Features of rehabilitation after ischemic stroke

In the first days after an ischemic stroke, the patient has a problem of swallowing, which doctors must deal with even in a hospital. Diet must be gentle. For feeding at the initial stages, use a teaspoon. It is better to drink from a special drinker.

After an ischemic stroke, human nutrition is subject to the following rules:

  1. Butter, as well as all animal fats should be replaced with vegetable (soy, olive, sunflower).
  2. The daily amount of meat and fish should be no more than 120 g, and the products must be well grinded so that there are no problems with swallowing.
  3. Kefir and cottage cheese should be included in the diet. Useful will be sour cream of low fat content. Fresh milk can cause bloating.
  4. If the patient loves seafood, then you can use them no more than 2 times a week.
  5. It is better not to give the patient white bread, sweets, as well as confectionery. Baking should be from dark flour or whole grains. You can use crispbread soaked in soup.
  6. At night, you can give the victim tea with honey.
  7. As the chewing function is restored, the patient can include fruits and vegetables in the diet. He is allowed to chop well-grated apples, carrots. The daily rate of these products is 400 g.
  8. You can drink the patient ordinary water, green tea, fresh juices.

If a person who has an ischemic stroke has excess weight, then you need to get rid of it. Diet helps in this case.

Ischemic stroke is a violation of cerebrovascular circulation, resulting from a decrease in blood supply to certain parts of the brain. There are many different causes and mechanisms of the development of this disease, and it is from them that the medical prognosis and methods of secondary prevention often depend.

The key to achieving high results in post-stroke rehabilitation is to adhere to the following principles:

  • early start of the recovery phase;
  • an integrated approach to conducting medical rehabilitation procedures;
  • phased, consistent, continuity and continuity of medical influences;
  • an indiv >

The recovery period after ischemic stroke is divided into 3 stages:

  • early (up to 6 months from the time of cerebrovascular disturbance);
  • late (6-12 months);
  • residual effects (after a year).

For the most effective restoration of lost functions, rehabilitation measures should begin almost from the very first day of the patient’s stay in the hospital, immediately after the stabilization of vital signs. With the greatest speed and effectiveness, rehabilitation takes place in the first year after an ischemic stroke. As for the neurological disorders observed during the period of persistent residual phenomena, they are practically not subject to recovery.

After removal from the acute state, the patient is sent to an outpatient rehabilitation facility or, if it is impossible, they are discharged home with the condition of further rehabilitation treatment.

To eliminate the consequences of neuronal damage, prevent the development of complications, restore motor activity, improve the psychoemotional state and improve the quality of life of the patient, medical and non-drug rehabilitation methods are used.

Due to the fact that the preserved nerve cells of the brain take on the functions of the lost, in order to accelerate and maintain compensatory processes, they need additional recharge. For this, a course of drug therapy is prescribed. It includes general-purpose drugs aimed at the metabolic protection of cerebrovascular structures, correctors of cerebral blood supply and B vitamins. In a hospital setting, these medications are used in injection form, and after discharge, in tablet form.

Patients with diabetes mellitus are given insulin therapy in parallel. If an ischemic stroke has developed against the background of cardiovascular pathologies, blood diseases, etc., a preventive treatment of the underlying disease is carried out to prevent a second apoplexy stroke.

Non-drug rehabilitation methods

Non-drug measures aimed at restoring post-stroke patients include preventive measures such as quitting alcohol and smoking, losing body weight (for overweight patients), and diet therapy. Vegetables and fruits rich in fiber and folic acid, low-fat dairy products and lean meat should predominate in the patient’s diet.

What is a stroke dangerous?

The danger of a stroke lies in the fact that it affects not only adults and pensioners, but also children, newborns and pregnant girls. A lot of reasons lead to its development: heredity, aneurysm, pathology, tumors, improper lifestyle or hypertension. However, in most cases, the symptoms are not particularly manifested, and the symptoms are often attributed to fatigue or weakened immunity. Therefore, treatment does not start on time.

A stroke can instantly develop into an acute phase, hemorrhage in the brain or death of nerve cells begins. If we talk about a microstroke, then its periodic recurrence often leads to dementia, loss of mental abilities or memory. A spinal stroke can result in disability.

According to recent studies, about 450 thousand strokes occur annually in Russia, 111 thousand in Ukraine, half of all strokes result in death.

For this reason, the disease takes second place after heart disease, which leads to death or disability. More than 30% of the population suffers from a stroke before the age of 45 years. Moreover, men are most affected by it due to the lack of timely treatment.

The consequences of types of stroke

The death of brain nerve cells resulting from oxygen starvation entails the development of neurological and neuropsychic disorders, and also leads to disruption of domestic and social adaptation.

