Treatment of stroke in a hospital: length of stay of the patient in the hospital. Diagnosis and treatment of stroke in Moscow

Risk factors for stroke and heart attack

Planning a preventative treatment regimen is based on addressing risk factors that are largely similar for heart attack and stroke.

Metabolic risk factors include:

dyslipidemia (impaired lipid metabolism - organic compounds, including fats and fat-like substances);
arterial hypertension;
obesity;
metabolic syndrome;
diabetes mellitus and other endocrinopathies;
coagulopathies (diseases that develop as a result of disorders of the blood coagulation and anticoagulation systems).

Common markers of heart attack and stroke are:

previous cardiovascular diseases;
peripheral vascular pathology;
calcium index;
stress test results;
hypertrophy (thickening of the wall) of the left ventricle.

Atherosclerotic stenosis of the carotid arteries and brain tumors increase the risk of stroke. The provoking factors of a heart attack are:

atrial fibrillation;
dysplasia (developmental disorder) of connective tissue;
arteritis;
diabetes.

Although the incidence of stroke is higher in men, it is more severe in women, and about half of deaths from stroke occur in women.

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Signs of a stroke

To diagnose cerebral blood supply disorders, it is necessary to use stroke recognition techniques:

When trying to smile, you need to pay attention to the corners of the mouth - in case of a stroke, it can be directed downwards, the smile looks crooked and asymmetrical;
When trying to speak, it may be difficult to pronounce even the simplest words and sentences;
When trying to raise both arms, asymmetry is observed;
The protruding tongue falls to the side.

If at least one of the symptoms is positive, you must immediately call an ambulance. Under no circumstances should you give him water, feed him, lift him, or take him by handy transport to the nearest hospital, as this can cause harm.

For lower limbs

Exercises for the lower extremities begin to be performed as soon as the patient regains consciousness. At the initial stage, the instructor helps to bend and straighten the lower limbs; over time, the patient will be able to imitate walking in a prone position, then get out of bed, learn to maintain balance, and walk without support. Exercises for patients in the supine position:

The patient is in a supine position, the leg is straightened. The instructor turns the leg with the foot inward, then outward.
The patient is in a supine position, the leg is bent at the knee. Holding one hand under the knee, the instructor performs circular movements with the limb, holding and pressing with the other hand in the hip joint area.
The patient is in a supine position, the affected leg is bent at the knee. The instructor fixes the leg at a right angle, holding it with the other hand under the knee, bends and straightens the lower limb.
The patient is in the same position on his back, with the leg fixed at a right angle. The instructor, holding the patient's leg under the knee, moves it away from the body and returns it back.

These exercises are performed by the patient after he is allowed to sit:

In a half-sitting position, holding the edges of the bed with both hands, stretch both legs forward as evenly as possible, bend over, throwing your head back. While stretching your limbs, take a deep breath, return to your previous position and exhale.
Remain in the same body position, keep your breathing calm and deep, slowly lift your right leg up and lower it back, then your left leg.
In a half-sitting position, bend your leg, pull your bent leg at the knee as close to your chest as possible (you can help with your hands), and tilt your head forward during the exercise. Bending the leg, inhale, straightening the limb, exhale, return to the previous position.

Help in the acute period

Which doctors are needed in the treatment of stroke depends on the period of the disease, but in any case, they must be experienced, highly qualified specialists who know how to properly provide assistance in this situation.

When diagnosing an ischemic stroke in a patient, the doctor’s goal is to restore blood supply with subsequent rehabilitation. This may require blood thinning medications or mechanical removal of the clot using a catheter. To remove atherosclerotic plaques, endarterectomy is performed, and to increase the diameter of blood vessels, plastic surgery with stenting is performed.

Passive and active rehabilitation after stroke

The first classes with the patient are conducted by a physical therapy instructor in the ward. The patient performs simple movements with his arms and legs with the help of an instructor - this type of rehabilitation is called passive. Passive rehabilitation of the upper and lower extremities begins with the development of large joints with a gradual transition to small joints. Rehabilitation therapy begins with the shoulder and hip joints. After developing the hip joint, the instructor helps the patient flex and extend the lower limb, develops the knee, then the ankle joint, and lastly the doctor develops the joints of the foot.

