Automotive training after a stroke. Illness is not a death sentence. Activities for psychological recovery

Stroke, or cerebral circulatory disorder, is one of the most common causes of death and disability among the population of most developed countries. In this case, death is possible not only during the strike itself, but also during the first few weeks after it. About 35% of patients die within three to four weeks after a stroke. About 60% of those who survived become disabled.

Relatives of a patient who has suffered a brain stroke should know that recovery from a stroke is a long, difficult, but very important process. The main goal of rehabilitation measures is primarily the restoration of the brain, motor abilities and speech, social adaptation, as well as the prevention of recurrent strokes and their complications. The role of family members cannot be overestimated. Their participation, patience and correct actions largely determine whether (and how quickly) the lost functions can return.

The recovery period after a stroke is a difficult stage in the life of not only the patient, but also his family. Violations can be very serious and depend on how much and what part of the brain is damaged. Patients may experience impairments in limb movement, coordination, vision, swallowing, speech, hearing, and the ability to control bowel movements and urination. As a rule, they have difficulty perceiving information, get tired quickly, do not control their emotions, and become depressed. Recovery of patients can take more than one month and even more than one year.

It should be said that full recovery is not always possible. Poor blood circulation in the brain often leads to irreversible consequences. Therefore, you need to be prepared for the fact that you will have to adapt to the defect that has appeared and learn to do homework in new conditions. It is important to remember that a positive attitude and perseverance can shorten the recovery time and, over time, fully or partially restore motor and other abilities.

With the joint efforts of doctors and relatives, the patient has the opportunity to return to normal life, become socially active and able to work. Restoration of function largely depends on how early the intervention was started. In addition, it is important not to be lazy and train the affected side. Today, patients and their relatives have access to recovery centers where qualified assistance awaits them.

Recovery levels

There are three levels of recovery after hemorrhagic or ischemic stroke.

The first one is the highest. This is true restoration, in which all functions are completely returned to their original state. This option is possible if there is no complete death of nerve cells in the brain.
The second level is compensation. Functions are compensated by functional restructuring and the involvement of new structures. This is an early recovery period - usually the first six months after a stroke.
The third level is readaptation, that is, adaptation to the emerging defect. In this case, the use of canes, wheelchairs, walkers, and orthoses is implied.

Forecast

Unfavorable factors for recovery:

large lesion of the brain;
location of the lesion in functionally important areas (for speech and motor functions);
poor blood circulation around the affected area;
advanced age;
emotional disturbances.

Favorable prognostic factors include:

early spontaneous recovery of functions;
early start of restoration activities.

Main principles of recovery

Early start of restoration of lost functions.
Adequacy and integrated approach.
Good organization of events, regularity and long duration.
The patient and family members should actively participate in the rehabilitation process.

Immediately after the patient recovers from the acute condition, it is necessary to begin rehabilitation measures. As a rule, programs are developed individually, after the doctor determines the extent to which certain functions have been lost: walking, swallowing, talking, caring for oneself, and performing ordinary everyday activities.

As already mentioned, the main burden of recovery falls on the shoulders of close relatives. You must be prepared for the fact that improvement may not occur for a very long time, and the recovery time will be delayed. It is important to be patient, maintain a positive attitude, and praise the patient for the slightest achievements. At the same time, help should be dosed so that the stroke survivor strives to quickly become independent. The role of the family is as follows:

conducting classes with the patient to restore the ability to move, speak, read, write, walk, and household skills;
involving the patient in various activities, since inaction leads to blues, depression and apathy;
help to reintegrate into society.

Motion restoration

Normalizing motor activity and restoring muscle strength after a stroke is a primary goal. Treatment by position is prescribed from the first day of illness. Its duration is determined by the doctor individually. The doctor shows the relatives how to position the affected limb and how to use sandbags or splints to fix it. Treatment is carried out twice a day for half an hour after therapeutic exercises. Do not place affected limbs down while eating or immediately after eating. If you complain of numbness and discomfort, you need to change the position of your arm or leg.

To help the patient recover quickly, already on the second day after the stroke, to improve mobility in the joints, passive movements are made, which should be leisurely, smooth and in no case cause discomfort or pain. They are usually performed with the help of a physical therapy instructor. Bend and straighten the affected limbs, move them to the sides, and rotate them.

