very important not to see a repeated stroke in a patient: it can be hidden behind such a sharp deterioration in well-being. Therefore, each such situation is an indication for a medical examination and an ambulance call.

Vascular dementia as a disease can also occur with light intervals. This disease, as it were, erases in layers those skills that have been acquired by a person throughout life.

Dementia after a stroke is necessarily combined with coronary heart disease, diabetes mellitus, arterial hypertension. In this case, there are always changes in the vessels of the brain, neck, fundus. Patients must be periodically examined by a cardiologist for assistance and selection of concomitant therapy.

The risk of developing post-stroke dementia depends on how carefully relatives or the patient himself monitors his blood pressure, cholesterol and low-density lipoprotein levels and their correct ratio, blood viscosity, how carefully all the recommendations of the attending physician are followed.

Unfortunately, modern medicine does not have the ability to effectively treat dementia and prevent its progression. Prescribed drugs can only remove or weaken individual unpleasant manifestations of the disease, partially slow down its development. Therefore, the leading role in helping patients with dementia belongs to the daily full care of them.

The most important:

1. try to prevent the development of infectious diseases and the worsening of the course of a somatic disease of your loved one, as this negatively affects the course of dementia;

2. create a comfortable and simple environment: familiar favorite items, their location. In a familiar environment, the patient feels most comfortable. The appearance of strangers in the house, moving dramatically worsen his condition. In the room where the patient is located, there must be a firmly established and habitual order for placing clothes, shoes, and other everyday items;

3. control the mode of taking prescribed drugs. Their irregular intake or overdose can dramatically worsen the patient's condition.

Patience needed!

When communicating with a loved one with dementia, never forget that you are communicating with a sick person who has a mental disorder, many character traits that attracted you before have been lost, and behavior has changed (alas, not for the better). Remember that against the background of rare temporary improvements, the disease, as a rule, will intensify, the patient's condition will worsen. Personality change progresses, emotional attachments to loved ones and the ability to empathize weaken, grouchiness, stubbornness and resentment increase.

In the future, orientation in time, space, and the environment is disturbed. Patients do not know the date, they can get lost in a familiar place, they do not always understand where they are, they do not recognize acquaintances and close people. And although such a person can serve himself, cope with personal hygiene, he already loses the skills to use everyday household appliances, such as a telephone, gas stove, TV remote control, etc. Then he can no longer be left alone unattended.

Vascular dementia rarely reaches the degree of deep total disintegration of the psyche, but over time, a sick person becomes a heavy burden for others and relatives. Here are some excerpts from the stories of relatives about their loved ones with dementia.

“After the stroke, my mother-in-law changed a lot, became unkind, suspicious, capricious. The person is simply unrecognizable! Her general health is now not bad, she even goes out to breathe on a bench at the entrance. She tells her neighbors all sorts of fables: either I was going to poison her, or we don’t let her sleep at night, or we lock her in the toilet. Her husband talks to her, shames her, but she either denies her stories, even yells at him or cries that we are slandering her. I once came home from work - it smells strongly of gas. The burner tap on the stove is open. Now we turn off the gas, leave the food in thermoses.

“I’ll put food for my mother, which we immediately eat ourselves, and she says that it’s not a pig to eat this, she throws the plate away. I take her by the hand to take her to the room or to the kitchen - she starts to twitch, scream that I beat her. After a stroke, my mother has been living with us for almost three years, but lately she wants to return home. When we leave, we have to lock it with a key, since she left once. We literally missed in 15 minutes, and she is gone! They searched all evening, night, morning. They called all the relatives, her friends, hospitals, morgues. Bypassed all neighboring yards. Almost went crazy! Well, an acquaintance works in the police, he helped us (and a missing person’s report is accepted only after three days). The next day at 12 o'clock she was found at the other end of the city.

“Mom started talking a lot. He talks to an imaginary woman, then he calls me mom, then he calls me sister. She stopped reading completely, often cries.

Do not try to convince patients in such cases, prove your case, appeal to their conscience, reason, logic. The person's personality has already been changed by the disease. This is not the same mother, mother-in-law, wife, not the same father, husband whom you have known all your life. You just need to remember: everything that your loved one does and says is not due to his malicious intent, deceit, harmfulness. This is a manifestation of the disease. Therefore, try to be patient with his “whims”, “antics”, be attentive, friendly and sensitive in dealing with him, because he still remains your dear person!

Do not forget that dementia is one of those
diseases that need to be treated before the first signs appear, therefore
medical supervision and implementation of recommendations for the treatment of chronic
diseases affecting the vascular system is the key to quality
and fulfilling life at any age.

Stroke Prevention Steps

Finishing the story about the consequences of a stroke, I would like to remind you once again: in many cases, a vascular catastrophe can be avoided; for this, the main attention should be paid to prevention. The most significant factors that can be corrected include arterial hypertension, coronary heart disease, diabetes, smoking, increased body weight, high cholesterol.