The rehabilitation specialist performs massage from the foot to the thigh. During hand rehabilitation, exercises begin with the development of the shoulder joint, then flexion-extension and rotational movements of the hands are carried out in the area of the elbow and hand joints. Massage of the upper limbs is performed from the fingers to the shoulder. A set of exercises combined with massage stimulates brain function. With partial restoration of motor function, exercise therapy exercises become more complex, and the patient begins to perform the exercises independently. The time for gymnastics increases from 10 minutes to half an hour, and active rehabilitation of the patient begins.

If the brain damage is significant, the patient is paralyzed, sensitivity is lost, rehabilitation is carried out with the help of medication, massage, electromagnetic stimulation of nerve cells, acupuncture, and reflexology. After partial restoration of motor function, the rehabilitation doctor introduces therapeutic exercises into the program.

How long to stay in hospital if you have a stroke

Poor blood circulation in the brain, in other words, stroke, treatment involves three stages:

prehospital;
stay in the intensive care unit;
treatment in a general ward.

The length of stay of a patient in a hospital, according to treatment standards, is 21 days, provided the patient has no violations of vital functions, and 30 days in case of serious violations. When the length of a patient’s stay in a hospital is insufficient, a medical examination is carried out followed by the development of an individual course of rehabilitation.

All patients diagnosed with stroke are subject to hospitalization. The length of stay in intensive care depends on a number of factors, including:

depression of vital functions;
degree of damage to brain tissue. With a major stroke, patients stay in intensive care longer;
the need for constant monitoring if there is a high risk of recurrent stroke;
severity of the clinical picture;
level of depression of consciousness and others.

Basic and differentiated therapy

Treatment of a patient in the intensive care unit involves basic and differentiated therapy.

Basic treatment is aimed at:

fight against cerebral edema;
restoration of normal functioning of the respiratory system;
patient nutrition;
maintaining hemodynamics at an acceptable level.

Differentiated therapy involves:

normalization of arterial and intracranial pressure, elimination of cerebral edema after hemorrhagic stroke. In the first two days, a decision is made regarding the need for surgery. Neurosurgeons at the Yusupov Hospital daily perform surgical interventions to eliminate the consequences of stroke and save the lives of hundreds of patients. All manipulations are carried out using modern medical equipment using effective proven techniques;
accelerating metabolic processes, improving blood circulation and increasing the resistance of brain tissue to hypoxia when diagnosed with ischemic stroke. The length of stay in intensive care directly depends on the timely and adequate course of treatment.

In most cases, young people recover much faster than older patients.

It is possible to transfer a victim from the intensive care unit to a general ward after meeting a number of criteria:

the patient can breathe independently, without the support of devices;
the patient is able to call a nurse or doctor for help;
there is a stable level of heart rate and blood pressure;
the possibility of bleeding is excluded.

Only after the patient's condition has stabilized can the doctor transfer the patient to the ward. In a hospital setting, various rehabilitation procedures are prescribed to quickly restore lost functions.

In the neurology department of the Yusupov Hospital, patients are not only developed an individual course of rehabilitation therapy, but also given psychological support.

If necessary, psychologists work with loved ones and relatives of the patient to teach them the basics of caring for a person who has suffered a stroke.

Leg exercises

Leg exercises after a stroke are a particularly important process through which the patient can restore the functions of the musculoskeletal system and return to normal life. A set of workouts for developing the lower extremities of the body:

From a sitting position, lean back on the pillow, holding the bed with both hands, while stretching your legs in front of you. After this, it is necessary to begin smooth deflections of the torso while simultaneously moving the head back. Next, the patient makes a deep entrance for 5 seconds, after which he returns to the starting position. The number of these exercises for stroke is from 6 to 8 times.
Sit on a comfortable surface and straighten your legs, then slowly throw your arms back, throwing your head back and straightening your back. Next move your shoulder blades and stay in this position for a few seconds. Repeat the exercise 4 to 6 times.
Bend your legs at the knee joints and lie on the hard floor, then lift them one by one to the chest, holding this position for 10-15 seconds. If necessary, you can help with your hands. This set of exercises after a stroke helps restore the functionality of the hip joints.
Take a comfortable position on your side while bending your knees. Try to spread your knees to the sides as much as possible, holding this position for 10 seconds. It is important that the feet do not come off each other.

In addition to the exercises described above after a stroke, restoring healthy leg function is possible with simpler steps. Thus, the patient is recommended to alternately swing his limbs 3-4 times a day and rise on his toes, holding onto the wall.