Restoring motor activity after a stroke

When the patient is in a supine position, he can do exercises such as rolling his eyes, blinking, moving his gaze to the sides, up, down.

First, the patient is seated on the bed for several minutes, gradually increasing this time. Then they teach him to stand, while he holds on to the headboard or the hand of an assistant. It is better to buy high shoes so that your foot does not roll in.

Soon you need to move on to learning to walk. This function may not be restored soon. The patient needs to be helped when moving and not left alone. Gradually move to walking with support. This could be a chair, a playpen, or a cane. When progress is noticeable, it is recommended to go outside.

If the patient uses a wheelchair, then it is necessary to learn how to move it from the bed to the chair and back.

Speech restoration

Speech disorders often occur with brain damage. The patient may have difficulty expressing his thoughts, as well as understanding someone else's speech. Speech functions take a long time to recover - within 3-4 years. This process requires the participation of a specialist in this field.

Violations can be varied. The patient does not understand what is being said to him. The patient is able to understand what is said to him, but cannot express his thoughts. He may use incorrect words and have difficulty reading and writing.

In this case, you need to be patient, speak slowly, pronounce the words well, use simple phrases, give the patient time to understand what was said. Ask questions in such a way that he can answer yes or no.

In addition, after a stroke, disorders of the muscles of the tongue and face often occur. In this case, speech is slow and unintelligible, the voice is muffled. The speech therapist will teach the patient exercises that train the tongue and facial muscles, and will also provide a list of words to improve the pronunciation of sounds. Classes must be conducted regularly. It is better to do exercises in front of a mirror.

Swallowing recovery

After an acute cerebral circulatory disorder, difficulties with chewing, swallowing, and saliva production often occur. Patients cannot feel food on one side of the mouth.

To restore swallowing function, special exercises are also used to restore the strength of the muscles that are involved in swallowing and improve the mobility of the tongue and lips.

To make swallowing easier, you need to choose foods that are easy to chew and swallow. It should not be hot or cold, with an appetizing smell. The patient should be fed only in a sitting position.

Home improvement

Changes are needed in the apartment to make the patient’s life safer and more comfortable. There should be no high thresholds or carpeting in the house. It is better to purchase a special bed with high sides to avoid falls. There should be railings and handrails everywhere so that the patient can hold on. The apartment needs good lighting, and in the patient’s room the night light should be turned on all night.

Prevention of recurrent stroke

After a stroke, it is important not only to recover, but to prevent a recurrence of the stroke. To do this you need to lead a healthy lifestyle:

Take medications regularly.
Normalize weight.
Carry out daily blood pressure monitoring.
Do therapeutic exercises.
Completely quit smoking and alcohol.
Control sugar and cholesterol levels.
Consult a doctor periodically.

Sanatorium rehabilitation after stroke

A stroke survivor may be sent for treatment to a sanatorium, where various recovery methods are used. They use balneotherapy, mud therapy, physiotherapy, massage, physical therapy, climatotherapy, and drug treatment.

After an ischemic stroke, radon, hydrogen sulfide, iodine-bromine, carbon dioxide baths, and mud therapy in the form of applications are effective.

Physical activity is useful both after ischemic and hemorrhagic stroke. Therapeutic exercise is hygienic gymnastics, measured walking two to three times a day.

After a hemorrhagic or ischemic stroke, different types of massage are used in the sanatorium. Usually the procedure is carried out in the morning after breakfast.

In the sanatorium, patients who have suffered a stroke are taught work skills. For this purpose, mobile and stationary stands with a set of household and household items are equipped. Among the recovery methods, the sanatorium also uses auto-training and psychotherapy.

Despite the fact that the prevalence of acute vascular disorders in the brain (stroke) and mortality from them are quite high, modern medicine has the necessary treatment methods that allow many patients to stay alive. What then? What conditions and requirements does the patient face in his future life after a stroke? As a rule, most of them remain disabled forever, and the degree of restoration of lost functions depends entirely on timely, competent and comprehensive rehabilitation.

As is known, when cerebral circulation is impaired with brain damage, there is a loss of various body abilities associated with damage to one or another part of the central nervous system. In most patients, motor function and speech are most often impaired; in severe cases, the patient cannot stand up, sit, eat food on his own or communicate with staff and relatives. In such a situation, the possibility of at least a partial return to the previous state is directly related to rehabilitation after a stroke, which should be started, if possible, from the first days after the onset of the disease.