• Physical activity is an effective factor in the prevention of obesity, type 2 diabetes, arterial hypertension. During physical education, blood properties improve, and the risk of thrombosis decreases.
• Diet aimed at preventing atherosclerosis: limiting foods containing cholesterol and animal fats. Eat more fruits, vegetables and grains vegetable oil, sea fish.
• Smoking cessation: Nicotine causes vasoconstriction and stimulates the progression of atherosclerosis.
• Blood pressure control: arterial hypertension and atherosclerosis are closely related diseases, so their treatment and prevention must be carried out in parallel.
• Control of blood fats: a violation of the lipid composition of the blood leads to the development of atherosclerosis, which increases the risk of stroke.
• The fight against diabetes mellitus: this disease is associated with an increased risk of vascular damage and the intensive development of atherosclerosis.

Material: Irina Shaposhnikova

In part, we have already touched on this issue above when we talked about the restoration of motor abilities. After all, in the human psyche everything is interconnected: in the process of learning to walk and all other movements, down to the smallest and most accurate, all mental functions will inevitably be restored and developed. But, of course, special exercises are also required, aimed at the development of each specific area of ​​the psyche.

The volume of our book does not allow us to dwell on this problem in detail, but there is a truly boundless sea of ​​\u200b\u200bliterature that is sure to be useful to you. And first of all, you need to pay attention to all kinds of "educational" books for children. preschool age. There you will find a considerable number of tasks, teaching methods aimed at developing thinking, attention and memory. We have already said that you should not neglect all kinds of "children's" activities, such as modeling from plasticine or drawing. To this, you can add many other "entertainment". The so-called "finger games" are especially useful: you probably know at least one of them, the famous "Thieving Magpie". In this way, you can "act out" almost any rhyme, accompanying their reading with various finger movements (you can clench your fingers into fists, clap your hands, click them, and so on). With frequent repetition, the patient memorizes the rhyme with you (an exercise for memory), tries to repeat all gestures correctly, in accordance with the words spoken (trains attention), and all the manipulations that you perform with his fingers (alternately bending them, as in that Thieving Magpie, light stroking or rubbing), have a strong stimulating effect on the restoration of speech (it is known that there are points on the fingers that are directly connected with the speech centers of the brain).

Many recovery exercises intellectual abilities, you can spend with the patient "on the job": while cleaning in his room, while eating, in the bathroom, you can, for example, play "words" with him. There are a great many variants of this game; the one that I remember from my own early childhood was called "loading a ship." The rules are simple: you "load the ship" with all the items that come to your mind, the name of which begins with the letter "A" (or "D", or "U" ...). The winner is the one who "loads his ship" with a large number of items. Another well-known option is the game "to the cities": you say one name, your partner must remember the city whose name begins with the same letter that the name of the first one ended with (that is, together you build a chain like "Armavir - Rzhev - Washington" and etc). Along the way, the task can be complicated: for example, to name the cities of only one country or continent.

You can play synonyms or antonyms (that is, select words with a similar or opposite meaning), compose short poems (line-you, line-your partner). However, the enumeration of all possible occupations of this kind can be continued indefinitely; the general idea is probably clear to you. The main thing is to try to fill every free minute of the patient with a variety of exercises "for the mind".

L. Obraztsova

"Restoring intelligence, memory, attention after a stroke" article from the section

After suffering a stroke

L. Stolyarova, A. Kadykov, L. Chernikova, M. Burlakova

Violation cerebral circulation- a common disease, especially among the elderly. It is caused by damage to the vessels of the brain, which carry the necessary nutrients and oxygen to nerve cells. Most often, cerebral vessels are affected in such common diseases among middle-aged and elderly people as arterial hypertension and atherosclerosis.

Scientists have identified a number of adverse factors that contribute to the development of stroke, which are called risk factors. The presence of one such factor in a person does not mean that he will definitely develop this disease. But he is still several times more likely to get sick than any other person of the same age as him, but prosperous in terms of risk factors. The combination of several risk factors dramatically increases the likelihood of developing a stroke.

Risk factors include: hereditary predisposition (the presence of similar diseases in parents and close relatives), arterial hypertension (high blood pressure), obesity, lack of physical activity (hypokinesia), smoking, alcohol consumption, prolonged neuropsychic overexertion.

Our twenty years of experience in the rehabilitation of patients with the consequences of a stroke suggests that the role of their families, relatives and relatives in the restoration of impaired functions is invaluable.

This includes moral support and assistance in doing homework in therapeutic exercises (for patients with movement disorders), assistance in mastering speech, reading and writing (for patients with speech disorders), creating conditions at home that are optimal for the successful recovery of the patient.

