Recovery after a stroke part 1. Recovery after a stroke of speech and movements. Stages of recovery after a stroke at home
Vascular dementia is one of the most unfavorable variants of the course of chronic ischemic brain disease. Our consultant: Nina Minuvalievna Khasanova, angioneurologist at the First City Hospital in Arkhangelsk.
It is noted that this disease occurs, as a rule, in old age. The cause of dementia after a stroke is associated with damage to the part of the brain that is responsible for memory or the performance of any skills.
Vascular dementia (dementia) is a combination of symptoms that are manifested by a deterioration in memory, thinking, a decrease in the ability to perform skills in everyday life, which either stops or significantly complicates the patient's independent life and his usual work.
Vascular dementia after a stroke is not necessarily an emerging symptom. This condition occurs when there is a pronounced lesion of the brain tissue or as a result of a repeated stroke against the background of uncontrolled arterial hypertension.
If a person after a stroke becomes apathetic, tearful, quickly emotionally exhausted, his mental abilities deteriorate, he ceases to be interested in family life, friends, this may be the first sign of oncoming dementia, which requires a doctor's examination for timely treatment.
The onset of post-stroke dementia, unlike, for example, Alzheimer's disease, is acute. For example, even on Wednesday, a person behaved normally, and on Thursday morning he became aggressive, uncontrollable, his memory deteriorated sharply. It is very important not to see a repeated stroke in a patient: it can be hidden behind such a sharp deterioration in well-being. Therefore, each such situation is an indication for a medical examination and an ambulance call.
Vascular dementia as a disease can also occur with light intervals. This disease, as it were, erases in layers those skills that have been acquired by a person throughout life.
Dementia after a stroke is necessarily combined with coronary heart disease, diabetes mellitus, arterial hypertension. In this case, there are always changes in the vessels of the brain, neck, fundus. Patients must be periodically examined by a cardiologist for assistance and selection of concomitant therapy.
The risk of developing post-stroke dementia depends on how carefully relatives or the patient himself monitors his blood pressure, cholesterol and low-density lipoprotein levels and their correct ratio, blood viscosity, how carefully all the recommendations of the attending physician are followed.
Unfortunately, modern medicine does not have the ability to effectively treat dementia and prevent its progression. Prescribed drugs can only remove or weaken individual unpleasant manifestations of the disease, partially slow down its development. Therefore, the leading role in helping patients with dementia belongs to the daily full care of them.
The most important:
1. try to prevent the development of infectious diseases and the worsening of the course of a somatic disease of your loved one, as this negatively affects the course of dementia;
2. create a comfortable and simple environment: familiar favorite items, their location. In a familiar environment, the patient feels most comfortable. The appearance of strangers in the house, moving dramatically worsen his condition. In the room where the patient is located, there must be a firmly established and habitual order for placing clothes, shoes, and other everyday items;
3. control the mode of taking prescribed drugs. Their irregular intake or overdose can dramatically worsen the patient's condition.
Patience needed!
When communicating with a loved one with dementia, never forget that you are communicating with a sick person who has a mental disorder, many character traits that attracted you before have been lost, and behavior has changed (alas, not for the better). Remember that against the background of rare temporary improvements, the disease, as a rule, will intensify, the patient's condition will worsen. Personality change progresses, emotional attachments to loved ones and the ability to empathize weaken, grouchiness, stubbornness and resentment increase.
In the future, orientation in time, space, and the environment is disturbed. Patients do not know the date, they can get lost in a familiar place, they do not always understand where they are, they do not recognize acquaintances and close people. And although such a person can serve himself, cope with personal hygiene, he already loses the skills to use everyday household appliances, such as a telephone, gas stove, TV remote control, etc. Then he can no longer be left alone unattended.
Vascular dementia rarely reaches the degree of deep total disintegration of the psyche, but over time, a sick person becomes a heavy burden for others and relatives. Here are some excerpts from the stories of relatives about their loved ones with dementia.
“After the stroke, my mother-in-law changed a lot, became unkind, suspicious, capricious. The person is simply unrecognizable! Her general health is now not bad, she even goes out to breathe on a bench at the entrance. She tells her neighbors all sorts of fables: either I was going to poison her, or we don’t let her sleep at night, or we lock her in the toilet. Her husband talks to her, shames her, but she either denies her stories, even yells at him or cries that we are slandering her. I once came home from work - it smells strongly of gas. The burner tap on the stove is open. Now we turn off the gas, leave the food in thermoses.
“I’ll put food for my mother, which we immediately eat ourselves, and she says that it’s not a pig to eat this, she throws the plate away. I take her by the hand to take her to the room or to the kitchen - she starts to twitch, scream that I beat her. After a stroke, my mother has been living with us for almost three years, but lately she wants to return home. When we leave, we have to lock it with a key, since she left once. We literally missed in 15 minutes, and she is gone! They searched all evening, night, morning. They called all the relatives, her friends, hospitals, morgues. Bypassed all neighboring yards. Almost went crazy! Well, an acquaintance works in the police, he helped us (and a missing person’s report is accepted only after three days). The next day at 12 o'clock she was found at the other end of the city.
“Mom started talking a lot. He talks to an imaginary woman, then he calls me mom, then he calls me sister. She stopped reading completely, often cries.
In such cases, do not try to convince patients, prove your case, appeal to their conscience, reason, logic. The person's personality has already been changed by the disease. This is not the same mother, mother-in-law, wife, not the same father, husband whom you have known all your life. You just need to remember: everything that your loved one does and says is not due to his malicious intent, deceit, harmfulness. This is a manifestation of the disease. Therefore, try to be patient with his “whims”, “antics”, be attentive, friendly and sensitive in dealing with him, because he still remains your dear person!
Do not forget that dementia is one of those
diseases that need to be treated before the first signs appear, therefore
medical supervision and implementation of recommendations for the treatment of chronic
diseases affecting the vascular system is the key to quality
and fulfilling life at any age.
Stroke Prevention Steps
Finishing the story about the consequences of a stroke, I would like to remind you once again: in many cases, a vascular catastrophe can be avoided; for this, the main attention should be paid to prevention. The most significant factors that can be corrected include arterial hypertension, coronary heart disease, diabetes mellitus, smoking, increased body weight, and elevated cholesterol levels.
