Therapeutic exercise for recovery after a stroke is a vital method of rehabilitation. Exercise after a stroke

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Rehabilitation after a stroke at home involves exercise, exercise (physiotherapy exercises), massage and medication.

The list of exercise therapy exercises for stroke is selected by the doctor based on the patient's condition, however, it is possible to give approximate recovery complexes that are safe to perform at home.

About the benefits of exercise therapy

Gymnastics after a stroke has a lot of useful properties:

Physical exercise is indicated to maintain joint mobility and normalization muscle tone(with a stroke, the motor function of the arms and legs decreases).
Prevents the formation of bedsores in the area of the feet, back and those places on which the pressure is greatest.
Helps to restore the work of the brushes.
Helps to relieve the symptoms of paralysis, restoring the functions of the limbs and body.
Removes muscle hypertonicity, normalizes the work of the affected muscles.

Exercises after a stroke are shown to people who have had this terrible disease.

Preparatory activities

Before using exercise therapy, it is worth preparing the patient.

How to do it:

Necessary (every 2-3 hours). Such measures are required to prevent blood stasis.
Then, with the same frequency, it is worth doing passive exercises: make movements with outside help. This technique allows you to relieve muscle tension.
After that, breathing exercises are added. They normalize gas exchange, improve muscle function.
At the end go to physical activity active type. This includes walking after a stroke. They make it possible to return to a normal form and minimize the likelihood of subsequent relapses of the disease.

Help with walking

The rehabilitation complex is planned so that physical therapy after a stroke is the final point of the activities. It is indicated only when the patient's condition is stabilized.

The goals of therapeutic charging

A set of exercises for stroke is designed to achieve several goals:

Prevent the formation of bedsores.
Prevent the development of congestive pneumonia.
Relieve spasm of the left and right side body in stroke.
Stop the development of heart failure, and also prevent the atrophy of the affected muscles.

In severe cases, a person literally has to learn to walk again, use household appliances, and take care of himself. The solution of these problems is designed to help exercise therapy after a stroke at home.

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Passive loads

Before performing a set of passive exercises, the patient is shown performing a massage. In short, it is based on the following principles:

Physical impact is performed with light stroking in a circular motion.
Massage is done starting from the upper sections (head, collar area). Then they move on to the legs.
The impact on the back is carried out by tapping movements.
On pectoral muscles affect starting from the center chest and moving on to the armpits.
Hands and feet are massaged in this sequence. Arms: shoulders, forearms, hands, fingers. Legs: buttocks, thighs, shins, feet, toes.
Massage begins on the healthy side (left if the right side is affected and vice versa).

After performing the massage, you can start exercise therapy at home.

Exercises:

Take a rounded object, place it in the patient's hand. Help to hold the object in hand. Similar exercises for fine motor skills of the hands should be performed more often, they will help restore the work of the hand and fingers.
Bend and unbend your legs. It is necessary to make movements so that the limb straightens itself, having traveled along the surface of the bed. Even in passive exercises, the participation of the patient is important.
Squeeze and unclench the fingers of the affected hand.
Raise and lower your arms (movement falls on the shoulder joint).

There is another exercise of the passive type. The leg or arm should be hung on a towel or elastic bandage. Now you need to make rotational movements, as well as move the limb to the right and left.

Passive exercise for recovery after a stroke are designed to prepare the patient for a full-fledged physical education. They are performed 2-3 times a day (initially 2, then 3). Duration - about half an hour.

mental training

Treatment after hemorrhagic stroke(and ischemic "fellow") should be comprehensive and systematic. Therefore, you can not do without mental stress. They help restore damaged neurons, train memory and restore normal thinking process. Patients develop aphasia after a stroke. Mental exercises for stroke help normalize speech functions.

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Active physical activity

Lying exercises

Work begins in the acute period.

Grasp a distant object behind you with your hands (a headboard will do). On the count of “one”, perform a “pull-up”, straightening the legs and arms as far as possible. Then return to the original position.
With an effort to straighten the affected arm, starting with the fingers, then moving to the hands and forearms. With the help of a tire and an elastic bandage, fix the limb in a similar position for half an hour. This exercise allows you to restore hand function after a stroke.
"Slip". Done with effort. Lying on the bed, they try to alternately bend the legs at the knees so that the feet do not come off the surface of the bed. It is performed 8-12 times.
Make alternate turns of the head to the left and to the right. Exercise is necessary to relieve hypertonicity of the cervical muscles.
Lie down straight. Hands at the seams. The body is relaxed. Bend on the count of "one" right hand at the elbow, fix it in this position for a second or two. Then lower the limb onto the bed. For a count of two, bend the other arm. In addition to the above exercise for the hands, you can perform its complicated version. Suspend the limb with a bandage and perform all kinds of movements: flexion, extension, rotational movements.
Bend your fingers into a fist and unbend back. After stroke hand function deteriorates sharply. Thus fine motor skills will recover and gradually the fingers will return to normal condition. To restore the power characteristics, it is permissible to use a ring expander.

Specified exercise therapy complex with hypertension and stroke should be performed with great care. However, the performance of these exercises is allowed in the acute period of the course of the disease. They are also suitable for the disabled.

Complexes from a sitting position

For treatment, classes are resorted to at the end of the acute period. The complex of exercise therapy for the treatment of stroke includes the following payloads:

Sit straight. It is advisable to use a chair with a back. On the count of "one" take a breath and bring the shoulder blades behind your back. On the count of two, return to the original position. This load is designed to develop the muscles of the shoulder girdle.
Rotational movements of the head. 8-10 times in each direction. When performing, it is important to adhere to safety precautions: a dislocation or fracture of the cervical vertebrae is possible, the movements are slow and smooth. The load is considered part of the vestibular gymnastics.
Take a stalk from a shovel or other similar stick. Place it perpendicular to the floor to form a fulcrum. Now you need to take hold of the "shell" with both hands. Leaning on a stick, make rocking movements back and forth, gradually increasing the amplitude. Breathing is even, it can not be knocked down. After a stroke, this load is designed to relieve excess back muscle tone.
Perform flexion and extension of the fingers.
Sit on a chair. Try to slowly bend back, bringing your shoulder blades together and moving your arms and head back. "Freeze" in a curved position for 2-3 seconds.
Take a sitting position on the bed. Legs should hang freely. Do swings with the lower limbs. You should start at a slow pace, gradually building up strength. Such exercise therapy after a stroke is necessary for the development of the lower extremities.

Complexes from a standing position

These exercises are ideal for the heart and blood vessels, but should be performed in the later stages of rehabilitation, due to their complexity for a patient after an ischemic stroke.

Stand up straight. Legs at shoulder level. For such exercise therapy (therapeutic gymnastics), you will need a fulcrum in the form of a chair back or something similar. On the count of "one" raise your leg, put it on a chair. Return to original pose. On the count of two, raise the other leg. Run 3-6 times.
On the account of "one", slowly raise the upper limbs above the head. Stay in this position. Put your hands down on the count of two. The rise is carried out on inhalation, lowering the arms - on exhalation. Such exercise therapy in violation cerebral circulation necessary for the development of hands after a stroke and the normalization of breathing.
False steps. Legs at shoulder level. On the count of "one" push the leg forward, making a false step, on the count of "two" put the limb back, on the count of "three" return to the starting position. Repeat 5-7 times for each limb, starting with a healthy one.
Pick up a tennis ball or other rounded object. Throw it from hand to hand. Therapeutic gymnastics of this kind with a stroke helps to restore coordination. It is better if such a load is performed in conjunction with an assistant.
Sipping. It is necessary to stand on your toes and stretch your arms up, as if wanting to reach the ceiling.
Walking in one place (30 seconds-1 minute).
Get up. Hands on the belt. Make a twisting turn to the right, spread the upper limbs. Repeat on the other side.
Doing squats. This exercise exercise therapy for ischemic stroke should be done with caution, as it increases blood pressure.
Get up. Hands on the belt. Make tilts to the right and left.
Perform forward lunges.
Legs at shoulder level. Raise your right leg. Do circular swings with a limb. Repeat the same with the other leg.

