One of dangerous consequences A stroke for a person is complete or partial paralysis of the body. The second option is easier to deal with, especially if the upper limb is paralyzed. We will discuss how to properly restore a hand after a stroke in the material below.

Lack of sensitivity in the hands after a stroke - how does this happen?

Initially, before restoring a limb after apoplexy, it is necessary to understand the mechanism of development of paralysis. A stroke is a sudden and sometimes long-term disruption of blood flow in the vessels of the brain (in a certain area). It is difficult to predict which hemisphere it will be and which part of it. In turn, impaired blood circulation in the brain is formed either as a result of rupture of an artery or as a result of its thrombosis. As a result, neurons (aka cells) of the brain, along with blood and red blood cells, do not receive enough nutrition, and therefore oxygen. At this moment their death begins. Brain cells responsible for the mobility of the upper and/or lower limbs, mobility of facial muscles, functioning of sensory organs, etc.

Important: a less favorable prognosis for recovery in patients with paralysis of the left side of the body, since in this case the right hemisphere brain With this pathology, the patient’s speech is not impaired, which complicates the primary diagnosis, and therefore takes away from the patient precious time. The longer the patient does not receive first aid, the greater the consequences will be, and the more difficult the recovery will be. Therefore, if the patient’s left hand after a stroke, recovery should be more persistent and lengthy.

Causes of upper limb paralysis

Partial or complete paralysis of the upper limbs in the patient occurs against the background inflammatory processes in the area of ​​the left hemisphere of the brain, frontal lobe or cerebellum. They are responsible for high-quality motor activity of the limbs. Moreover, the patient may experience both complete immobility of the limbs and partial disturbances in the form of tremor, lack of response to external stimuli, and partial hypotonicity of the arm muscles.

Doctors distinguish two types of paralysis:

• Central. Formed against the backdrop of a failure of the entire nervous system after a stroke.
• Peripheral. Here only some nerve endings are affected.

Important: recovery period for a patient with arm paralysis it can take up to 1.5–2 months. However, the result is worth it.

Types of paralysis

Before you begin rehabilitation therapy and exercises for the hands and fingers for a stroke, you should be prepared for the fact that rehabilitation for older people is somewhat more difficult. The fact is that side effects limb paralysis are also decreased muscle tone, bedsores, and muscle paresis. All this will have to be dealt with comprehensively. However, doctors advise starting to work with the patient’s arm literally on days 2–3 in order to avoid additional thrombosis in insensitive limbs.

When the left side of the body is paralyzed, the patient experiences the following types of numbness and decreased sensitivity:

• Hepaesthesia. Characterized by decreased sensitivity of the entire left side of the body.
• Hemiplegia. Paralysis of the left leg and arm. Sometimes the facial muscles are affected.
• Hemianopsia. Decreased vision or complete loss of vision.

Important: left-sided paralysis is observed in patients with stroke more often than right-sided paralysis.

For paralysis right side The patient's body exhibits the following types of paralysis:

• Synkinesis. Spontaneous twitching and movements of a paralyzed arm or leg.
• Motor aphasia. Speech disorder, complete or partial.
• Paralysis of facial nerves and muscles.
• Movement coordination disorders.
• Difficulties in ability logical thinking, writing and reading, memory disorders.

Treatment

When a person has apoplexy, the transmission of nerve impulses is disrupted. the main task rehabilitation measures - to restore the hand’s ability to receive these impulses and send them back to the brain. To do this, it is necessary to restore blood circulation in the hand and metabolism in its cells. It is for this purpose that special massages, gymnastic physical therapy exercises and exercise equipment for the arm after a stroke.

Advice: All manipulations during a patient’s recovery after a stroke must be consistent and systematic. In this case, it is advisable to carry out the entire complex of therapy at a temperature that is comfortable for the patient, but not in a hot room, but in a slightly cool room. And all exercises that relieve muscle spasms should be done only while exhaling.

Therapeutic actions

Upon appointment drug therapy To restore the body, a patient after an apoplexy is prescribed the following drugs:

1. "Lioresal" (aka "Baclofen"). The drug actively inhibits the transmission of nerve impulses that lead to contraction of the arm muscles. As a result muscle tone subsides, and the muscles are ready to receive a massage. The pain subsides.
2. "Tizanidine." The drug has a similar effect to the first one, eliminates pain, but the effect of its use lasts much less. Therefore, most often “Tizanidine” is used to relieve symptoms, but not for quality treatment.
3. Klonopin or Valium. They also actively reduce muscle spasticity.
4. Phenol. Neutralizes muscle spasms.
5. Botox injections. Also works against spasm. Injections are given into the spine or arm muscle.