- Physical activity is an effective factor in the prevention of obesity, type 2 diabetes, and arterial hypertension. During physical education, blood properties improve, and the risk of thrombosis decreases.
- Diet aimed at preventing atherosclerosis: limiting foods containing cholesterol and animal fats. Eat more fruits, vegetables and cereals, vegetable oil, sea fish.
- Smoking cessation: Nicotine causes vasoconstriction and stimulates the progression of atherosclerosis.
- Blood pressure control: arterial hypertension and atherosclerosis are closely related diseases, so their treatment and prevention must be carried out in parallel.
- Control of blood fats: a violation of the lipid composition of the blood leads to the development of atherosclerosis, which increases the risk of stroke.
- The fight against diabetes mellitus: this disease is associated with an increased risk of vascular damage and the intensive development of atherosclerosis.
Material: Irina Shaposhnikova
Hello, dear readers and guests of the site dedicated to neurorehabilitation. Let's talk today and take a closer look consequences of a stroke- ischemic and hemorrhagic, as well as everything connected with this.
Consequences of a stroke.
Violations of any functions after a stroke are directly dependent on its severity, and severity, in turn, on the size of the focus and its location in the brain.
The nature and persistence of the consequences of a stroke depends on the size of the focus in the brain and its location.
Of course, it would be fair to note that the size of the focus and its localization are far from all factors that determine the persistence of the depth of neurological disorders caused by a stroke, the consequences of which (the nature and severity) can vary greatly, depending on the specific case. What does it depend on?
The persistence of the consequences is in a strong relationship with the time and volume of treatment and rehabilitation, but we will talk about this a little later, read on.
The degree of dysfunction after a stroke is not always persistent. With a small stroke, the consequences may be minimal or even absent, but this does not happen so often. We will discuss cases when these consequences are present and they are persistent. We will analyze in more detail what exactly the consequences of a stroke are and how they are expressed. Below are the most significant violations of body functions that occur after a stroke.
Right-sided and left-sided hemiparesis
One of the most common persistent consequences of a stroke is a decrease in strength in half of the body. As a rule, after a stroke, there is a decrease in muscle strength in one of the sides of the body, which is opposite to the damaged hemisphere of the brain: if hemiparesis of the left side of the body is a persistent consequence, the stroke occurs in the right hemisphere. By the same principle, hemiparesis of the right side of the body, in which a stroke is observed in the left hemisphere. That is, the focus of infarction in the brain is located in the opposite hemisphere of the affected half of the body.
It also happens that a stroke leads to a complete lack of muscle strength in half of the body, which is called hemiplegia. With hemiparesis, a person experiences difficulty in moving, with hemiplegia, the difficulties are even more significant. Simply put, hemiplegia is paralysis in half of the body (complete lack of movement).
Habitual movements in the body are disturbed, many people have to learn to perform normal daily activities again in order to be able to take care of themselves, be able to eat, change clothes and walk. In general, to do everything that before the illness was considered extremely simple and ordinary to perform. It is the decrease in muscle strength in half of the body that is the main reason for the disability of a person after suffering a violation of cerebral circulation. It is because of this that patients lose the ability to move independently - or lose this ability completely or it is significantly impaired.
As you have already described, gait after a stroke can often be disturbed, while a person begins to move with great difficulty. In some cases, assistive devices may be needed - special walkers, a support cane or a crutch. The characteristic Wernicke-Mann posture develops when walking. Individual parts of the body may be affected without involving the entire half of the body. Depending on the affected half of the body, there are left-sided and right-sided hemiparesis.
Central prosoparesis
Fig.1. Central paresis of the facial muscles (central prosoparesis) The next, one of the most common consequences, is the so-called central prosoparesis, in which the mimic muscles suffer, resulting in facial asymmetry, as in Figure 1. At the same time, a decrease in strength is observed not in the entire half of the face, but only in its lower part, capturing the mouth, cheek, lips.
The eyelids and eyes with this paralysis of the mimic muscles remain unaffected, despite this, the distortion is quite noticeable and causes discomfort not only during meals or liquids. Central prosoparesis regresses with recovery from stroke.
With central prosoparesis, food intake and fluid intake are difficult. A person experiences obvious discomfort when performing some actions with facial muscles. Habitual emotions are more difficult to express, due to a decrease in strength in facial muscles, sound production is disturbed and speech begins to suffer.
The defect itself brings a tangible inconvenience purely from the cosmetic side. Distortion of the face causes great emotional discomfort, especially when communicating with other people. This can cause isolation and renunciation of communication with others and cause deep depression.
Speech disorder
Speech disorders after a stroke are also quite common, at the same time it is one of the very first signs of an onset (upcoming) cerebrovascular accident. Speech impairment is the result of damage to the speech centers of the brain, which is a partial or complete loss of the ability to speak and perceive someone else's speech, called aphasia.
According to statistics, such violations are observed in a quarter of all people who have experienced a stroke, their consequences can be quite persistent. Sometimes it is difficult for a person to speak, due to a violation of the possession of the speech apparatus, and the speech of such people is fuzzy, as if “porridge in the mouth”, but such a violation is called . dysarthria more common in stem stroke or localization of this focus in the cerebral cortex. The next speech disorder is aphasia.
Aphasia is the complete absence of speech. Aphasia can be of several types, to name some of them - with the defeat of the speech center responsible for the pronunciation of speech, motor aphasia develops. When the focus of the stroke is located in the center of speech, which is responsible for its perception, the so-called sensory aphasia develops. With sensory aphasia, a person does not understand what is being said to him and does not understand what he needs to answer. If both centers are affected, mixed or sensory-motor aphasia. The “pure” form of aphasia is extremely rare, and in stroke, it is the mixed form that most often occurs.
There are other types of speech disorders after a stroke, which we will discuss in detail in the following articles on speech disorders. And now let's move on ... In addition to the violations listed above, there are the following consequences of a stroke.
Disorders of coordination of movements
Impairment of blood circulation in the parts of the central nervous system responsible for the coordination of movements and as a result of a stroke can lead to coordination of movements, which is called ataxia. Disturbances in coordination of movements often occur with stem stroke and this is due to the fact that in the stem part of the brain there are centers for coordinating movements in our body.
