Rehabilitation after a stroke - features and advice from doctors

Cognitive processes

There are three types of cognitive impairment after a stroke:

Damage to one of the cognitive functions: memory (amnesia), the ability to perform any actions (apraxia), impairment of visual, auditory, tactile perception (agnosia).
Violation of several functions that generally do not affect social adaptation.
Multiple injuries that lead to social maladaptation: impaired attention, memory, volitional processes. In this case, post-stroke dementia is diagnosed. In older people with dementia, household activity decreases and self-care skills are lost. This category of patients is at risk of recurrent stroke.

The first and second variants of the disorder can be corrected due to the plasticity of the brain: damaged functions are compensated by functions that remain intact.

Rehabilitation of older people with post-stroke dementia includes sessions with psychologists. With the help of special exercises, patients develop auditory and visual memory, the ability to concentrate, and solve logical problems. The recovery process is accompanied by drug therapy.

Rehabilitation after a stroke at home

After overcoming the acute period in the hospital, a rehabilitation period begins for a pensioner with a stroke. Relatives need to decide where it is better for an elderly person to undergo a recovery course: at home or in a rehabilitation center.

You may also be interested in the article: How to obtain patronage for an elderly person

If the family has decided to independently care for the patient after a stroke, they need to follow the recommendations of the attending physician and maintain constant contact with specialized specialists: a psychologist, a neurologist, a speech therapist.

At home, a separate place is assigned to a bedridden patient after a stroke. The bed is equipped with an anti-decubitus mattress. A small table is placed nearby, on which essential items are placed: a bottle of water, care products, a table lamp.

Specialists can come to the home 1-2 times a week, work with the patient and teach home methods of conducting developmental activities. The rest of the time, family members carry out the recommended exercises with the pensioner for 10-20 minutes several times a day. During weekly visits, specialists monitor the dynamics of changes, make additions and adjustments.

Motor abilities are restored using a complex of therapeutic exercises. Before performing the exercises, it is advisable for the patient to take a shower or bath to warm up the body. If there are contraindications to taking a bath or other difficulties, the affected areas are warmed with a heating pad. The muscles will be more flexible and there will be no pain.

Examples of gymnastic exercises:

pulling up while lying on your back, holding the headboard of the bed;
eye movements left and right, up and down with closed and open eyelids;
alternately raising the right and left arms and legs;
bending the knee and grabbing the shin with the hand;
joint movements of healthy and motionless limbs to the right and left with a rubber ring put on them.

When carrying out therapeutic exercises, the pensioner’s condition is closely monitored. He shouldn't get tired. If such signs are observed, it means that the amount of stress does not correspond to the physical strength of the patient. We need to make an adjustment: reduce the pace and number of exercises.

Speech is restored by memorizing poetry and tongue twisters. At the initial stage, simple children's poems are chosen, which are easier for a pensioner to recite after a stroke. Gradually more complex material is selected.

Looking at family photographs can activate the process of remembering, since it is easier for the patient to recall the past in his memory. An elderly person remembers acquaintances and friends in the images, then the events associated with them. He tries to pronounce the names of the places he has visited, the objects he sees in the images.

Scientists believe that singing has a beneficial effect on people who have suffered a stroke. If they hear singing, sing together with loved ones, speech activity will be restored faster.

For rehabilitation to be successful, an elderly person should not be in a social “vacuum”: you constantly need to communicate with him, talk, ask questions, even if at first he cannot answer them. In this way, the patient’s desire to speak is stimulated, he remembers words and their meaning.

Chess, checkers, and dominoes are used to develop thinking abilities. In a family, even a small child can take part in restoring the health of a grandfather or grandmother by putting together puzzles, mosaics, or playing a board game.

A separate issue is the organization of nutrition for an elderly person after a stroke.

Excluded from use:

alcoholic drinks;
fatty and spicy foods;
coffee, strong tea;
sweets.

It is advisable to add to the diet:

drink liquid of at least 1.5 liters. per day;
increase consumption of fruits and vegetables;
eat whole grains;
replace sweets with dried fruits.

Food should consist of useful substances and be easily digestible so that the body is not overloaded.

It is useful to cook boiled vegetables, dishes from lean fish and meat, and porridge with low-fat milk. If there are paresis and problems with swallowing, the patient is fed through a tube with ready-made nutritional mixtures. As soon as the opportunity arises, you need to take the patient for a walk. Staying in the fresh air is good for brain activity, the body receives oxygen and vitamin D, and appetite appears.

You may also be interested in the article: How to choose a private facility for the elderly

The moral atmosphere in the house is of great importance. Patients who receive family support recover faster. If they experience hostility from others or rudeness, the healing process is slowed down. There is no need to criticize and laugh at clumsiness and awkwardness. Only with encouragement will an elderly person develop a strong desire to overcome the disease.