All post-stroke disorders are usually divided into 5 main groups:

  • motor: paralysis, paresis, increased muscle tone, impaired voluntary purposeful movements;
  • Sensitive: paresthesia, numbness of the limbs, loss of control over one’s own body;
  • speech: complete or partial loss of speech, impaired understanding of conversational speech, misunderstanding of allegories, sayings, etc .;
  • cognitive: post-stroke dementia, manifested by disorders of thinking, memory and attention;
  • extracerebral: violation of chewing and swallowing, visual, auditory, tactile disorders, dysfunction of the pelvic organs (intestines and bladder), etc.

Unfortunately, the consequences of acute cerebrovascular accident are virtually impossible to avoid. However, with a timely diagnosis, prompt medical care in the acute period and adequate rehabilitation treatment, partial or complete restoration of lost functions can be achieved.

Since there are several types of stroke, the consequences from them are different.

Hemorrhagic stroke occurs a little less often, but is accompanied by cerebral edema, coma and partial loss of some human capabilities. As for the ischemic, they rarely die from it, but often it ends with a second stroke.

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Ischemic

With an ischemic stroke, the patient may experience a mild loss of motor and mental abilities, but after rehabilitation they return. With regard to mortality, despite the frequency of development of this particular type of disease, the rate is about 30% in men and 40% in women, subject to prompt medical care.

Hemorrhagic

With a hemorrhagic stroke, the brain suffers quite a lot, hemorrhage often begins in all areas of the cerebral cortex, lacunae can form, and then myocardial infarction begins. Therefore, the consequences are difficult to predict. This may be a coma or cerebral edema, paralysis or complete loss of speech or vision.

In this case, not only rupture of capillaries and blood vessels occurs, but also hemorrhage into the subarachnoid space of the brain. Because of this, there is little time for rehabilitation, and people often become disabled or even die. The death rate is almost 80%. Especially such a stroke is dangerous for newborns.

Features of nutrition during rehabilitation

Rehabilitation after a stroke is a mandatory process that is necessary for everyone who was able to survive the disease. It is best to undergo rehabilitation in specialized centers or in a hospital. If rehabilitation is not involved, then the patient may never regain the lost opportunities, and the risk of developing a second attack is doubled.

On average, recovery takes at least one to three months, but in complex cases and in advanced age it may take about six months.

You also need to understand that some functions will not be fully returned, and you need to continue the procedure after discharge, in full. Take equal time to take medication, massage, diet, relaxation and gymnastics.

Recovery function
Methods used
Recovery function
Methods used
Driving opportunities
1.
Massage. Perform all of his tricks should be a specialist. The implementation of the procedure depends on the general condition of the patient. At first, simple grinding and kneading of paralyzed limbs will come in handy.
2.
Exercise therapy. First, extension and flexion of the affected limbs are used, as well as smooth turns of the head to the sides. Next, a specially designed set of exercises is used. Special simulators are also useful.
Driving opportunities
1.
Massage. Perform all of his tricks should be a specialist. The implementation of the procedure depends on the general condition of the patient. At first, simple grinding and kneading of paralyzed limbs will come in handy.
2.
Exercise therapy. First, extension and flexion of the affected limbs are used, as well as smooth turns of the head to the sides. Next, a specially designed set of exercises is used. Special simulators are also useful.
Speech
To restore this function after an ischemic stroke, special exercises with a speech therapist are necessary. You need to perform these exercises yourself. With the patient it is necessary to talk as much as possible and call him to answer. First he must answer any simple words (monosyllables).
Speech
To restore this function after an ischemic stroke, special exercises with a speech therapist are necessary. You need to perform these exercises yourself. With the patient it is necessary to talk as much as possible and call him to answer. First he must answer any simple words (monosyllables).
Memory
To do this, you need to solve riddles, crosswords, learn poems, and short proverbs with the victim. Gradually, these exercises need to be complicated.
Memory
To do this, you need to solve riddles, crosswords, learn poems, and short proverbs with the victim. Gradually, these exercises need to be complicated.
Fine motor skills
In this case, regular sensory games for children up to a year will help to recover from an ischemic stroke. Designers, cubes, pyramids should be used. It is necessary to give the patient tasks for sorting buckwheat, sorting pasta.
Fine motor skills
In this case, regular sensory games for children up to a year will help to recover from an ischemic stroke. Designers, cubes, pyramids should be used. It is necessary to give the patient tasks for sorting buckwheat, sorting pasta.
Swallowing
To restore this function, you must simulate swallowing with an empty mouth; yawn, opening his mouth as wide as possible; gargling with water; coughing (breathing exercises are often used for this); inflating cheeks with air retention for a few seconds.
Swallowing
To restore this function, you must simulate swallowing with an empty mouth; yawn, opening his mouth as wide as possible; gargling with water; coughing (breathing exercises are often used for this); inflating cheeks with air retention for a few seconds.