Exercise with a gymnastic ball

These exercises after a stroke can be performed at home, but it is better if the exercises are carried out under the supervision of a doctor, especially if exercise therapy is prescribed for chronic diseases of the cardiovascular system.

Eye Complex

Exercises physiotherapy exercises are also indicated for the restoration of oculomotor functions in paresis of nerves and muscles.

The complex includes the following movements:

Left-right.
Up down.
"Eights".
Intense contraction of the eyelids.
Circles (first clockwise, then counterclockwise).
Frequent blinking.

Loads for hands

After a brain injury, the hands are the first to suffer. To restore motor functions, a set of exercise therapy exercises after a stroke is shown.

Among them:

Squeezing the fingers, followed by unclenching.
Free swings of the limbs (exercises, like a "mill" or "scissors" in a standing position).
Movements with brushes in a circle.
Flexion of the arms in the elbow joints, followed by extension.
Loads on the shoulder joints (up and down).

Hand development

Loads for the legs

A set of exercises after a stroke for the legs includes:

Flexion and extension of the toes.
Abduction of the legs to the sides (movements begin with the hip joints).
Pulling socks towards you.
Flexion-extension of the lower extremities at the knees.

These sets of exercise therapy exercises are not contraindicated in cardiovascular diseases.

Complex for articulation

Complex 1

Pulling the tongue forward. In this case, the amplitude of movement should be maximum.
Clicking tongue (clicking movements up and down).
Curling lips into a tube.
Alternate biting of the upper and lower lips.

It is also necessary to lick the lips with the maximum possible amplitude, first clockwise, then counterclockwise.

Complex 2

Smile, hold the smile on your face for 5-10 seconds.
Try to roll your tongue into a tube.
Make circular movements with your tongue hanging out.
Say the alphabet in order.
Pronounce simple words(mom, dad, etc.).
Pronounce Difficult words and tongue twisters (in the late rehabilitation period).

These exercises are most effective for restoring speech after a brain stroke. Speech therapy advises to perform these complexes 2-3 times a day for 15-30 minutes.

Breathing exercises

Difficult exercises are contraindicated, as there is a high risk of growth blood pressure. The essence of the only allowable load is to make rhythmic inhalations and exhalations, change the frequency of respiratory movements, alternating abdominal breathing with chest breathing. Such breathing exercises with a stroke of the brain, it saturates the cells with oxygen and restores normal gas exchange. It is possible to inflate balloons.

Smirnova Olga Leonidovna

Neurologist, education: First Moscow State Medical University named after I.M. Sechenov. Work experience 20 years.

Articles written

Stroke is a serious disease that occurs when there is a violation of the blood circulation of the brain and leads to the death of most of the nerve cells. The consequence of the disease is the loss of some of the functions that dead cells performed, as a result, the patient has problems with speech, complete or partial hearing loss, and paralysis.

Physical therapy after a stroke will help restore lost functions to the body, so such a serious illness is not a sentence at all.

Exercise therapy as an important stage of rehabilitation

Restoring the body after a stroke is a complex, lengthy, but necessary process, since a period of forced immobility entails the development of extremely.

The final recovery of a person takes place at home, under the supervision of loved ones and loving people. The success (complete or partial) of a patient who has lost some functions depends on how persistent and purposeful their actions are, and how precise the rules for performing exercises are: the ability not only to serve themselves, but also to move.

Restorative gymnastics after a stroke is one of the most effective and available methods, aimed at making the inactive nerve cells of the brain, which are located near the lesions, work. This allows you to return the lost sensitivity to the limbs, and in the case of positive dynamics, the ability to move.

Exercise therapy for stroke performs certain tasks and prevents the occurrence of:

bedsores;
heart failure;
thrombi, embolism;
atrophy and muscle spasms;
contractures (limitation of mobility in the joints of paralyzed limbs).

Systematically performed exercises for recovery after a stroke have a beneficial effect on metabolism and blood circulation, normalize the work of all body systems, and contribute to. In the future, the accuracy of movements returns to the patient, he can write, draw, as well as use household items and serve himself.

Doctor's recommendationsByphysical educatione

When does physical at home start? This will depend on the observations of the attending physician, whose recommendations come from individual features the patient, his ability to recover, areas of the brain, as well as the completeness and effectiveness of the therapy received.

The first 6 months is an acute period during which one part of the cells dies, the other retains the ability to perform its functions, but in the presence of a stimulating factor, which is the complex of rehabilitation exercises for stroke.

If a person is not in a state between life and death, in other words, he is not in a coma, retains consciousness, and on the third day he is shown breathing exercises. This is a necessary condition for rehabilitation in order to prevent congestion in the lungs, to strengthen the separation of sputum, to eliminate paresis of the muscles of the face.

After being released from medical institution physical education for the patient is an integral part of recovery, so exercises after a stroke should continue at home.

As soon as the patient is able, he is shown recovery walks, the time of which is gradually increased.

The late rehabilitation period begins after 6 months. At this time, stroke patients need sanatorium treatment at least 2 times a year. Therapy carried out by medical personnel includes not only sports and recreation complexes, but also additional measures effects on the body, such as acupuncture, electrosleep, oxygen baths, and others.

To achieve maximum efficiency, physiotherapy exercises should be combined with psychocorrection and classes aimed at social adaptation.

Support is essential at every stage of recovery. mental activity when nerve cells receive commands from muscle memory. Each human action must be accompanied by mental orders that stimulate the limbs to move.

Contraindications to exercise therapy after a stroke

Exercise therapy is not indicated for all stroke patients. There are a number of contraindications that you need to know in order to avoid undesirable consequences. This applies to patients:

in a coma;
having disorders, aggressive changes in behavior;
with old age;
suffering from epileptiform seizures, convulsions;
with severe concomitant diseases (diabetes, oncology, tuberculosis).

If you experience headaches, increased blood pressure, weakness in the process of exercising, it is necessary to reduce the load. Relatives will need a lot of patience and endurance to help native person adapt to the surrounding reality and master the necessary everyday skills.

In order for the process to progress more intensively, they themselves have to learn the basic movements and their sequence. At the same time, for rehabilitation after a stroke, the patient must be encouraged in every possible way, to stimulate the desire to recover in him, because friendly support, participation, attention and good emotions will give him energy and faith in his strength.

Principles of breathing exercises

The simplest exercise at the first stage of training is to exhale through pursed lips or through a tube dipped into a bowl of water. After the patient gets a little stronger, an exercise is shown to improve the respiratory system, which consists in inflating a balloon. These simple manipulations allow a stroke patient to see and hear the results of their activities (increase in the volume of the ball, gurgling water) and stimulate him to further actions.

The basic principles of respiratory gymnastics are the implementation of several deep breaths, hold your breath for a few seconds, gradually exhale. Exercises should be performed frequently, but there should be rest between them. It is contraindicated for the patient to strain while holding his breath, otherwise he will develop dizziness, which will negatively affect his well-being.

If the patient is allowed to sit, you need to make sure that his back is straight - so the air will expand the lungs as much as possible.