Hand massage

First of all, when restoring a limb, it is necessary to restore relative sensitivity to it by restoring blood circulation. To do this, you will need a massage course lasting 20–25 sessions. Massaging light hand with stroking and kneading movements, starting from the shoulder and moving towards the hand and fingers. The purpose of this direction is the movement of blood flow from the main artery to small capillaries and vessels.

It is forbidden to use intensive kneading and rubbing. This can injure spastic arm muscles. start lung massage spiral and zigzag movements. You can gradually increase the intensity, but without special effort. Finish the hand massage on the fingers of the limb.

After the massage, it is necessary to work on all joints. At first she will be passive. Work begins from the shoulder joint, moving to the joints of the fingers. Each point should have 5–7 circular or flexion-extension movements.

Important: Any restorative exercises, including massage, should be started on the healthy side of the body. This will activate the areas of the brain responsible for body mobility. In this case, the patient must send mental commands to the immobilized hand and remember the process of its movement. When performing a massage, you can also use a special massager.

Gymnastics for the arm

After the relative sensitivity to the hand returns due to the course of massage, you can move on to special exercises that strengthen muscle tone. They start by developing the shoulder muscles and joint. The complex looks like this:

• Abduction of the arm. Take any weight and try to raise your arm to shoulder level. Then move your hand to the side and lower it. Initially, the patient may not be able to cope with the task. It is necessary to help him and raise his hand so that the patient can hold the weighting agent himself. At first, you can start the complex without it until the muscles are in good tone.
• Flexion. Raise your hand with the weight up and lower it to the starting position. It is not necessary to use a weighting object at first. Each exercise should be performed 5-10 times on each hand.

In order to develop the elbow joint, there is the following set of exercises:

• Bend the arm at the elbow from a standing straight position. Performed first without a weighting agent, then with it.
• Bend your torso forward, move your elbow back and bend and straighten your arm at the elbow. Each exercise is done 5-10 times.

Advice: Initially, you can purchase an orthosis for the patient - a special device-bandage for fixing the joints of the hand. Orthotics have proven themselves very well today. The price of such a retainer is quite reasonable and averages 3,300 rubles and more.

Hand and finger exercisers

To develop the hand and joints (to restore hand function), you can use special hand trainers to help improve fine motor skills. You can use the following:

• chess and checkers;
• Rubik's Cube;
• constructor;
• puzzles;
• plasticine.

Additionally, you can collect matches or buttons scattered on the table. However, before re-developing fine motor skills, you need to develop your hand well. To do this, after the massage you need to perform the following exercises for the hand after a stroke:

1. Rubbing and kneading the fingers. Light stroking is permissible from the palm side.
2. Rotations of the hand. Place your palms on your knees and try to turn them palm side up and then return them to their original position. The frequency of the exercise is 10 times.
3. Raising your fingers. The hands are placed on the knees, palm down, and try to lift each finger in turn from the thumb to the little finger and back.
4. Spreading fingers. You need to try to push them apart as wide as possible and bring them back.
5. Bringing your palms together.
6. Clenching your hands into a fist.

Important: Let’s not forget that we do all the exercises for the healthy arm, too, starting with it. It is worth knowing that if your hand begins to swell and swelling appears, you should consult a doctor. A muscle may have been injured during exercise.

After the relative sensitivity and performance of the paralyzed hand has been restored, you can begin to strengthen the tone of the arm muscles and develop the wrist joint. For this you will also have to take a weighting agent. A set of exercises for hands looks like this:

• Rotations of the hand. Take weights in both hands, pull your arms towards you, bending them at the elbows, and begin rotating your hands in one direction and the other.
• Movement of the brush down and up. Take weights in both hands and try to lift your hand up and down.

In addition to the complex, you can use a rubber band. They tie him to the door handle and pull him with maximum force with his hand that has lost sensation.

Advice: you can contact your local outpatient clinic for exercise therapy for use there special equipment, intended for the recovery of post-stroke patients.