There are different degrees of expression. In the most favorable case, these vestibular disorders disappear within the first day after the acute cerebrovascular accident. In other, more severe cases, unsteadiness when walking and dizziness persist for a longer period and may last for months.
visual impairment
There may be visual impairments of the most diverse nature. Visual impairment depends on the location of the stroke and the size of the focus. The most common form of visual impairment is visual field loss(hemianopia). In this case, as you may have guessed, half or a quarter of the visual picture falls out. If a quarter of the picture falls out, it is called a quadrant hemianopia.
Other consequences
- Hearing impairments (hypoacusia), smell impairments (hypo-, anosmia), loss of movement skills with the strength stored in them (apraxia) and other disorders that can and should be treated, rehabilitation in this case is very important and should be carried out in a timely manner.
- Loss of sensation after a stroke. Violation of sensitivity after a stroke can be of a different nature, but most often it is a loss of the ability to feel pain, recognize heat, cold, and a part of the body as such. It is also possible the appearance of pain syndrome, which is of the most diverse nature and localization. Most often, there is a decrease in sensitivity in any part of the body, this phenomenon is called hypesthesia.
These dysfunctions may well manifest themselves as the first signs of a stroke at the very onset of the disease and persist for an indefinitely long time in the absence of active recovery of impaired neurological functions.Please note that the severity of all these changes and their persistence directly depend on the size of the focus and the nature of the stroke. Read more about the factors that play a major role in the development of ischemic stroke and the formation of its consequences.
Depression
Depression- another consequence of a stroke that can negate any efforts of a doctor and loved ones to restore lost functions. According to some reports, up to 80% of stroke survivors suffer from depression in varying degrees of severity. This is a rather serious consequence that can and should be treated.
In addition to the mood for recovery, an additional no less important “bonus” of eliminating depression will be an analgesic effect. It has long been proven that depression can exacerbate pain in a person, and with a stroke, pain is not uncommon. Prescribing antidepressants can help with this problem.
It is extremely important to prescribe the “correct” antidepressant, since some of them can cause an “inhibitory effect”, which in some cases can also reduce a person’s desire to follow the doctor’s recommendations and activate for better rehabilitation.
A stroke, the consequences of which remained after a course of treatment in a hospital, is a frequent phenomenon. Such people need a full-fledged rehabilitation course, which often begins already in the hospital. The rehabilitation course itself is prescribed individually, depending on the severity and persistence of the consequences, as well as on the time that has passed since the stroke and the general condition of the patient.
If the hospital failed to fully restore a person after a stroke, then further treatment is desirable to be carried out in a specialized rehabilitation center.
Read about an example of such a rehabilitation center in the article.
What it is? A stroke is an acute violation of cerebral circulation, leading to persistent focal damage to the brain. May be ischemic or hemorrhagic. Pathology is accompanied by an acute violation of cerebral circulation, damage to blood vessels and the central nervous system. If the normal blood flow is disturbed, the nutrition of the nerve cells of the brain worsens, and this is very dangerous, since the organ works due to the constant supply of oxygen and glucose to it.
Let's look at what signs are characteristic of a stroke, why it is important to help a person in the first minutes of the onset of symptoms, and also what are the possible consequences of this condition.
What is a stroke?
A stroke is an acute violation of the blood circulation of the brain, causing damage and death of nerve cells.
During " therapeutic window”(conditionally called the first 3-6 hours after a stroke), it is possible to prevent the irreversible consequences of ischemia and cell death by medical manipulations.
Strokes occur in people in a wide age range: from 20-25 years to old age.
- Narrowing or blockage of blood vessels in the brain - ischemic stroke;
- Hemorrhages in the brain or in its membranes - hemorrhagic stroke.
The frequency is quite high, with age it increases significantly. Mortality (mortality) from stroke remains very high. Treatment is aimed at restoring the functional activity of neurons, reducing the influence of causative factors and preventing the re-development of vascular catastrophe in the body. After a stroke, it is very important to rehabilitate a person.
Every person needs to know the signs of the disease in order to respond in time to a brain catastrophe and call an ambulance team for themselves or their loved ones. Knowing the basic symptoms can save someone's life.
Kinds
There are 2 main types of stroke: ischemic and hemorrhagic. They have a fundamentally different mechanism of development and require radically different approaches to treatment. Ischemic and hemorrhagic strokes account for 80% and 20%, respectively, of the total population.
Ischemic stroke
Ischemic brain damage occurs in 8 cases out of 10. Mostly it affects the elderly, after 60 years, more often men. The main reason is the blockage of blood vessels or their prolonged spasm, which entails a cessation of blood supply and oxygen starvation. This leads to the death of brain cells.
This type of disease can develop more often at night or in the morning. There is also a connection with a previous increased emotional (stress factor) or physical activity, alcohol consumption, blood loss, or the progression of an infectious process or somatic disease.
Hemorrhagic stroke
What is this? Hemorrhagic stroke is the result of hemorrhage into the substance of the brain after damage to the walls of the vessel. Violation of functional activity and death of neurocytes in this case mainly occurs due to their compression by a hematoma.
The occurrence of hemorrhagic stroke is associated mainly with diffuse or isolated cerebral vascular pathology, due to which the vascular wall loses its elasticity and becomes thinner.
Often accompanied by loss of consciousness, more rapid development of stroke symptoms, always significant neurological disorders. This is due to the fact that in this case the cerebral circulation is disturbed due to rupture of the vascular wall with an outpouring of blood and the formation of a hematoma or as a result of impregnation of the nervous tissue with blood.
In 5% of stroke cases it is not possible to determine the type and mechanism of development. Regardless of the type of stroke, its consequences are always the same - a sharp, rapidly developing dysfunction of a part of the brain due to the death of part of its neurocyte cells.
The first signs of a stroke in an adult
Signs of a stroke should be known to all people, regardless of their medical education. These symptoms are primarily associated with a violation of the innervation of the muscles of the head and body, so if you suspect a stroke, ask the person to perform three simple actions: smile, raise their hands, say any word or sentence.
In a person who suddenly felt "lightheaded", vascular problems can be assumed by the following signs, which can be taken as the first signs of a stroke:
- Numbness of body parts (face, limbs);
- Headache;
- Loss of control over the environment;
- Double vision and other visual disturbances;
- Nausea, vomiting, dizziness;
- Motor and sensory disorders.