Directions and stages of rehabilitation

It is known that the number of neurons in the brain exceeds our daily needs, however, in conditions of unfavorable conditions and their death during a stroke, it is possible to “switch on” previously inactive cells, establish connections between them and, thus, restore some functions.

To limit the size of the lesion at the earliest possible date, medications are prescribed after a stroke that can:

Reduce swelling around the affected tissue (- mannitol, furosemide);

Provide a neuroprotective effect (Actovegin, Cerebrolysin).

Restorative measures should be selected and carried out individually depending on the severity of the condition and the nature of the violations, but they are carried out for all patients in the following main areas:

The use of physical therapy and massage to correct movement disorders;

Restoration of speech and memory;

Psychological and social rehabilitation of the patient in the family and society;

Prevention of delayed post-stroke complications and recurrent stroke, taking into account existing risk factors.

Or a heart attack, accompanied by necrosis and death of neurons with dysfunction of the part of the central nervous system in which it developed. As a rule, cerebral infarctions with small sizes and hemispheric localization have a fairly favorable prognosis, and the recovery period can proceed quickly and very effectively.

It takes the life of most of its survivors, and in surviving patients most often leads to persistent impairment of various functions without the possibility of their complete or even partial recovery. This is due to the fact that during hemorrhage, a significant volume of nervous tissue dies, and interactions between the remaining neurons are disrupted as a result of cerebral edema. In such a situation, even years of regular and persistent training, unfortunately, do not always give the expected result.

Recovery from a stroke can take quite a long time, so the effectiveness of measures taken at this time depends on the patience and perseverance of relatives, friends and the patient himself. It is important to instill a sense of optimism and faith in a positive outcome, to praise and encourage the patient, since many of them are prone to manifestations of apathy and irritability.

When certain parts of the brain are damaged, astheno-depressive syndrome is especially pronounced, so do not be offended if a person close to you who has suffered a stroke is not in the mood, grumbles at family members and refuses to do exercises or massage. There is no need to insist on their mandatory implementation; perhaps it will be enough to just talk and somehow distract the patient.

Disability after a stroke still remains a significant medical and social problem, since even with the most thorough and timely treatment and rehabilitation, most patients do not fully regain their lost abilities.

Therapy that will help the patient recover faster should be started early. As a rule, you can start it at stage of inpatient treatment. In this regard, physical therapy methodologists, rehabilitation doctors, and massage therapists will provide significant assistance in the department of neurology or vascular pathology of the brain. As soon as the patient's condition has stabilized, it is necessary to transfer him to rehabilitation department to continue rehabilitation treatment. After discharge from the hospital, the patient is observed in clinic at the place of residence, where he performs the necessary exercises under the supervision of a specialist, attends physiotherapeutic procedures, massage, a psychotherapist or speech therapist.
It would not be amiss to send the patient to a rehabilitation center, modern and well-equipped, designed for neurological patients, where there are all the necessary conditions for further correction of lost functions. Due to the high prevalence of acute vascular pathology of the brain, which increasingly affects the young and able-bodied population, the creation of such centers, although expensive, is completely justified, since it allows the use of the maximum possible number of treatment methods with the fastest return of patients to their usual way of life.

Restoration of motor functions

Among the consequences of a stroke, motor disorders occupy one of the main places, since they are expressed to one degree or another in almost all patients, regardless of whether a heart attack or a cerebral hemorrhage occurred. They are expressed in the form paresis(partial loss of movement) or paralysis(complete immobilization) in the arm or leg. If both an arm and a leg on one side of the body are affected at the same time, they speak of hemiparesis or hemiplegia. It happens that changes in the limbs are not the same in severity, however, restoring the function of the hand is much more difficult due to the need to improve fine motor skills and writing.

There are various methods of restoring motor function:

Electrical stimulation;

Using the biofeedback method.

Physiotherapy

The main and most accessible method of recovery from paralysis is physical therapy (kinesitherapy). Its tasks include not only the development of the previous strength and range of motion in the affected limbs, but also the restoration of the ability to stand, walk, maintain balance, and also perform ordinary household needs and self-care. Activities that are familiar to us, such as dressing, washing, eating, can cause serious difficulties if even one limb is affected. Patients with severe disorders of nervous activity cannot sit up in bed independently.

