Smirnova Olga Leonidovna

Neuropathologist, Education: First Moscow State Medical University named after I.M. Sechenov. Work experience of 20 years.

Posted articles

Walking after stroke occurs in stages. Muscles of legs and torso are strengthened gradually, the ability to coordinate their movements returned, maintain balance. To eliminate motor disorders, you need a lot of time, but if you make an effort, you can achieve good results.

Consequences for motor function

There is an acute circulatory disorder in the brain. As a result, the body suffers from lack of oxygen and nutrients, which leads to cells of cells. After the attack, such violations arise:

Violates the ability to walk. The patient can not get out of bed on their own.
There are sharp mood differences, positive emotions are replaced by negative.
Cognitive functions become unstable.
There is no connected speech.
There is a violation of swallowing reflexes.

In the presence of these disorders, treatment should begin as quickly as possible, otherwise the full paralysis will arise.

To say exactly when a person fully recovers after an attack, no specialist will be able. The program is selected separately for each case. This applies to the development of exercises to return the ability to move.

After an acute circulatory disorder in the brain, detect motor disorders in such signs:

There is a scalance of gait that healthy people are not observed.
It is impossible to bend and disperse the leg and hand or completely straighten. The foot can constantly stay in a straightened position.
The gait becomes uncertain, and the steps are wrong. It is impossible to move quickly.
It is not possible to fully become the sole of the victim. Therefore, to walk the patient begins with a sock, and not from the heel, as ordinary people do.
Each next step can lead to an unexpected drop, as the sensitivity is reduced.
The movement of the patient of a person has similarities with a circular.

Some patients are restored very quickly and learn to walk already in 2-3 months after an attack, and others need much more time. It all depends not only on the degree of lesions, but also from the correctness and regularity of home treatment. Accelerates the process of recovery the use of special, but not everyone can afford it. Therefore, many use homemade devices for workouts of legs and hands.

If after the stroke there are bad legs, what to do, you need to learn from specialists. The rehabilitation period should be started as early as possible, but only after the completion of drug treatment.

First, the patient must learn to sit and only then can try to get out of bed. At first, even sitting will be difficult, so close should be followed so that the patient does not fall.

Gradually, the victim will begin to keep balance, can keep the torso in the correct position, which is necessary for walking.

You should also return the ability to bend and blends the leg and hand.

Recovery promotes application:

special canes with four supports;
orthopedic shoes with a small heel and wide sole. It is desirable that the fasteners are well fixed the ankle joint of the affected limb.

It is necessary to ensure that the person after the suffered stroke has developed independence and was able to serve himself and walk without any assistance.

How to develop a gait

In order for the patient to learn how to walk after a stroke, he needs to help. In rehabilitation centers, the method of drawing before the path of the track with traces is used. There are patients on them and begin to make the first steps. This method can be applied at home. It helps to restore motor functions faster.

Start walking after a stroke the victim will be easier if:

use holders for fixing the foot;
put on the knee pads so that the knee is not bent, and the leg was held in vertical position.

After the ability to climb to feet without assistance, you can connect running trackcreated specifically for stroke patients.

It is important that the classes are not conducted in a rapid pace, as it may incorrect to work an ankle joint.

The recovery rate can be different:

If the stroke manifested itself in the form of a small ischemic circulatory disorder, the ability to manage the limbs to a person will return within a month.
The average degree of stroke, which is always accompanied by the loss of consciousness, allows only half to save motor activity. Therefore, the patient needs to gradually train movements. At first there will be a warm-up in the lying position. Gradually, go to more complex exercises.
Stroke, accompanied by strong hemorrhage, leaves no chance of recovery. This condition is considered incompatible with life.

Procedure for training

Restoration of the limbs after a stroke consists of:

passive in bed;
seats in bed;
getting up and standing on site without support;
walking legs using the technical means of rehabilitation, and later without them.

The restoration of the vestibular apparatus after a stroke is very important, since it is with its help a person holds an equilibrium. All workouts need to be carried out, gradually increasing the load. It is impossible to start teaching the patient to walk if he can not sit on his own in bed or make even the simplest movements.

Exercises for legs after stroke are developing individually. They must be the most physiological.

You need to master the exercises in this order:

The first group consists of turning from the side on the side in bed, repulsion of the body with legs from the back of the bed, attempts to take a sedentary position and suddenly without falling.
The second group enshrines the ability to sit on their own. During this period, you can sit out active gymnastics, lower your feet from the bed and to build a healthy leg.
To the third group you can proceed when the patient will be stable to stay on healthy leg. In this case, you can already use walkers.
The fourth group - with the help of walkers, you can stand and carefully stop with legs on the leg.
Running to the fifth group can independently produce a steady gait using walkers. Legs can already withstand large loads, the patient can pass distances more than before, the intensity of the exercises can be strengthened.

In theory, this option is considered ideal. But in practice, everyone goes much longer and more difficult. Often comprehend failures, there are breaks in progress, the attacks of the decline of the mood and the loss of faith in their strength occur. But gradually faith returns to victory, and the treatment continues.

How to learn how to use walkers

As soon as the patient learns to confidently stand on the legs without support, he can begin to make the first steps. Without an assistant in this matter, it is not necessary to do so, as he must insure from a paralyzed side to prevent fall.

The patient should put a hand to the assistant on the neck and move the knee in his knee. Fixing the joint you can take the first step.

The task of the assistant is not only support for the patient, but also control the correctness of its gait. When the patient is moved with the help of walkers, it is necessary to ensure that the setting of the foot, the knee turn and the hip joint were correct.

The whole process has several features:

The patient cannot fully grab the assistant hand, as it is weakened.
To take a step, he needs to throw out his leg forward, which leads to the cling of the feet of the assistant.
It is much more convenient to support the patient with a healthy part of the body, but the knee joint will not be fixed and the patient will not be able to hold onto the wall of a healthy hand.

The main goal of the use of walkers is to gain the ability to bend the leg in all joints, otherwise the patient will constantly cling to the foot for the floor. The assistant must remind a person that the leg should be raised above and bend it in all joints.

Easy movement will help high boots, fixing ankle joint. The sore hand should be recorded with a golk, so that during the movement it did not write, and the shoulder head did not come out of the articular depression. During classes, the patient's heart should be controlled and leisure him.

When the patient learn to move with the help of walkers without assistance, you can start walking yourself. This is done by cane, holding the walls, moving the chair in front of you. But it is important to ensure that the load is evenly distributed. You can not spare a sore leg, relying more on healthy.

Treatment of massage

To speed up the recovery process and in the brain can be used. Foot massage after stroke (and full body) are performed using:

Strokes. A relaxed palm slide over the surface of the skin, collecting it into large folds. First, strokes must be superficial, but gradually their depth should be increased. They must capture fat fabric and muscles. A specialist's hand should move with zigzags, spiral. With this massage, you can bring the body into tone and, removing the upper cell layer, improve the blood circulation and nutrition of tissues.
Rubbing. Due to this, the elasticity of tissues increases, swelling decreases due to the movement of the fluid. It is necessary to rub the skin with the help of the pillows of the fingers, the base of the palm or compressed in the fist.
Kneading. This is such a type of passive gymnastics. During the procedure, the muscle is captured, delayed and squeezed. There are also some impact on the vessels. The kneading helps to increase elasticity and tone muscular fibers. Therefore, in the presence of spastic changes, the procedure is prohibited.
Vibration. The specialist performs oscillatory movements with a relaxed hand on the affected part of the patient's body. Massage C. different speed and amplitude. Therefore, the result may be different. If the vibration is strong, then the muscle tone is reduced, and if high - rises. Movements are usually performed on the right left.