Many relatives of patients, and the patients themselves, in conversations and letters, ask us how to properly conduct classes at home to restore movements and speech, how to eat and behave properly so that a stroke does not happen again, they ask us to give specific recommendations and advice. The need for a popular manual for the family on the issue of restoring the functions impaired as a result of a stroke in patients is long overdue. And the idea arose to write such a manual, using the experience of treating post-stroke patients at the Research Institute of Neurology of the Academy of Medical Sciences, in the hope that this knowledge would help speed up the recovery of impaired functions and prevent stroke relapses.

What you need to know about stroke

Among the disorders of cerebral circulation, leading to impaired delivery of oxygen and nutrients with blood to the entire brain and its individual areas, there are cerebral crises and strokes.

In a cerebral crisis, the blood supply to the brain is interrupted for a short time. For a crisis, the so-called cerebral symptoms are especially characteristic: a sharp headache, nausea, and sometimes vomiting, dizziness, weakness, short-term (for a few seconds) loss of consciousness.

Cerebral symptoms in stroke in some cases are absent, in others they are pronounced. A cerebral stroke is characterized by the occurrence of focal symptoms in the form of impaired speech, movements, coordination disorders, indicating the development of a lesion in a particular area of ​​the brain.

Stroke is of two types. Distinguish between cerebral hemorrhage (synonym: hemorrhagic stroke) and cerebral infarction (synonyms: ischemic stroke, softening). The first occurs due to a rupture of a vessel (often with high blood pressure) and usually occurs with loss of consciousness, while the second occurs when a blockage or sharp narrowing of a vessel supplying blood to a certain area of ​​​​the brain.

Cerebral infarction rarely occurs with loss of consciousness. Most common cause blockage of the vessel is atherosclerosis, in which sclerotic plaques form on the inner wall of the vessel. In places where they are located, blood clots often form - blood clots that clog blood vessels. Another mechanism of blockage of the vessel is also possible: plaques of large vessels (aorta, carotid arteries) sometimes ulcerate, pieces (emboli) come off from them, which are brought into smaller vessels with blood flow and clog them.

Clarify your understanding of how the brain works

The dangerous consequences of a stroke will become clearer if you at least briefly familiarize yourself with the basic principles of the structure and functioning of the brain. Formed as a result of a long evolutionary development, the human brain is a complex system. Processing all the information about the surrounding world perceived by the senses, the brain organizes and plans human activities. Such mental functions as thinking, memory, speech, arose with the development of the brain.

Separate areas of the brain make different contributions to the organization of certain mental functions. So, for example, the frontal lobes of the brain are responsible for drawing up a program of activity, its planning. Here is a classic example. The bee builds its architecturally perfect honeycomb, blindly obeying instinct, and the architect intelligently conceives the building plan. And the frontal lobes take a major part in the creation of this plan.

In right-handed people, which include the vast majority of mankind, in the lower frontal gyrus of the left hemisphere of the brain (in its posterior sections) there is a speech center, named after the French scientist who discovered it, called Broca's center. In left-handers, Broca's center is sometimes located in the right hemisphere.

At the junction of the frontal and parietal lobes of the cerebral hemispheres, in the region of the anterior and posterior central gyri, in the cortex there is a representation of the motor analyzer. This center regulates the performance of voluntary movements, perceiving and processing information about the sensations that arise in the sensitive apparatus of the muscles, ligaments and joints.

The region of the motor analyzer in the left hemisphere controls the movements of the right limbs and the mimic muscles of the right half of the face. The region of the motor analyzer in the right hemisphere controls the movements of the left limbs and the mimic muscles of the left half of the face. In the occipital, temporal and parietal areas of the cerebral cortex, the reception, processing and storage of information coming from the sense organs are realized, ideas about the world around a person are formed.

So, for example, the occipital regions are connected with the organ of vision, visual information enters and is processed here, visual images are formed. Information from the organ of hearing enters the temporal regions, information from the skin, muscles, and joints enters the parietal regions. This is a feeling of heat, cold, pain, pressure. In the parietal region, a tactile image of an object is formed, and in the region lying at the junction of the parietal, temporal, and occipital, an idea of ​​space is formed.

In right-handers, in the posterior sections of the left superior temporal gyrus, there is a center for understanding speech, called the Wernicke center (after the scientist who discovered it). Information about the sounds of speech coming to the temporal region from the organ of hearing is processed in this center into phonemes - units of speech, which makes it possible to perceive speech and understand its meaning. In the symmetrically located zone of the right hemisphere, there is a center for understanding the sounds of music.

Center for the regulation of autonomic functions - metabolism, vascular tone, thermoregulation (regulation of body temperature) and others, maintaining the necessary balance with environment The internal environment of our body is located in the deep subcortical structure of the brain - the hypothalamus. The brainstem (connecting the brain and spinal cord) also contains various autonomic centers related to the regulation of respiration, cardiovascular activity, and metabolism. The centers of balance and coordination of movements are located in the cerebellum adjacent to the brain stem.