Recovery period

The rehabilitation period is aimed at restoring lost functions and improving the quality of life of patients who have suffered a stroke. The doctor develops a rehabilitation program individually for each patient, taking into account the scale of the vascular accident, age, comorbid pathology, etc.

In case of strokes, doctors assign a special role to the prevention of recurrent strokes, which includes proper nutrition, giving up bad habits, eliminating excess weight, and regular monitoring by a doctor.

Is full recovery possible after a stroke?

The patient’s relatives play a significant role in the rehabilitation of a patient after a stroke. It depends on their attention, care, patience and correct actions whether the patient’s lost functions can return.

The recovery process after a stroke is a difficult period, both for the patient himself and for his loved ones. The rehabilitation time depends, first of all, on the degree of damage to brain tissue. Patients may have impaired coordination of movements, mobility of limbs, speech, memory, hearing, and vision.

The patient’s persistence and positive attitude can speed up the recovery time of lost functions.

An experienced team of doctors will speed up the rehabilitation process thanks to a well-designed individual treatment program.

Levels of recovery after stroke

After hemorrhagic and ischemic strokes, there are three levels of recovery:

the first is the highest. We are talking about the complete restoration of lost functions to their original state. This option is possible in the absence of complete death of nerve cells in a region of the brain;
the second level is compensation. The early stage of recovery, usually in the first six months after a stroke. Lost functions are compensated by the involvement of new structures and functional restructuring.
The third level involves readaptation, that is, adaptation to the emerging defect. The patient’s relatives and friends play a significant role in this process. They are the ones who help the patient learn to live with the emerging defect.

Specialists at the Yusupov Hospital, if necessary, work with the patient’s relatives, teaching them the specifics of care, as well as providing them with psychological support.

How to teach sitting, standing, walking

Already in the first days after a stroke, if the general condition is satisfactory, it is recommended to teach the patient to sit and stand. It is necessary to prepare in advance a scarf for fixing the arm, a rubber traction for the leg, and also choose comfortable shoes with low wide heels that fix the ankle joint (for example, weightlifting shoes, light men's shoes).

They begin to put the patient in bed as soon as his well-being and the state of the cardiovascular system allow. These periods can range from 3-5 days to 2-3 weeks from the onset of the disease and are determined by the attending physician.

Initially, the patient is in a reclining position for 3-5 minutes. For this purpose, a pillow is placed under his head and back. Gradually, in this way, over 2-3 days, the patient is transferred to a semi-vertical position, but sitting with legs down is allowed only approximately on the 4-5th day of classes. In this case, a pillow is placed under the patient’s back, the paretic arm is fixed with a scarf, and a bench is placed under the legs. The time of sitting in bed with legs down should be gradually increased from 10-15 minutes to 1-2 hours or more, depending on the patient’s well-being.

As soon as the patient begins to sit in bed with his legs down, exercises to strengthen the leg muscles are included in the complex of therapeutic gymnastics: using a rocking roller, an elbow expander or a rubber “frog” to fill air mattresses with air, adapted for training the lower leg muscles and developing movements in the ankle joint

At the same time, they begin to use exercises for the sore hand with various objects (for which some children's toys can be used). It is recommended to assemble and disassemble pyramids, children's construction sets, and various figures from cubes.

An important stage is learning to stand and walk. The patient is brought to him gradually. First, preparatory exercises are performed - passive and active imitation of walking in a lying position.

A passive imitation of walking consists in the fact that the practitioner, clasping the ankles of both legs of the patient with his hands, alternately bends and extends them at the knees, without lifting the feet from the sheet. Active imitation of walking is performed by the patient himself, if he retains the mobility of his paretic leg. If it is not there, then the practitioner helps the patient “walk.” The latter straightens and bends the healthy leg independently.

In agreement with the attending physician, the patient is then taught to stand. The first time he is asked to stand up, holding the bedside frame or headboard with his good hand. The practitioner must help the patient from the side of the paretic limbs. The patient should be supported by the waist, while simultaneously fixing the knee joint of the paretic leg in an extended state.

The patient should stand straight, evenly distributing body weight on the sick and healthy sides. At the very beginning of training, the patient can remain in a standing position for no more than a minute. Gradually, the time of standing on your feet is increased to 5-7 minutes. After the patient can confidently, holding the headboard of the bed, stand independently on both legs, they move on to teaching him how to alternately transfer the weight of the body to the healthy and sore leg.