Such treatment can be carried out at home. It is carried out on their own close people, hire a specialist or use massagers.

Relatives of the victim must carry out a massage from the defeat, gradually moving towards other sites. After the stroke in people in the tone remain only:

palular surface, front of the shoulder and forearm;
breast muscle;
the front of the thigh and the back of the shin;
muscles soles.

These areas can be massaged only superficially, stroking or lightly rubbing. For the rest of the plots are intensive movements.

Massageing the patient in the lying position, you need to put the pillow under the head, and the roller's knee. So that the healthy limb does not move, it can be consolidated with weighting agents.

The process of recovery after stroke is heavy and long, but if the victim himself and his relatives themselves will make all possible efforts, the result will be positive.

Avtolyakbez

Recovery methods after stroke. Learning to sit, stand, walk

Learn to sit

If a large amount of time you spent lying, then the lying lifestyle was the norm for you.

Start to accustom yourself to a vertical lifestyle.

First you need to learn to sit in bed: you lie on the back, under the body and head assistant puts the pillows, the number of which gradually increases.

At the same time, your body should be assisted very well, and from all sides there must be pillows.

The first time you can sit no more half a minute (or less).

A few days later - a minute. Control yourself, and with severe dizziness again stick to bed.

Each day you increase for a few minutes that you spend sitting.

When you sit, control the position of your legs, try not to bend them.

Feel the burden when the legs touch the floor, try to control this load, evenly distributing the weight on both legs.

Then you need to learn to sit down from the position of the lying on the side with the lowering of the legs from the bed.

First, this action must be performed with a support on the elbow, and then - on the straightened hand.

When you learn to sit, lowering your feet to the floor, then you need to periodically exercise "walking sitting".

Its essence is that you need to sit down, put your legs on the floor, fix the body in a vertical position (pillows). And flipped by legs forward-back, imitating walking.

Learning standing

At the first attempts to stand after a long stay in the lying state, it should be noted that the muscles amazed after the stroke of the legs are very weak, and most of them are atrophied.

Also consider that the disapped leg muscles are very weak and also some of them can be atrophied.

It is necessary to start to get on your feet only with the assistant, since it will make it very hard and dangerous.

Training to the transition to the vertical posture is made like this. Source position - sitting. Your legs stand on the floor on the width of the shoulders.

The assistant sits on the contrary. Your knees rest in the knees of the assistant, the palm of which are under your hips.

You, relying about the shoulders of the assistant, get up with it.

When you rise, do not immediately load the striking leg.

First, carefully become healthy, and then gradually load the other.

Watch out for your well-being. Controlling themselves, gradually increase the time you spend standing on your feet.

Learn to evenly distribute weight on both legs.

Over time, changes will begin to occur in the anatomical level - the muscles begin to perform their own direct duty, accordingly increase blood flow to lower limbs, neurocents begin to recover.

All these processes cannot happen imperceptibly, so be careful and ready for bad well-being, dizziness, itching in the leg.

Learning to walk

If your condition already allows you to stand on your feet, you can start doing the first steps.

Make a few first steps and to keep on the legs will be very difficult, so you start walking only with the assistant.

Help is to support you from the amazed side. The assistant throws your hand on his neck and his knee supports your knee, fixing in this way the knee joint in place. This method is good with the exception of some nuances.

It is very difficult on your part to hold on to the assistant to the amazed hand, especially since the sensitivity of the hand is still very low, and you will incorrectly assess the power with which you rely on the assistant.

And from the psychological side, a weakly sensitive hand creates very unpleasant sensations.

With the foot, the situation is also not easy. In most cases, in order to take a step, you will throw the leg to the side, and the assistant's leg, which he tries to fix your knee will, just interfere.

The situation when an assistant supports you with a not affected side, more comfortable and represents more freedom of movement.

But here there are drawbacks - the knee joint is not fixed and there is no possibility to stay healthy hand over the wall or furniture.

The main task during movement is to teach the patient to bend the affected foot in all three joints so that the stop does not cling to the floor to the toe.

For this, the assistant, supporting the patient, gives the team "Raise the leg as high as possible, bend it in a hip, knee and ankle joints."

To facilitate the coordination of the movement of the legs during walking, it is recommended to use a special track with the markup of the Stop setting.

In order for the patient not to forget above to raise the leg, the lumps are placed between "prints" through which it is necessary to overplay.

To prevent the collapsed hand collected and the outlet of the brachial bone head from the articular depression during the movement, this hand needs to be recorded on the gathering.

During training, movement should be followed by the condition of the cardiovascular system and strictly adjust the rest in the sitting position.

When you master the movement with the assistant and dizziness will not be no longer, start to master the independent movement - keeping over the wall, or rearrange yourself a chair, or with a cane.

Do not try to spare a sore leg and transfer the bulk to the leg healthy.

On the contrary - to train the body's damaged stroke.

Further development of motor functions legs, her power characteristics And the recovery rate will depend on your workouts and from your perseverance.

At the same time, remember that the legs were turned away from walking, so the leg in the ankle joint will often be edited and turned.

The time for which you need to learn to walk on your own, different sick for each patient. Given the many factors affecting the speed of recovery, try in one or three months to teach yourself to independent movement.

Naturally, the gait you will not be perfect, it will be difficult to overcome the steps, but still without an assistant you can walk.

Now you need to develop and improve the minimum that you have achieved.

Smooth floor in an apartment or asphalt road with time will cease to give the necessary load to your leg.

One way to give a load foot is movement in a viscous medium that will be loaded.

In the simplest case, the medium that will load the leg can serve a thick high grass, and in winter - thick snow.

Also, the medium that gives the load is water. A very interesting effect is obtained when walking in water with a small level of water - approximately the knee or lower.

Also perform the exercises that will use the entire body entirely.

Turns, squats, slopes to the sides and forward. But remember: in the first months after the stroke, it is very dangerous to tilt the head below the pelvis.

Therefore, the slopes to the floor are mastered very gradually.

How to learn to walk again after the stroke?

Many brain strike victims lose their ability to move independently. How to learn to walk after a stroke? It is extremely important to return from a long bed mode and immobilization to the vertical position gradually. Especially if the head and "jump" blood pressure is spinning.

Begin rehabilitation

To learn how to go again as quickly as possible, the recovery process should be started immediately after the acute stroke phase passes. This process should include the following steps:

passive gymnastic exercises in bed;
seat seat;
independent stacking and standing in place;
initial walking with technical means of rehabilitation, and then without support.

Treatment in combination with minimal exercises gives nice results As at first and in the future, when the patient proceeds to active gymnastics. Many doctors insist in the earliest period of the rehabilitation of patients, but in no case to force them!

Everything training exercises It is necessary to perform in stages, not forgetting that all his time is. It is unacceptable to teach the patient to walk with the help of walkers and especially crutches, if he still does not sit on his own. Or teach him to sit when he has not yet managed to restore the ability to make the simplest television.

Procedure for training

So that the patient's rehabilitation turned out to be effective, tactics medical physical education Must be designed exclusively individually. Moreover, all exercises should be carried out in a strict sequence so that they are the most physiological.