A significant part of the cerebral hemispheres and the brain stem is occupied by nerve conductors (pathways) that carry out numerous connections between individual areas of the brain, between the brain and spinal cord.

In the most general form, let us consider how the implementation of purposeful movement takes place. An impulse with an order (for example, “raise your hand up”) from the cortical part of the motor analyzer follows the nerve pathways in the brain stem to the spinal cord. At the border between the brainstem and the spinal cord, the pathways cross, so that the paths from the right hemisphere are directed to the left half of the spinal cord, and from the left to the right half.

Further, the pathways end at various motor neurons (nerve cells) of the spinal cord. In this case, nerve impulses intended, in particular, for the arm, go to the motor neurons of the cervical region, addressed to the leg - to the neurons of the lumbar region. From the motor neurons, the spinal cord, along its anterior roots, and then along the peripheral nerves, impulses are sent to the muscles innervated by them. At the same time, feedback from the muscles is carried out - along the peripheral nerves, then along the posterior roots (in the spinal cord), then along the sensory pathways of the spinal cord and brain, nerve impulses enter the region of the motor analyzer in the cerebral cortex, signaling that the order has been executed.

Consequences of a stroke

But here is the defeat of any of the listed departments nervous system leads to the fact that the order to perform a particular movement will not be executed. With a stroke, much depends on the localization (location) of the lesion.

So, for example, if the area of ​​the motor analyzer or the path leading from it to the motor cells of the spinal cord is affected, then motor disorders will develop: paralysis (complete immobilization of the limbs - arms or legs, or arms and legs), paresis ( partial restriction limb movements, their weak mobility).

In right-handed people, with the localization of a stroke in the left hemisphere of the brain, a speech disorder often occurs - aphasia, usually combined with a right-sided movement disorder of the limbs (right-sided hemiparesis). The defeat of Broca's speech area entails the development of the so-called motor aphasia (when one's own speech becomes sharply difficult or completely impossible). The understanding of the speech of others in motor aphasia is mostly preserved.

With the defeat of Wernicke's speech area, sensory aphasia occurs, which is characterized by a violation of understanding the speech of others. The patient finds himself, as it were, in the position of a traveler who has entered a country whose language he does not understand. With the loss of self-control over the correct pronunciation of words in one's own speech (and the patient does not understand his own speech), she also changes. The speech of patients with sensory aphasia consists of fragments of individual words and phrases, a set of sounds. In medical practice, the speech of patients with sensory aphasia is figuratively called verbal okroshka.

In cases of extensive stroke, both speech areas can be affected, and then a severe speech disorder occurs: sensory-motor aphasia. In all forms of aphasia, other speech-related functions, such as writing and reading, also suffer.

Consider the damage to the cortex of the occipital region, the cerebral hemispheres, which perceives visual information. With the defeat of the left occipital region in the visual fields of both eyes, the right half falls out: the patient does not see objects located to the right of the center line in the field of view. When the right occipital lobe is damaged, the left half of the visual field falls out, respectively.

With the defeat of those areas of the cortex of the occipital lobe that do not perceive, but process visual information and form a visual image, it is not blindness or loss of the visual field that occurs, but the breakdown of visual representations - visual agnosia (unrecognition). The patient sees objects around him, faces, but does not recognize them. In milder cases, non-recognition extends only to rare objects, images of exotic animals, faces of unfamiliar people.

With the defeat of the parietal region, there is a violation of the tactile recognition of objects (with palpation) - astereognosis (stereo - volumetric, spatial; gnosis - recognition). With the defeat of the parietal lobe of the left hemisphere, astereognosis of the right hand occurs, with a right-sided lesion - of the left hand. Feeling familiar objects (for example, a key, a pencil, a matchbox, a comb) with a healthy hand, a person easily recognizes them with his eyes closed, while with astereognosis it is often not possible not only to name them, but also to determine the shape and material from which they are made. these items.

Often, with the parietal localization of a stroke, other sensory disturbances also occur: a decrease in the sensation of pain, cold and heat on the side of the body opposite to the lesion. With the defeat of the area located at the junction of the parietal, temporal and occipital lobes of the brain, there is a violation of orientation in space. A patient with such a disorder cannot find his house, apartment or ward in a medical institution, gets confused in the location of familiar streets, does not navigate the clock and the map.

The location of the focus of stroke in the cerebellum leads to impaired coordination of movements, unsteady gait, and constant dizziness.

The defeat of the vegetative centers located in the hypothalamus and the brain stem, which occurs more often with hemorrhage, is accompanied by complications from of cardio-vascular system and respiratory organs, often causes a sharp increase in temperature. Often, with damage to the hypothalamus and brain stem, a violation of consciousness occurs.