It happens that a stroke occurs suddenly, but more often it occurs against the background of precursors. For example, in half of the cases, ischemic stroke is preceded by.
If at least two of the following symptoms recur once a week or more often in the last three months, then an immediate visit to a doctor is required:
- Headache that does not have a specific localization and occurs with overwork or weather disasters.
- Vertigo at rest and aggravated by movement.
- The presence of tinnitus, both permanent and transient.
- "Dips" of memory for the events of the current period of time.
- Changes in the intensity of working capacity and sleep disturbances.
These symptoms should be considered as harbingers of the development of a stroke.
How to recognize a stroke?
To recognize this disease, pay attention to the following points:
- Take a closer look, ask if the person needs help. A person can refuse, because. I still don't understand what is happening to him. The speech of a person with a stroke will be difficult.
- Ask for a smile if the corners of the lips are located on a different line and the smile looks strange - this is a symptom of a stroke.
- Shake the person's hand if there was a stroke, then the handshake will be weak. You can also ask to raise your hands up. One arm will spontaneously drop.
When detecting signs of a stroke in a person urgently call an ambulance!!! The sooner qualified assistance is provided, the greater the chances of eliminating the consequences of this disease!!!
Causes
Doctors identify two main causes of stroke. This is the occurrence of blood clots in the circulatory system and the presence of cholesterol plaques that can block blood vessels. An attack can happen in a healthy person, but this probability is extremely small.
Pathology develops as a complication of the underlying disease of the heart and blood vessels, as well as under the influence of adverse factors:
- atherosclerosis of cerebral vessels;
- thromboembolism;
- hypertension ( arterial);
- rheumatic affections of the heart;
- myocardial infarction;
- heart surgery;
- constant stress;
- vascular tumors;
- taking certain types of drugs;
- alcoholism;
- smoking;
- cerebral artery aneurysm.
The development of complications is also possible against the background of general well-being, however, often the failure of compensation mechanisms occurs in cases where the load on the vessels exceeds a certain critical level. Such situations can be associated with everyday life, with the presence of various diseases, with external circumstances:
- a sharp transition from a lying position to a standing position (sometimes it is enough to go into a sitting position);
- dense food;
- hot bath;
- hot season;
- increased physical and mental stress;
- a sharp decrease in blood pressure (most often under the influence of drugs).
But the most common cause of a stroke is high blood pressure, 7 out of 10 victims of hemorrhage are people with (pressure above 140 over 90), a violation of the heart. Even a harmless atrial fibrillation causes the formation of blood clots, which lead to impaired blood flow.
Stroke Symptoms
The clinical manifestations of a stroke depend on its type, location and size of the lesion.
Symptoms of a stroke in adults:
- Signs of an impending stroke begin with headaches and dizziness that are not explained by other causes. Possible loss of consciousness.
- The loss of the ability to clearly express one's thoughts in words is one of the characteristic symptoms. A person cannot say anything specific or even repeat a simple phrase.
- The patient may begin to vomit, as well as with a concussion.
- Noise in the head.
- Forgetfulness appears, a person does not know or does not remember where he was going, why he needs the objects that he holds in his hands. Outwardly, this is manifested by absent-mindedness and confusion.
- Visually, the symptoms of circulatory disorders in the brain are visible on the face of a person. The patient cannot smile, the face is distorted, possibly cannot close the eyelid.
There are seven main symptoms before a stroke, which accurately indicate this disease:
- Distorted face (asymmetric smile, slanted eye).
- Incoherent speech.
- Drowsiness (apathy).
- Focal sharp pains in the head and face.
- Violation of vision.
- Paralysis of the limbs.
- Impaired coordination.
Signs of an impending stroke can be very diverse, so you should be extremely careful about what symptoms a person has before a stroke.
| Symptoms in adults | |
| Ischemic stroke | The most pronounced symptoms of ischemic stroke are observed with embolism or thromboembolism of the large arteries of the brain. It is typical for him:
In addition, during an ischemic attack, the swallowing reflex and speech may worsen in a person. Therefore, the patient may begin to stutter, not speak clearly. Due to damage to the spinal (vertebral) column, the patient may develop a lack of coordination, so he will not be able to move independently or even sit. |
| Hemorrhagic stroke | The first signs of a stroke (hemorrhagic type):
|
It is worth considering that if there are signs of a stroke, then the time of irreversible changes in the brain has already begun its countdown. Those 3-6 hours that are available for the restoration of impaired blood circulation and the struggle to reduce the affected area are decreasing every minute.
If the symptoms of a stroke completely disappear within 24 hours from the onset of its clinical manifestations, then this is not a stroke, but a transient cerebrovascular accident (transient ischemic attack or hypertensive cerebral crisis).
First aid
With a stroke, cerebral hemorrhage requires an immediate response to its occurrence, therefore, after the onset of the first symptoms, the following steps must be performed:
- Position the patient in such a way that his head is raised by about 30 °.
- If the patient has lost consciousness and is on the floor, move him to a more comfortable position.
- If the patient has prerequisites for vomiting, turn his head to the side so that the vomit does not enter the respiratory system.
- It is necessary to understand how the pulse and blood pressure of a sick person changes. If possible, you need to check these indicators and remember them.
- When the ambulance arrives, the doctors need to indicate how the problems began, how much worse the patient felt and looked, and what pills he took.
- move a person or shift him to a bed (it is better to leave him where the attack occurred);
- use ammonia to bring the patient to consciousness;
- force to hold the limbs in the event of convulsions;
- give the patient medicines in tablets or capsules that can get stuck in the airways (especially if he has a swallowing disorder).
Consequences
The most typical problems that arise after a stroke include the following:
- Weakness or paralysis of the limbs. Paralysis of one half of the body is most often manifested. The immobilization can be complete or partial.
- Spasticity of muscles. The limb is held in one position, the joints may gradually atrophy.
- Problems of the speech apparatus: indistinctness and incoherence of speech.
- Dysphagia is a violation of swallowing functions.
- Visual impairment: partial loss of vision, double vision, reduced field of coverage.
- Violation of the functions of the intestines and bladder: urinary incontinence or, conversely, the inability to excrete it.