Rehabilitation after ischemic stroke should take place under the constant supervision of attending physicians. The patient will need to make a lot of effort to get back on his feet. Moreover, he must be sure of a positive result.

Where to start rehabilitation?

Rehabilitation begins with a full examination, diagnosis and conclusion of a doctor – only then can a full-fledged program be developed for gender, age and characteristics of the patient’s body. Diagnostics will help establish the cause, determine the affected areas of the brain and develop possible solutions. Next, a package of techniques will be proposed, which often consists of taking medication, surgical intervention, treating pathogens, improving the condition of the cerebral cortex and tissues, physiotherapy, diet, etc.

Recovery of sensitivity and motor functions

From the very first days after an acute violation of cerebral circulation, the patient begins to restore motor activity. Initially, position treatment (antispastic styling) is performed, passive exercises and massage procedures are performed. Immobilized patients to prevent the formation of pressure sores every 1,5–2 hours must be turned from side to side.

To prevent the development of thrombosis, apply elastic bandaging of the lower extremities. In specialized rehabilitation centers, verticalizers are used to maintain the patient in an upright position, as well as computerized devices (robotic orthoses) that imitate the step, providing passive movements in the lower extremities.

The methods of active therapeutic gymnastics, prescribed after the patients begin to walk, include complexes of physical exercises for various muscle groups (flexion and extension, stretching, pulling up, etc.). Regular exercise therapy exercises with a gradual expansion of the range of movements prevent the development of contractures and contribute to the elimination of involuntary friendly movements of the limbs.

The complex of physiotherapeutic procedures prescribed during the rehabilitation period after ischemic stroke includes electrical stimulation of paretic muscles, vacuum massage, paraffin and ozokerite applications, drug electrophoresis, laser therapy, neuromuscular phoniatric stimulation, etc.

The choice of a particular recovery technique is carried out individually, taking into account the general condition of the patient and medical contraindications.

Stroke Rehabilitation Techniques

Rehabilitation methods are selected for the patient and a specific problem. Those who have lost the ability to move will need massage, swimming, the help of a neurologist and physiotherapist. If the patient can not speak, or he has problems with memory, then without a psychologist, speech therapist and taking medication can not do. At the same time, diet, medical treatment, physical activity, massages, hydrotherapy and walking are prescribed for each patient.

Memory

If you have lost memory or there are some problems with it, then most likely you will have to drink blood-stimulating pills and neuroprotectors, which will promote metabolism in the cells, help them get saturated with glucose and oxygen, and restore damaged cells and neurons. They also resort to the help of psychologists, although special exercises do not exist, because a lot depends on the age of the patient and the degree of brain damage.

If you lose the opportunity to speak or speak correctly, you need not only taking pills, but also working with a speech therapist, as well as daily exercises that children often do in kindergarten. In fact, the patient is taught to speak again. Recovery usually takes at least three months, as the left hemisphere of the brain suffers.

Vision

With a hemorrhagic stroke, vision often suffers, which is expressed in its complete or partial loss, inability to distinguish shades. It is also about damage to the left hemisphere of the brain or cerebellum. Then recovery takes at least two months, and much depends on the age of the patient, the degree of damage to the left hemisphere.

Mobility

The most common problem is loss of mobility and motor function. Patients suffer from paralysis, numbness in the limbs, loss of sensation, or back problems. For treatment and rehabilitation they use massages, gymnastics, medication, physiotherapy, hydrotherapy, and motor-physical therapy. It usually takes at least three months, but the consequences can be reminded of oneself even after recovery.

Motility

After an ischemic stroke, there is often a problem of fine motor skills, distraction, trembling hands and loss of coordination of movements. All this speaks of problems with the right hemisphere of the brain, but the problem is solved, and quite quickly. Often, rehabilitation takes about a couple of weeks or months, while using modeling, massages, medications, physiotherapy, hydrotherapy. It is important to conduct classes every day, using available tools.

Speech recovery

Speech function is one of the few that can recover in the late stage of ischemic stroke and even in the stage of residual effects. Therefore, close patient and patience may be required. It is necessary to talk with the patient very slowly and clearly, ask questions in such a way that he can answer them unambiguously (“yes” or “no”).

It is very important at this time to perform exercises prescribed by a speech therapist that strengthen the muscles of the maxillofacial region, learn to pronounce sounds again, then syllables and, finally, uncomplicated words. In process of “disinhibition” of the patient’s speech functions, they are prompted to pronounce phrases, automated series (ordinal count, name of the days of the week and months), read well-known poems, sing songs, pronounce proverbs, etc. Continuous stimulation of the speaking process gives good results during rehabilitation after ischemic a stroke.