Recovery after a stroke will be much more effective if you take Strelnikova's technique as a basis when performing breathing exercises.

Lying exercises

As long as the patient is not allowed to get up, he can do post-stroke exercises in the supine position, which are limited to moving the joints of the arms and legs. Then flexion, extension, rotation are gradually introduced, and the amplitude of movements also increases. You need to start small, not trying to complete the “maximum” program: 15 movements in each joint 3-4 times a day will be more than enough.

The passive mode assumes that other people will do the exercises for the patient, bending and unbending his limbs. In the active mode, the patient himself performs with the help of a healthy hand. As additional devices, a towel is used, which is hung over the bed, or a rubber ring.

When performing the complex, it is important to follow the sequence and develop the joints from the center to the periphery, for example, exercises for the arms are performed starting from the shoulder to the hand.

raising and lowering the arms along the body;
flexion and extension of the limbs in the elbow joint;
clenching fingers into a fist and unclenching;
fist rotation.

You need to do no more than 20 times in one approach.

Leg exercises:

flexion and extension of the legs at the knees;

abduction of the limbs to the side, using the hip joint;
pulling the socks up and returning them to their original state (exercise "pedal");
movement of the toes (flexion, extension).

The number of repetitions is 20 times.

For the muscles of the trunk (if there is a physical possibility):

without leaving the bed, perform body turns with a roll;
lifting the upper body, straining the abdominal muscles;
lifting the pelvis with the help of the shoulder blades, the back of the head, feet, elbows.

Perform no more than 10 times.

The following muscles also need to be developed: mimic, eye, neck.

Sitting exercises

When the doctor allows the patient to sit down, exercises performed while sitting are included in exercise therapy after a stroke at home. They are designed to strengthen the arms, back and prepare for walking.

The complex includes:

head rotation;
raising and lowering the legs;
flexion of the lower extremities;
pulling the knees to the chest;
swing your legs;
sitting on the bed with legs down, without support behind the back.

These exercises should be performed 6-10 times.

Grasping movements allow restoring fine motor skills of the hands: shifting grains of cereals (beans, beans) one at a time or in handfuls from one container to another, crushing sheets of paper, pieces of fabric, folding small items. Various educational games (pyramids, loto, mosaic) are very useful at this stage.

What exercises can you do while standing?

A patient who has received permission to stand and move around should diversify stroke exercises and increase their number. In this case, charging should begin with a simple complex. At first, it is performed with the help of outsiders, then independently.

It is advisable to use, however, a standard set of exercises after a stroke at home can be done with the help of aids. Be sure to have a point of support behind your back, which, in the absence of a special machine, can serve as the back of a chair or bed. This is necessary so that the examiner, who is not strong after a serious illness, can confidently keep his balance.

The simplest types of exercise therapy include:

swing limbs;
turns of the body to the sides;
lunges with weight transfer to the front leg;
rolling from toe to heel;
squats;
torso to the sides;
head rotation.

Gradually, the intensity of training increases. Classes include physical exercises such as jumping, backbends, "boxing" when turning the torso, as well as short walks on foot.

The above exercises for or hemorrhagic are an integral part of the patient's life. It is very important that a person who has had an illness does not lose the desire to regain lost functions, including household self-service skills. Physiotherapy - The best way recover from a severe illness.

Rehabilitation after a stroke involves the implementation of restorative measures in the complex - drug therapy, exercise therapy, physiotherapy, massages and non-traditional methods effects on nerve cells. Therapeutic exercise (exercise therapy) after a stroke occupies a predetermining place in this entire list, since by physical impact on atrophied muscles it can make immobilized limbs, speech apparatus, and visual organs “work”. The condition for the effectiveness of the recovery process in this case is the rational distribution of the load on the muscles and the regular implementation of the exercises recommended by the attending physician.

The role of exercise therapy in the recovery of the patient

Therapeutic exercise is an integral part of the recovery program after. Its benefits are as follows:

the possibility of restoring the mobility of the joints of the limbs and returning to normal tense muscles;
prevention of the occurrence of such complications as bedsores on the back, buttocks and feet in bedridden patients;
return of sensitivity and mobility of paralyzed limbs;
withdrawal muscle hypertonicity and prevention of the formation of contractures;
elimination of speech disorders by influencing the facial and linguistic muscles;
restoration of hand motor skills, writing and drawing skills;
improvement of vision;
restoration of the whole organism.

For the effectiveness of exercise therapy after a stroke, physical exercises must be combined with other recovery methods - medication, physiotherapy, social and psychological adaptation measures.

The recovery post-stroke period begins 3-4 days after the attack with passive gymnastics. Medical personnel or trained relatives perform the exercises instead of the patient, making their own efforts to restore sensitivity and strength in the limbs.

Passive exercise therapy begins with a massage, which includes the following manipulations:

stroking movements in a circle;
impact on muscle tissue, starting from the upper back and ending with the legs;
tapping on the back;
impact on the muscles of the chest - from the chest to the armpits;
massaging the arms from the shoulder joint to the fingers, and the legs from the buttocks to the foot.

Initially, the healthy side of the body is massaged, then the affected side.

Passive gymnastics can be performed both in a medical institution and at home. To do this, up to 3 times a day for half an hour, a health worker or a person caring for a sick person helps to perform the following exercises:

development of the arm - flexion of the fingers, followed by extension, rotation of the hand, flexion-extension of the elbow joint, raising and lowering the shoulder;
development of a paralyzed leg - flexion followed by extension of the fingers, circular rotation of the feet, bending of the leg at the knee and hip joint;
motor recovery and grasping reflex- a rounded object is placed in the affected hand of the patient;
development of limbs in a suspended state - a foot or hand suspended on a towel performs rotational and pendulum movements.

Are you worried about something? Illness or life situation?

To active exercise therapy after a stroke, when the patient begins to perform gymnastics on his own, they switch after the recommendation of the doctor. At first, the bias is made on exercises in the supine position, then the development of limbs while sitting is connected to them. With the confident performance of the described exercises, the patient is allowed to engage in physiotherapy while standing.

Lying exercises

Straightening of the affected limb - with effort, the limb in the joints is straightened as far as possible (the arm is in the elbow joint and wrist, the leg is in the knee) and is fixed for half an hour with a splint.
Head turns - slowly turn the head first to the left, then to the right, while fixing the gaze in front of you.
Flexion and extension of the limbs - in a flat position on the back, they first bend the arm at the elbow, fix it for a few seconds, then unbend it to its original position. A similar exercise is performed with the legs while bending them at the knee joint.
Bending the fingers into a fist - the exercise is performed up to 10 times per approach, alternately with both hands, first - the patient, then - the healthy one.
Pulling up the body - lying on your back, you need to take both hands on the back of the bed and pull yourself up to it, as if on a horizontal bar. In this case, the legs should be as straight as possible, and the socks should be extended.
Sliding legs - lying on your back with straightened legs, you need to bend them at the knees and pull them towards you, while the feet should not come off the bed.

Sitting exercises

Head rotation to the sides and tilts.
Leg swings - in a sitting position on a hard surface with outstretched legs, it is necessary to slowly raise one limb first, then the other.
Reducing the shoulder blades - sitting with straightened legs, you need to inhale to put your hands behind your back, clasp them in the lock for a few seconds and then slowly return to their original position as you exhale.
Exercise with a gymnastic stick - sitting on a chair, sports equipment is clasped with both hands and rests on the floor. Breathing evenly, it is necessary to swing the body in different sides while leaning on a stick.
Throwing a tennis ball from one hand to the other.