The volume and nature of the exercises performed depend on the severity of the patient's condition. In cases of deep violations, it is applied first passive gymnastics: a physical therapy instructor or relatives move the limbs of a bedridden patient, restoring blood flow in the muscles and developing joints. As health improves, the patient learns to sit down independently, and then to stand up and walk independently.

If necessary, use support - a chair, headboard, stick. If you have sufficient balance, it becomes possible to walk first around the ward, then around the apartment, and even down the street.

Some patients with small areas of brain damage and good recovery potential begin to stand up and even walk around the ward within the first week from the onset of a stroke. In such cases, it is possible to maintain working capacity, which is very important for young people.

If the course of the post-stroke period is favorable, the patient is discharged from the hospital for recovery at home. In this case, as a rule, the main role is taken by relatives and friends, on whose patience further rehabilitation entirely depends. The patient should not be tired by frequent and prolonged exercise. Their duration and intensity should gradually increase as a particular function is restored. To facilitate the movement of a sick person at home, it is good to provide him with special handrails in the shower and toilet, and small chairs for additional support will not be amiss.

Video: a set of active exercises after a stroke

Particular attention should be paid to restoring hand function with the ability to perform small movements and write. It is necessary to perform exercises to develop the muscles of the hand and restore coordination of finger movements. It is possible to use special simulators and wrist expanders. Along with gymnastics, it will also be useful to use hand massage, which helps improve trophism in the muscles and reduce spasticity.

This process may require a lot of time and perseverance, but the result will be the performance of not only the simplest manipulations such as combing, shaving, tying shoelaces, but even cooking and eating food yourself.

If the rehabilitation period is favorable, it is necessary to expand the patient’s social circle and household responsibilities. It is important that a person feels like a full member of the family, and not a helpless disabled person. You should not neglect conversations with such a patient, even if he cannot fully answer questions. This will help avoid possible apathy, depression and isolation of the patient with reluctance to further recovery.

Ways to “stir up” a patient from the outside

Electrical stimulation method muscle fibers is based on the influence of pulsed currents of various frequencies. At the same time, trophism in the affected tissue improves, muscle contractility increases, and tone is normalized during spastic paresis and paralysis. It is especially advisable to use electrical stimulation for long-term patients in whom active rehabilitation exercises are difficult or impossible. Currently, there are many different devices that allow you to use this method at home under the supervision of the attending physician at the clinic.

Using biofeedback method the patient performs certain tasks and, together with the doctor, receives audio or visual signals about various functions of his body. This information is important for the doctor to assess the dynamics of recovery, and for the patient, in addition, it allows him to increase reaction speed, speed and accuracy of actions, as well as observe positive results from the exercises performed. As a rule, the method is implemented using special computer programs and games.

Along with passive and active kinesiotherapy, massage after a stroke also has a good effect., especially with a tendency to spasticity and long-term rehabilitation. It is performed using conventional techniques and does not have any significant differences from that of other neurological diseases.

It is possible to begin massage in the hospital in the early stages of the post-stroke period. A massage therapist at a hospital or rehabilitation center will help with this. In the future, massage at home can also be entrusted to a specialist, or relatives themselves can master its basic principles.

Restoring speech and memory function

Restoring speech after a stroke is an important stage, first of all, in the social rehabilitation of the patient. The sooner contact is established, the sooner a return to normal life will become possible.

Speech ability is affected in most stroke survivors. This may be due not only to impaired functioning of the facial muscles and articulation, but also to damage to the speech center, located in the left hemisphere of right-handed people. If the corresponding parts of the brain are damaged, the ability to reproduce meaningful phrases, count, and understand spoken speech may disappear.

In case of such disorders, a specialist – speech therapist – aphasiologist will come to the aid of the patient. With the help of special techniques and constant training, he will help not only the patient, but also give advice to his family and friends regarding the further development of speech. Exercises to restore speech should begin as early as possible, and classes should be regular. The role of relatives in regaining the ability to speak and communicate with others cannot be overestimated. Even if it seems that the patient does not understand anything, you should not ignore him or isolate him from communication. Perhaps, even without the ability to say something, he perceives addressed speech well. Over time, he will begin to pronounce individual words, and then entire sentences. Restoring speech greatly contributes to the return of the ability to write.