Folk recipes

To help the body of a patient who has suffered a stroke, you can use some folk recipes treatment. They improve microcirculation, improve metabolism, normalize muscle tone and accelerate the transmission of nerve impulses.

You can use the following tools:

• Herbal tea. To prepare it, you need to take 100 g of birch buds, chamomile, caraway and St. John's wort. Ready mixture Brew a glass of boiling water in the amount of one tablespoon and leave for an hour. Then another 300 ml of boiled cooled water is added to the finished mixture. Bring the whole mass to a boil, but do not cook. Strained tea is drunk warm twice a day - in the evening and in the morning before meals. The course of such treatment is 30 days.
• Mumiyo and aloe juice. Combine 50 g each fresh juice aloe and 5 g mumiyo. Take one tablespoon of the prepared mixture before meals twice a day. The course of such therapy is two weeks.
• Mumiyo in pure form. It is recommended to eat 0.4 g of the product twice a day. You can drink mumiyo with a small amount warm water. The course of therapy is 10 days. Then you should take a five-day break and repeat the treatment again.
• May honey, mint and tea mushroom. To prepare the product you need to take 5 ml of tincture peppermint, one glass of honey and 60 g of tea mushroom tincture. All components are combined and stored in a dark place for 10 days. After the expiration date, you can take the product in the amount of one tablespoon three times a day.

Any recovery and rehabilitation measures for a patient who has suffered a stroke must be coordinated with the attending physician. Perhaps he will make some adjustments as the patient recovers. With a certain perseverance of the patient himself and the person helping him, success in rehabilitation after a stroke is ensured.

Partial paralysis of the limbs. When a hand is affected, a person’s ability to self-care is significantly reduced. Violations fine motor skills create many difficulties in the simplest things - such as turning on and off the light, tying shoelaces, fastening buttons. This article will discuss the question of how to restore a hand after a stroke if its functions were damaged (loss of sensitivity and mobility, weakness).

Tasks of complexes for hands

For this purpose, there are specially developed complexes of physiotherapeutic measures designed to at least partially restore lost functions. A specialist should recommend a specific complex suitable for each case. The specialist monitors the rehabilitation while the patient is in the hospital. Upon discharge, control passes to relatives. The main tasks of hand restoration after a stroke are eliminating problems:

• muscle spasticity;
• circulatory disorders;
• contracture;
• paralysis;
• atrophy.

A characteristic feature is that the arm recovers more slowly than the injured leg. The reason is that the affected arm is freed from work, while the leg is in similar situation forcedly continues to receive load when moving. Restoring a hand after a stroke is a long, labor-intensive process in which you should not expect quick results. But with some persistence, it is possible to return the lost functions, sometimes in full. In addition, finger exercises help activate the brain.

Start of exercises

At the beginning of the exercises, the help of another person is necessary - especially when mobility is completely lost.

At the same time, the assistant smoothly bends and extends the arm alternately at the shoulder, then at the elbow and hand. The patient himself tries to control his hand. With proper persistence, after a certain period of time you will actually be able to begin to move your hand a little.

There are separate tasks for independent completion. At first it is easier to perform them with eyes closed. Position - sitting or lying down, relaxed. Approximate sequence:

• imagine that the hand is listening, remembering the feeling before the loss motor activity;
• mentally “put” the sensation on your hand and try to feel control;
• try to move at least a finger.

Gradually, the movements will become better, and their amplitude will increase. The most important thing is not to stop studying and not to despair in the absence of quick results, or if progress is slower than predicted.

The first problem faced by the patient is muscle spasticity. It is caused by long immobility after a stroke, as a result of which the muscles shorten somewhat and lose elasticity. There are a number of rules to combat this phenomenon:

• change the position of your hand regularly during the day - approximately every 1-1.5 hours, avoiding staying in one position for a long time;
• During the day, perform stretching exercises and warm up your joints;
• Maintain a warm room temperature for the first time, remembering that lowering it increases spasticity;
• To get used to cold temperature gradually, but without fail;
• movements with only stroking;
• Before starting the exercises, rub and stretch the fingers of the paralyzed hand for 15-20 seconds.

Tasks are divided into passive (performed with an assistant) and active (independent). The complex should include both. All exercises are performed while exhaling.