Standing exercises

Raising the legs - leaning on the back of the chair with your hand, you need to alternately raise your legs and put them on the chair, and then return to the starting position.
Abduction of the leg to the side - in the same position, first one leg is retracted to the side and fixed for 3-5 seconds, then the other.
Raising the arms - placing the legs at shoulder level, you need to slowly raise your hands while inhaling, clasp them in a lock above your head, and then lower them down as you exhale.
Turns of the torso - standing with arms spread apart, turns of the torso are performed first in one direction, then in the other.
Tilts - in the position of the hands on the belt, and the legs - shoulder width apart, you need to inhale, tilt forward, linger for 3-5 seconds and then straighten up with an exhalation.
Squats - standing with a straight back, you need to inhale, stretch your arms in front of you and sit down as you exhale. After that, in a sitting position, inhale and exhale after getting up.
Walking in place - the exercise is performed for 20 seconds, after which a break is required to restore breathing.

With visual disorders caused by a brain stroke, the patient is prescribed medication and exercise therapy. The program is compiled individually for each patient, however, there are a number of basic eye exercises suitable for each of them:

"Palm pressing". Cover your eyes with your palms, then take a few deep breaths through your nose and exhale through your mouth. Next, with the palms, lightly press first on the top, and then lower part eye sockets. At the initial stage, the exercise is performed 3-5 times, gradually increasing the number to 15 repetitions.
"Closing". Both eyes close tightly, hold the position for up to 5 seconds, after which they sharply relax the eye muscles.
"Massaging the eyeballs". Closed eyes massage with fingers in a circle through the eyelids, while the pressure should be light.
"Pencil Exercise" The pencil is placed in front of the eyes, after which they begin to move it in a circle, in different directions, bringing it closer and further away. During this exercise, the head should remain motionless.

Mandatory exercises in restoring vision after a stroke are eye movements - left and right, beveling diagonally, up and down, in a circle, bringing the pupils to the bridge of the nose.

Exercise therapy for legs after a stroke

Finger movements - flexion, extension, fingering.
Abduction of the leg - in the prone position, the leg slides along the surface to the side, while the arms should be located along the body. When performing the exercise while standing, a chair is used instead of a support, and the leg, with a straight back, is retracted up and to the side.
Pulling up socks - socks must be pulled as much as possible towards you, resting your heels on hard surface.
Bending the legs at the knees - performed in all positions of the body.
Raising the heels - sitting on a chair, the patient raises the heels, thus emphasizing the force of gravity on the toes. After being in this position for 10-15 seconds, you need to return your legs to their original position and rest your heels on the floor.
Jumping - within a minute it is necessary to perform jumping up.

Articulation and speech

To restore speech and articulation to a patient who has had a stroke, it is necessary to perform exercises from the first days after the attack, which for healthy person may seem too simple:

"Smile". Smile broadly, exposing as many teeth as possible, stay in this position for 5-10 seconds, then close your lips.
"Swing". Stick your tongue out of your mouth, lift it up and try to reach it to the tip of your nose. After that, lower the tongue down, trying to reach it to the chin.
"Shovel". Stick out the tongue as far as possible, while lowering its tip down. Hold this position for 7-10 seconds.
"Tube". The lips are folded into a tube and pulled forward as much as possible.
"Groove". The tongue is protruded outward and folded in the form of a trough for 5-10 seconds.
"Bite". Lips alternately bite with teeth - first the upper, lifting the lower jaw up, then vice versa.

The exercise therapy program, which restores speech and articulation after a stroke, also includes pronunciation of the letters of the alphabet, words (from simple to complex) and tongue twisters.

After the patient has come to his senses and his main life systems begin to work stably, he needs to perform breathing exercises. Regular training of the respiratory system will strengthen it, normalize the functioning of the lungs and eliminate congestive processes, as well as reduce the hypertonicity of the facial muscles.

Before starting a workout, you need to sit down, lean on a hard surface, rest your feet on the floor or stretch them out on the bed, and put your hands on your knees. Exercises are performed from 4 to 8 repetitions, depending on the patient's well-being.

Exercise number 1.

Hands are spread apart. At the entrance through the nose, tilt forward, bringing the hands together in the form of hugging oneself by the shoulders. After a delay in this position for a few seconds, the hands are bred to their original position, while exhalation is carried out through the mouth.

Exercise number 2.

The palms are located on the hips in their first third. On inhalation through the nose, the arms are straightened at the elbows, the chest is pulled up. After a few seconds, exhalation is carried out through the mouth, the arms relax and the torso leans forward.

Exercise number 3.

The palms are located on the belt. When inhaling through the nose, the palms slide along the belt and close in front of the body with the back part as close as possible to each other, after which they fall down in this position. The chin at this moment should be pressed to the chest. On exhalation through the mouth, the hands are maximally retracted behind the back, and the head rises up.

When performing breathing exercises, the eyes should be open. In case of dizziness, shortness of breath or nausea, classes should be stopped, and further actions- agree with the doctor.

For the efficiency and speed of recovery of movement functions after a stroke, the following simulators are used:

Walkers are the simplest simulator used to restore walking function.
An exercise bike is necessary to restore the functions of movement of the lower extremities, strengthen the cardiovascular system and improve the body as a whole.
The “Buton” simulator is used to develop the hand, restore the grasping reflex, the “squeeze-unclench” function.
Simulator "Shagonog" - helps to strengthen the muscle tissue of the legs in bedridden patients.
Stander - helps to restore the functioning of the vestibular apparatus, giving vertical position body.
Robotic simulators are machines programmed to execute commands from the brain with parts of the body.
Step platform - helps to restore the function of walking up the stairs and strengthen the calf muscles.

Before using any exercise machine, you should consult your doctor. Only a specialist can recommend an effective model and the degree of load on the body, taking into account the nature of motor function disorders.

Contraindications for exercise therapy

Despite the effectiveness of the use of exercise therapy in recovery period after a stroke, there are a number of pathological conditions in which classes are contraindicated:

If there is a history of the described diseases, the attending physician draws up an individual program, selecting gentle exercises to restore motor functions. In case of acute conditions (for example, high temperature or hypertensive crisis) it is necessary to wait for the normalization of health and only after that proceed to physiotherapy exercises.

Stroke is a disease in which acute ischemia (impaired cerebral circulation) occurs as a result of occlusion (blockage) or stenosis (narrowing) of the main vessels of the brain. This is a severe pathology that requires a long recovery. Rehabilitation after a stroke at home involves exercise, exercise (physiotherapy exercises), massage and medication.

About the benefits of exercise therapy

Gymnastics after a stroke has a lot of useful properties:

Physical exercises are indicated to maintain joint mobility and normalize muscle tone (with a stroke, the motor function of the arms and legs decreases).
Prevents the formation of bedsores in the area of the feet, back and those places on which the pressure is greatest.
Helps to restore the work of the brushes.
Helps to relieve the symptoms of paralysis, restoring the functions of the limbs and body.
Removes muscle hypertonicity, normalizes the work of the affected muscles.

Exercises after a stroke are shown to people who have had this terrible disease.

Preparatory activities

Before using exercise therapy, it is worth preparing the patient.

How to do it:

It is necessary to constantly change the position of the lying patient (every 2-3 hours). Such measures are required to prevent blood stasis.
Then, with the same frequency, it is worth doing passive exercises: making movements with outside help. This technique allows you to relieve muscle tension.
After that, breathing exercises are added. They normalize gas exchange, improve muscle function.
At the end, they move on to physical activity of the active type. This includes walking after a stroke. They make it possible to return to a normal form and minimize the likelihood of subsequent relapses of the disease.