A stroke can also result in memory loss. Memory impairment in general is often found in patients with sclerosis of the cerebral vessels. It is difficult for such patients to remember names, phone numbers, they forget where they put the right thing. It is characteristic that the events of past years, especially those that occurred in youth and childhood, they remember well, while those that happened recently are easily forgotten and remembered with great difficulty. After a stroke, memory impairments are often aggravated and become the main complaints of patients.

With a stroke localized in the right hemisphere of the brain, with the development of left-sided hemiparesis, patients often underestimate or deny the motor defect that has arisen. So, for example, they claim that they can freely move their paralyzed limbs and do everything with them. At the request of the doctor, lift up the paralyzed left hand such a patient answers “please”, but at the same time raises a healthy right hand.

Simultaneously with the underestimation of the motor defect, such patients sometimes experience various strange, as they say, sensations in the paralyzed limbs. For example, that there were two left hands or that the (paralyzed) hand was like wood or covered with hair. These sensations do not at all indicate the presence of some kind of mental disorder in patients, usually they themselves do not actively express complaints about these oddities, understanding all their absurdity.

Fortunately, in most cases, the symptoms that have developed as a result of a stroke - paralysis and paresis, aphasia, agnosia - become less pronounced over time or disappear altogether. Gradually, movements appear in the paralyzed limbs, and patients with aphasia begin to understand the speech of others, to speak separate words.

Recovery principles

What determines the degree and rate of restoration of impaired functions? Why does everything pass without a trace for some, while for others a pronounced defect remains?

The possibilities of spontaneous (spontaneous) recovery depend on many factors, among which the main role is played by the size of the lesion and its localization in relation to one or another functional area of ​​the brain.

Even a small area of ​​damage in the area of ​​the motor analyzer in the cerebral cortex in the first days after a stroke can lead to the development of gross motor disorders. However, the surviving nerve cells gradually reorganize their work in such a way as to replace the failed ones, and as a result, the impaired motor function is restored. If all or almost all of the nerve elements of the motor analyzer are affected, or the paths that conduct nerve impulses to the motor cells of the spinal cord are grossly damaged, the restoration of motor functions is much worse.

When a blood vessel supplying a certain area of ​​the brain is blocked, the development of a collateral (roundabout) path of blood supply is of great importance for the restoration of function. The essence of this phenomenon is as follows. Along with the branches of the main blood vessel supplying this or that area of ​​the brain, collaterals of other vessels also come to it. With normal blood flow through the main vessel, such alternate blood supply paths are usually closed, as it were, and they begin to function intensively only when there is insufficient blood supply to such a site.

The most powerful collector of blood flow redistribution (Circle of Willis) is located at the base of the brain. It connects all the main trunks of large cerebral vessels, and such a collector ensures the alignment of blood flow when one of them is blocked. And the restoration of impaired functions largely depends on how quickly the collateral blood supply system begins to function, how fully it manages to compensate for impaired blood flow.

In a significant proportion of stroke cases, spontaneous (spontaneous) recovery is insufficient. That is why special rehabilitation treatment and education (retraining) of patients plays such a big role in the restoration of functions. So, for motor disorders, the main method of rehabilitation treatment is therapeutic exercises, and for speech disorders - classes with a speech therapist-aphasiologist.

On the one hand, the methods of restorative treatment contribute to the fact that inhibited, temporarily non-functioning cells near the lesion focus begin to actively engage in work, on the other hand, the methods are aimed at ensuring that the nerve cells of other functional areas of the brain, as it were, “connect” to the restoration of that function that is impaired.

Doctors are usually asked what can be hoped for in the course of rehabilitation treatment.

One of the main principles of rehabilitation treatment is its early start. A number of rehabilitation measures (classes with a speech therapist, massage and passive gymnastics, breathing exercises) begin already in the first days after a stroke, provided that consciousness is preserved and the general condition of the patient is relatively satisfactory. Early initiation of rehabilitation therapy can prevent the development of various pathological conditions that occur in a patient after a stroke, or reduce their severity. So, in many patients with paralysis and paresis during the first weeks (rarely months) there is an increase in the tone (tension) of individual muscle groups of the paretic limbs. And if you do not take the appropriate measures, which will be discussed, contractures (stiffness) will develop.

Another important principle of rehabilitation therapy is the duration and continuity of its implementation for several (usually at least 4-6) months after a stroke. In many cities of the country there is a system of phased treatment of patients who have had a stroke.

On the first day, patients are admitted to the neurological department of the hospital, and in the case of a severe stroke, to specialized intensive care units (or to the intensive care unit). In the neurological department, where patients stay for 1-1.5 months, they undergo the first stage of rehabilitation therapy, then they are transferred to a specialized rehabilitation department, where they receive active complex treatment for 1-2 months, including therapeutic exercises, massage, physiotherapy, psychotherapy , occupational therapy, and in case of speech disorders - classes with a speech therapist. In the future, they are discharged for outpatient treatment in the rehabilitation department of the polyclinic, and patients with a relatively good recovery of functions can be referred to a rehabilitation sanatorium.