The procedure for mastering the exercises is:

1st group of exercises - in bed: turning off the side on the side, pushing the body with legs from the back of the bed, switching to a sedentary position, not descending feet with bed, and return to a supreme position without falling.
The 2nd group of classes: fixing the ability to sit on their own on the bed, active gymnastics in a sitting position, learning the ability to lower the foot from bed, subsequently gradually engaging on a healthy foot.
The 3rd exercise group is done when the patient is steadily resting on a healthy foot. It's time to acquire walkers.
The 4th group of exercises - in the standing position with the use of walkers: Careful crossing from foot on foot.
5th Exercise Group: The patient produces a steady gait using walkers. Loads on the leg muscles are all increasing, patients with a sick distance gradually increase the intensity of classes medical gymnastics Enharged.

This is the perfect theoretical option. In practice, the process of the patient's verticalization is much more complicated, with frequent failures, interruptions, attacks of falnial mood and returning faith in victory over its immobility.

Rehabilitation means

IN medical centers For patients who have undergone a stroke, training skills takes place with the use of unique rehabilitation techniques. These are bargaining, and costumes "Regent", and parapaidiums, and "locoma", and treadmills. For initial verticalization, the kneeopors often use.

Of course, the wide possibilities of such specialized centers are much more preferable for patients. But it is not possible to use them. In most cases, teach patients to sit correctly, get up, walking at home. It is difficult to overestimate the value of the walkers.

Since the main purpose of their purpose is to provide a man with a reliable support when moving, then you need to choose this technical device is particularly thoughtful. It should be known that the walkers are produced by various modifications:

light "walking", adjustable in height and having anti-slip handrails;
high walkers with massive armrests for those who have weak wrists;
restored, rigidly fixed walkers that are suitable for stronger patients;
with two wheels only on the front rack or with four wheels.

How to master the walkers

When a person can confidently stand on his legs, you can start the first steps. At the same time, do not fall - the task is difficult, it is sure to need an assistant. It usually insures a patient with a paralyzed part of the body. The patient puts his hand to the assistant on her neck and knee rests on his knee, fixing the joint. Then take a step.

The assistant should not only securely insure the patient, but also to control the correctness of the formation of its gait. When a person can easily use walkers, it is important to constantly observe the correct setting of the foot, turning the knee, hip joint.

There is a lot of subtleties. Patient is difficult to hold onto a satellite with a weak sick. In addition, to take a step, the patient throws the leg forward and at the same time clinging to the foot of the fellow traveler. Therefore, it is still more convenient to support the patient with a healthy side of the body - so he has more freedom for movement. But the lack of this position is that the knee joint of the patient is not fixed and it does not have the ability to hold onto the walls with a healthy hand.

The main task of training with walkers - to teach a person bending the sore leg in all joints, otherwise the stop will cling to the floor all the time. It is desirable that the assistant constantly reminds: "Raise the leg above! Separate B. tazobed Susta. Now in the knee and in the ankle joint! "

Make the movement of the boots with high boots that are well fixed by ankle joint. In order to prevent the sick hand and exit the head of the shoulder from the articular depression during the movement, this hand should be recorded with a tire. In addition, you need to follow the work of the patient's heart and give him a breather in time.

When he is mastered to walk with an assistant and will not experience dizziness, you can start walking yourself, holding a chair in front of the walls or leaning on a cane. But at the same time you can not spare a sore leg and have a load on a healthy limb.

It is necessary to constantly train the damaged side of the body!

The last stage of rehabilitation

When a person learns to walk with the help of a cane, you should continue training along the track from the traces of the stop, accurately falling into them. Such a track is easy to do at home itself, spreading the wallpaper with a length of 3-5 m on the floor, according to which the patient is hidden with a flushing paint. With movements on this track, he should not have all the time to look at his feet - it is possible to do it only occasionally. Need to look forward. Very can interfere with walking after the contracture stroke - the limited mobility of the joints of the limbs. In this case, various clamps, lantietes should be applied.

As the functions of the limbs will be improved, you can additionally turn out torso, cautious slopes to the sides, squats. It is very useful to sneeze.

It is advisable to restore the ability to go for 1-2 months. Let the gait be still quite a row, let it be difficult to overpower along the steps, but still walk on their own - great privilege. The most important thing is not to despair and do not lose faith in indispensable recovery.

But you need to be a realist: Even when the patient already stands on his feet, there can be a lot of problems ahead. Often there is a pretty persistent deformation of the gait, because of what the walking delivers a lot of inconveniences and even suffering. But it only means that it is necessary not to stop there, but continue to train. A further correction of the gait and a new supply of patience will be required!

How to learn to walk after stroke

Consequences for motor function

In the stroke, an acute circulatory breakdown occurs in the brain. As a result, the body suffers from lack of oxygen and nutrients, which leads to cells of cells. After the attack, such violations arise:

Violates the ability to walk. The patient can not get out of bed on their own.
There are sharp mood differences, positive emotions are replaced by negative.
Cognitive functions become unstable.
There is no connected speech.
There is a violation of swallowing reflexes.

In the presence of these disorders, treatment should begin as quickly as possible, otherwise the full paralysis will arise.

To say exactly when a person fully recovers after an attack, no specialist will be able. The rehabilitation program is selected separately for each case. This applies to the development of exercises to return the ability to move.

After an acute circulatory disorder in the brain, detect motor disorders in such signs:

There is a scalance of gait that healthy people are not observed.
It is impossible to bend and disperse the leg and hand or completely straighten. The foot can constantly stay in a straightened position.
The gait becomes uncertain, and the steps are wrong. It is impossible to move quickly.
It is not possible to fully become the sole of the injured leg. Therefore, to walk the patient begins with a sock, and not from the heel, as ordinary people do.
Each next step can lead to an unexpected drop, as the sensitivity is reduced.
The movement of the patient of a person has similarities with a circular.

Some patients are restored very quickly and learn to walk already in 2-3 months after an attack, and others need much more time. It all depends not only on the degree of lesions, but also from the correctness and regularity of home treatment. Accelerates the process of recovery the use of special simulators, but not everyone can afford it. Therefore, many use homemade devices for workouts of legs and hands.

First, the patient must learn to sit and only then can try to get out of bed. At first, even sitting will be difficult, so close should be followed so that the patient does not fall.

Gradually, the victim will begin to keep balance, can keep the torso in the correct position, which is necessary for walking.

You should also return the ability to bend and blends the leg and hand.

Recovery promotes application:

special canes with four supports;
orthopedic shoes with a small heel and wide sole. It is desirable that the fasteners are well fixed the ankle joint of the affected limb.

It is necessary to ensure that the person after the suffered stroke has developed independence and was able to serve himself and walk without any assistance.

How to develop a gait

Start walking after a stroke the victim will be easier if:

use holders for fixing the foot;
to wear knee pads so that the knee is not bend, and the leg was held in a vertical position.

After the ability to rise to the feet has returned without any help, you can connect a treadmill, created specifically for stroke patients.

It is important that the classes are not conducted in a rapid pace, as it may incorrect to work an ankle joint.