The rehabilitation complex is planned so that physical therapy after a stroke is the final point of the activities. It is indicated only when the patient's condition is stabilized.

The goals of therapeutic charging

A set of exercises for stroke is designed to achieve several goals:

Prevent the formation of bedsores.
Prevent the development of congestive pneumonia.
Relieve spasm of the left and right sides of the body during strokes.
Stop the development of heart failure, and also prevent the atrophy of the affected muscles.

In severe cases, a person literally has to learn to walk again, use household appliances, and take care of himself. The solution of these problems is designed to help exercise therapy after a stroke at home.

Passive loads

Before performing a set of passive exercises, the patient is shown performing a massage. In short, it is based on the following principles:

Physical impact is performed with light stroking circular movements.
Massage is done starting from the upper sections (head, collar area). Then they move on to the legs.
The impact on the back is carried out by tapping movements.
The pectoral muscles are affected starting from the center of the chest and moving to the armpits.
Hands and feet are massaged in this sequence. Arms: shoulders, forearms, hands, fingers. Legs: buttocks, thighs, shins, feet, toes.
Massage begins on the healthy side (left if the right side is affected and vice versa).

After performing the massage, you can start exercise therapy at home.

Exercises:

Take a rounded object, place it in the patient's hand. Help to hold the object in hand. Similar exercises for fine motor skills of the hands should be performed more often, they will help restore the work of the hand and fingers.
Bend and unbend your legs. It is necessary to make movements so that the limb straightens itself, having traveled along the surface of the bed. Even in passive exercises, the participation of the patient is important.
Squeeze and unclench the fingers of the affected hand.
Raise and lower your arms (movement falls on the shoulder joint).

There is another exercise of the passive type. The leg or arm should be hung on a towel or elastic bandage. Now you need to make rotational movements, as well as move the limb to the right and left.

Passive exercises for recovery after a stroke are designed to prepare the patient for a full-fledged physical education. They are performed 2-3 times a day (initially 2, then 3). Duration - about half an hour.

mental training

Treatment after a hemorrhagic stroke (and ischemic "colleague") should be comprehensive and systematic. Therefore, you can not do without mental stress. They help restore damaged neurons, train memory and restore normal thought processes. Patients develop aphasia after a stroke. Mental exercises for stroke help normalize speech functions.

Active physical activity

Lying exercises

Work begins in the acute period.

Grasp a distant object behind you with your hands (a headboard will do). On the count of “one”, perform a “pull-up”, straightening the legs and arms as far as possible. Then return to the original position.
With an effort to straighten the affected arm, starting with the fingers, then moving to the hands and forearms. With the help of a tire and an elastic bandage, fix the limb in a similar position for half an hour. This exercise allows you to restore hand function after a stroke.
"Slip". Done with effort. Lying on the bed, they try to alternately bend the legs at the knees so that the feet do not come off the surface of the bed. It is performed 8-12 times.
Make alternate turns of the head to the left and to the right. Exercise is necessary to relieve hypertonicity of the cervical muscles.
Lie down straight. Hands at the seams. The body is relaxed. On the count of "one", bend the right arm at the elbow, fix it in this position for a second or two. Then lower the limb onto the bed. For a count of two, bend the other arm. In addition to the above exercise for the hands, you can perform its complicated version. Suspend the limb with a bandage and perform all kinds of movements: flexion, extension, rotational movements.
Bend your fingers into a fist and unbend back. After a stroke, the function of the hands deteriorates sharply. Thus, fine motor skills will be restored and gradually the fingers will return to their normal state. To restore the power characteristics, it is permissible to use a ring expander.

The specified complex of exercise therapy for hypertension and stroke should be performed with great care. However, the performance of these exercises is allowed in the acute period of the course of the disease. They are also suitable for the disabled.

Complexes from a sitting position

For treatment, classes are resorted to at the end of the acute period. The complex of exercise therapy for the treatment of stroke includes the following payloads:

Sit straight. It is advisable to use a chair with a back. On the count of "one" take a breath and bring the shoulder blades behind your back. On the count of two, return to the original position. This load is designed to develop the muscles of the shoulder girdle.
Rotational movements of the head. 8-10 times in each direction. When performing, it is important to adhere to safety precautions: a dislocation or fracture of the cervical vertebrae is possible, the movements are slow and smooth. The load is considered part of the vestibular gymnastics.
Take a stalk from a shovel or other similar stick. Place it perpendicular to the floor to form a fulcrum. Now you need to take hold of the "shell" with both hands. Leaning on a stick, make rocking movements back and forth, gradually increasing the amplitude. Breathing is even, it can not be knocked down. After a stroke, this load is designed to relieve excess back muscle tone.

Perform flexion and extension of the fingers.
Sit on a chair. Try to slowly bend back, bringing your shoulder blades together and moving your arms and head back. "Freeze" in a curved position for 2-3 seconds.
Take a sitting position on the bed. Legs should hang freely. Do swings with the lower limbs. You should start at a slow pace, gradually building up strength. Such exercise therapy after a stroke is necessary for the development of the lower extremities.

Complexes from a standing position

These exercises are ideal for the heart and blood vessels, but should be performed in the later stages of rehabilitation, due to their complexity for a patient after an ischemic stroke.

Stand up straight. Legs at shoulder level. For such exercise therapy (therapeutic gymnastics), you will need a fulcrum in the form of a chair back or something similar. On the count of "one" raise your leg, put it on a chair. Return to original pose. On the count of two, raise the other leg. Run 3-6 times.
On the account of "one", slowly raise the upper limbs above the head. Stay in this position. Put your hands down on the count of two. The rise is carried out on inhalation, lowering the arms - on exhalation. Such exercise therapy in violation of cerebral circulation is necessary for the development of hands after a stroke and the normalization of breathing.

False steps. Legs at shoulder level. On the count of "one" push the leg forward, making a false step, on the count of "two" put the limb back, on the count of "three" return to the starting position. Repeat 5-7 times for each limb, starting with a healthy one.
Pick up a tennis ball or other rounded object. Throw it from hand to hand. Therapeutic gymnastics of this kind with a stroke helps to restore coordination. It is better if such a load is performed in conjunction with an assistant.
Sipping. It is necessary to stand on your toes and stretch your arms up, as if wanting to reach the ceiling.
Walking in one place (30 seconds-1 minute).
Get up. Hands on the belt. Make a twisting turn to the right, spread the upper limbs. Repeat on the other side.
Doing squats. This exercise exercise therapy for ischemic stroke should be done with caution, as it increases blood pressure.
Get up. Hands on the belt. Make tilts to the right and left.
Perform forward lunges.
Legs at shoulder level. Raise your right leg. Do circular swings with a limb. Repeat the same with the other leg.

These exercises after a stroke can be performed at home, but it is better if the exercises are carried out under the supervision of a doctor, especially if exercise therapy is prescribed for chronic diseases of the cardiovascular system.

Eye Complex

Physiotherapy exercises are also shown to restore oculomotor functions in paresis of nerves and muscles.

The complex includes the following movements:

Left-right.
Up down.
"Eights".
Intense contraction of the eyelids.
Circles (first clockwise, then counterclockwise).
Frequent blinking.

Loads for hands

After a brain injury, the hands are the first to suffer. To restore motor functions, a set of exercise therapy exercises after a stroke is shown.