To do this, the patient is asked to place his feet shoulder-width apart and slightly sway from side to side. In this case, you can use a rubber “frog”, on which the patient presses with the paretic leg: if the load on the sore leg is large enough, a characteristic sound of air escaping will appear. The patient must be supported while performing this exercise.

When the patient has mastered this exercise, it is necessary to teach him to stand on one leg, first on the healthy one. In this case, the paretic leg is in a bent position (with the help of the practitioner). When learning to stand on a sore leg, the student must first fix the knee joint of the paretic leg in an extended state at a right angle. It is better if another person is present to support the patient.

When performing this exercise, it is necessary that the patient has reliable support: a high headboard, a bedside frame, a bracket driven into the wall. There should be a chair behind him for safety or rest.

Teaching a patient to stand is an important and responsible stage in treatment. Do not rush to move on to the next exercises until the patient learns to feel confident on his feet independently, without your help. If you rush, the next stage may be unnecessarily delayed.

Learning to move should begin with the “walking in place” exercise. Then the patient must learn to walk forward, backward, sideways along the bed or table. He must do all this while holding onto the bedside frame or table. In the future, they begin to teach the patient to move without the help of these supports, but with support.

During recovery, at first the patient uses a three- or four-legged crutch when moving, then a stick. When learning to walk, you should pay attention to the position of the foot, check the patient’s stability, make sure that he bends his leg sufficiently at the hip and knee joint, does not lift it to the side, does not touch the floor with his toe, and places his foot correctly.

During training, it is better to fix the sore arm with a scarf to prevent stretching of the shoulder joint bursa, and to eliminate foot sagging, use devices that fix it: a rubber rod (connecting a sock or shoe with a garter located above the knee) or boots with a high rigid fastening.

To consolidate the skill of correct foot placement, it is advisable to walk along a path on which traces of training steps are marked. Another method is used for the same purpose - overcoming obstacles 5-15 cm high (for example, planks that are placed in front of footprints on the same path). You should constantly adjust the position of the foot when resting the entire sole on the floor, as well as when moving the leg.

When the patient begins to move independently around the room, the goal of physical therapy will be to strengthen the leg muscles necessary to restore correct gait.

At the next stage, the patient is taught to walk up the stairs, and one must be especially careful to protect the patient from falling. Since the patient expends significant effort during these exercises, it is necessary to pause from time to time to rest in a sitting position and to perform breathing exercises.

Simultaneously with exercises to restore leg function, exercises for the arm are performed. These are the already mentioned exercises with small objects - cubes, pyramids, plasticine, the use of a rocking table, a spring microexpander in the patient's position sitting at the table, and without objects. Here is one of them: the patient is seated with the affected side of the body on the table, and his outstretched paretic arm is placed on the table. The practitioner takes the patient’s hand, fixing his shoulder near the elbow. Then, shaking lightly, slowly bends the arm at the elbow and straightens it.

Another exercise is recommended. Starting position: sit facing the table, place your feet shoulder-width apart, place the sore arm bent at the elbow at a right angle, palm down (forearm along the table) with fingers straight and spread apart. The practitioner presses the patient’s hand to the table with one hand, and with the other raises the patient’s elbow up, shaking it lightly.

The following exercise helps reduce tone in the flexors of the forearm, hand and fingers. The patient is seated on a chair so that the hand of the affected hand is placed under the sore thigh. The practitioner, holding the shoulder with one hand, clasps the patient’s elbow with the other and straightens his arm at the elbow, shaking it lightly.

Various hanging movements and swinging of the limbs are also used to relax muscles. For example, the patient is seated with the affected side of the body against the back of a chair and the hand of a healthy hand is placed in the axillary area. As a result, the sore arm ends up suspended and is slowly swung, gradually increasing the amplitude. The same exercise can be performed on the couch: the patient lies on his back, with his sore arm hanging down.

To reduce muscle tone in the muscles of the hand, it is recommended to rub its back surface in the direction from the fingertips to the wrist.

The following exercise is also useful. The practitioner clasps the patient’s thumb with one hand, and with the other all the others (four fingers folded together) and performs their maximum extension, while simultaneously abducting and extending the patient’s thumb. The hand should be held in this position for 1-3 minutes until muscle relaxation is observed.