Most stroke patients experience memory loss. They have difficulty remembering past events in their lives; the faces of relatives may seem unfamiliar to them. In order to restore memory, you need to constantly train it using simple exercises and techniques. In many ways, these exercises can be reminiscent of activities with small children. So, with the patient you can learn nursery rhymes that are easy to remember and reproduce. First, it is enough to memorize one sentence, then a whole stanza, gradually complicating and increasing the amount of memorized material. When repeating phrases, you can bend your fingers, forming additional associative connections in the brain.

In addition to poems, you can remember events from the patient’s life, how the day went, what happened a year or month ago, and so on. As memory, speech and cognitive functions are restored, you can move on to solving crosswords and memorizing various texts.

It is useful to carry out memory restoration exercises constantly: while eating, while cleaning the house, while walking. The main thing is that they should not cause anxiety to the patient and cause negative emotions (memories of unpleasant events from the past).

Video: exercises for speech restoration with afferent aphasia

Psychological and social rehabilitation

In addition to caring for a patient after a stroke, restoring motor and cognitive functions, psychological and social adaptation is of no small importance. It is especially important in young and able-bodied patients with a small amount of brain damage, who are likely to return to their previous lifestyle and work.

Considering the possible pain syndrome, the inability to perform usual activities, participate in social life, as well as the need for constant help from others, such patients are prone to depression, attacks of irritability and isolation. The task of relatives is to provide a favorable psychological environment in the family, to support and encourage the patient.

Sometimes there are hallucinations after a stroke, and the patient may describe them to relatives. In such cases, do not be alarmed: as a rule, prescribing special medications is sufficient to eliminate them.

The rehabilitation measures carried out must correspond to the real functional capabilities of the body, taking into account the depth of neurological disorders. You should not isolate the patient, citing his loss of ability to speak normally or forgetfulness - it is better to tell him the right word or assign him simple homework. For many, for effective recovery and an optimistic attitude towards exercise, it is important to feel needed.

In addition to creating psychological comfort at home, sessions with a psychotherapist and, if necessary, prescription of medications (sedatives, antidepressants) have a good effect.

Social adaptation plays an important role in returning to normal life. It’s good when there is an opportunity to return to your previous job or do another, simpler one. If a person is already retired or emerging impairments do not allow him to work, he needs to look for other ways of socialization: visiting the theater, exhibitions, finding a hobby.

A specialized sanatorium is another method of social adaptation. In addition to physiotherapeutic procedures and classes with various specialists, the patient sometimes receives a much-needed change of environment and additional communication.

Prevention of late complications and recurrent strokes

Most patients and their relatives are interested in the question: what are its complications in the future? What treatment is needed after a stroke? To do this, it is enough to follow simple conditions:

Continuation of initiated rehabilitation measures (physical therapy, massage, memory and speech training);

The use of physiotherapeutic methods (magnetic, laser therapy, heat therapy) to combat increased muscle tone in the affected limbs, adequate pain relief;

Normalization of blood pressure (in case of previous hemorrhage and presence), prescription (in case of ischemic brain damage);

Normalization of lifestyle with the elimination of bad habits, adherence to diet after a stroke.

In general, there are no strict restrictions or significant dietary features, so after a stroke you can eat everything that will not harm a healthy person.

It is, however, necessary to take into account the concomitant pathology and the nature of the existing changes. If the function of the pelvic organs is impaired, the patient is in a supine position, it is advisable to exclude foods that help slow down the passage of intestinal contents, and increase the proportion of vegetable salads, fruits, and cereals. To avoid disorders of the urinary system, it is better not to get carried away with sour, salty, or sorrel dishes.

The diet for cerebral stroke depends on the mechanism of occurrence of acute cerebrovascular accident and previous causes. So, in case of hemorrhages as a result, it is better not to eat salty foods, drink plenty of fluids, or strong coffee and tea.

It is necessary to adhere to it after an ischemic stroke (cerebral infarction). In other words, you should not give preference to fatty, fried foods, and easily accessible carbohydrates, which contribute to the development of atherosclerotic damage to the vascular walls. It is better to replace them with lean meats, vegetables and fruits.