Where there is no such well-organized rehabilitation assistance, the patient can receive the necessary treatment at home. invaluable help medical workers relatives and friends of the patient can provide assistance here.

The success of rehabilitation treatment largely depends on the active position of the patient himself. This is due to the fact that in rehabilitation therapy the main role is played by the learning process. And here, as in school, there may be capable and less capable, active and inactive "students". Helping the patient to master the “subjects” well in therapeutic exercises, speech therapy exercises is an important task not only for specialists in rehabilitation education, but also for the patient’s relatives and friends.

How to help the patient in the first days after a stroke

If a stroke occurs, it is most advisable to urgently hospitalize the patient in the neurological department of the hospital. If, for some reason, this cannot be done and the patient remains at home, it is necessary to organize a hospital for him at home. And this means that while the doctor and nurse regularly visit the patient, monitor the state of his health, perform medical procedures, the main responsibility for caring for the patient is borne by his relatives and friends.

The first days of a patient who has had a stroke must comply with bed rest. The question of its duration and gradual expansion is decided by the doctor. The duration of bed rest depends on the severity of the patient's condition and, above all, on the state of his consciousness, as well as on the nature of the stroke: with a hemorrhage, the need for rest is greater than with a cerebral infarction.

Research results prove that even in healthy young people, prolonged bed rest leads to changes in the muscular system, cardiovascular system and respiratory organs, to metabolic disorders.

In patients who have had a stroke and who observe prolonged bed rest, there may be a slowdown in the speed of blood flow through the vessels, which, in turn, often causes an increase in blood clotting and the formation of blood clots. With bed rest, the lungs are not sufficiently ventilated, which results in the development of congestion in them, against which pneumonia easily develops.

Bed rest is not an obstacle to the activation of the physical activity of patients, even if very limited at first. If consciousness is not disturbed, you can start doing gymnastics from the very first days: at first passive, then active. To prevent the development of contractures, paralyzed limbs are given a certain position. And in order to prevent bedsores and congestion in the lungs, it is necessary to turn the patient in bed every 2 hours.

If the patient is conscious, it is advisable to carry out breathing exercises with him several times a day. The simplest breathing exercises performed even by weakened patients are inflating rubber toys, ball chambers.

It is desirable that the room in which the patient is located is bright, protected from noise, and well ventilated. The room must be kept clean and tidy. Wet cleaning of the premises is carried out 1-2 times a day. The optimum air temperature in the room is 18-20 degrees. In summer, a window or window should be kept open,

while avoiding drafts, and in winter open the window for 5-10 minutes every 1-2 hours. During airing, the patient is well covered with a blanket, put on his head knitted hat. The latter can be replaced with a scarf, towel or scarf.

The bed on which the patient lies should not sag. The most hygienic and comfortable foam mattress. If the patient does not control his physiological functions, an oilcloth is placed on the mattress under the sheet along its entire width. When changing bed linen, which should be carried out regularly, the patient is carefully turned to the edge of the bed. The old sheet is folded like a bandage, and a fresh sheet is spread on the vacated part of the bed, where the patient is turned over.

Skin care requires special attention. Every day you should wipe the body with warm water and soap, then with water without soap, and at the end of the procedure wipe dry. It can be replaced by a faster wiping with a towel moistened with a disinfectant solution (which can be used as camphor alcohol, cologne, alcohol in half with water, table vinegar - 1 tablespoon per glass of water). One end of the towel is moistened with a solution, slightly squeezed and wiped over the skin of the back, neck, and anterior surface of the chest.

Especially carefully and often it is necessary to wipe the axillary areas, inguinal folds and those located under the mammary glands in women. At least twice a day, it is necessary to wash the skin of the genital organs and the anus with warm water and soap or a weak solution of potassium permanganate and wipe it with a gauze swab, for which you should purchase a forceps in a pharmacy.

You can wash the sick with water from a jug or with a sponge. Hands are washed in the morning, before each meal, and the rest of the time it is necessary to monitor their cleanliness.

Particular attention should be paid to oral care, as severely ill patients often develop inflammation of the oral cavity - stomatitis. Teeth should be brushed at least twice a day, rinse your mouth after each meal. Seriously ill patients wipe their mouths with cotton

a ball moistened with a 5% solution of boric acid or a 0.5% solution of soda, or a weak solution of potassium permanganate.

If discharge from the eyes appears, sticking eyelashes and eyelids, they are removed with a cotton swab moistened with a 2% solution of boric acid. Rinse eyes daily with warm boiled water.

It is also necessary to constantly monitor the hygiene of the hair. They should be combed daily, especially in women.