The recovery rate can be different:

If the stroke manifested itself in the form of a small ischemic circulatory disorder, the ability to manage the limbs to a person will return within a month.
The average degree of stroke, which is always accompanied by the loss of consciousness, allows only half to maintain motor activity. Therefore, the patient needs to gradually train movements. At first there will be a warm-up in the lying position. Gradually, go to more complex exercises.
Stroke, accompanied by strong hemorrhage, leaves no chance of recovery. This condition is considered incompatible with life.

Procedure for training

Restoration of the limbs after a stroke consists of:

passive gymnastic exercises In the bed;
seats in bed;
getting up and standing on site without support;
walking legs using the technical means of rehabilitation, and later without them.

Exercises for legs after stroke are developing individually. They must be the most physiological.

You need to master the exercises in this order:

The first group consists of turning from the side on the side in bed, repulsion of the body with legs from the back of the bed, attempts to take a sedentary position and suddenly without falling.
The second group enshrines the ability to sit on their own. During this period, you can sit out active gymnastics, lower your feet from the bed and to build a healthy leg.
To the third group you can proceed when the patient will be stable to stay on a healthy foot. In this case, you can already use walkers.
The fourth group - with the help of walkers, you can stand and carefully stop with legs on the leg.
Running to the fifth group can independently produce a steady gait using walkers. Legs can already withstand large loads, the patient can pass distances more than before, the intensity of the exercises can be strengthened.

How to learn how to use walkers

The patient should put a hand to the assistant on the neck and move the knee in his knee. Fixing the joint you can take the first step.

The whole process has several features:

The patient cannot fully grab the assistant hand, as it is weakened.
To take a step, he needs to throw out his leg forward, which leads to the cling of the feet of the assistant.
It is much more convenient to support the patient with a healthy part of the body, but the knee joint will not be fixed and the patient will not be able to hold onto the wall of a healthy hand.

Treatment of massage

To speed up the process of recovery and improving blood circulation in the brain, you can use a massage. Foot massage after stroke (and full body) are performed using:

Strokes. A relaxed palm slide over the surface of the skin, collecting it into large folds. First, strokes must be superficial, but gradually their depth should be increased. They must capture fatty tissue and muscles. A specialist's hand should move with zigzags, spiral. With this massage, you can bring the body into tone and, removing the upper cell layer, improve the blood circulation and nutrition of tissues.
Rubbing. Due to this, the elasticity of tissues increases, swelling decreases due to the movement of the fluid. It is necessary to rub the skin with the help of the pillows of the fingers, the base of the palm or compressed in the fist.
Kneading. This is such a type of passive gymnastics. During the procedure, the muscle is captured, delayed and squeezed. There are also some impact on the vessels. The kneading helps to increase the elasticity and tone of muscle fibers. Therefore, in the presence of spastic changes, the procedure is prohibited.
Vibration. The specialist performs oscillatory movements with a relaxed hand on the affected part of the patient's body. Massage is carried out at different speeds and amplitude. Therefore, the result may be different. If the vibration is strong, then the muscle tone is reduced, and if high - rises. Movements are usually performed on the right left.

Such treatment can be carried out at home. It is carried out on their own close people, hire a specialist or use massagers.

Relatives of the victim must carry out a massage from the defeat, gradually moving towards other sites. After the stroke in people in the tone remain only:

palular surface, front of the shoulder and forearm;
breast muscle;
the front of the thigh and the back of the shin;
muscles soles.

These areas can be massaged only superficially, stroking or lightly rubbing. For the rest of the plots are intensive movements.

Massageing the patient in the lying position, you need to put the pillow under the head, and the roller's knee. So that the healthy limb does not move, it can be consolidated with weighting agents.

The process of recovery after stroke is heavy and long, but if the victim himself and his relatives themselves will make all possible efforts, the result will be positive.

Rehabilitation after stroke: how to learn to walk

The stroke takes millions of lives around the world, leaves people with disabilities, and it is not completely recoverable after the attack. The effects of impact may be complete or partial paralysis, the loss of familiar skills, the person becomes incapacitated and requires regular care from the side. The dependence of the patient from caring people along with the state of health provokes psychological problems. In this case, the assistance of a psychologist is required, the patient needs to be prepared for difficulties on the way to recovery.

Restoration of motor functions - an important stage of rehabilitation.

In addition to supporting close people, the patient himself must make considerable efforts to restore lost functions. The rehabilitation period can last both for several months and years. The course is to use comprehensive measures aimed at restoring speech, motor, cognitive functions. When the crisis period was passed, the patient requires a long rehabilitation, because to learn how to walk after a stroke is again very difficult. With rehabilitation activities should not be tightened, they should be started immediately after medication therapy for the restoration of cerebral circulation. The patient should not get used to the bed mode than before it is possible to raise it from the bed, the faster the recovery process will start.

Effect of stroke on motor functions

Acute circulatory disorder causes failures of all organism systems. In addition to incoherent speech, dysphagia, the patient has numbness numbers, paralysis. If you do not take action on time, these symptoms can do a constant phenomenon. The presence of muscle cramps can be extremely dangerous and foreshadow repetition.

To disrupt motor functions, such signs are characteristic:

there is uncertainty, gaitty precision;
inability to develop the speed of movement;
the patient can not bend, break or rectifted the hand or leg as much as possible;
the painful spasm of the muscles of the legs prevents the bending of the pelvic and knee joints, often occurs in the foot;
the movements of the paralyzed leg can enhance hand spasms;
coordination of movements is broken;
partial or complete lack of limb sensitivity;
the patient does not turn out to put the leg on the sole, as a result, when walking movement begin with a sock, and not from the heel;
walking after a stroke can be accompanied by sudden drops.

Rehabilitation activities are beginning to be carried out individually, there are no clearly established deadlines for the restorative process, it all depends on the state of the patient. Some patients begin to walk after 2 - 3 months, another need much more time to return lost functions. In any case, patient and close people need to be patient and work to obtain a positive result.

Despite the significant impact of the scales of brain damage to the dynamics of recovery, the support of relatives is greatly assisted in the success of events. No less important and psychological setting The patient himself. The depressive state caused by the feeling of helplessness, doomes and reluctance to act, can destroy all the unfolded work on rehabilitation.

Medicase therapy does not end after the acute phase of pathology. The patient can prescribe medications over a long period, depending on the state and symptoms:

drugs that stabilize the normal blood flow by vessels normalizing the work of the heart;
means to reduce blood pressure in the case of its high indicators;
medicines that dilute blood preventing the formation of blood clots in the limbs (not used with hemorrhagic stroke);
miorlaxants, removing muscle spasms;
neurotrophic preparations that promote motor activity;
antioxidants to restore brain cells.

How to start walking after stroke

To raise a person from bed as soon as possible, you must start with simple exercise, gradually moving to more serious training. The patient after a stroke is extracited and often does not want to do anything to improve their condition. The task of a psychologist and loved ones is positively to set up a patient for recovery. Despite the duration of the rehabilitation period, the patient has a chance to return completely or partially lost as a result of the attack of the function.

