Home Stroke Rehabilitation Program

After a stroke, patients experience a disruption in many areas of the body and a loss of skills, such as walking, talking, and the ability to talk about themselves. This requires a variety of activities, which include not only physical exercise, but also various physiotherapy procedures, and much more. Therefore, it is especially important after returning from a medical institution to rehabilitate after a stroke at home.

Recovery stages

Since a stroke is an acute disturbance of blood circulation in the area of ​​the brain, it requires gradual recovery and a gradual increase in the load on the body.

The patient is usually in a hospital for about 20-25 days, after which the first of the three stages of rehabilitation at home begins – early. Its duration does not exceed three months, and the following goals are set for the patient:

  • Restoring the ability to sit on the bed on your own, stand next to it, then go to the restroom and perform everyday functions such as dressing and eating on your own.
  • Self-maintenance of personal hygiene.
  • Restoring control over the urinary system.
  • The return of visual acuity and speech quality.
  • Restoration of sensitivity.

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Most often, by the end of the second month of the first stage, a person manages to stand on his feet without help and maintain balance at the same time. To move, he also needs support in the form of a stick or a walker.

The second stage takes up to six months from the moment of the attack and is based on the fact that it is required to return completely or partially his self-care skills. The basis of this period is training walking. In the first weeks, it should be carried out with the help of loved ones or an instructor, as well as with devices such as a stick. After six months of this stage, the patient should:

  • Walk without any help or additional items.
  • Use cutlery, writing accessories.
  • Read, memorize and repeat whole texts.

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The third part – the completion of recovery takes a period from the end of six months after a stroke to a year. He must walk, gradually increasing the duration of his stay in the air, speech is actually restored, and at this time the emphasis is on developing fine motor skills of the hands.

Interesting! With a reasonable approach to the rehabilitation period, by the end of 18 months from the moment of the attack, about 90% of patients become able to conduct normal and independent life without the support of outsiders.

What is the main thing in rehabilitation

How long it takes a person to rehabilitate after a stroke, and how much lost or impaired functions will be restored, depends on some aspects:

  • Where is the focus located, and how large it is.
  • What was the state of health before the attack.
  • Conditions at the workplace and at home.
  • The degree of motivation.
  • The attitude of loved ones and their support.
  • Professionalism of attending physicians and instructors.

In this regard, three basic principles are formed, which should correspond to medical rehabilitation at home:

  • Multidisciplinary.
  • Early start.
  • Continuity and continuity.

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The team of specialists whose goal is to help the patient and cure him should include:

  • The resuscitator starts working from the first hours after the attack.
  • Neurologist.
  • A physician and physical therapy instructor, like a resuscitator, starts early.
  • Physiotherapist, connects from 3-5 days.
  • A neuropsychiatrist is necessary at the first stages not only for the patient, but also for his relatives.
  • Speech therapist.
  • Physiotherapy nurse.
  • An occupational therapist may join later or not be included in the process at all.

This provides a multidisciplinary approach to recovery.

An early start depends largely on the patient, since he must be ready at the earliest opportunity to begin the struggle for his recovery as a fully functioning member of society. And continuity and continuity means that there should be no breaks between inpatient treatment and each stage of home rehabilitation.

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Features of rehabilitation after ischemic and hemorrhagic stroke

Those patients who have experienced an ischemic or hemorrhagic stroke and are completely or partially paralyzed require special attention in three aspects of recovery:

  • Decreased muscle spasm.
  • Recovery of the upper limbs.
  • Recovery of the lower extremities.
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In order to relieve muscle spasm, you need to use the Bobath method, which includes a series of movements, they are repeated first three times, then five, doing everything slowly and carefully. The complex contains:

  • Abduction of the thumbs up to the formation of an angle of 90 degrees, in this position it is required to hold out for about three minutes.
  • Pull all fingers of the hand spread apart.
  • With outstretched fingers, first bend and straighten the hand, then bend the arm at the elbow joint, and the next time the movement is done in the shoulder joint.
  • Gradually pull a straight big toe towards you and freeze for two minutes.
  • Lying on your back, bend your knees, if this causes difficulty, you can tap your hand on the popliteal fossa. Then take the big toe and gently pull the foot to the side and down. As a result, the posture should look so that the legs are turned outward, slightly bent at the knees, and the heels or feet completely touch.

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The upper limbs are somewhat more difficult to restore than the lower ones, therefore, the following exercises are used to strengthen the shoulder girdle:

  • Leaving a straight arm to the side.
  • Outlining a circle with shoulders in turn or at the same time.
  • Raises the shoulders with a sharp drop.
  • Reduction and dilution of the shoulder blades.

Only after the exercises for the shoulder have been done do they move down to the elbow joint and after it to the wrist. At the same time, the latter is given the most time, since its recovery is the most difficult.

A convenient program has been created for the legs, including:

  • Bringing the leg bent at the knee joint to oneself and its subsequent straightening.
  • Leaving the leg to the side without lifting it out of bed.
  • Sliding heels on the bed.
  • Simulated cycling.

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Psychological support as part of recovery

Given how much the patient’s life changes after a stroke, depression often occurs, from which it is very difficult to return a person to a positive outlook on their future. The patient needs constant communication, moral support and regular contact with the outside world. His home environment should be extremely positive. Conversations between the patient and his loved ones must include various topics that are distracted from the treatment.