Sometimes the patient experiences involuntary concomitant movements, that is, when the leg is bent at the knee, the arm at the hand and elbow simultaneously bends. The same can be observed when coughing and sneezing. A number of exercises help eliminate friendly movements.

The following can also be recommended. Sit facing the table with your feet shoulder-width apart. Place your hands on the table and press the healthy sore hand. Slowly bend and straighten your leg at the knee (if this is difficult to do, then you should help the sore leg with the help of the healthy one), while simultaneously holding your arm in an extended position. You can also sit on a chair and stretch your arms forward (paretic below, healthy above), put them on a cane, which is located on the side of the sore leg.

It is necessary to keep your arms extended the next time you move your legs. Place the sore leg on the knee of the healthy one, return to the starting position, place the healthy leg on the knee of the sore one, return to the starting position. In addition to exercises for paretic limbs, the complex of therapeutic exercises must include exercises for healthy limbs. Actually, every therapeutic gymnastics procedure from the first days of classes should begin with exercises for healthy limbs.

It should also be borne in mind that throughout the entire recovery period, in addition to active gymnastics (light resistance training, relaxation exercises, and breaking concomitant movements), passive movements continue to be used for the joints of paretic limbs.

Patients will be able to perform some of them independently. For example, for the shoulder joint - lock your arms, raise them up (the healthy arm works, the sick one is passive), then tilt them left and right. Take the gymnastic stick with both hands, lift it up (the healthy arm works, the sick one is passive), lower the stick behind the head. Passive movements for the wrist joint can also be carried out by the patient himself, helping himself with his healthy hand - doing extension, flexion, circular rotation in one direction and the other. Passive movements for a paretic foot can be performed with a healthy hand, placing the bent sore leg on the knee of the healthy one.

When performing both active and passive movements, it is necessary to achieve the greatest possible range of movements. These exercises should be performed rhythmically, at a calm pace. As noted above, all active movements should be alternated with relaxation exercises.

Prognosis for recovery after stroke

Favorable factors for recovery after a stroke include:

timely early start of rehabilitation therapy;
spontaneous early recovery of lost functions.

Among the unfavorable factors of recovery after a stroke are:

advanced age of the patient;
large area of brain tissue damage;
poor blood circulation around the affected brain tissue;
damage to cells in functionally important areas of the brain.

Basics of Stroke Recovery

In the process of rehabilitation, the positive attitude of the patient himself and his desire to return to independent life are important. Psychological support and assistance from the patient’s relatives plays a huge role. You can make an appointment with a neurologist by phone.

Memory recovery after stroke

Treatment of patients after a stroke takes place in the neurological department. Memory restoration depends on many factors: the size of the area of brain damage, the location of the damage, and the timeliness of medical care. The faster blood circulation in the brain is restored, the greater the chance of memory recovery after a stroke.

Memory restoration after a stroke is possible with the participation of several specialists - a neurophysiologist, psychologist, neuropsychologist, neuropsychiatrist. Help for a patient after a stroke is provided at the rehabilitation clinic of the Yusupov Hospital. In the hospital, the patient is treated according to an individual recovery program; many specialists take part in the development of such a program. When developing the program, the patient’s health condition, the severity of brain damage, and memory impairment are taken into account.

In some cases, it takes several years to restore memory and speech; during recovery, the doctor prescribes medication, a special diet, various trainings - color therapy, rhythm therapy, music therapy and others. Memory restoration at home is not always successful due to the lack of a training program and knowledge in the field of rehabilitation of patients after a stroke.

You can make an appointment with a neurologist at the Yusupov Hospital by phone. Consultation with a specialist, full patient care, rehabilitation using innovative equipment, massages and exercises will help the patient regain full memory.

Restoring a hand after a stroke

A positive attitude and support from family have an impact on rapid recovery from illness. Partial paralysis of the arm is a common occurrence after a stroke and is characterized by stiffness of movement and limited motor ability of the arm. Functional paresis (partial paralysis) refers to neurological syndromes, caused by disruption of the nervous system, damage to the nervous system pathway due to damage to the cerebral cortex after a stroke. Paralysis of the arm is the complete absence of voluntary movements of the limb.