Important points

Training will bring maximum benefit if you remember some points:

• • the work begins with the healthy side, this activates the areas of the brain responsible for the movement of the limbs. Concentration of attention on the limb is mandatory;
  • mandatory participation of the patient in - when performing them, be sure to mentally send an impulse to the diseased limb;

• daily change of tasks - either making them more difficult or replacing them with others;
• carrying out movements in full - this increases the patient’s self-confidence and helps in recovery;
• the use of objects in training - both those specially designed for gymnastics and household objects;
• training first the large flexor and extensor muscles, then the development of fine motor skills;
• after mastering simple exercises you can move on to composing more complex ones, which will require not only coordination, but also the use of memory, which is also beneficial in the post-stroke period.

The principles of rehabilitation are based on the activation of the patient’s volitional activity. After the first movements in the hand appear, further recovery will gradually occur. The main condition is to continue to do gymnastics regularly after a stroke.

Massage

The massage begins with the healthy hand. Movements should be quick, rubbing, not causing painful sensations.

Hand massage

After the feeling in the hand returns, it is recommended to continue working with the fingers, as this activates the brain. As success develops, your fingers begin to warm up. To restore fine motor skills, you can use a small bubble ball.

An effective exercise: first spread your fingers wide and then clench them into a fist. The load should gradually increase. Then they move on to training the muscles of the shoulder girdle, which are responsible for raising and lowering the arms.

What determines the speed of recovery?

For each patient, it is selected individually by a specialist who knows how to develop a hand after a stroke. Recovery time depends on a number of factors:

• what kind of stroke occurred and on which side;
• degree of damage to brain tissue;
• timely start of treatment;
• techniques and drugs used during the rehabilitation period;
• whether a conversation was held with a psychologist, and how successful it was.

For minor brain injuries, recovery takes little time. In case of serious damage, the count can last for years.

At the end of rehabilitation, you can help the patient by engaging in simple hobbies based on active use motor skills. Good effect give games of chess and checkers, beadwork, folding mosaics, puzzles, construction sets with small details, crafts from colored paper, origami.

Sports activities are also useful - you just need to watch the dosage of the loads. Cycling, light jogging without obstacles, and Nordic walking have a beneficial effect.

ethnoscience

Before Using Methods traditional medicine It is required to notify the attending physician and obtain his consent. Some tools actively used:

• hand ointment based on pine needles and bay leaf;
• tincture of mountain arnica flowers;
• honey and royal jelly;
• herbal preparations based on mint, motherwort, St. John's wort, etc.;
• compositions based on Japanese sofra.

It happens that it is not possible to fully restore physical activity at home. In this case, a sanatorium-resort course in a specialized sanatorium can help. There, qualified care is provided, classes are held individual program, including exercise therapy. Doctor-led rehabilitation goes where faster. Often, medical institutions also conduct massage courses, which will come in handy later.

Video

Exercises for hands

Good day, friends. Often, after a spinal injury or stroke, a person’s hand and steering wheel are partially or completely paralyzed, which, as you understand, does not allow you to carry out your usual activities and is extremely disruptive.

Exercises for the hands I won’t describe it in detail, everything is shown in detail below in the video (it’s better to see it once), I’ll just add that in addition to exercises for the hands, you should definitely do exercises for finger motor skills that help restore movements, sensitivity and certain areas of the brain.

Also, with paralysis of the hand, it is not possible to simply tie shoelaces; to train this skill, there is a special sneaker with lacing on which you need to learn these movements.

Must be fulfilled previously familiar movements such as turning the light on and off, closing the door, tightening the nuts and much more. In hospitals, as a rule, there are special stands with imitation of these exercises for the hands. where you can hone these actions, and in rehabilitation centers there are robotic mechanotherapy simulators, such as in the center of Sestroretsk.

In principle these exercises for hands enough, the main thing is to do them regularly. Let me remind you once again about the video at the end of the article, which shows in detail how, for example, to perform a set of exercises.

I would like to add something: if you live in Moscow and have problems with your teeth, I recommend you a good dentistry on Serpukhovskaya.

Restoring hand movements after a stroke

Return to normal life It’s possible - you just need patience and work on yourself

The consequences of a stroke depend on the individual case. One may lose speech, another may lose memory, and so on. These processes can be restored using special techniques. In this article we will look at what can be done if problems with the arm begin after a stroke.