Duration of rehabilitation after a stroke

No doctor will tell you the exact dates for recovery, since often patients suffer from other chronic diseases that have to be treated along the way, which takes even more time.

In addition, the brain cells in all are not restored in the same way, and often advanced age becomes an obstacle in this process. Young people can expect a full recovery three to eight weeks after completing all the procedures. As for retirees, it may take them at least five months before at least part of their physical or mental capabilities returns. But you need to be prepared for the fact that some functions will be returned only partially.

As for the state of coma or cerebral edema, here time does not play into the patient’s hands. Since the cerebral cortex is affected more deeply, without the possibility of recovery.

Recovery of chewing functions and swallowing movements

One of the key problems in the nutrition of post-stroke patients is neurogenic dysphagia (swallowing disorder). This neurological disorder, which occurs as a result of damage to the medulla oblongata region, leads to the fact that a person cannot independently swallow even water or liquid food.

In some cases, this condition is supplemented by pain immediately at the time of ingestion, or food, getting into the respiratory tract, causes acute asphyxiation (suffocation). Therefore, in violation of the act of swallowing, the patient is fed with special nutritional mixtures through a nasogastric tube. In especially severe cases, patients are transferred to parenteral (intravenous) nutrition.

With the restoration of swallowing functions, they gradually switch from tube feeding to normal. In the early rehabilitation period, food should be semi-fluid, uniform and nutritious. They feed the patient in a calm environment, giving him a comfortable sitting or semi-sitting position. In no case should you be in a hurry so that a person does not choke. After eating, the oral cavity is thoroughly cleaned of food debris.

To restore the functional activity of the chewing and swallowing muscles and improve the movement of the lips and tongue, special exercises are prescribed. They should be performed regularly, throughout the entire period of post-stroke rehabilitation.

Rehabilitation drugs

Preparations and medications for rehabilitation can be prescribed only by the attending physician after the diagnosis, because only certain groups of substances or combined medications may be required. Often, patients need nootropics, neuroprotectors, neurostimulants and substances to restore blood circulation. In some cases, antidepressants and coagulants are prescribed. We are talking about Vinpocetine, Actovegin, Aspirin, Papaverine, Glycine, Cavintol.

Rehabilitation after ischemic lesions does not go away without the use of drugs. The following drugs are usually prescribed to the patient:

  1. Improving blood circulation in the brain: Cavinton, Pentoxifylline.
  2. Nootropic substances: Piracetam, Noofen.
  3. Combined drugs: “Fezam.”
  4. Soothing medicines: “Glycine”.
  5. Muscle relaxants that relieve muscle cramps: Sirdalud.

Most of the drugs presented to the patient should be taken throughout the rehabilitation period. Some of them are appointed for life. This avoids new attacks of ischemic stroke. It is strictly forbidden to independently change the dosage of drugs or stop the course of therapy.

Recovery of impaired function of the pelvic organs

Loss of control over physiological functions (urination and defecation) often causes depression in post-stroke patients. As a rule, after medical treatment, a person begins to independently control these physiological processes. However, until the patient is able to reach the toilet, a vessel or a toilet chair installed next to the bed is used.

Nutrition after a stroke

Another important factor that contributes to a speedy recovery is diet and rejection of harmful products. It is important to exclude alcohol, cigarettes, coffee, fatty and salty foods from the diet, consume as many vegetables, natural cereals, dairy products, juices, boiled meat, fiber and fruits as possible.

When implementing the recommendations of specialists, rehabilitation will be faster, and in the future you will not have to remember a stroke.

Do a diet, walks in the fresh air, moderate use of a computer, reduced stress level with your usual way of life, and then the consequences of a stroke will never bother you.

Recovery of mental performance and domestic skills

To restore cognitive functions of the brain, patients who have suffered an ischemic stroke during the rehabilitation period are prescribed neurometabolic psychotropic drugs that improve memory and stimulate cognitive activity.

If you have serious psychological problems, you may need the help of a neuropsychologist or psychotherapist. Also in this situation, it is recommended to perform special exercises to train memory, logical thinking and memorization.

A prerequisite for a gradual return to independent life is the restoration of lost self-care skills. This modern area of ​​physical rehabilitation is called ergotherapy. Its main goal is to contribute to the maximum adaptation of a person, the development of actions corresponding to his needs and individual needs, and the restoration of motivational habits of behavior in everyday life.

But the most important thing for post-stroke patients is the constant help and support of loved ones, gaining confidence in their own abilities. It is these key components that will help maintain motivation to achieve a result, maintain an optimistic attitude and surpass even the bold forecasts of doctors.

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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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