Stroke and alcohol are incompatible things , regardless of whether the patient has a heart attack or hemorrhage. Drinking even small doses of alcohol leads to an increase in heart rate, increased blood pressure, and can also contribute to. These factors can cause a recurrent stroke with worsening neurological impairment and even death.

Many patients, especially young people, are interested in whether sex after a stroke is acceptable. Thanks to various studies, scientists have proven not only the absence of harm from it, but also its benefits in the rehabilitation process. However, there are certain nuances associated with a serious illness:

Possible dysfunction of the genitourinary system, decreased sensitivity and potency;

Taking antidepressants, irritability and apathy with decreased libido;

Movement disorders that make sexual intercourse difficult.

If the recovery period is favorable, a return to normal marital relationships is possible as soon as the patient feels strength and desire. The moral support and warmth of your spouse will also help improve your psycho-emotional state. Moderate physical activity and positive emotions will have an extremely beneficial effect on further recovery and return to a full life.

The consequences of a stroke for a person’s general health depend directly on the volume and location of the lesion in the brain. With severe and extensive strokes, complications from other organs are inevitable, the most common of which are:

Inflammatory processes of the respiratory system (congestive pneumonia in bedridden patients);

Dysfunction of the pelvic organs with the addition of a secondary infection (cystitis, pyelonephritis);

Bedsores, especially if not properly cared for;

A decrease in intestinal motility with a slowdown in the movement of contents through it, which is fraught with the development of chronic inflammation and constipation.

When caring for a patient who has suffered a stroke, it is necessary to remember that a person who has suddenly lost his previous way of life, the ability to work and communicate in his usual environment, requires manifestations of not only moral support, but also affection and kindness.

In general, rehabilitation after an ischemic stroke is faster and easier than after a hemorrhage. Many patients return to their normal lifestyle quite early, and young and able-bodied people even regain their skills at their previous jobs. The outcome and consequences of the disease depend on the patience, perseverance and desire for recovery not only on the part of the patient, but also on the part of his relatives. The main thing is to believe in a successful outcome, then a positive result will not be long in coming.

Video: how to restore movement after a stroke? “Live Healthy” program

To increase volitional activity during therapeutic exercises, psychotherapeutic stimulation is used in the form of autogenic training, which is carried out by a methodologist in parallel with therapeutic exercises.

Autogenic training is built in accordance with the stages of physical therapy in the system of patient rehabilitation.

The first period is the main one, its task is to teach patients to actively relax muscles.

Period II - the use of ideomotor movements in autogenic training with the aim of localized impact on isolated muscle groups against the background of general muscle relaxation.

Period III - the use of ideomotor movements to activate patients and help them master the skills of proper walking and self-care.

In the first period, classes are conducted in a group method 2 times a day. In the first half of the day by a physical therapy methodologist, in the second half - using a recording that is transmitted via a repeater.

Autogenic training is used as a preparatory measure for teaching patients to actively relax muscles.

Stage I

Objectives: to cause a feeling of heaviness in the healthy hand (Sessions I and II).

Text of the self-hypnosis formula - introductory part:

Take a deep breath.

Breathe evenly and calmly.

Eyes closed.

Relax all muscles.

Main part:

I am calm.

I'm completely calm.

Nothing worries me.

All the muscles of my body are relaxed, my arms and legs are pleasantly relaxed.

My whole body, arms and legs are pleasantly rested.

I am calm.

I'm completely calm.

The healthy arm became heavy.

I'm completely calm.

Final part:

Take a deep breath.

Breathe calmly.

The heaviness of the arms and legs goes away.

The feeling of warmth and muscle relaxation remains.

A feeling of complete peace is maintained.

You feel good.

Open eyes.

Stage II

Objectives: to cause a feeling of heaviness and warmth in the healthy hand (III-VI sessions).

The introductory part is the same as in the first stage.

Main part:

I am calm.

I'm completely calm.

Nothing worries me.

All the muscles of my body, arms and legs relax pleasantly.

I am calm.

I'm completely calm.

I feel a pleasant heaviness in my good hand.

The healthy arm became heavy.

I'm completely calm.

I dilate the blood vessels in my healthy arm.

I feel a pleasant warmth in my healthy hand.

Hot blood warmed my hand.

The healthy hand became hot.