Before this, it is worth noting that correct instructions regarding activities related to the restoration of the arm, it is necessary to consult a physiotherapist, because he will be the one who will be able to select the most suitable complex for a particular person. Also, you should not think that the result will be instantaneous. Sooner or later, it will happen, the main thing is not to give up. It is possible that the functionality of the hand will be fully restored, but before that you need to try very hard.

In total, restoration of hand movements after a stroke is aimed at eliminating the following problems:

• muscle spasticity;
• paralysis;
• contracture;
• atrophy;
• circulatory disorders.

After a stroke, a person whose arm mobility is impaired first faces a problem such as muscle spasticity. Because the muscles for a long time were motionless, they lost their elasticity and shortened a little. Muscle tone increases due to paralysis. And because of this, spasticity occurs, manifested in stiffness and limitation of movements. There are several recommendations that, if followed, will help combat this problem.

Need to change hand position frequently

No need to let your hand long time was in the same position.

You need to perform exercises several times a day to stretch your muscles and warm up your joints.

The room should be maintained at a comfortable temperature, as low temperatures slightly increase hand spasticity and discomfort.

TO low temperatures you should also get used to it. There is no need to strive to warm conditions have become an integral parameter for normal living.

Any exercise, active or passive, must be performed along with an extended inhalation. This means that exercises for spastic, that is, tense muscles, must be performed while exhaling.

Passive movements, indicating the presence of an assistant, are performed in one direction and in one plane.

Muscle massage, which involves increasing tone, is performed only by stroking.

Start

Rehabilitation needs to start with someone's help

The first movements will most likely be performed with an assistant. He needs to carefully and smoothly bend and straighten his arm at the shoulder, then at the elbow and hand. He will also bend his arm back and forth, side to side, and in other ways. The assistant should be told to perform the movements with the patient's hand that he would perform himself. At this time, the patient himself should try to begin to control his hand, mentally helping the assistant. Thanks to this, after a certain period of time, the feeling that the hand can be controlled will begin to appear. Even if you only manage to pull your hand, it will already be a small victory.

There is an exercise for you to do on your own. To do this, you need to lie down or sit down, relax and close your eyes. It is advisable to imagine that the hand is obedient. It’s easier to do this if you remember the feelings before the stroke. It is advisable to imagine a mental picture of how the hand is freely controlled. Then this picture should be, figuratively speaking, “superimposed” on a real hand and try to feel control. If even one finger moves, it is already a success. But you shouldn’t stop, you need to move on, and then two fingers will move, then the hand, and so on.

It must be remembered that these are just examples of the first movements of the hand. They depend on the type of stroke, its severity, and other factors. Recovery of the arm is slower than recovery of the leg because the latter occurs somewhat unnoticed. This is explained by the fact that the affected leg is used in one way or another to make necessary movements, for example, walking around the kitchen, to the toilet, and so on. In comparison, the affected hand is freed from work, which is completely transferred to the healthy hand.

Additional exercises

Massage is an integral part of rehabilitation

Additionally, you can do a massage. The main thing is that it brings pleasant sensations, not pain. You can start the massage with a healthy hand, after which you can move on to the paralyzed hand. Let the movements be fast, but not forceful. It is better to perform massage twice a day - in the evening and in the morning, lasting from ten to thirty minutes.

After the hand begins to feel, it is advised to continue exercises with the fingers, because their activities are connected with the brain. Again, you should remember how they moved before the attack, and then you should try to move them. At first the movement will be very small, but gradually it will increase.

After the result is more obvious, you can begin to stretch your fingers. You can do this using massage movements on each finger separately. Then it is advised to do next exercise: The fingers in the hands are spread wide and then clenched into a fist. This must be repeated several times, gradually increasing the load.

Then you can move on to training the muscles of the shoulder girdle, since that is where they are the most developed. They are responsible for raising the arm and lowering it. During training, it is important to learn new movements without concentrating only on raising your arm. For example, you can imitate the flight of birds. Even if some exercises look funny, the main thing is that they give the expected result.

It is recommended to use a swing to strengthen the shoulder girdle. For example, you can push off from a pillar with your hand. If you change the angle of bend of the arm, different muscle groups will be loaded.

ethnoscience

You can use traditional medicine methods. However, you should also consult your doctor about this. Here are some examples folk ways recovery.

1. Royal jelly and honey.
2. An ointment based on pine needles and bay leaves, which is rubbed into the affected hand.
3. Tincture of mountain arnica flowers.
4. Medicine based on Sophora japonica.
5. Collection of herbs from motherwort, mint, St. John's wort and so on.