Among them:

Squeezing the fingers, followed by unclenching.
Free swings of the limbs (exercises, like a "mill" or "scissors" in a standing position).
Movements with brushes in a circle.
Flexion of the arms in the elbow joints, followed by extension.
Loads on the shoulder joints (up and down).

Loads for the legs

A set of exercises after a stroke for the legs includes:

Flexion and extension of the toes.
Abduction of the legs to the sides (movements begin with the hip joints).
Pulling socks towards you.
Flexion-extension of the lower extremities at the knees.

These sets of exercise therapy exercises are not contraindicated in cardiovascular diseases.

Complex for articulation

Complex 1

Pulling the tongue forward. In this case, the amplitude of movement should be maximum.
Clicking tongue (clicking movements up and down).
Curling lips into a tube.
Alternate biting of the upper and lower lips.

It is also necessary to lick the lips with the maximum possible amplitude, first clockwise, then counterclockwise.

Complex 2

Smile, hold the smile on your face for 5-10 seconds.
Try to roll your tongue into a tube.
Make circular movements with your tongue hanging out.
Say the alphabet in order.
Say simple words (mom, dad, etc.).
Pronounce complex words and tongue twisters (in the late rehabilitation period).

These exercises are most effective for restoring speech after a brain stroke. Speech therapy advises to perform these complexes 2-3 times a day for 15-30 minutes.

Breathing exercises

Difficult exercises are contraindicated, since the risk of an increase in blood pressure is high. The essence of the only allowable load is to make rhythmic inhalations and exhalations, change the frequency of respiratory movements, alternating abdominal breathing with chest breathing. Such breathing exercises during a cerebral stroke saturate the cells with oxygen and restore normal gas exchange. It is possible to inflate balloons.

simulators

Stroke rehabilitation equipment makes the recovery process faster and more efficient.

Exercise equipment after a stroke includes:

exercise bike. The exercise bike helps to quickly restore lost motor functions, gently trains the cardiovascular system, preventing the recurrence of acute ischemia of cerebral structures. The task of the exercise bike is not limited to this. It contributes to the overall improvement of the body due to effective aerobic exercise.
Mini exercise equipment for limbs. Arm simulator after a stroke, called "Bud". Leg trainer - "Shagonog".
Verticalizer. Suitable for vestibular gymnastics. Gives the body a vertical position, allowing you to prepare for "upright walking".
« Active-passive” simulators. You can't do without them if we are talking about the restoration of the affected limbs.
Simulator Lokomat. At its core, this is an exoskeleton that teaches the patient to walk again, facilitating the process of movement.
Walkers after a stroke. Needed to learn to walk again. Their use is indicated in violation of the functions of the lower extremities. According to the mechanism of action, they are similar to an exercise bike and Lokomat.

Exercise machines for restoring vital functions after a stroke are diverse and should be selected by a doctor.

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Total information

A stroke occurs when the blood circulation process in the brain is disturbed, which inevitably leads to cell death.

During this, a person loses one of the possibilities or several at once, for example:

paralysis of the whole body;
problems with pronunciation of sounds;
complete loss of the ability to speak;
paralysis of one side of the body;
hearing loss;
inability to see.

Which particular set of exercises after a stroke will be required in a particular case is determined by the doctor, judging by where exactly the lesion occurred and how extensive it is.

If, as a result of this pathology, the left hemisphere is affected, then the following processes occur:

Right side paralysis.
Misperception of space.
Motor memory is partially absent, for example, the patient cannot hold a pen or a spoon correctly, and so on.
impulsive movements.

When the right hemisphere is affected, the following occurs:

The problem with the speech apparatus.
Left side paralysis.
Slow behavior.

Lesion Variations

There is also mild form stroke - when there is a slight paralysis or lack of external signs. In this case, medicines and physical exercises will help to recover in just a few months. But the situation is completely different with an ischemic stroke of the brain stem, here there may be no coordination disorder at all, but the pathology is hidden inside. Then the improvement is often not only visible, but also temporary.

The main task after a stroke is physical rehabilitation, that is, restoration of the sensitivity of the limbs. To this end, it will be necessary to restore to some extent the activity of the brain cells located in the affected area. But since dead nerve cells can no longer be restored, it is necessary to make others work instead of them.

But, gymnastics should be carried out only after the approval of a specialist and under his control at first.

There is a stroke with gross paralysis, which is much more difficult to cure. With due effort, the patient can begin to serve himself only after a minimum of six months of treatment. Often it is not possible to achieve a complete recovery or it occurs after a few years.

A stroke with acute and fairly persistent neurological disorders is very common - this is when complete paralysis of one side of the body occurs. The cure in this case is also difficult, it is limited by the ability to sit and it can happen even after a few years.

What exercise can help you achieve

Exercise therapy after a stroke is intended for:

prevention of muscle atrophy;
partial, and at best, complete return of the accuracy of all movements;
prevention of heart failure;
relief of muscle tension that occurs with paralysis;
return of normal blood supply;
prevention of congestive pneumonia;
preventing the formation of blood clots;
preventing the formation of bedsores.

If there are no special contraindications for the patient, then he can already begin to work out a set of exercises for a stroke even on the fifth day.

The decision to authorize a doctor is made up of several factors:

The complexity and timeliness of proper treatment.
The individual's ability to rehabilitate.
The extent of affected brain tissue.

Gymnastics after a stroke has a positive effect on the ongoing metabolism and blood circulation. Often even severe forms of stroke can be cured with the help of classes, people gradually begin to be able to draw, write and work with small details again.

The most acute period is considered to be the first three days after ischemic stroke, five days and seven days. If a person survived these days, then within six months, the processes of cell death continue to proceed in his body. But at the same time, physical education assistance under the supervision of a doctor is aimed at maintaining the ability of other cells to function, the same applies at home, the exercises here will be quite simple, but their effectiveness has been proven.

But classes should be continued at home, here you will need the active help of loved ones who are required to familiarize themselves with how to properly perform physical exercises in ischemic stroke. They should help and encourage the patient, noticing all his small victories.

All exercises are similar to how exercises are done in babies, but in this case it is aimed at tremendous progress.

Passive exercise

Although the body is this moment without movement, the affected areas require active recovery.

After a stroke, charging is most possible only in a passive form, that is, instead of the patient, the limbs should bend and unbend outsiders:

The procedure begins with the fingers of the hand from the side of paralysis, then bending is done with a healthy hand.
Then rotate with a brush.
Bend the arms in the elbow area.
After that, you need to go to the legs, the lesson methodology is similar.

Another method for warming up is the recovery complex. simple exercises made with a piece of rubber, which must be sewn into a ring. The elastic should be put on alternately, first on the hands, then on the legs, the limbs should be spread and reduced. The rubber ring will also help restore the functionality of the fingers, for this you should put it on them and stretch it.

All exercises are performed for at least ten minutes, gradually increasing the time to half an hour, but breaks are necessary every ten minutes.

Another exercise partially resembles a bicycle, but without the active participation of the patient.

It is important to pay due attention to the eyes, helping them with a kind of gymnastics:

Move your own gaze in different directions.
Make rotational movements. You need to do this first with your eyes open, and then with your eyes closed.

It is necessary to close your eyes and hold them longer in this position, then open and blink. It is necessary to blink strongly enough, clamping and unclenching the eyelids.
Turn your head, but at the same time the look remains in place.

Since stroke patients experience spasm of the limbs, fixing the limb in an extended form by tying it to a stick can help them. But such manipulation is carried out only for half an hour and only if the patient does not feel severe pain wherein.

Even when a person is not able to move independently, he must imagine during the recovery exercises after a stroke that he is doing it on his own. This will help to organize a signal to the brain that the body is doing this on its own and visualization helps to re-learn how to move.