Recovery procedures are in the following events:

At the first stage, a passive charging is required, which does not require to get up from bed. It is carried out by health workers or close patients. Gymnastics trains the function of flexing the joints, for this, alternately raise, bend into the elbow one, then another hand, then carry out similar exercises for each leg.
The simulator bed is provided to start the process of learning the correct movement of the legs on initial stageHe imitates walking.
Approximately 4 - 5 days after the attack of the patient are trying to squeeze. Achieve a vertical position helps special adaptation. At first, the patient sits on the bed, then heats his feet on the floor.
Next, you can simulate walking, going through the legs in a sitting position. The need for a vertical position is not established by accurate terms and depends on the individual state of the patient.
At this stage, preparatory work is underway for walking practice, effectively use the "bike" movement, since it will use all muscle groups.
Hydrotherapy involving the use of hydromassage contributes to the improvement of blood circulation.
Ozochlorite applications, treatment with paraffin compresses.
Massages, which are an effective and integral part of the treatment.
Hydrotherapy, ozocenite applications, massages help get rid of muscle seizures.
Rehabilitation is successfully carried out at home, where the patient tries to perform ordinary household actions that develop motility.
The use of simulators significantly speeds up the recovery process. There are several types of fixtures for the development of walking skills, getting out of the chair, bike trips, treadmills.
After some time (the period of rehabilitation is individual), the patient manage to stand up on his feet. Standing and walking is not easy to patient in post-ply. Starting to make the first steps follows with the support of another person, then independently with the help of supports.
You can place traces of the patient with the aim of further correction of the gait. To secure the skill of the right leg, you need to walk along the marked track with the steps specifically applied to it.

With the beginning of the training stage, the walking skill will need to be acquired:

orthopedic shoes on a wide sole with a small lifting;
for fixing the foot, special holders are used;
also, it is also advisable to wear the pneaks, so that while walking the leg in the knee did not bended.

Often, after the stroke there are bad legs, what to do in this case, know in the rehabilitation center, but the ability to afford expensive procedures is not all. No less effective can be home learning walking on the principle of "scientific walking as I go myself", exercise is possible with the help of loved ones.

Exercises to restore walking skill

The number of repetitions will depend on the patient's condition, if some exercises should not be done under power, the patient can be helped. It is better to carry out too active exercises when the patient feels better.

in the position of bent footah in the knees of the patient rectifies one one, then another leg, starting movement with a healthy limb;
echoing one leg to another alternately;
the patient turns the foot, then inward, then on the parties;
extension and bending of the joints of the arms and legs;
exercise "Bike";
handscaping to the side: Exercise is performed lying on the back with legs straightened or bent in the knees;
populate the pelvis: the legs are bent in the knees, in the position of the lying sick lifts and lowers the pelvis;
transfer of a straightened leg over another;
shiny bending;
lokia on the side of the patient should be raised and lowering the leg, then, turning over to the second side, the same thing to do with the second foot.

Restore muscle control is not as simple, but the efforts made by the patient and its relatives sometimes reach incredible results. In medical practice, many cases, when it would seem, completely hopeless patients returned to her former life.

It occurs in stages, step by step, the muscles of the legs are gradually strengthened, the balance and coordination of movements are being coordinated, together with this are being mastered for walking movement. Of course, working with post-pillars, you will strive to restore not only walking, but all other lost movements, especially self-service skills. In this article we will talk about how to restore walking after strokeSo that the walking system is understood. The intras of the post-patient remembers all the movements with which he possessed before the stroke happened, but the connection between the brain and muscles was lost. Our task to help this connection is to restore that the brain "saw" his periphery and began to manage it. LFK after stroke Plays this huge role in complex therapy.

Well, if your patient regularly engaged in physical education to a stroke, then restoring a walk and other skills will happen easier and faster. It is likely that during the study of therapeutic physical education with post-pillars, you will handle yourself without helper.

If the patient is sweating, has excess weight, diseases of the joints, then alone can not cope, as it is very difficult to raise such a person, you will spend a lot of strength and, despite this, get low results. In addition, there is a danger to drop it, as such a patient is almost "wooden". Even an experienced LFC instructor one will not cope.

Preparation for walking begins from the first days after the stroke, when the prevention of stopping stop, muscle contractures and joint atrophy is carried out. We talked about this in the article.

To enhance the effect of therapeutic physical education, I highly recommend applying - therapy before exercising.

How to restore walking after stroke.

We help us passive gymnastics on all joints of legs and hands with the gradual inclusion of active movements depending on the state of the patient and its ability to understand you.

The combination of passive gymnastics with massage elements has favorably affects the nervous system and the appearance of neuromuscular pulses.

Do not forget about the need to prevent thromboembolism: During the PFC on the patient's feet, dress elastic stockings or use elastic bandages. Leave your fingertips to the fingertips open to control the blood circulation in the tissues of the stop and the legs: the fingers should be pink and warm.

Passive gymnastics on the legs begins with stop (bending, extension and rotation), then continues on the knee and hip joints. The knee joint bends and extension. The hip joint requires volumetric movements: flexion and extension, lead and bring, rotation. Rotation in the hip joint is convenient to perform, bending the foot of the patient in the knee joint and keeping one hand over the foot, and the other hand is for the knee. Passive circular motions In the hip joint, they are approximately as in small children with hipoplace of hip joints.

During passive gymnastics, we strive to gradually "turning" passive movements into active.

As soon as you start connecting active movements, you should have a creative approach with the individual features of the post-pilla and sedent.

The principle of incorporating active movements is based on the activation of the volitional activity of the post-pod.

1). Send pulses. (The information on the site is sometimes repeated, but it is necessary). The patient mentally represents any movement in the limbs. At first he makes movement from a healthy side, commemorating the feeling of this movement. Then the same movement mentally repeats on the affected side. The message of pulses a patient can do on his own during the day. Mind movements should be simple and short. For example, flexion and extension of hands in locks Susta, compressing and connecting the brush, lifting the straightened hand and so on. The sending of pulses can be strengthened with the help of a conscious (mental) weightlifting. For example, the patient represents that in his hand a heavy dumbbell is tied to the leg, and you need to raise it.

2). During passive gymnastics, speak the patient: "Help me! I will ask the amplitude of the movement, and you perform the movement itself. " You must learn to feel when your student can independently perform at least part of the movement. At this time, without tearing off the hands from the limb, weaken your impact, let the student make a maximum of effort. All movements are carried out at a slow pace.

3). Full of the patient's movement cannot be performed immediately. Therefore, it is necessary to master it first in parts, then part of this movement.

Take an example exercise "bike", as it is indicative, all groups of leg muscles are involved in it.
"Bicycle". Right position - the patient lies on the back, the legs bent in the knee joints, the feet stand on bed.
1 - tear off the foot from bed, the thigh bent in the knee joint legs approaching the stomach.
2 - straighten your leg up - forward.
3 - Lower the straightened foot on the bed.
4 - bend your leg, tightening the foot closer to the pelvis, return to its original position.

In order for the patient to be able to independently perform the exercise "bike", we will apply a mastering first of the first part of the exercise, we will teach the "walk" in the position lying on the back, alternately tearing off the foot of the bent feet from bed; Then separately stretch the lifting and lowering of the straightened legs; And also separately - gliding in bed footsteps, straightening and bending legs with a complete amplitude. We moderately help the "sick" leg to carry out all these movements, the day of the day weakening your help until the patient makes the movement completely independently. We combine all parts of the movement to one whole and rejoice in success. If the student exercises "coryavo", then we must ask the desired amplitude to achieve a full-fledged high-quality movement. (We take limb in hand, the student works himself, and we control and regulate the volume of movement).

We also master all the other desired movements in parts, then connect them to one whole with the control of the quality of movement.

We are interested in loose walk after stroke. Therefore, the exercises for training walking will be further listed. These exercises should not be applied immediately in one lesson. We gradually restore active movements and gradually complicate the tasks.