- Mental pathologies: depression, fear, excessive emotionality.
- Epilepsy.
| Left sided stroke | Right sided stroke |
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Signs of a coma
Coma after a stroke attack develops quite quickly, acutely and has the following symptoms:
- Man suddenly lost consciousness
- His face turned crimson red.
- Breathing became loud, wheezing
- The pulse became tense, blood pressure increased
- Eyeballs deviated to the side
- Pupils narrowed or became uneven
- Pupillary reaction to light became sluggish
- Decreased muscle tone
- There is a disorder of the functions of the pelvic organs (urinary incontinence)
How many years do people live after a stroke?
There is no definite answer to this question. Death can occur immediately after a stroke. However, a long, relatively full life for decades is also possible.
Meanwhile, it has been established that mortality after strokes is:
- During the first month - 35%;
- During the first year - about 50%.
The prognosis of stroke outcome depends on many factors, including:
- The age of the patient;
- Health conditions before stroke;
- Quality of life before and after a stroke;
- Compliance with the regime of the rehabilitation period;
- Complete elimination of the causes of stroke;
- The presence of concomitant chronic diseases;
- Presence of stress factors.
Diagnostics
Diagnostic measures include:
- Inspection. SPL test. It is called by the letters of the first three actions that the patient must perform: smile, speak and try to raise his hand.
- Assessment of the general condition of the patient by a doctor.
- An accurate and prompt examination of the patient is prescribed, magnetic resonance therapy or computed tomography will help.
- Lumbar puncture will distinguish cerebral hemorrhage from other brain pathologies.
- Computed and magnetic resonance imaging are used to detect the fact of a stroke, clarify its nature (ischemic or hemorrhagic), the affected area, and also to exclude other diseases with similar symptoms.
Treatment and rehabilitation after a stroke
The optimal terms of hospitalization and initiation of therapy are considered to be the first 3 hours from the onset of clinical manifestations. Treatment in the acute period is carried out in intensive care units of specialized neurological departments, then the patient is transferred to the early rehabilitation unit. Before establishing the type of stroke, basic undifferentiated therapy is carried out, after an accurate diagnosis is made, specialized treatment is carried out, and then long-term rehabilitation.
Treatment after a stroke includes:
- conducting a course of vascular therapy,
- the use of drugs that improve brain metabolism,
- oxygen therapy,
- restorative treatment or rehabilitation (physiotherapy exercises, physiotherapy, massage).
In the event of a stroke, call an ambulance immediately! If you do not provide immediate assistance, this will lead to the death of the patient!
To prevent complications, therapy is carried out using the following drugs:
- cerebroprotectors restore the structure of damaged brain cells;
- blood thinners (only indicated for ischemic stroke);
- hemostatics, or hemostatic agents (used for a clearly established stroke of hemorrhagic origin);
- antioxidants, vitamin preparations and drugs that improve metabolism and blood circulation in tissues.
Rehabilitation activities:
- are carried out from the very beginning of a stroke and continue while maintaining a neurological deficit throughout life with the participation of the patient, a team of health workers and relatives;
- proper care of the patient's body, the use of special devices;
- breathing exercises (for the prevention of pneumonia);
- as early as possible activation of the patient's motor regimen, ranging from short sitting down in bed to a full-fledged physiotherapy;
- the use of various physiotherapeutic and other methods: electroprocedures, massage, acupuncture, classes with a speech therapist.
Folk remedies to restore the body after a stroke
Before using folk remedies, be sure to consult with your doctor, because. possible contraindications.
- Rosehip cinnamon. The fruits and roots of the plant are used to prepare a decoction, which is introduced into general baths in the treatment of paralysis and paresis. The course is 25 procedures, the broth is poured into water at a temperature of 37-38 ° C.
- Bath with sage after suffering a stroke. 3 cups of sage herb pour 2 liters of boiling water. Let the product stand for 1 hour, strain and pour into a bath of warm water. Take these baths every other day.
- Very useful and such a decoction: a teaspoon of crushed dry peony roots should be poured with a glass of boiling water. After that, insist for an hour and strain. Use a tablespoon of decoction 5 times a day.
- Laurel oil. This remedy is prepared as follows: 30 g of bay leaf should be poured with a glass of vegetable oil. Infuse for 2 months, while every day you need to shake the jar. The oil must be filtered and then brought to a boil. The mixture is recommended to be rubbed into paralyzed places.
Prevention
Stroke belongs to the category of those diseases that are easier to prevent than to treat. Stroke prevention consists of:
- It can be prevented with the help of a rational organization of the work and rest regime, proper nutrition, sleep regulation, a normal psychological climate, sodium salt restriction in the diet, timely treatment of cardiovascular diseases: coronary heart disease, hypertension.
- The best way to avoid a stroke is to prevent atherosclerosis and other cardiovascular diseases. Blood pressure control and checking for are important here.
- If necessary, take medications that improve the microcirculation of cerebral vessels, and it is also possible to take drugs that prevent a lack of oxygen (hypoxia) of the brain as prescribed by a doctor.
It's all about a stroke: what are its first signs and symptoms, the features of its treatment and subsequent recovery in men and women. Be healthy!
Stroke is a serious disease, often leading to death or disability. This is not surprising, because with a hemorrhage in the brain or an interruption in the supply of oxygen to it, part of the nerve cells irreversibly dies. Recovery after a stroke is possible due to brain plasticity - the ability to assign lost functions to previously unused cells and form new neural connections. The effectiveness of this process strongly depends on the time that has elapsed since the crisis, so promptness is important at each stage of treatment.
Initially, patients are admitted to the intensive care unit, then to the neurological hospital. After that, the longest stage, which directly depends on the patient and his relatives, passes - the rehabilitation period.
The effectiveness of rehabilitation after a stroke and its duration depend on many things: the timely detection of symptoms and the start of treatment, the type and severity of the stroke, the general health of the patient, the presence of concomitant diseases or senile dementia, the age of the patient. The mental state of the patient and his willingness to make efforts to recover after a stroke in order to return to a full life, support from relatives are also important.
The recovery period after a stroke can range from 1 month to 2 years. Some are able to rehabilitate almost immediately, others remain permanently bedridden invalids, and they are not even assigned rehabilitation measures. Therefore, the referral to rehabilitation should be assessed as luck. 85% of those who have suffered an ischemic stroke can be returned to full life in a year and a half, and two-thirds of these people recover in the first 3-4 months.