Stages of diagnostics of the acute period

Stage 1. The victim is urgently hospitalized. The doctor receives basic information from the words of the patient, his relatives or surrounding people. External signs of cerebral circulatory disorders, emotional background, physical stress, and blood pressure levels allow a diagnosis to be made fairly quickly and accurately. The patient's medical history is studied for the presence of other diseases that can provoke the development of ischemic stroke (arrhythmia, atherosclerosis, previous heart attack, etc.). However, the possibility of making an incorrect diagnosis exists in the case of an epileptic seizure, a brain tumor, a head injury, a hypoglycemic state, etc.
Stage 2. The most important point of this stage is to quickly and accurately determine the nature of the disease. The tactics of first aid and further treatment will depend on this. A computed tomography scan of the brain is performed, since the clinical picture alone cannot provide completely reliable information.
Stage 3. After a quick history has been collected, the clinical picture has been identified and a CT scan has been performed, the doctor begins to choose treatment tactics. The subtype of stroke is also determined (lacunar, atherothrombotic or cardioembolic, etc.). The correct choice of therapy will help not only provide timely assistance to the victim, including surgery, but also prevent a possible recurrence of a heart attack in the future.

Recovery in a boarding house

Rehabilitation of an elderly person after a stroke at home requires the full-time employment of one of the relatives for the next six months. While the patient is bedridden, he cannot be left at home alone for two reasons: he is helpless and it is necessary to deal with him several times a day. The volume of care is so large and multidirectional that soon the caregiver himself will need support and replacement.

In boarding houses for the elderly, professionals are involved in the rehabilitation of patients. Special equipment is used for treatment. An individual program is developed for each patient. Restoration methods that have been developed over the years produce positive results within a month.

Memory training

Memory and intellectual function training occurs simultaneously with speech restoration. The patient should try to repeat the syllables, words, phrases spoken by the assistant, gradually increasing the interval between pronouncing the word and repetition.

Board games, composing stories based on pictures, solving crossword puzzles, and even simple conversations help restore thinking abilities. Near each item in the room you can put a card with its name. As cognitive functions are restored, the patient can read, watch films, and discuss their content.

Rehabilitation exercises on simulators

The Yusupov Hospital uses two types of simulators for the rehabilitation of patients after a stroke - mechanical and robotic. Mechanical exercise machines include exercise bikes, treadmills, and exercise machines for restoring balance and gait. Robotic simulators are equipped with electronic biosensors that stimulate activity by influencing the affected limbs. Robotic simulators have wide functionality; they are programmed taking into account the patient’s needs, promote the transmission of nerve impulses from the brain to the injured limb, and stimulate motor activity.

Rehabilitation exercises after a stroke are performed using multifunctional exercise equipment and sports equipment. There are different types of simulators:

To restore motor activity, use a flexion/extension simulator, a simulator for developing the joints of the limbs, exercise tracks, and exercise bikes.
For bedridden patients, exercise equipment in the form of a bed or bicycle is used.
To restore balance, gait, and motor activity, a horizontal simulator is used.
For patients who cannot yet stand, a seated exercise machine has been created to develop and strengthen the back muscles.

Together but apart

I realized a very important thing for myself: it is necessary to always be there, but at the same time, my participation in rehabilitation should also be as inconspicuous as possible. Standing over your soul is a hopeless matter. We have to resort to tricks. To make sure my husband doesn’t get bored doing his exercises, I do gymnastics at the same time (wonderful motivation, by the way). In order not to remind him every time of the need to do this and that, I made a list of activities recommended by experts - and I try to distance myself from it. My husband learned to read in early childhood, and he’ll manage somehow. Against each point there are numbers - ones and twos. “2” means that two people need to do the exercise. We try to postpone these until the second half of the day, when I finish work.

For the shoulder joint

Restoration of the forearm and shoulder joint takes place with the help of flexion and extension exercises, rotation, push-ups, muscle tension and relaxation, clapping, and massage. To do this, use exercise machines, dumbbells, and various devices. First, the arm is kneaded, then a set of exercises is performed; therapeutic exercises are always combined with a massage of the limbs. A set of exercises for the shoulder joint:

The patient lies on his back, arms extended along the body. The instructor holds his hand at the elbow to avoid bending, takes the patient's palm with his other hand and moves the patient's arm up and down.
The instructor performs circular movements with the patient's arm fixed in a straightened state.
The patient lies on his back, with his arm slightly to the side. The instructor turns the straightened arm over, palm down, then up.

Driving

A stroke can affect your ability to drive safely in a variety of ways, such as your physical condition, visual impairment, or difficulty concentrating for long periods of time. In the first months, even after a mini-stroke, you are not allowed to drive. After some months, you will need to visit your doctor, who will give you advice and recommendations regarding driving and will tell you whether you can start driving again. They will likely refer you to have your driving abilities reassessed. It is important to tell your insurance company that you have had a stroke.

Five minutes

It's no secret that the majority of disabled people (like all of us, for that matter) spend almost all their time on the Internet. A rule that has long been forgotten by everyone: every half hour of working at the computer you need to take a break. It seems like a small thing, but try to force yourself! For example, I fall off the monitor only when my eyes stop showing and my brain stops thinking. Now I feel better. I'm not alone. For a short distraction, we have separate “menu” items – activities that take 5-10 minutes.

We play ball (if it’s difficult to throw a ball, a tied scarf, for example, is perfect, it flies slower and is easier to catch), we dance, sing songs, lay out small objects on the table, remember their location, and then the one who drives changes something here and there. I already wrote about dancing last time - it’s much simpler than it seems. There were difficulties with singing. It turns out that most of the songs are very fast. I have recorded a huge number of karaoke collections; Only a few songs turned out to be suitable for our family duet, mainly Russian folk and Cossack songs. So we sing without words, howling with some single sound, which is terribly fun - I recommend everyone to try it. And we are still tormenting the guitar, trying to achieve a more or less passable performance of one English-language song. But here everything is ahead.