All exercises standing should be done with the protection of the knee joint from re-installing back. I recommend to purchase a special orthosis for the knee joint with hinges, which allows you to be free to bend and blends the leg in the knee joint, but eliminates the re-installing of the joint, which is due to the weakness of the muscles of the paralyzed leg.

This orthosis will be useful to your patient while walking yet. for a long timeSince even when the movements in the leg and restore the walking skill, the weakness of the muscles remains. If there is no such possibility, then at least make a bandage to the knee joint with an elastic bandage.

When unscrewing a paralyzed hand, be sure to fix the hand of the bandage "Kosyanka" or use a special bandage for your hand before the patient takes a vertical position sitting or standing.

Exercises to restore walking after stroke.

The number of repetitions indicate does not make sense, as it depends on the state of the patient and the complication of the load (from 4 to 10 repetitions).

1). Sliding footsteps in bed. Lying on the back, legs bent in the knee joints, feet - on bed. Alternately straighten and flexing legs back, starting with healthy.

2). Foot leg. The initial position is the same (lying on the back, the legs are bent in the knee joints, the feet - in bed). 1 - Healthy leg to throw through the "patient" (just leg to foot). 2 - return to its original position. 3 - "Patient" to put on a healthy leg. 4 - initial position.

3). Heel on the knee. The initial position is lying on the back, the legs are bent in the knee joints, the feet - on the bed. 1 - Healthy leg to put on the knee of "patient" legs. 2 - initial position. 3 - the same "patient" foot. 4 - initial position.

4). Leg to the side - knee. The initial position is lying on the back, the legs are bent in the knee joints, the feet - on the bed. 1 - Healthy leg put on the "patient" leg to the leg. 2 - the same (healthy leg) away to side and lower to bed, so that there is a complete amplitude of movement. 3 - Again a healthy leg to put on the "patient" foot to the leg. 4 - return to its original position. The same repeat the "sore feet."

five). "Bike" with each foot, starting with healthy.

6). Foots inside - out. Lying on the back, legs straightened and placed on the width of the shoulders. Turn the foot socks into the inside, then turn the foot socks to the sides.

7). Sliding heel on the front surface of the tibia. Lying on the back, legs straightened. 1 - Put the heel of a healthy leg to the nape "sick" legs closer to the knee joint. 2 - 3 - to slide the heel along the front surface of the tibia to the foot "Sick" legs and back. 4 - return to its original position. The same repeat the "patient" foot.

8). Rapid up straightened legs. Lying on the back, the legs bent in the knee joints, the feet are standing on the bed. Straighten a healthy leg, sliding a stop in bed. Raise and lower it several times, then return to its original position. The same to perform the "patient" foot.

9). Warheading to the side. This exercise can be performed from the initial position lying on the back with both straightened legs and bent in the knee joints. 1 - take a healthy leg aside and put it. 2 - return to its original position. 3 - 4 - the same "patient" foot.

10). Complete the previous exercise in the original position lying on your back with straightened legs. 1 - take a healthy leg to the side, put. 2 - Move a healthy leg to the "patient" leg to foot, as if crossed legs. 3 - Move a healthy leg aside again, put. 4 - return to its original position. The same to perform the "patient" foot.

11). Lifting pelvis. Lying on the back, the legs bent in the knee joints, the feet are standing on the bed. Raise and lower the pelvis first for a small height, then the day of the day is increasing the pelvis height.

12). Big bends. Lying on the stomach, legs straightened, the foot "sick" legs on an ankle healthy. Bending and blending legs in the knee joints, focusing the attention of the student on the "patient" foot to strengthen the message of pulses. For the "patient" legs is a passive exercise.

13). Let's complicate the exercise "Flexion of the Glands". Lying on the stomach, legs straightened. Alternately bend and blends legs in the knee joints, starting with a healthy side. Moderately help the patient lift the leg of the "sick" leg. Impulse sending impulses: let's notify that a heavy weight is tied to a sore leg.

14). Flexion to the side. Lying on the stomach, legs straightened. 1 - bend a healthy foot in the knee joint, gliding knee in bed to the side. 2 - return to its original position. 3 - the same "patient" foot. 4 - initial position.

fifteen). Leg through the leg. Lying on the stomach, legs straightened. 1 - transfer a straightened healthy leg through the "patient", touch the bed of bed. 2 - return to its original position. 3 - 4 - the same "patient" foot.

16). We put a foot on your fingers. Lying on the stomach, legs straightened. 1 - slightly raise the legs and put the feet on your fingers (stopping the stop). 2 - put the stops again at the starting position.

17). Raise your leg lying on my side. Lying on the side, healthy limbs on top, legs straightened. Raise and lower a straightened healthy leg. Then repeat on the other hand, for this turn the student to "healthy" side.

In the same initial position (lying on the side) bending and blending the leg in the knee joint, leading your knee to the stomach, to remove the straightened leg back, transfer the leg through the leg.

18). "Pushing me with the foot." The patient lies on the back, "sick" foot (stop) rests in the chest of an instructor, who, as it were, pupils on the leg of the student. Let the team "and-and-once!". At this time, the patient pushes the foot of the instructor, straightening his leg.

19). Turn in bed. We teach yourself to turn into bed not only in order to restore the skill of turn, but also to strengthen the muscles of the body. The patient lies on the back, legs bent, feet stand on bed. 1 - Tilt the knees in the "patient" side, the patient himself makes effort to complete the full turn on the "patient" side. 2 - return to its original position. 3 - the same with a turn to a healthy side. Remember that it is impossible to pull for a paralyzed hand due to the weakening of the muscular corset of the shoulder joint.

20). Spring on the edge of the bed. After we have mastered the turn in bed, we train the skill of sitting on the edge of the bed. After the patient turned on his side, lower his legs down from the edge of the bed, the patient is repelled by hand from bed and straightens. Without your help, he will not be able to do this. Start mastering the attachment after turning on a healthy side, as the patient is easier to push off the bed with a healthy hand. Support the student on the edge of the bed so that his feet firmly rest in the floor, they need to be placed on a small distance from each other for the stability of the design. The patient's body is straightened and slightly leans forward to transfer the center of gravity to the foot so that there is no fall back. (Pause a pause to adapt the patient to a vertical position, ask: whether the head does not spin). Then you need to return to the starting position lying on the back, but your head to the other side. Now we perform climbing on the edge of the bed after turning to the paralyzed side. Here you will need more effort to support the student, as it is still difficult to sit down after turning to the "patient" side. Again, we create a stable design so that the patient does not fall: the feet are placed, firmly rest in the floor, the housing is straightened and very slightly tilted forward. We hold the patient, let's get used to the vertical position a little. Then again slowly lay in the bed on the back.

21). Row. Running to the floor from the bed or from the chair - sophisticated exercise. It is impossible to make a fall in the patient, as this can lead not only to injury, but also complicate further exercises: it will be afraid to make some exercises, refuse to go. Therefore, we teach the upset gradually. Now our student can already turn into bed on the side, sit on the edge of the bed, sit on a chair without support.

We start training lecting from the edge of the bed. The patient sits on the edge of the bed, the legs firmly rest in the floor. Click the patient with your hands for chest, With our feet, we create a solid obstacle to the patient's stop so that they do not move during the rise. Swing together with the patient and help him to get a little, taking the pelvis from the edge of the bed about 10 cm, in this position it is not delayed, immediately Sadim back on the bed. We repeat several times, trusting the student more and more independence.