Is it possible to completely restore the brain after a stroke? Unfortunately no. Instead of damaged areas of the nervous tissue, voids filled with liquid are formed, which affects the loss of certain functions. A stroke leads to impaired memory and speech, coordination, especially fine motor skills, mental disorders, loss of control over one side of the body. From here we get the answer to the question of how to recover from a stroke - you need to return the lost abilities or compensate for them with new ones. You should not hesitate - neural connections are most easily formed if you start classes immediately after you get out of the crisis. It is important not to give up until the functions that require long-term exercises are restored, to continue taking the necessary drugs.
Complex of rehabilitation measures
Recovery after a stroke includes the return of psychological and physical usefulness, speech and memory functions, and the prevention of relapse by controlling blood pressure, eating healthy, giving up bad habits, and changing lifestyle for the better. How long the rehabilitation will last depends on the sequence of the patient regarding the instructions of the attending doctors.
Physical component
Physical rehabilitation for stroke includes active (physiotherapy exercises, or exercise therapy) and passive measures (massage, magnetotherapy, physiotherapy) to restore motor functions. The latter often seems preferable to patients, but is not able to replace physical exercise. If financially feasible, home stroke rehabilitation may include an exercise therapy specialist, but visiting a rehabilitation center and exercising with other patients will be the most beneficial.
Some of the exercises are available in bed. Often, stroke survivors experience excessive tone of the limbs, which can freeze in an awkward position. In such cases, you need to gradually increase the amplitude of movement and relieve muscle tension. Passive gymnastics is possible with a gradual connection of the patient's efforts. The following measures are available:
The hand after a stroke should be exercised by bending and unbending the fingers, the hand.
By moving the limbs in the joints, you can gradually regain control over the body.
The rotational movements available to a healthy person are helped by a caregiver to help a sick person.
Stretching of the limbs bent by spasm is a measure to combat paralysis, when the fingers, and then the entire hand, are fixed with bandages to a flat object for half an hour or more.
A patient who has succeeded in restoring his arm after a stroke can perform manipulations with a towel suspended over the bed, making all possible movements with it. After the towel rises, and the exercises are complicated by the weight of the patient.
The rubber ring can be stretched between the limbs in different combinations.
An increasingly larger roller, placed under the knee, serves to restore the functions of the leg.
The patient can help himself with his hands in flexion and extension of the legs, alternately grabbing the shins and leading the feet along the bed.
Reaching up to the back of the bed, the patient can sort of pull himself up while stretching his feet and toes.
Another set of exercises available to bedridden patients is eye gymnastics (movements from side to side, circular movements, focusing on near and distant objects, blinking, strong squinting).
A stroke survivor undergoes recovery gradually, then proceeding to gymnastics in a sitting position. It is aimed at the transition to purposeful movements and preparation for walking. Patients do:
- alternating leg raises;
- connection of the shoulder blades and tilting the head back on inspiration with relaxation on the exhale;
- arching the back back on inspiration with relaxation on exhalation.
Then comes the turn of standing exercises and a return to subtle movements. The complex includes:
- picking up small items from the floor or table;
- sipping with raising hands on inhalation and returning to the starting position on exhalation;
- torso inclinations;
- exercises for the hands, including with the help of an expander;
- exercise "scissors";
- squats.
Finally, the patient can proceed to exercise therapy itself. It is worth doing it diligently, since the length of stay in the rehabilitation center is short. You should not allow overwork: all exercises should correspond to the current capabilities and condition of the patient.
Before class, the muscles are warmed up with a warm-up, warm water treatments, a heating pad or massage. A positive effect will be the presence of relatives in the classroom, who can not only help the patient in the exercise, but also convince him of the benefits of hard work.
Exercise therapy is aimed at restoring movements in the previous volume, maintaining balance, walking, performing household tasks and switching to self-service. After all, the usual dressing or eating for stroke survivors suddenly become difficult operations.
In the early stages, passive measures can be used. They will not replace exercise therapy, but they will help prepare the patient for gymnastics. They include electrical stimulation, massage, magnetic and physiotherapy. Currently, an effective tool is the biofeedback method, when a patient performs tasks with the help of a computer program or game, receiving sound or visual signals about the functioning of the body together with the doctor.
Mental component
Not surprisingly, a stroke becomes a severe ordeal, often causing depression or apathy. Patients become irritable, quick-tempered and aggressive, having lost the former ability to control emotions. Often they themselves do not notice how difficult they have become in communication. The patience of relatives, their warmth and support are important, allowing them to overcome the crisis and undergo psychological rehabilitation after a stroke.
It is necessary to maintain good spirits and an optimistic attitude, and if you notice symptoms of depression, start treatment. Modern medicine will cope with it with the help of dietary supplements or psychotherapy. However, all drugs must be prescribed by a doctor, including antidepressants. A good option would be a specialized sanatorium that allows you to change the situation and conduct complex therapy.
Recovery of speech and memory
With the defeat of the corresponding centers of the brain, the return of functions will be gradual. A speech therapist should deal with a patient who has lost his speech, and relatives should constantly talk. Another obstacle on the way to full communication is the “freezing” of facial muscles, which is eliminated by the following exercises:
- grinning;
- curling lips into a tube;
- light biting of the lips;
- pushing the tongue forward;
- licking lips in different directions.
First, the pronunciation of sounds returns, then words. The singing heard by the patient and attempts to reproduce it will be an excellent help. You can say part of the word to the patient so that he completes it. A good effect is the repetition of rhymes and tongue twisters.
Restoration of memory is helped by taking certain medications. Otherwise, the process is reminiscent of working with children and includes memorizing and repeating numbers and phrases, playing games, board games that allow the patient to concentrate on one action. It is useful for a stroke survivor to remember and describe what happened to him over the last day, week, month, etc.
Return to normal life
Someone gets the opportunity to return to home conditions almost immediately, but many things will inevitably undergo changes. New restrictions will appear, and familiar things will require re-accustoming to them. It will be necessary to constantly measure blood pressure and follow all the recommendations of doctors. How to live after a stroke in order to maintain health and avoid relapse?