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What should be the patient’s nutrition

In the first 14 days after the attack, the patient is fed exclusively with a teaspoon. At the same time, food is made semi-liquid, thoroughly chopped and rubbed through a sieve.

After the restoration of swallowing, patients are transferred to a more solid food, removing from the diet that which will increase cholesterol: baked goods, baked goods and fatty foods. They try to include as much as possible in the menu base:

  • Wheat, rice and buckwheat.
  • Vegetables, especially peas, beans, foods with a dark green and orange tint.
  • Fruit, fresh or dried.
  • Dairy products with a low percentage of fat.
  • Protein, especially boiled or steamed poultry and fish.
  • Nuts and products with natural fats in small quantities, vegetable oils.

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Restoration of important body functions and skills

Impaired speech and vision is a big problem for people after a stroke.

To restore speech, the help of a speech therapist and the participation of the patient’s roommates are required, who will read the ABC book to him, help gradually pronounce sounds, then syllables and words. With a prolonged lack of progress, a person is taught sign language to make life easier.

Important! During communication with the patient, speech should be quiet, measured and absolutely calm. They recommend asking questions and trying to learn some songs or tongue twisters.

Restoration of vision requires the inclusion of gymnastics for the eyes in rehabilitation, for example, the patient can follow an object without turning his head. There are also computer programs aimed at training visual function and eye movement.

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Physiotherapy exercises for the patient

In the first few days after the patient is discharged, the restoration of motor functions begins in the most gentle way – the person should simply change the position of the body in bed. After that, they already switch attention to passive exercises in order to gradually relax and prepare the muscles for future loads.

Each day of the patient begins with a small warm-up, then during the day specific loads are given, which necessarily alternate in order to gradually connect different muscle groups. In this case, the training program is created individually for each patient, and it is strictly forbidden to violate it, as this can cause a new attack.

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Other types of fragments of rehabilitation

Recovery requires not only therapeutic exercises, proper nutrition and psychological support, other methods must be used as well.

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Ergotherapy

The inclusion of occupational therapy in treatment requires equipment for the patient’s home for his comfort: the installation of handrails and additional handles, shelves, seats, tabletops and stops, as well as bedside tables. The patient is gradually taught how to wash with an electric toothbrush, comfortable nail scissors and nippers are selected, and an electric razor is chosen.

Important! With regard to dressing, the person must adapt to the fact that first put things on the affected part of the body, and then on the healthy one.

It is better for him to comb while sitting, leaning his elbows on the table. In terms of eating, you will need to take deep plates, light cups with two handles, and to simplify eating, attachments can be put on the devices that increase the gripping area.

To make life easier for the patient, button fasteners, special door handle covers and elongated shoe horns can also be used.

Massage

Classes are complemented by massage from the early stages. In the case of ischemic stroke, it is used from 2-4 days after the attack, in the case of hemorrhagic – from 6-8 days. The first procedures carried out last 5-10 minutes, then gradually the time increases to 30 minutes.

The general course should include 20-30 massage sessions daily. After that, there is a break for one and a half to two months, and the sessions are resumed.

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For massage, it is not necessary to invite a masseur, it can be done to the patient on his own, the main thing is to first get advice from a specialist and discuss it with the attending physician.

Manual therapy

Home treatment may include soft tissue manual therapy, which can help with increased muscle tone, tension in the ligamentous apparatus, pain, and joint stiffness. But it is not allowed in the presence of skin lesions in the area of ​​future manipulation, in malignant neoplasms, acute diseases and pathologies of a mental nature.

Physiotherapy of a different kind

Patients can also undergo rehabilitation using other options for physiotherapy, for example:

  • Electrophoresis with Euphyllin, Papaverine, Magnesium sulfate or potassium bromide.
  • Electrical stimulation of spasmodic muscles with modulated currents.
  • Magnetotherapy.
  • Laser therapy
  • Heat therapy with paraffin, ozokerite or mud.

Also in the recovery period included spa treatment.

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The use of folk remedies

Folk recipes are often used in the rehabilitation period. You can use tools such as:

  • Tincture on pine cones. For her, a few cones are crushed and poured with vodka, then the mixture is sent to a jar, closed and left in the refrigerator for a couple of weeks. Drink the composition in a tablespoon after breakfast daily.
  • Citrus tincture. Pass 2 lemons and 2 oranges through a meat grinder, after removing the seeds, and add 24 tablespoons of pure honey to them. The composition is placed in a jar and left for hours in a room, after which it is stored in the refrigerator. Use a tablespoon two to three times a day inside, washed down with tea.
  • Laurel-based rubbing. For her, take 30 g of bay leaf, pour 200 ml of olive oil into it and let it brew for two months in a warm and dark place, then boil and cool. Rub the product into the paralyzed limbs.

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The correct approach to rehabilitation after a stroke will make it easy to recover a person at home. And the early start of recovery activities increases the volume of the return of lost skills and functions.

Rehabilitation at home. My rehabilitation after a stroke Rehabilitation after a stroke on your own at home. Exercises for the paralyzed arm.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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