Stage III

Objectives: to cause a feeling of heaviness and warmth in the healthy leg against the background of relaxation of the healthy arm (VII-X sessions).

Main part:

I am calm.

I'm completely calm.

Nothing worries me.

All my body muscles, arms and legs feel pleasantly relaxed.

All my muscles are pleasantly rested.

I'm completely calm.

My good arm became heavy.

The blood vessels dilated.

Hot blood warmed my healthy hand.

I am calm.

I'm completely calm.

I feel a pleasant heaviness in my good leg.

The healthy leg became heavy;

I'm completely calm.

I dilate the blood vessels in my healthy leg.

The blood vessels dilated.

Hot blood warmed the healthy leg.

The healthy leg became warm.

I am calm.

My good arm and good leg are heavy and warm.

I'm completely calm. The final part is the same as in stage I.

Stage IV

Objectives: to cause sensations of heaviness and warmth in the sore arm against the background of relaxed healthy limbs (XI-XIV sessions).

The introductory part is the same as at stage I.

Main part:

I am calm.

I'm completely calm.

Nothing worries me.

My whole body, arms, legs are pleasantly rested.

I'm completely calm.

I feel a pleasant heaviness in my good arm and good leg.

The good arm and the good leg became heavy.

I'm completely calm.

The blood vessels dilated.

I feel a pleasant warmth in my healthy arm and healthy leg.

Hot blood warmed the healthy arm and leg.

I'm completely calm.

The sore arm became heavy.

I'm completely calm.

The blood vessels dilated.

Hot healthy blood warmed the sore hand.

The sore hand became hot.

I'm completely calm. The final part is the same as in stage I.

Stage V

Objectives: to cause sensations of heaviness and warmth in the sore leg against the background of relaxed healthy limbs and a paretic arm (XV-XX sessions).

Main part:

I am calm.

I'm completely calm.

Nothing worries me.

All my muscles are pleasantly relaxed.

My body, arms and legs are pleasantly rested.

I'm completely calm.

I feel a pleasant heaviness in my sore arm.

The sore arm became heavy.

I'm completely calm.

I dilate the blood vessels in my sore arm.

The blood vessels dilated.

I feel a pleasant warmth in my sore hand.

Hot blood warmed the sore hand.

I'm completely calm.

I feel a pleasant heaviness in my sore leg.

The sore leg became heavy.

I'm completely calm.

I dilate the blood vessels in my sore leg.

The blood vessels dilated.

I feel a pleasant warmth in my leg.

Hot blood warmed the sore leg.

I'm completely calm.

All muscles of the body, arms and legs are relaxed.

My arms and legs are heavy and warm.

I'm completely calm. The final part is the same as in stage I.

In periods II and III, training is carried out using an individual method. Self-hypnosis formulas are developed individually for each patient, depending on the functional state of the muscles of the paretic limbs. In period II, the sequence of imaginary movements corresponds to the sequence of movements used in physical therapy. The workout begins and ends with active relaxation of all muscles. During training, alternating tension and relaxation of certain muscle groups is provided. Relaxation is given before a movement that requires relaxation of the muscle group that has just performed the movement.

For example:

I can mentally clench my fingers into a fist.

Now I relax the muscles in my arm.

All my muscles are relaxed.

The feeling of tightening my fingers has disappeared and I can freely straighten my fingers, spread them, connect them, even oppose the first finger to the second, third, fourth, fifth.

In period III, as in period II, the lesson begins and ends with complete muscle relaxation.

Imaginary tasks and instructions for performing a particular movement must correspond to the tasks and instructions included in the physical therapy lesson.

If the patient has all active movements, it is advisable to use autogenic training on the topic “arm, leg, strong”, where self-hypnosis formulas for muscle strength should alternate with relaxation formulas.

Demidenko T. D., Goldblat Yu. V.
"Therapeutic exercise and autogenic training in the residual period of cerebral stroke" and others

The consequences of a stroke in a patient are determined by the presence of spasms in the arms and legs. Behavioral characteristics are subject to great change. It becomes difficult to communicate with such a person, depression appears.

After an illness, the patient may refuse to eat or exercise for days on end, and be active in everything that happens around him. The mood changes: from a strong feeling of anger to completely unexpected fun and joy.