Diet
The patient's diet should be balanced. There are no significant restrictions, but it may be advisable to predominate in food products that do not linger in the intestines and do not cause constipation, that is, vegetables, fruits, cereals. The load on the urinary system will reduce the smaller amount of salty, sour and spicy foods. Excluding coffee and tea from the diet will have a beneficial effect on pressure, and avoiding fatty foods and fast carbohydrates will help keep blood sugar levels normal, which will also reduce the risk of a second stroke. Uncompromising should be the rejection of only one thing - alcohol.
Citrus fruits and tincture of pine cones are shown to those who have suffered a stroke - a folk remedy whose phytoncides maintain a good condition of nerve cells. It is also useful to drink an increased amount of liquid, 2-3 glasses per day.
dwelling
Taking the patient home, relatives must strictly follow the recommendations of specialists on how to care for the patient after a stroke. Changes in the apartment can take a lot of time. You will have to remove away all dangerous and capable of falling on the patient objects. Carpets, wires, etc. may lead to a fall. If the patient uses a walker or a wheelchair, it is necessary to provide him with free access to all rooms, consider overcoming steps or thresholds.
Greater independence will be provided by handrails in the bathroom, a bench in the shower, a special toilet seat. A shower, by the way, is preferable to a bath. The thermometer in it will save the patient with reduced heat sensitivity from burns. It is worth thinking about unbreakable dishes and small chairs on which the patient can lean. It will be useful to install handrails also by the bed and in general in any place where the stroke survivor will get up and sit down.
For independent walks outside the home, it is worth providing a person with a mobile phone with a one-button call function in case of a fall or a second stroke.
Job
Here we are dealing with a double-edged sword. On the one hand, returning to this part of life will be an important part of socialization. On the other hand, mental changes and physical limitations may require early retirement or a remote profession. It is important not to rush to return to the workplace, to make sure that the necessary opportunities have fully returned. If this is not the case, it is worth approaching with optimism the time freed up for your favorite hobby and communication with your family.
Personal life
Sex for stroke survivors is not only acceptable, but also beneficial in terms of rehabilitation. Violation of motor skills, apathy, troubles from the genitourinary system may appear (potency and sensitivity decrease). However, with a successful combination of circumstances, an active sex life will help to establish an emotional state and make the patient happy again.
One of the serious diseases that often occur as a result of hypertension, as well as atherosclerosis of the cerebral vessels, is a stroke. Treatment of this disease, subject to its success, can prolong the vital activity of a person. The danger of a stroke lies in the high probability of negative consequences, because. Quite often, the result is a person's disability.
Among the elderly, stroke is the most frequently reported cause of death.
A stroke is characterized by an acute violation of the blood circulation of the cerebral cortex, which results in damage and death of nerve cells.
A stroke is a number of other pathological conditions, including:
- Hemorrhage in the brain;
- brain infarction;
- Subarachnoid hemorrhage.
There are two types of strokes:
- Ischemic;
- Hemorrhagic.
They not only differ in origin, but each of them is treated according to a different scheme.
Peculiarity ischemic stroke is a violation of the blood supply to certain areas in the cerebral cortex due to blockage of the artery by a thrombus or atherosclerotic plaque.
Hemorrhagic A stroke occurs when an artery ruptures and bleeds. The cause of this type of disease is a rupture in an enlarged section of the artery due to a congenital pathology of the vessel, called an aneurysm, or a rupture of the artery, the background for which may be high blood pressure.
Types of strokes Stroke of any kind requires urgent action, medical attention and treatment. The clinical picture with hemorrhage develops so rapidly that the ability to cure the disease is limited by time. Only with the timely provision of qualified assistance, brain damage can be minimized, preventing the manifestation of complications in the future.
Stages of treatment
In order to know how to treat a stroke, it is necessary to represent the sequence of the main stages of this process, which consists of:
- emergency care;
- inpatient treatment;
- Rehabilitation or sanatorium therapy.
Signs of a stroke
In order to recognize the symptoms of a dangerous illness in a person in time, it is necessary to remember them firmly.
The signs of a stroke are:
- sudden weakness;
- Paralysis or partial numbness of the muscles of the face or limbs (most often only on one side);
- Speech disorders;
- visual impairment;
- The appearance of a strong and sharp headache;
- Dizziness;
- Loss of balance and coordination, gait disturbance.
A stroke often takes a person by surprise and at this moment it is very important that the people around show attention and provide first aid.
If you notice a passerby on the street behaving unnaturally, you should not assume that he is drunk until a stroke test is performed according to the following plan:
Steps to take before the ambulance arrives
If there is a suspicion of a stroke that a person can catch at any time - at home or on the street, you should do the following as soon as possible:
- Lay the patient on his back try not to touch his head;
- Provide free access to fresh air, the source of which can be an open window or a fan. For the same purpose, it is necessary to exclude any squeezing of the body from a tight tie or collar, belt;
- If the patient shows signs of vomiting, turn his head in any direction to avoid getting vomit into the bronchial area;
- When possible cold compress will help placed on the head or a heating pad with ice;
- The patient, if he is conscious, can be ask about his hypertension and give him a pill under the tongue (often hypertensive patients hold the necessary medicines in the pocket);
- preliminary blood pressure measurement- one of the useful actions that can be performed with a special apparatus at hand;
- A distraction procedure that can be done at home is placement of mustard plasters in the calf area on the legs.
Help and first actions of medical workers
In the first minutes after arriving at the location of the affected person from a stroke, the specialists of the ambulance team assess the severity of the patient's condition. Their main task is to transport the patient to a hospital equipped with an intensive care unit.
During transportation:
- Measurements of blood pressure;
- The introduction of drugs that correct the work of the cardiac and respiratory systems.
Patients who:
- Were found in a coma;
- When they have circulatory disorders in the brain in terminal states of various pathologies of internal organs or tumors.
Symptomatic care is provided to patients with such deviations, after which the call is transferred to the clinic.
In which department are they placed with a stroke?
After hospitalization of the victim, treatment of a cerebral stroke in hospital begins with its placement in the intensive care unit, or intensive care. This requires the presence in the clinic of the appropriate unit, equipped with special equipment and qualified personnel.