Let's complicate this exercise: we train the rise with movement on the edge of the bed One, then to the other side of one back bed to another. First, we rearrange the patient's feet a little, then transplant it a little on the stop point of the stop in the floor. Then again we rearrange the feet of the student and so on. They moved to the back of the bed, sat, rested, and again transplant along the edge of the bed now in the other direction. We seek the patient as much as possible to perform movements, we try to hold intuitively less it.

The rise is convenient to train, or by moving the patient to the back of the bed so that he keeps him a healthy hand, or to put a chair with a high back, for which the patient can stay. We support it and control so that the stops do not move during the rise. The student is already ready to do physically and morally stand up and stand, keeping the support, because we strengthened the muscles that participate in the upset. The muscles are still weak, but the movement can. We show him the technique of getting on myself: I sit on the chair sideways to the patient: I swung a little back (for the "runway"), then ahead with the selection of the pelvis from the chair, moved the severity of the body to the feet and neatly straightened. This we will do decisively, as slowly get up hard. Sit down in the reverse order, but slowly: during lowering the pelvis on the seat of the chair, the housing is slightly tilted forward. They sat on the chair and straightened the housing, without leaning back on the back of the chair. Explain that it is necessary to sit straight, hold the housing in a vertical position to train your body muscles.

The most reliable and comfortable support to keep hands - Swedish wall. If there is such an opportunity, the patient holds both hands behind the Swedish wall crossbar at the level shoulder belt, The "patient" hand can be contacted to the crossbar with an elastic bandage. Patient can be drunk to swedish wall On the chair - a catalog, or he sits on a chair face to the Swedish wall. The patient gets up and sits down, as described above, holding his hands behind the crossbar. The complication of this exercise is possible by reducing the height of the chair: the lower the chair, the greater the load on the muscles of the legs, the hands are more straightened. To reduce the possible muscle spastic, let us make an exhalation during the seating.

22). Peretpatka in place. The initial position standing, hold on to the support, legs are arranged on the width of the shoulders. To transfer the severity of the body is on a healthy, then on the "patient" leg, as if slightly swaying on the sides to transfer the severity of the body from one foot to another (without tearing off the floor from the floor). Then this exercise complicate due to the separation of the foot from the floor by several see. When the feet from the floor, the swinging on the side is replaced by lifting legs - walking in place.

Next, learn to walk on the spotHigh raising her knees.
Here we will be treated with a heel on a sock in a standing position, legs together.
We will master the "bike" alternately each foot in the standing position,
step one foot forward, then back through a low bar, a stick.
We take it alternately to remove the straightened legs back, putting the stop on the sock,
and also sniffed the legs back (that is, the patient takes the shin back so that the stop is pointing up, and the knee joint is down).

23). Foot exercises sitting on a chair. In the initial position of the patient sitting on the chair train various movements feet:
ride with heel on sock,
alternately rotate footsteps and counterclockwise,
sliding footsteps in advance - back alternately counter movements,
movement "foot leg",
alternate feet to face,
alternate lifting straightened legs forward - up,
"Stepping" sitting on a chair.

As soon as the student can make the goal movement back, you can start learning walking. Not immediately, but warning it in advance that tomorrow (or the day after tomorrow) you will start training walking. This will help your student mobilize forces for this difficult work. He will worry, worry, think about it, wait for you, represent how it will walk. This is an additional message impulses to the muscles of the legs.

Restoring walking after stroke.

Now, finally, the long-awaited moment came when the patient will make the first steps.
First, make some exercises for hands and for legs in the position lying on the back and sitting on the chair, practice to get up, flipping off legs on the leg, divert the shin back and sitting. You already have experience with post-pillars and you can choose any exercises to prepare the patient for walking. Do not overcome it. Walking will require a lot of strength.

So, the patient sits on the edge of the bed, the feet are slightly placed and firmly rest in the floor. You sit next to him from a healthy side in an embrace, the patient grabs you for the neck of a healthy hand. You need to get together on the team "And-and-time!". Stand up, straightened. Now you do as if the jolt movement and the hull, and the patient's foot hugging, so that the patient's foot is moved forward by inertia. At this time, when the "patient" leg moves forward, remind a student to try to make a stepping movement. Next, the patient comes to the "patient" foot, transfers the center of gravity to it, holding a healthy hand for you, and rearranges a healthy leg forward. You make a push again. The "patient" leg of the student moves forward. Etc.

Without having experience restoring a walk from post-duty patients, invite an assistant just in case to exclude possible difficulties. The assistant can help the patient's "patient" to move. Just do not need a "patient" foot to rearrange too far, step forward should be small.

You need to train not only walk forward, but also back. At each new step, it is necessary to strive for the patient to perform a "patient" moving movement. Come up with how to attach a wide ribbon to his foot so that you can raise your foot behind the tape so that it bends when the knee is lifted.

As soon as you realize that, despite the weakness of the muscles, the patient still walks, it is a big joy. Congratulations! Well done!

The following describes the idea of \u200b\u200brational recovery of post-pods, as an option if you have the necessary conditions For such classes. Your enthusiasm is required, the patient should not have a significant overweight, it must be adequate, you need a free place in the room for classes on the floor, a large carpet and, of course, a physically strong assistant.

Pretty quickly will go to restoring movements at the post-pillary, if applying exercises lying on the floor (on the carpet), which are built according to the stages physical development Baby child:
lying on the stomach raise your head
turn with side on the side
ride on the floor from one edge of the carpet to another,
get up in a bronewood
crawl in the knee-cycular position, then crawl forward,
crowd in Plastanski (lying on the stomach).
If everything works well, you can gradually include any exercises.

You need to apply such a technique only with the assistant, since this work is very hard for your spine.

After a while you will see that your student knows more than he knew how to stroke.

Let me remind you that you learn all the manipulations to work out on a healthy person, which imitates a paralyzed patient, and only then use them on a post-duty patient.

Another advice: be prepared for the fact that your patient has an intestine work in the exercise of the exhibition, he may want to insert. If you have the opportunity to come to the toilet and sit on the toilet, then for your patient this is a real holiday, the reward for the works.

How to raise a post-pillage with gender?

Move the stable stool closer, put the patient on your knees in front of the chair (check the chair, as convenient), make it stopped with your hands on the chair seat. Next, you need to put a healthy foot of the patient forward on the foot. Now he himself gets up on a healthy leg, leaning on a healthy hand on the chair, and straightens with your support. It remains to put your student on the chair, wheelchair or bed. It's not as simple as it is written here. Remember about the danger of falling back when straightening the case. Patient lifting from the floor, do it, do not pull for a paralyzed hand.

Loose walk after stroke - Not a simple matter, but interesting and joyful. In order to succeed in restoring movements from post-duty patients, he needs enthusiasm, sincere desire and interest in this case, an email and physical strength. Only your mood you can "light up" the patient and convince him to fight for your health. There are cases when a person after a stroke refuses to do something for recovery, lies and is waiting for death. It is absolutely easy to fix it. Bring joy and hope to his life, and he will and be engaged, and wait for you with impatience every day.

Next remains daily to train the balance, coordination of movements, strengthen the muscles of the body, legs and hands. Your student should be able to act with both hands, so the next article will be self-service skills.