Behavioral disorder

The right hemisphere is responsible for the psyche and behavior; the zone of mental functions is located there. Its defeat occurs with an extensive impact of a right-sided stroke, which is determined by instantaneous pathological processes in the cerebral cortex during stroke.

Depression in people after a stroke occurs due to their own incapacity, the inability to live normally and fully. It seems that no one needs them, even the world becomes different from how it was felt before the stroke. Make sure that the patient does not become depressed or have suicidal thoughts.

More often, a changing internal state is associated with mental disorders when the patient is confused about recent events. This is possible if the patient's initial rehabilitation took place after a severe cerebral hemorrhage.

Most people have trouble sleeping as a result of a stroke; victims wake up several times a night. Due to insufficient sleep, there is a sharp jump in the emotional state; at these moments they become more aggressive, uncontrollable by others.

Social and psychological adaptation

The period after a stroke is especially acute for those who, before the illness, were engaged in active activities or were in a high position. This age ranges from 25 to 60 years:

Such a person finds himself in a pathological state when even basic actions and skills become complex:

They are unable to answer simple questions due to the weakness of the facial and articulatory muscles responsible for the control and correctness of speech.

There is no need to be offended and shout at such a person if for some reason he does not want to answer requests or do simple exercises. So that a patient after a stroke can feel love from his loved ones, pay him more attention by giving him small tasks around the house.

It is important that a person undergoing rehabilitation after a stroke is surrounded by people. This is achieved if the patient is admitted for treatment to a sanatorium center for the rehabilitation of insular patients.

Communicate and encourage the patient more often. Give him faith in a speedy recovery. Together, remember the fun moments from your life together. In particularly difficult circumstances, seek the help of a psychotherapist.

At retirement age, you can engage in various types of home hobbies: learn to knit or sew toys for your own grandchildren from colored scraps. Such people should go outside more often, to various city events or exhibitions.

The role of psychological assistance

The help of a psychologist after a stroke mainly consists of helping a person learn to control his actions and behavior in society. Reduce depression and anxiety, increase the volitional side of behavioral factors, overcome difficulties on your own.

Together with psychological consultation, the patient’s perception processes are improved. The attending physician prescribes drugs with sedative properties, which improves blood flow to the brain and increases the mental abilities of a stroke survivor.

Thanks to this approach in the treatment of stroke, the doctor, based on the results of the psychological conversation, determines a specific algorithm for further rehabilitation. Selects appropriate medications and the most appropriate advice when caring for a patient at home.

It consists of correcting instability of behavior, which manifests itself for the following reasons:

Damage to areas of the brain responsible for the cognitive side of thinking after a stroke. The patient is unable to assimilate new information and cannot remember scenes from his life before the illness. The patient does not determine a specific position, it becomes difficult for him to reproduce simple words, his train of thoughts becomes less adequate.

Resolves issues related to volitional character, which is necessary for patients during the period of rehabilitation of motor disorders after a stroke.

Acalculia, at the time of such a sign of a stroke, the patient does not determine where it is less or more.

Helps identify existing gnosis disorders. When the patient does not recognize familiar faces. Including concepts and shapes of objects turn out to be difficult. Has disorientation in his own sensations, where the paralyzed arm or leg is located. People in this state are unable to remember why they ended up in the hospital. Due to speech disorders, a sick person gets confused in the name of an object.

Psychological counseling at home

Work with a psychologist at home is carried out according to the progress of the patient’s treatment in the hospital.

If in a hospital a psychological course takes place according to a scheme of 1 to 1.5 hours per lesson, conducted once or a couple of times within one week, then after discharge the patient can communicate with a psychologist at home, at least 10 times in 6 months.

This will allow you to observe how a person behaves after a stroke before and after psychological counseling.

At the beginning of rehabilitation

The patient does not have a real picture of what is happening to him. Therefore, even after a partial return of lost functions, the patient is not always fully aware of what happened. When caring for such a person, relatives need not only to monitor his hygiene and exercise, but also pay attention to changes in his behavior:

The patient is crying or depressed.

The patient does not behave too actively and denies the presence of ailments. Refuses to do physical exercise and is often nervous.

Such people who, due to the significant consequences of a stroke, begin to worry too much about their well-being, feel useless.

Only positive emotions can be useful, and in no case reproach or resentment.