Recovery from a stroke may involve the hand or the entire limb. With partial paralysis, the ability to move the arm or hand freely is impaired; the person cannot fully care for himself or perform basic actions. To restore motor ability, the patient must perform daily exercises for finger motor skills and limb motor skills.

The rehabilitation process of restoring motor activity of the limbs requires patience from the patient and a lot of work - this will allow you to return to a full life after a stroke. You can make an appointment with a neurologist by phone. The rehabilitation doctor will develop individual exercises for the patient, the patient will be under constant medical supervision and receive qualified assistance from specialists.

Why does the hand stop moving after a stroke?

A stroke occurs due to an acute circulatory disorder in the brain, in which a portion of it dies. Depending on which part of the brain is affected, a person’s brain function is impaired. Because of this, various organs may stop functioning, including limbs - for example, a hand. Because the nerve pathways cross, the left arm will be affected if the stroke occurs in the right hemisphere, and vice versa.

At the same time, there is another dependence: the closer to the right hemisphere the stroke occurred, the more painful the damage to the limbs is felt. This happens because it is in the right hemisphere of the brain that the nerve centers responsible for the motor activity of the body are located. Therefore, a stroke, after which the left arm fails, usually requires longer rehabilitation.

Both types of stroke - ischemic and hemorrhagic - can cause such lesions and impair the motor activity of the hand. Disturbances can be different: pain, loss of sensitivity and coordination, complete paralysis of a limb.

Factors influencing the speed and quality of rehabilitation

There are many factors that influence the speed of recovery after a stroke, so predicting the duration of rehabilitation and likely results is quite difficult.

How long rehabilitation after a stroke will last depends on the individual parameters for each person, as well as on other factors:

volume of damage: an extensive stroke significantly worsens the severity of the patient’s condition, and also causes many neurological complications that adversely affect the timing of recovery and its quality;
patient’s age: the older the victim, the longer the recovery;
localization of damage: circulatory disorders of deep structures are difficult to treat;
type of stroke: hemorrhagic strokes are less common, but occur in a more aggressive form, and also have a high mortality rate, although the prognosis for rehabilitation is more favorable than for ischemic stroke;
caused by disorders: the presence of multiple cerebral symptoms, comatose states, severe paralysis and sensory disturbances give an unfavorable prognosis for recovery;
timeliness of therapy: the most positive results of therapy can be achieved by starting treatment measures in the first 4 hours after the onset of the first symptoms; seeking help at a later time worsens the prognosis;
compliance with medical recommendations: after the patient is discharged from the medical institution, the patient is given recommendations that can improve the quality of life, prevent the formation of relapse and negative complications.

The severity of the lesion has the greatest impact on the likelihood of restoration of lost functions and the timing of rehabilitation. With extensive strokes, violations of the most important functions are observed, even if the prescribed rehabilitation program is followed, the prognosis is rather disappointing. The greatest difficulties arise with the complete return of speech and motor functions. Close relatives who will devote a lot of time to special activities with the patient can positively influence the situation.

Treatment by positioning on the back and on the healthy side

The paretic limbs are positioned with the patient in a supine position so that the muscles in which tone usually increases after a stroke (shoulder adductors, arm flexors, hip adductors, leg extensors and dorsal flexors of the foot) are stretched. To do this, place a chair with a pillow at the patient’s bedside, on the side of the paralyzed limbs, on which the sore hand is placed, palm up.

The arm is straightened at the elbow and moved to the side at an angle of 90 degrees. A cotton swab covered with oilcloth is placed under the patient's armpit. The fingers are extended. The hand and forearm are bandaged to a splint, which can be cut out of some hard material (for example, plywood) and covered with gauze.

To fix the position of the hand, place a bag of sand or salt (weighing 0.5 kg) on it. The paralyzed leg is bent 15-20 degrees at the knee, under which a bolster is placed. The foot rests against a wooden box (“boot”) covered with soft material. It is recommended to put a small pillow in the boot to better support the foot.

The patient can remain in the supine position for 1.5 to 2 hours. Then it should be turned onto its healthy side.

When laying the patient on his healthy side, as opposed to laying him on his back, the paralyzed limbs are given a flexion position. The sore arm is bent at the shoulder and elbow joints and a pillow is placed under it, and the paralyzed leg is bent at the knee and hip joints and also placed on a pillow. Just as in the supine position, it is very important to ensure the correct position of the hand and foot. The fingers of the hand should be straightened, the hand should be tied to the splint and lie on the pillow, palm down. The foot should rest against the box. The patient can remain in a lying position on the healthy side for 30 to 50 minutes.