A recovery course in a sanatorium would be a good idea

It may not be possible to return your hand to its previous state of activity at home. Then it is best to undergo a recovery course in a specialized sanatorium, where you will be provided with good care and passing all necessary procedures. In addition, you can enroll in courses special massage, which will be carried out by experts in their field. Let us remember that one of the goals of the hand restoration process is precisely the restoration of blood circulation. Massage helps with this. Thanks to good blood circulation, arm activity will be restored much faster.

Under the supervision of an experienced doctor, recovery will be much more effective. Of course, you need to look for and ask for new methods of recovery, but it is best to discuss all your actions with your attending physician, who, taking into account the characteristics of his patient, will choose the most best ways restoration of motor activity of the hand.

Exercises to restore finger mobility

A stroke is usually accompanied by paralysis (paresis) of one side of the body. Accordingly, in addition to the classification of strokes according to other criteria, for example, causes: ischemic and hemorrhagic, there is a difference in strokes according to the side of the body that was affected by paralysis: right-sided and left-sided strokes.

In most cases, paralysis of body parts is temporary and after a certain, usually short time, their mobility and functions can be restored. Human rehabilitation activities after a stroke are devoted to restoring the functions of body parts.

To restore the functions of the hands after a stroke, there are exercises that I would like to offer to your attention. These exercises are quite effective. With their help, I restored the mobility of my left (I have a left-sided stroke) arm, by a subjective estimate of 80-90 percent.

I received the list and type of these exercises from the doctor who was engaged in physical therapy in the hospital where he was treated immediately after a stroke.

The pictures describing exercises for the fingers after a stroke did not seem very informative to me, so I took photographs of these exercises.

The final restoration of normal function of the injured hand consists of increasing the strength of the hand during movements and giving these movements precision.

To restore the accuracy of movements in the hand, it is necessary to eliminate all phenomena of characteristic spasticity through correct positioning.

Movement in the shoulder and elbow joints should be restored first. The muscles of the paralyzed arm should be strengthened with active exercises.

The patient should be taught to support, fix the paralyzed arm and make movements in space from various positions, leaving the hand free to perform the functional movements described below (Fig. 85).

• hold a rolled up towel (stick or rope) in front of the patient;
• teach the patient to grab the towel and let go of it; and/or
• grab the towel with your hands from bottom to top;
• the paralyzed arm should be straightened and extended forward (anti-spastic position);
• the patient holds his hand against yours (palms touching without pressure) and follows the movements you perform (Fig. 85.1).

In order to facilitate hand movements, the patient should be advised to think about the movements he performs in the corresponding joints. Remember that all your commands should be slow and clear (for example: “Think about your elbow..., look at it..., help me bend it..."). If the patient cannot follow the commands, demonstrate the required movement yourself.

Rice. 85-85.1. Increasing arm strength after stroke

It's best to start with a simple sequence of movements or a series of actions. It is necessary to encourage the patient to independently repeat these movements many times. The effectiveness of the movements can be enhanced by matching pressure with the hands (from the base of the palm through the straightened elbow to the outwardly rotated shoulder).

Let the patient hold various items And plastic materials(for example, plasticine or modeling wax, molding clay, pieces of rubber different shapes, balls different sizes etc.). This will allow him to gain experience in handling objects different weights, shapes and structures. The patient will have to train different ways picking up and holding objects. Remind him that he must perform all exercises alternately with both hands.

Exercises to develop precision of hand movements.

When performing movements with the hand of a paralyzed arm, its elbow should rest on the table (see Fig. 44, 45) until normal muscle tone is restored in the arm.

The patient should practice the following movements:

• clenching the hand into a fist;
• flexion/extension of the arm at the elbow joint;
• flexion of the hand at the wrist joint forward/backward;
• rotation with a brush;
• folding the hands with the palms straightened and spread apart, including the thumb (the healthy hand helps the movements of the paralyzed hand);
• connecting the fingertips of both hands and pressing them against each other;
• rolling the palms over a cylindrical object (bottle, jar);
• connecting the fingertips as for grasping objects;
• precise movements, including taking small items(for example, when building a toy tower from small components), pinch grips (as when grasping a pen).