Patients are examined by a neurologist. A consultation with a neurosurgeon may be required. The treatment regimen, as well as in which department the patient will be located, is determined by the doctor, depending on the established type and severity of the disease. The main tasks of the hospital depend on the type of the disease.
Treatment in a hospital. Preparations.
Treatment for hemorrhagic stroke.
For the treatment of the brain in the development of hemorrhagic stroke, therapy should include a number of specific tasks, these are:
- Elimination of puffiness in brain tissues;
- Decrease in intracranial and arterial pressure;
- Treatment aimed at increasing blood clotting and the density of the vascular walls.
With all the actions of the medical staff, a certain position of the patient on the bed is observed. For this, a functional bed with a raised headboard is used. Ice is placed on the patient's head, and heating pads are placed on the legs. Relaxing the muscles will help ensure the created hamstring. For the same purpose, you can put a roller under your knees.
Drug treatment includes the use of the following drugs for intravenous drip use:
- Magnesium sulphate;
- Dibazol;
- Aminazin;
- Pentamine.
Due to the increased risk of reducing blood clotting, medications that activate thrombosis in the vessels can be administered. This type of therapy should be carried out under the control of a laboratory blood test for a coagulogram.
In the first 2-3 days are prescribed:
- Calcium chloride;
- Vikasol;
- Aminocaproic acid.
In cases where on the third day after a stroke there are pronounced signs of atherosclerosis and subarachnoid hemorrhage, proteolytic enzymes can be prescribed:
- Gordox;
- Contrykal.
One of the effective modern drugs used in the treatment of cerebral stroke is Etamsilat. It allows you to stop blood loss, improve microcirculation in damaged areas of the brain, and normalize vascular permeability. At the same time it serves as an excellent antioxidant.
If cerebral edema has severe meningeal symptoms, a spinal puncture should be performed with caution, in which small amounts of CSF are extracted.
Treatment for ischemic stroke
In the second type of cerebral stroke, the actions of specialists will be aimed at solving the following tasks:
- Improvement of blood supply to tissues;
- Formation of increased resistance to lack of oxygen;
- The introduction of drugs to improve the metabolism in the surviving cells.
The position of the patient in bed should be comfortable, but his head should not be raised as high as it should be done in a hemorrhagic stroke.
In ischemic stroke, treatment must necessarily include vasodilators. To a greater extent, collaterals are used, which are auxiliary capillaries that can partially replace natural ones.
For this purpose, the following agents are used in the form of solutions for intravenous drip injection:
- Eufillin;
- No-shpa;
- Papaverine;
- A nicotinic acid;
- Complamin.
used medicine to improve hemodilution - Reopoliglyukin, which improves blood supply by reducing blood clotting.
Medical control and treatment includes a careful measurement of the volume of fluid injected, which in excess can be dangerous by increasing tissue edema. Caution also requires the use of diuretics, especially if there is hypertension.
Along with fibrinolytic agents, anticoagulants are used. In stroke therapy, the important term “golden hour” is used. It serves as an indicator of the maximum effectiveness of drug administration to reduce blood clotting, as well as to predict the disease.
Due to too long transportation to the clinic, it becomes difficult to distinguish between different types of stroke and provide proper treatment assistance, and its optimal time is missed.
On the first day, ischemic stroke is treated by injecting a solution of Fibrinolysin with Heparin.
After that, the treatment regimen includes:
- Intramuscular injection of Heparin;
- After 3-5 days, a transition to Fenilin and Dicoumarin is recommended.
In the treatment of young and middle-aged patients, Pentoxifylline is used to help improve blood density.
Elderly patients for treatment are prescribed:
- Parmidin;
- Xanthinol nicotinate;
- Anaprilin (with existing tachycardia);
- Cavinton, Cinnarizine (allows to improve vascular tone).
Medicine has found that in ischemic stroke, the combined use of Curantyl and Aspirin will help reduce the risk of re-development of the pathology.
The patient's arousal syndrome can be cured by prescribing barbiturates. Metabolic failure should be treated with drugs of the metabolite class (Piracetam, Aminalon, Cerebrolysin), which also increase the resistance of cells to oxygen deficiency.
Surgical methods
Sometimes a stroke can be beaten with surgery. If a patient has been diagnosed with a hemorrhagic stroke, then surgical methods of treatment can only be used if young or middle age, and also if lateral hematomas and hemorrhages in the cerebellum have been diagnosed.
The indications for the operation are:
- The impossibility of removing cerebral edema by other means;
- The occurrence of signs of compression by a hematoma;
- Suspicion of the possibility of repeated hemorrhage in the brainstem or hemispheres.
The best time for the operation is 1-2 days. The hematoma is opened and removed. If ruptures of the aneurysm of the brain were detected, the vessel is ligated.
Surgical treatments for ischemia are used in rare cases. Indications for surgery is the diagnosis of narrowing of the carotid, vertebral or subclavian artery, causing pathology.
Patient care
In order to recover from a stroke, it is very important to provide proper patient care.
Care measures during inpatient treatment include:
- A certain diet, including juices, liquid high-calorie meals;
- In a coma, nutrition is carried out using a probe;
- Prevention of congestion in the lungs and bedsores, for which the patient is turned over every 2-3 hours, a rubber circle is placed in the sacrum, and dense rings under the heels;
- Monitor the cleanliness of bed linen, do not allow high humidity;
- The skin should be treated with a weak solution of manganese, camphor alcohol or solcoseryl ointment;
- The oral cavity is treated with boric acid;
- A catheter is used to remove urine, with constipation, laxatives are given and an enema is given.
Rehabilitation
It is possible to safely eliminate the consequences of a stroke with well-organized rehabilitation.
Help for a survivor of a brain stroke should include the following measures and actions:
- Gentle massage of the limbs from the second week of illness;
- Therapeutic exercise, contributing to the restoration of motor functions with a gradual increase in intensity.
- Kinesiotherapy, which develops small hand movements, helping the patient in self-care in new conditions;
- Water procedures aimed at muscle stretching, oxygen baths, hydromassage.
With properly taken therapeutic measures for stroke, as well as well-organized rehabilitation, up to 70% of people who have had a brain stroke return to independent life.
The best period for rehabilitation measures and assistance is the first three years, during which it is necessary to stock up on patience and faith in success.
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