These neurological practices show that the age of patients faced with stroke has changed - people from 40 to 55 years old are in the risk area today, as well as patients of more mature and elderly. After 55-60 years, the probability of violations in the blood circulation of the brain increases sharply.

The consequences of a stroke (brain infarction) are detected immediately and detected after some time. Among them - loss of speech and vision, logical thinking and memory, motor disorders of varying degrees up to full paralysis.

Learn to go after a stroke - one of the most important tasks in the rehabilitation of the affected patient. Despite the obvious complexity of the conscious movement, it is necessary because it helps to normalize the work of the brain, coherence of movements, the resumption of motility.

Walking should be preceded by a recovery massage, physical exercisesperformed under the guidance of a medical worker. When elementary exercises, as well as the ability to sit the steel is possible for the patient, it is necessary to move to the restoration of walking and walking.

First steps - technology of proper movement

After a stroke, the tone of the muscles of the limbs, legs and hands cease to obey, their movements become inconsistent. The muscular tone of the sore limb changes its position, as a result of which the gait becomes a package - knee joints It turn out to be overly relaxed, stops stop.

When moving, such a foot makes not a direct movement from the heel to the toe with further flourishing on the heel, but it goes on a semicircular with a support on the sock. This causes a slowing down step, the sick leg clings to the floor and the entire process of movement becomes traumatic.

Learn how to step on the leg, work out the desired position of the foot - this mandatory conditions To start walking. The patient himself or his assistant must follow to:

from the first step, with the first contact with the floor of the foot rest on the heel, and not on the sock;
stop moved directly, and did not describe the semicircle;
the knee was bent at the time before the stop becomes the heel.

At this stage, the desire of the patient is very important to restore walking and even lying in bed it is important for him to represent himself going straight, with the correct setting of stop. This will help him in direct training walking.

Physical and moral support

There are various recovery simulators and helpers for learning verticalization and movement after stroke. In a hospital, this can be special technical devices, at home the doctor recommended the kneeopors (at the initial stage) and walkers that allow the patient not only to make the first steps, but also to return walking as a familiar skill.

Walkers - the main and simplest means to move the means for the movement of people suffering from walking. Their selection is carried out on the basis of the individual characteristics of the patient. Walkers are:

Insulte patients should be paid attention to fairyless options, since they have more resistant to coordinate movement, more stable.

In the first workouts with walkers, assistant insurance is required, which not only supports the patient, but also controls proper position Foot, its direct movement, as well as bending a hip, knee, ankle joints. The assistant must find a convenient position in which the necessary support would be carried out, it was possible to light patient's thigh, the ability to correct the oblique steps.

In addition, at this stage, moral support for the patient is very important - this will bring the success of the restoration of walking.

How to restore traffic with Scandinavian walk?

Restoration of walking and walking after a stroke is a process that occupies a long time period. Patients who have learned to walk with walkers are often difficult to go to normal walking, as they still need a support. Doctors recommend in this case Scandinavian walking.

Scandinavian walking is a type of movement, in which walking relies on special sticks, creating the body additional points of the support. Skiers who are not able to train in the summer use this sport so as not to lose the activity of all involved in ski Run. muscle groups.

The popularity of the Scandinavian walk in rehabilitation medicine increases - it appeals to it when the support is necessary for movement, as well as if the recovery is hard, the patient was not physically active before the disease.

For people who have undergone stroke, Scandinavian walking - a real find:

Scandinavian walking today is actively used as one of the forms of therapeutic physical education, its influence on post-pillary patients is terrible.

It has been proven that the period of complete or partial immobility after a stroke is significantly reduced at regular classes scandinavian walking.

It is important here to comply with the principle of progress - from the period of addiction to the sticks to which the patient is based on, several training steps, to confident movement by distance.

Moreover, regular classes Scandinavian walking is considered today as a method for the prevention of primary and re-strokes.

The time of rehabilitation after a stroke is individual, but the main progress of motor activity occurs in the first 3-4 months after impact. That is why motor activity, skill and desire to walk must be constantly reinforced.

Help and care for loved ones, positive emotional background on the one hand and technical devices in the form of walkers, sticks, regular walking, on the other hand, are able to "lift to their feet" even an elderly person. Thrust hard work to restore walking and walking will be wrapped with the joy of re-opened features.

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The goal of workout walking

. The purpose of the exercise data is the restoration of lost automatic walking skills. To gain true independence when driving, walking should be effective, safe and adaptable. You must teach the patient to walk along different types of terrain, surrounded by other people, see and bypass obstacles. When walking, he must keep his head raised and look forward, and not down to the ground;

It is very important to teach the patient to hold balance in the initial position before starting the movement. If he is afraid that he will lose an equilibrium, he will not be able to move, because it will be filled with fear. The feeling of equilibrium is generated when the patient is trying to keep its position in the conditions of easy opposition, which assists assistant (see the section "Handpoint");

Remember that you should always be close to the patient (from the defeat) and provide it with the necessary help.

The following fig. 60 illustrates the foot movement phases when walking normally.

Fig. 60. Phases of foot movement when walking normally

In people who have undergone stroke, the gait is changing. In the case of severe paralysis or those who started walking without prior training, the following gait options are usually formed:

A person cannot bend a paralyzed leg in the knee while walking. As a result, his paralyzed stop clings for irregularities and the leg remains behind, instead of advance.

. The paralyzed foot is taken out passively forward using the rotation of the body around the axis of a healthy leg. The leg remains straight in the knee and is given to the outside to help the foot break away from the ground (Fig. 60.1).

The gait of such a person becomes clumsy. Each time he has to make considerable efforts to describe the semicircle, to carry a paralyzed foot forward. These considerable efforts will only increase muscle tone in a paralyzed leg.

Fig. 60.1-61. Without prior training, the patient involuntarily produces a special type of gait

Another option gait is walking sideways.

This method of gait is usually used by people who are relying on their own head (Fig. 61).
The first advance is put forward wand. Then a healthy leg is transferred to it. The paralyzed leg pulls up to a healthy leg, but at the same time it is a little behind it.

With timely interference and right training These problems can be avoided.

Special attention in positions should be drawn to the position of the thigh, the knee, ankle Sustava And feet:
. The patient must learn to stand correctly. This means that the weight of his body should be transferred to the heel, and the entire foot should stand on the floor, and both feet are parallel. If necessary, the assistant sets the stop in the desired position. The heel should not break away from the floor. You can help the patient to hold the correct position by applying pressure with hands towards the thigh to the heel (for this you need to put your hands to the patient on the hips, and then sharply and strongly render pressure down).

The foot should be a little bent in the knee (to avoid re-installing).

The thigh must be advanced forward.

The movements of the paralyzed leg when walking can strengthen the "bending spasm" in the muscles of a paralyzed hand. This should be avoided. The following illustration (Fig.62) shows the incorrect way to support the patient when walking.

Fig.62. Pay attention to the position of the paralyzed hand

Wrong way:
. The patient's hand pulls up, turning it inside, while it is bent in the elbow.

The right way:
. You must control the position of the hands supporting it on a distal (brush) and proximal (shoulder) levels.

The position itself must be "restoring" (the hand is turned outward, straightened in the elbow, brush is dispersed back).

Stand closer to the patient so that you can also follow the position of the knee of a paralyzed leg.

A.P. Grigorenko, J.Yu. Chefranova