In bed rest, physiological functions, such as urination and defecation, occur in the patient's supine position, and for this it is necessary to have special devices (bedpan and urinal). After use, the urinal and vessel should be thoroughly washed in hot water, then rinse the urinal with a solution of potassium permanganate, and the vessel with a 3% solution of chloramine. In addition, for patient care, it is advisable to purchase a gas outlet tube, a rubber enema or Esmarch's mug, a heating pad, a thermometer, forceps and tweezers at the pharmacy.

Seriously ill patients often develop bedsores in places subject to pressure and friction in bed: most often in the sacrum, less often in the area of ​​​​the shoulder blades, heels, buttocks, and the back of the head. First, skin damage, soreness, then vesicles with purulent contents appear, at the site of which an ulcer may subsequently occur. To prevent the development of bedsores, it is necessary to carefully observe all the above hygiene rules, and massage and wipe the possible places of formation of bedsores with camphor alcohol. It is necessary to ensure that wrinkles do not form on the sheet.

If skin damage has already occurred, the reddened areas should be lubricated 1-2 times a day with a concentrated solution of potassium permanganate. If bedsores occur in the area of ​​the sacrum, a rubber circle covered with a sheet should be placed under the pelvis, so that the sacrum is above its opening.

Equally important are properly organized nutrition and drinking regimen. The patient should drink at least 2 liters of liquid per day (in the form of weak tea, boiled water, juices, milk, broth). Otherwise, the body is in danger of dehydration. Nutrition should be in accordance with the diet prescribed by the doctor. If a patient who has had a stroke also has diabetes mellitus, he is prescribed a special anti-diabetic diet with a sharp restriction of sweet and fatty foods, and in case of liver disease, a liver diet.

The patient may choke while eating. This often happens in the first days after a stroke. Therefore, the food should be mashed, and the patient should be fed with a teaspoon or dessert spoon, and drink from a special drinker (can be replaced with a small teapot).

With the normalization of swallowing and the improvement of the general condition, the diet is expanded. If in the first days the patient is given predominantly liquid food (juices, broths, tea, liquid pureed soups, kissels, kefir, yogurt), then later fresh vegetables, soft-boiled eggs, mashed potatoes, steam cutlets are allowed.

It is necessary to limit the use of table salt, sweet and fatty foods, to refuse spicy snacks, smoked meats. Completely exclude strong coffee, strong tea and, of course, alcoholic beverages from the diet, which ignorant relatives sometimes seek to give to patients in small doses in order to increase appetite. Smoking should also be strictly prohibited.

In the first days after a stroke, patients often experience constipation. In their warning big role belongs to the organization of rational nutrition. Food must necessarily contain a significant amount of substances that accelerate the passage of food through the intestines and its emptying. These include foods rich in organic acids and fiber (yogurt, kefir, black bread, fruit and vegetable juices, fresh fruits and vegetables, prunes and dried apricots puree, honey), mineral waters containing carbon dioxide. If diet therapy does not help, mineral waters are additionally prescribed, which have a pronounced laxative effect (Batalinskaya, Lysogorskaya, Novo-Izhevskaya), or laxatives. If necessary, resort to cleansing enemas.

In the first 2~3 weeks, the patient needs constant monitoring. Twice a day (at 7-8 and 18-19 h) patients should measure the temperature and count the pulse. If the patient suffers from hypertension, it is advisable, under the guidance of a doctor or nurse, to master the technique of measuring blood pressure. In the acute period of a stroke, which lasts an average of 3 weeks, it is recommended to measure blood pressure 2-3 times a day.

It would be correct to have a special notebook in which you need to record daily temperature, pulse, blood pressure, whether there was a stool, and also what medications the patient took during the day. The attending physician must be informed about all the changes that have occurred in the patient's condition, and what kind of appetite, sleep, mood he has, and finally, with what frequency and when physiological functions occur. This information will help the attending physician to more fully monitor the course of treatment of the patient at home.

In the first time after a stroke, many are in an extremely dejected state, they are irritable and even aggressive. On the part of relatives and friends, great tact and endurance are required in such cases. The patient needs to be reassured, distracted from his oppressive thoughts, to maintain his faith in recovery.

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Mental disorders after a stroke (acute cerebrovascular accident) include dementia - acquired dementia, as a result of which there is a gradual loss of previously acquired skills and knowledge, and it also becomes difficult to master new information and skills.

After a stroke, mental disorders appear such as changes in speech, writing, and other cognitive or neurological functions. To correct the consequences of a stroke, in addition to drug treatment, conduct psychological rehabilitation, which helps the patient cope with disorders after a stroke.

The danger of dementia

Dementia is a common and rapidly progressive disease. So, in 2009, there were about 35 million people with dementia, and as of 2015, there were already more than 46 million.

Scientists predict an increase in the number of patients with this mental disorder to 131 million by 2050. More often after a mental disorder is not treatable, therefore it is important to diagnose and treat acute cerebrovascular accident and other diseases that provoke the development of pathology in a timely manner.