The patient sits with his elbows on the table. Both palms are joined and clenched, and the fingers are straightened:

Extension of the paralyzed palm is trained. At first, these movements are performed passively with the help of the healthy hand (see Fig. 48), and then gradually more and more actively, and now the healthy hand provides increasing resistance (Fig. 85.2).

Rice. 85.2-86. Wrist extension

Ask the patient to stand at the table (as shown in Fig. 41.1). In this case, you need to be sure that the weight of his body is accurately distributed on the correctly positioned arm (shoulder turned outward, elbow and palm straight):
. ask the patient to roll an object made of some soft material on the table, pressing it with the palm of his hand. When the object moves away, the fingers straighten, and when it comes back, they relax and bend slightly (Fig. 86).

In the same position of the patient, the palm of the paralyzed hand is pressed against the surface of the table, all fingers are open and straightened.

The patient extends the hand and lifts it off the table. The base of the palm remains pressed to the surface (Fig. 87).

• both hands of the patient are connected with palms; all fingers are straightened. The hand of the affected hand is bent forward, the healthy hand is used to create measured resistance to its movements (Fig. 88).
• The forearm of the paralyzed arm lies on the table, palm facing down. The patient flexes the hand, raising the palm up and leaving the fingers in contact with the surface of the table (Fig. 88.1).

Rice. 87-89. Wrist flexion

Transferring body weight to your fingertips

. the patient stands in front of the table. The pads of the fingers, including the thumb, are pressed tightly to its surface. The patient leans on his fingertips and gradually increases the load on them with the weight of his body, while controlling their position (Fig. 89).
. the patient tightly grasps a small ball with his palm and then releases it, opening his palm and straightening his fingers (Fig. 90).

Rice. 90-91.2. Bringing and spreading fingers

Thumb Opposition:
. bending thumb, the patient alternately touches the pads of the remaining fingers with its tip (Fig. 91);
. patient in healthy hand holds a piece of some spongy substance (for example, foam rubber) and plucks it off with the fingers of a paralyzed hand small pieces. To grasp, the thumb and index, thumb and middle, etc. fingers are used in turn (Fig. 91.1);
. between big and index fingers a piece of elastic material rolls over (Fig. 91.2).

A.P. Grigorenko, Zh.Yu. Chefranova

So the hand exists to move the hand to where it needs to be. If the brush can be used in any way practical way, all the muscles of the arm will work hard for this. In other words, getting your hand involved will help your entire hand heal. But what if your brush isn't working yet? As a rule, the hand is the last of all body parts to be restored. Hand healing usually begins in the muscles and joints closest to the body and works its way down the limb. In people who have had a stroke, movements are usually restored in the following order:

1. muscles that move the scapula;
2. muscles that move the shoulder joint (which allows the shoulder to move);
3. muscles that move the elbow;
4. muscles that rotate the forearm (rotate the palm up and down);
5. muscles that move the wrist;
6. muscles that move the hand and fingers.

Remember that the hand has a greater chance of recovery if the hand is working. But because the hand is the last to recover, it cannot be used to resume movement of the rest of the arm. However, recently researchers, entrepreneurs and bioengineers have begun to study the mystery of the hand. The result of these studies and experiments has been the clinical use of a variety of technical devices, orthopedic devices, instruments and methods designed to “turn on” the hand.

How it's done?

The way the hand is “turned on” depends on how many movements the hand can initially perform. Often, people who have suffered a stroke greatly underestimate the movements of their hands. They tend to think that since the hand has no practical use, any movement of the hand is unimportant. But even a small amount of movement is essential to achieving one goal - recovery.

If you are proficient in any movement at any joint, you can build on it through repeated practice. This method requires you to try again and again to achieve the final amplitude of this movement. For the fingers, this would mean opening and clenching as much as possible. Achieving the final amplitude requires special attention to the final part of both of these movements. Thus, you should open your fingers as much as possible and then try to open them a little more. Next, you should strive to clench your hand into a fist as tightly as possible.

The movement with which you open your hand may be nothing more than the ability to relax your fingers enough to allow them to open. Being able to relax your fingers and open them up a little is important because “it takes two to tango.” The muscle that opens the fingers must be activated, but it is equally important that the muscles that close the fingers relax. It is this “dance” different groups muscle tension is a problem when you try to open and then close your hand. Once you can straighten and bend at least one finger, repeat these movements for as long as you can. Do this while watching TV, talking on the phone, everywhere and always. With a certain amount of luck, other fingers will follow, and eventually the thumb, if you try to clench and unclench them again and again.