During the first days after the disease, they regularly alternate between placing the paretic limbs in the position of the patient on the back and the healthy side. Treatment by position is not performed during meals, sleep at night, or other therapeutic measures.

Styling paretic limbs prevents the development of muscle contractures, helps reduce muscle tone and prevents the development of pain in the joints (especially in the shoulder). In addition, changing the patient's position in bed every 1-2 hours prevents the development of bedsores.

Stroke Prevention

Prevention of heart attack and stroke in women and men are links in one chain of measures that prevent disability and death in people suffering from cardiovascular diseases.

Cardiologists and neurologists at the Yusupov Hospital use modern diagnostic methods to examine patients, allowing them to identify risk factors for vascular diseases and take measures aimed at preventing diseases. Medicines for the prevention of stroke and heart attack allow you to control the course of the disease, reduce the incidence of acute cardiovascular crises, and the likelihood of complications.

Chance of full recovery after stroke

The rehabilitation period is individual; for some, a few months are enough; for others, it will take years to achieve a positive result. The earlier restoration procedures are started, the more favorable the prognosis. At the same time, the patient’s attitude and focus on results is important; The greater a person’s desire to return to a full life, the more effective the classes and exercises.

At the Yusupov Hospital, a well-coordinated team of professionals (neurologists, rehabilitation specialists, therapists, cardiologists, speech therapists, psychologists) takes part in the rehabilitation of patients after a stroke. Doctors create an individual program for each patient, aimed at the best possible result, observing the following principles:

early start of restorative procedures;
systematicity and duration of events;
complexity of procedures;
multidisciplinarity of classes;
compliance of procedures with the patient’s condition;
active interaction between doctors and the patient and his family.

You can make an appointment with the doctors at the Yusupov Hospital and find out how much rehabilitation after a stroke costs by calling.

Passive movements and massage

Simultaneously with positional treatment, they begin to engage in passive gymnastics (movements in the joints of paretic limbs, which are carried out by a physical therapy methodologist or a person replacing him). Passive movements are carried out without active muscular assistance from the patient. They are performed carefully, at a slow pace.

Passive movements are carried out as fully as possible, isolated in each joint. To do this, the person working with the patient clasps the paretic limb above the joint being worked on with one hand, and with the other below this joint. And the development is carried out in the following sequence: shoulder, elbow, wrist joints and fingers, hip, knee, ankle joints and toes. The volume and tempo of movements gradually increase, their number for each joint can be from 5 to 10. Passive movements in the first days after a stroke are recommended to be carried out 2-3 times a day for all joints of the limbs.

When performing movements, the initial position of individual parts of the limbs is of great importance.

For example, during passive movements in the shoulder joint, the patient is placed on his healthy side, and the affected arm is bent at the elbow. With one hand they fix the shoulder joint of the sore arm, with the other they clasp the arm bent at the elbow joint and make circular movements, pressing towards the shoulder joint, as if screwing the head of the humerus into the glenoid cavity. Abduction of the hip is more complete when the leg is bent (at the hip and knee joints), since this reduces muscle tension in the adductor muscles of the thigh, and the resistance of these muscles decreases.

On these same days, you should begin to do a light massage of both healthy and paretic limbs. If you can use a variety of massage techniques when massaging healthy limbs, then when massaging paretic limbs you need to be very careful. The fact is that excessive massage can lead to a sharp increase in the tone of certain muscle groups, which is undesirable. Therefore, when massaging paralyzed limbs, it is recommended to use the following rules.

Massage on the arm should begin from the shoulder, and on the leg - from the buttocks and thigh (the patient's position is lying on his back or on his healthy side). Then they move on to massage other parts of the limbs.

When massaging muscles in which the tone is usually increased (pectoralis major muscle, biceps brachii, flexors of the hand and fingers, quadriceps femoris, triceps surae), only light stroking should be used. In this case, the pace of massage movements should be slow. When massaging their antagonists, in which the tone is usually also increased (extensors of the forearm, hand and fingers, posterior femoral group, tibialis anterior and peroneus longus muscles), you can still use other massage techniques: rubbing and shallow kneading. These muscles can be massaged comparatively more energetically and at a faster pace.