Types of dementia

Depending on the affected area, there are such types of dementia as:

• cortical;
• subcortical;
• cortical-subcortical;
• multifocal.

Cortical dementia develops as a result of the abuse of alcoholic beverages, as well as in Alzheimer's and. In cortical dementia, the area affected is the cerebral cortex.

The cause of subcortical dementia is bleeding into the white matter, as well as Huntington's. The affected areas are the subcortical structures of the brain.

With a stroke, the cortical and subcortical areas of the brain are most damaged (cortical-subcortical dementia). Multifocal dementia develops due to a pathological process in different parts of the central nervous system.

Why vascular dementia develops

The cause of the development of pathology is an acute or chronic violation of cerebral blood flow. Due to the fact that the tissues partially or completely lack the necessary volume of blood, neuronal necrosis is observed. An acute disorder can be triggered by ischemic (acute cerebrovascular accident due to blockage of cerebral arteries) or hemorrhagic (acute cerebrovascular accident developing due to rupture of intracerebral vessels) strokes.

Provoke ischemic, hemorrhagic stroke can factors such as:

• arterial hypertension (high blood pressure);
• heart diseases;
• diabetes mellitus (atrial fibrillation);
• taking drugs;
• elderly age;
• overweight.

Also, a stroke develops for such psychological reasons as the presence of severe stress and prolonged emotional overstrain.

Chronic circulatory disorders, as a rule, go unnoticed. Dementia develops gradually as a result of blockage of small blood vessels in atherosclerosis or an insufficient volume of delivered blood in cardiovascular insufficiency. Due to the presence of compensatory mechanisms in the initial stages of dementia, it is almost impossible to identify it.

Signs of vascular dementia

Vascular dementia combines cognitive and neurological disorders. Cognitive impairment occurs within one month of a stroke. In the case of many small strokes, symptoms of cognitive impairment appear within six months. Symptoms, their degree of manifestation depend on which part of the brain and how much it will be damaged. Typical symptoms of vascular dementia are:

• a decrease in the number of human interests;
• oppression of mental functions (thinking, perception);
• deterioration in the flexibility of thinking.

Negative changes in a person's memory appear already at the beginning, but more mildly in comparison with their manifestation in Alzheimer's. A person forgets some episodes, has difficulty learning new material. However, passive recollection comes easily to him. Difficulties arise when a person tries to remember certain things (active recall). People in the early stages of dementia suffer from impaired speech and writing. They forget some words or do not understand their meaning. During a conversation, they may make mistakes in spoken words, as they do not understand their meaning.

Progressing, mental disorders after a stroke are aggravated. A person cannot remember how to use things that are familiar to him. It becomes difficult for him to navigate in space, especially where he has never been before. It is difficult for such a person to make a purchase on his own, to draw up documents. People with the late stage of dementia need constant care, because without outside help they are not able to feed and clothe themselves.

Vascular dementia is characterized by an undulating course. The patient may experience inexplicable rage, irritability, distrust, but after a while these emotions disappear without any reason. Also, after a stroke, the development of a depressive state or psychosis is possible.

Diagnosis of vascular dementia

In order to identify dementia, the doctor collects an anamnesis. It is also based on signs that indicate the presence of dementia:

1. There is evidence of a violation of the patient's memory. The doctor finds out this information by interviewing the patient and his relatives.
2. There are signs (mistakes in oral speech), agnosia (difficulty in perceiving surrounding information), apraxia (impaired movement).
3. Violation of interaction with the social environment, the appearance of bad relations in the patient's family.
4. No symptoms of delirium (mental disorder) were found.
5. Brain defect recorded using tests (EEG, magnetic resonance and computed tomography of the brain, rheoencephalography, ultrasound).

How to cure a mental disorder

Medicines are prescribed by the doctor depending on the course of the disease. Objectives of therapy: elimination of cerebrovascular accident, maintenance of normal blood flow to the brain, as well as the elimination of disorders caused by dementia. To eliminate cognitive impairment, the doctor prescribes medications such as:

• antioxidants;
• neuropeptides;
• nootropic drugs;
• neurotrophic drugs;
• antidepressants;
• membrane-stimulating drugs;
• sedatives;
• neuroleptics.

To restore the psyche after a stroke, people are prescribed a special diet, and measures are taken to normalize blood pressure. Since the use of drugs may cause a paradoxical effect from their intake, it is important to monitor the somatic and mental state of the patient, and in the absence of a therapeutic effect of the drug or the patient's state of health worsens, immediately replace the drug.

Important! Only when necessary and in small doses, drugs that depress cognitive functions are used.

Features of caring for patients with dementia

People with a mental disorder, in addition to drug therapy, need appropriate care. Patients are shown labor and group therapy. They need comfortable and safe living conditions. Sometimes the keys to the apartment are taken away from the patient, and access to the gas stove is also eliminated in order to protect his life.