But what if you don't have any movement? Or, as is the case with most people who have had a stroke, you can make a fist but cannot unclench it? In such situations, various devices and devices are designed to help.

• One type of machine you can try uses cyclic electrical stimulation. IN in this case This is electrical stimulation to activate the muscles that open the hand. These muscles are located on back side forearms. The device stimulates the hand to open and then stops the stimulation. It typically cycles on and off for about five seconds, releasing the hand, and then stops stimulation for about 10 seconds. This machine is relatively inexpensive, and once your doctor or therapist teaches you how to use it, you can do it at home. If assistance is also needed to squeeze the hand, the machine can be programmed to first open the hand and then turn off the stimulation and squeeze the hand.
• Electrostimulation device based on EMG. These devices require some effort before electrical stimulation of the muscles. Here's how they work. The stroke survivor receives an auditory or visual stimulus to open his arm and tries to tense the muscle. As soon as the muscles contract even a little, the stimulation opens the hand. These machines are sensitive and pick up muscle activity even if you cannot see your arm moving. Such devices include Mentamove, Biomove, NeuroMove and MyoTrac Saebo Infiniti.
• Orthopedic device with electrical stimulation. This orthopedic device is a hard plastic that perfectly molds to the shape of the forearm and provides necessary stimulation muscles. It has an advantage over other forms of electrical stimulation in that you can move your arm and hand and perform hands-on activities. The only such device is Bioness H200.
• Spring orthopedic device for finger straightening. This device uses springs and pulleys attached to a rigid orthotic to facilitate finger extension. You can move your arm and hand and perform practical grasping movements. This device helps the fingers release an object after a person has grabbed it. This opportunity is provided only by the SaeboFlex orthopedic device.

Some of the proposed devices require special training medical personnel. To find out where doctors use these machines in your area, you can contact the manufacturer of the machine.

All these devices can ensure that you do not large quantity voluntary movements. Once you have voluntary movements, you can begin to engage in repetitive practice on your own.

Here are two more ways to restore hand movement that do not require the use of any devices.

• Passive movements in the joints. Recent research has shown that passive joint movements begin to gradually rewire the brain. This can serve as an impetus for the start of the neuroplastic process. Neuroplastic changes will be greater as you move independently, but passive movement of the joint can help people who have had a stroke and are in the early stages of recovery. Interestingly, many robots used in rehabilitation, including those made by Myomo, use some passive movement to stimulate recovery. The more movements you can do on your own, the more recovery you will achieve.
• Repeated practice of bending. Although it may not seem to make sense at first, clenching your fingers into a fist helps you regain control of your hand. People who have had a stroke have difficulty opening their hand due to spasticity in the muscles that grip the hand and fingers. Muscle spasticity is caused by too much control spinal cord and poor brain control. Squeezing your hand will force the muscles to work, which helps restore brain control over them. This will reduce muscle spasticity. By choosing this strategy, you are also working on relaxing your hand. So first you have to squeeze your hand and then relax, squeeze and relax. To prevent your nails from cutting into your palm, and to do this in different positions of the hand, squeeze an object. A classic example is a tennis ball. You can also use any toys that can be squeezed or something that passively opens the hand to make the next attempt to grasp the object. Combine repetitive flexion practice with an active stretching program. The fingers should be stretched until both fingers and wrist are maximally painlessly straightened (“prayer hand position”),
• As shown in some studies, mirror therapy triggers the process of activating neuroplasticity in people who have suffered a stroke and are at the initial level of recovery. With mirror therapy, you see the healthy side in the mirror and it seems to you that the movements on the damaged side are quite normal. This therapy can be performed even when there is little or no movement in the affected arm.

Thus, the scheme of work will be as follows: use something (device, technique, etc., as described above) to restore movement at least partially. Repeat it many times. Once repeated practice has provided sufficient movement, you can use therapy forced movements to continue recovery.

What precautions should you take?

Any type of repetitive practice requires significant effort. You force your muscles and brain to work in a “new way” (if you count down the time from a stroke). Your muscles and brain change. This transformation requires a lot of energy. Fatigue often causes you to pay less attention to safety, which increases the risk of injury, which in turn can interrupt the recovery process. Make sure you are well rested.