Sitting exercises

As soon as the doctor allows you to sit, it is necessary to continue to exercise exercise therapy for a stroke:

Take a reclining position, then the patient takes the bed with his hands and straightens his legs as much as possible. Then you should bend a little so that his head rests on the pillow and take a deep breath.
In the same position, but completely sitting, it is necessary to alternately raise each leg, breathe slowly and evenly.
The leg should be bent and with the help of the hands pull it towards you, the head should be tilted slightly forward.
For rehabilitation after a stroke, the following is often used - it is necessary to hang a towel over the patient's bed, for which a person will pull himself up, while stretching his arms, gradually moving on to warming up the back muscles.

At home, exercises can also include this - sitting on the bed, you should bring your arms as far back as possible and at the same time straighten your shoulders, your head should be raised, after such tension you need to return to the starting position.

All exercises after a stroke must be carried out, carefully monitoring breathing and general condition patient, that is, he should not be in pain and the patient should not be very tired.

Exercise after a stroke at home means, first of all, the support of loved ones and their positive attitude for recovery, as well as active assistance.

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Preparatory period for exercise therapy

The benefits of exercise leave no doubt - any movement in the paralyzed part of the body accelerates the blood, prevents its stagnation, and at the same time restores muscle memory.

One cannot hope that only a complex of exercise therapy, or only drug treatment, will save from a stroke. It is necessary to adhere to a comprehensive rehabilitation course.

At the beginning of the hospital stay, physical exercises and patient care are carried out by doctors. However, upon discharge, the daily burden is shifted onto the shoulders of relatives. Therefore, it is recommended to save or learn a memo on how to properly assist the patient. Here are the rules for consistent physical impact after a stroke:

If the patient was paralyzed during an ischemic attack (even on one side of the body), the first 2 weeks it will be possible to influence the muscle complex only with a competent change of position.
Turn the patient over in bed every 2-3 hours to avoid bedsores and blood stasis.
After a week or two, they switch to passive types of exercise, produced by the influence of a nurse or relatives. Their goal is to relax the muscles and prepare for further stress.
As soon as the patient achieves the first movement in the paralyzed limb, they pass a active pursuits. The first time is in bed, then getting up and moving on to slow walks.

In the rehabilitation period after a stroke, relatives require attentiveness and regular exercise. One must be prepared to devote at least 2-3 hours at intervals during the day to the patient's recovery program.

It is important to understand that the stroke exercises given below as an example are designed for general case. And for each individual anamnesis, it is necessary to calculate their intensity.

Massage and passive exercise after a stroke

Before proceeding to exercise therapy, the paralyzed limbs of the patient are subjected to massage. There are rules for massage procedures that are common to all:

Before exercising, you should warm up the skin and cause blood flow with soft circular movements.
While massaging the hands, they move from the hand to the shoulder, the legs - from the foot to the hips.
The back is massaged using slightly sharper movements - tapping and pinching, but without the use of force.
Stretching the chest, you need to move in a circular motion from the center outward, applying light pressure.

Now that the patient's body is ready for exercise, they move on to passive physical education. Here are some basic manipulations for paralyzed limbs after a stroke, carried out by relatives:

Flexion and extension of the arms or legs: the patient should lie on his back. The limb should be raised and bent at the joint so that when it is extended, it slides along the bed. Thus, the legs restore motor memory.
Exercises with a wide linen elastic band help (the width is like that of an elastic bandage, 40 cm). A ring is sewn from it according to the diameter of the legs and put on both limbs. Next, move the simulator up, parallel lifting or massaging the legs. Or the same with the hands, in the upward position, with the rubber band on, the patient must bend and unbend the arms at the wrist joint.
On their own, the patient can do the following: a fixed limb is hung on a tape or towel so that the patient can wind or even rotate the limb in a loop.

It should be remembered about the systematic: any physiotherapy should be done for 40 minutes twice, and after the 2nd week three times a day.

Mental physical education

We must not forget that muscle memory controls the limbs. Remember the film by Quentin Tarantino, in which the paralyzed heroine Uma Thurman lived for hours on end with one thought: to make her toe move on her paralyzed leg. We know the outcome, because by the middle of the picture she was already running along the walls. This example inspires both hope and an incentive: you need to do not only passive, but also mental gymnastics.

Influencing the recovering nerve cells in the brain, you need to repeat the command many times. If it is difficult for the patient to master this yet, it is necessary for relatives to pronounce the command aloud and force the patient to repeat it: “I move my toe,” etc. This method of suggestion has another plus - the rehabilitation of the patient's neurological condition and speech apparatus.

Transition to exercise therapy in a sitting position

Around the third week of rehabilitation, it is time to start the exercises when the patient has taken a sitting position:

It’s worth starting with the eye muscles - moving the eyeballs from top to bottom, from right to left and diagonally. Alternate between closed and open eyelids. In addition to muscle memory, it normalizes blood pressure.
After the gymnastics for the eyes is completed, you need to relieve tension by closing your eyes tightly and opening your eyelids, repeat 10-15 times.
Next - head rotation and exercises for the neck. On each side, at a slow, not sharp pace, repeat 6-8 times.
If one side was affected during a stroke, you should try to perform symmetrical movements with a moving hand with a motionless hand. For example, lie on your back and try to raise both arms, rotate your hands at the same time.
Grasping movements are essential for finger motility. You can get a set of expanders of various densities.
The same for the feet: stretch and contract on yourself, trying to achieve movement in both limbs.

Gradually, in a sitting position, you can move on to more amplitude options: lifting yourself, with the help of a headboard and a belt. Lifting limbs, first 3-4 times. Reducing the shoulder blades in a sitting position - 5-6 times. And so on, under the supervision of loved ones.

We perform exercise therapy while standing

The options that physical education implies for arms and legs in a standing position are already much larger. Therefore, we present a complex of "basic exercises" on which all gymnastics is built:

Straight stance - hands at the seams, the position of the legs shoulder-width apart. Raising the arms on the inhale, circular lowering down on the exhale. The course of movements is from 4 to 6 times.
Turns of the torso - the legs are wider apart, inhale for a count of one, exhale for two and slowly twist the torso to the side. Repeat at least 5 times on both sides.
Squats: as you exhale, try to sit down without tearing off your heels. Hands are extended forward. At the bottom, inhale and on the second exhale rise. The goal is to maintain balance, stretch the muscle group of the legs. Repetition - from 4 to 8 times.
Tilts: feet shoulder width apart, hands on the belt. On exhalation, tilt to the right or left, the opposite hand stretches up.
A good exercise for arms and legs at once is swings: the arm is extended, with the leg to the side to do swing movements. The amplitude is small, it is desirable to lean on the back of the bed with the other hand, for example. The main principle is not to hold your breath, repeat on each leg up to 7-8 times.
Raising the legs on toes, rotating the hand or ankle, bringing the hands into the lock behind the back - these exercises knead the joints well.

The set of exercises for a stroke necessarily includes daily walking. To load your arms and give work to your legs, you can walk with ski poles in your hands. Thus, there is always support and an additional therapeutic cardio load is performed.

Regarding walking: doctors recommend starting walking with the support of a person on the paralyzed side, at first intervals of 15-20 seconds with a break, then increase the pace. Already in the later stages of rehabilitation, patients are prescribed jogging, as good remedy dispersal of blood, normal load on the heart and all muscle groups.

Do not overdo it - do not load yourself more than the program requires. Rest is now important for the body, not sporting achievements. In the future, therapeutic exercises of the legs and arms will be needed for at least another three years. However, it is recommended not to start the exercises after healthy lifestyle life to avoid recurrence.

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Principles of action of exercise therapy in neurological patients

The brain is a collection of neurons that numerous connections connected to the whole body. Each group of nerve cells is responsible for the regulation of a specific function of organs and systems. For example, the motor zone provides the ability of a person to make voluntary movements, the brain center of vision and hearing provides the correct perception and analysis of visual and auditory stimulation.

With a stroke, the death of nerve cells in the area of \u200b\u200bcerebral infarction or hemorrhage occurs. Depending on the control of which functions is located in this place, various neurological manifestations arise: paralysis, speech disorders, movement coordination.

The return of lost functions after a stroke occurs in 3 ways:

restoration of those structures of the nervous tissue that have reversible damage, that is, they have not died, but are in a depressed state;
restoration of completely dead elements by replacing them with new ones;
the transfer of duties of dead neurons to neighboring nerve cells.

Exercise therapy for stroke helps to speed up all these mechanisms and reduce the time to return lost functions.

Restoration of structures of the nervous tissue with reversible damage

These mainly include the restoration of the conductivity of the nerve fibers of cells that did not die, but fell into deep biochemical stress. Physical exercises after a stroke, which the patient performs on his own or with the help of an instructor, create a powerful stream of nerve impulses from the muscles to the brain. Due to this, the oppressed nerve cells are awakened, and new pathways for the transmission of excitation to the central nervous system are formed. nervous system. Thus, the foundations are laid for the complete control of the brain over the functions of the body: the return of lost voluntary movements, speech.

Restoration of dead elements to new ones

Here it is necessary to clarify that we are not talking about dead nerve cells located directly in the area of hemorrhage or brain infarction and not subject to recovery, but about the growth of neuron processes that remained alive after suffering an attack of the disease. Due to the formation of numerous new nerve fibers, there is an increase in the number of contacts between nerve cells and the organs controlled by them. All this helps to restore lost functions even with a small number of neurons that have survived.

Gymnastics after a stroke increases blood flow to moving muscles, which means it increases nutrition and oxygen supply. All this leads to increased growth of new nerve fibers. Constant stimulation of the brain by nerve impulses that occur in the muscle during movement leads to an increase in the contacts of neurons with each other, which also has a good effect on the control of organs.

Transfer of duties of dead neurons to neighboring nerve cells

As you know, "nerve cells do not recover", so the focus of a stroke later turns into a scar. However, nature has laid in the body an amazing function of transferring the duties of dead cells to neighboring elements. In the brain, after an acute circulatory disorder, the functions of destroyed nerve cells begin to be performed by their healthy neighbors. The transfer of authority occurs solely under the stimulating action of nerve impulses. This is exactly what therapeutic exercises after a stroke are aimed at, because muscle movements are a powerful source of nervous excitation transmitted to the brain.

Exercise therapy depending on the stage of the stroke

The main goals of exercise therapy in patients with stroke are:

restoration of voluntary movements;
preventing the formation of adhesions in the joints;
decrease in muscle tone on the paralyzed side;
strengthening the body.

From how much time has passed from the first signs of a stroke, the following periods of the disease are distinguished:

acute (first 72 hours);
acute (up to 28 days);
early recovery (from 28 days to 6 months);
late recovery (from 6 months to 2 years);
period residual effects(more than 2 years).

Each of these periods corresponds to a separate set of exercise therapy exercises.

Acute and acute period

Restorative gymnastics after a stroke is indispensable already in the first days of the patient's stay in the intensive care unit. An exercise therapy instructor or a trained relative conducts sets of exercises aimed at preventing respiratory complications and preventing the formation of contractures in the joints on the injured side.

For these purposes, breathing exercises, positional treatment and passive movements are used.

Breathing exercises

Recovery activities correct breathing begin with 2-3 days of treatment in the ICU. Breathing exercises after a stroke, they consist in a change in the rate and depth of inhalation and exhalation controlled by the patient, following the commands of the exercise therapy instructor. These can be rhythmic breathing under the count, exercises for an arbitrary decrease in the frequency of respiratory movements; change in the type of breathing, for example, from chest to abdominal and vice versa.

Position treatment

It is necessary to prevent the appearance of contractures (stiffness) of the joints. Flaccid paralysis, observed in patients in the first 2 weeks after a stroke, is gradually replaced by spastic. Due to the increased tone, irreversible changes occur in the joints on the diseased side, which lead to limitation of movements in them. To combat this complication, such a method of exercise therapy as treatment with a position is used.

It consists in the following: the diseased limb is laid in such a way that it is maximally extended and in a position opposite to the action of spasmodic muscles. For example, on the hand increased tone after a stroke, it is most often observed in the muscles that adduct the shoulder and turn the palm inwards, bending the fingers of the hand. Therefore, the treatment position in this case will be the following: the diseased arm is straightened, laid aside by 30-40⁰ (gradually bringing it to 90⁰), lies on a chair placed next to the bed; the palm is open, the fingers are straightened (to fix this position, a bag of sand placed on the palm is used); thumb is in a grip position (as if there is a small ball in the palm that he is holding).

Treatment with the position is carried out every 1.5-2 hours, while it is held until the onset discomfort or pain in healthy muscles.

Passive gymnastics

It is performed only after a treatment session with a position when muscle tone weakens. Classes begin with a healthy limb, in which active movements are carried out (the patient himself performs exercises), covering all types of movements in a particular joint (flexion-extension, abduction-adduction, rotation). Then they move to the diseased side, the movements in the joints of which are performed by the exercise therapy instructor. Passive exercises against stroke begin to be performed from the distal extremities (from the joints of the fingers), gradually moving up.

However, despite the seeming simplicity, the movements must be performed according to certain rules otherwise they may cause harm. An excellent illustration for the main methodological approaches This section of exercise therapy is a video of passive gymnastics after a stroke:

An approximate set of exercise therapy exercises for stroke for bedridden patients

The total duration of the complex is 25-30 minutes. During the session, it is necessary to take breaks for 1-2 minutes, focusing on the well-being of the patient. Finish gymnastics correct styling paralyzed limb (treatment by position).

Massage for a stroke can be prescribed 2 weeks after the onset of the disease. It includes the simplest classical techniques: light stroking on the affected side and moderate rubbing, kneading on healthy muscles.

Early recovery period

Exercises for recovery after a stroke during this period, along with passive ones, include active movements of the diseased limb. Even the slightest ability of muscles to voluntary contraction should be used to restore lost motor functions. Training for active muscle contraction must be included in the daily exercise therapy complex.

A complex of exercise therapy using active movements, which includes exercises for the hand after a stroke, looks something like this:

The ability of the patient to maintain balance while sitting independently is a sign that it is necessary to diversify the exercises performed. The exercise therapy complex includes movements in the lower back and neck: tilts, turns.

Preparation for walking begins with imitation of walking movements in the supine position.

late recovery period

A feature of exercise therapy during this period is the addition of exercises to overcome resistance to the complex of daily gymnastics. The effect of classes directly depends on the correct technique. To make it easier to understand how exactly you need to perform the movements, you can view an approximate complex exercise therapy after stroke video:

A huge role in the formation of normal muscle tension and acceleration of the processes of returning motor functions is played by massage after a stroke. It should be carried out several times a year for 10-20 sessions.

The famous expression “nerve cells do not regenerate” is, unfortunately, true. However, even after losing a significant number of neurons in the stroke area, it is possible to achieve good recovery voluntary movements with the help of physiotherapy exercises.