Recovery after hemorrhagic stroke

Recovery after a hemorrhagic stroke is a complex of measures aimed at returning to the habitual way of life, i.e. to the level of activity that the patient had before the disease. Very often, such measures are called rehabilitation. In rehabilitation actions, all patients with a history of hemorrhagic stroke are needed without exception. Rehabilitation after hemorrhagic stroke is a long and time consuming process, but it is just as necessary as inpatient treatment, and no less significant. It should be noted that a competent set of restorative measures, both in hospital and at home, can return a person to a full life.

A huge role in the recovery after hemorrhagic stroke for the patient is played by his family and friends who can provide moral support, strengthen the spirit of the patient. Do not forget that the most important component of rehabilitation is love and attention.

How long does it take to recover?

During the recovery period of hemorrhagic stroke, several stages are distinguished:

• early recovery period - lasts up to 6 months after a vascular accident;
• late recovery period - 6 to 12 months after hemorrhage;
• the period of the residual phenomena after the transferred hemorrhagic stroke is the period after the year.

Rehabilitation is most effective in the first 12 months. Those. all measures should be implemented as much as possible in the first year after the stroke, then the result will be tangible and significant. In the period of residual events, it is not necessary to speak directly about recovery, usually neurological disorders in this time interval are practically not subject to recovery. Therefore, you should not hesitate, but start practicing as early as possible.

In the process of recovery after hemorrhagic stroke, several important principles are singled out, observance of which allows achieving better results:

• as early as possible - i.e. measures for recovery should be used already in the period of inpatient treatment for hemorrhagic stroke;
• continuity - classes should be daily, without any "days off";
• moderation - a metered approach individually to each patient in accordance with its capabilities. This means that one should not be required to recite verses or sing songs from a patient with a pronounced speech disorder, at first it is necessary to restore speech functions to the level of consumer services, and then proceed to more complex manipulations;
• complexity - the use of different methods for recovery (medical, physiotherapy, psychological, etc.).

Rehabilitation tasks

The whole complex is aimed at:

• restoration of domestic opportunities (movement, self-service, doing simple housework, etc.);
• restoration of professional capacity for work (if possible, we must seek a return to the old profession, if there are contraindications or impossibility of performing previous labor skills, retraining is desirable);
• preservation of social activity and significance of the patient;
• prevention of repeated strokes and complications.

What complications may occur after a hemorrhagic stroke?

Neurological defects after hemorrhagic stroke depend on the scale and localization of hemorrhage. All of them can be conditionally classified as follows:

• impellent - weakness and loss of muscle strength in the limbs (paresis and paralysis), impossibility or difficulty sitting, walking, turning over in bed, increasing muscle tone in the limbs, or spasticity. Naturally, such violations entail a loss of self-service skills: dressing, bathing, using spoons and mugs, etc .;
• sensitive - numbness of the limbs, a feeling of lack of hands or feet, pain, paresthesia (a feeling of crawling, chills). Sometimes, sensitivity disorders cause the impossibility of "controlling" one's own limb and, consequently, performing self-service skills;
• speech - the most diverse (from illegibility of speech, or dysarthria, to the complete absence of speech, called aphasia, can separately break the understanding of speech and its reproduction, that is, there are situations when the patient understands everything, but can not say anything, and the opposite, when he can speak, but does not understand anything). To the same group of violations include the impossibility of correct counting and reading, misunderstanding of the time by the clock, the frequency of the days of the week, months in the year, etc .;
• violation of the act of chewing and swallowing - from choking to total loss of the ability to self-chew and swallow food;
• disruption of the functioning of the intestine and bladder - delay or incontinence of urine and stool;
• violations of the processes of thinking and behavior - tearfulness, apathy, depression, lack of "life taste", loss of ability learn (household items: what is needed for a spoon, a chair, a toilet, family and friends), violation of attention, memory. Possible violations of the motor action program. For example, to go to the toilet, the patient first urinates, and then takes off his underwear, and does not understand what to do vice versa.

In many respects the process of recovery from a hemorrhagic stroke consists in training again many skills and actions: it is necessary again learn to read, count, talk, dress, use objects of everyday use, etc. Of course, it is impossible without outside help. Therefore, the rehabilitation process is not a struggle of the patient alone with the result of the disease, but a joint group (medical, nursing, psychological, logopedic, family) work.

What do you need to restore?

Improving the quality of life in a patient with a history of hemorrhagic stroke is achieved by using a variety of measures. Let us consider them below.

Medication

The remaining neurons of the brain have the ability to "take over" the lost functions, but at the same time the load on them increases, which requires an additional "recharge". In addition, that part of the neurons that did not die during the hemorrhage, restore their functions as the hematoma dissolves. In order for this process to be more active, drugs are used.

In addition to the course of inpatient treatment, carried out after the direct development of hemorrhagic stroke, additional courses of inpatient preventive treatment once every three months during the entire recovery period, i.e. during a year. In this case, the patient receives nootropics in the injectable form (piracetam, gliatilin, cerebrolysin, actovegin, semax, etc.)drugs to improve neuromuscular conduction (neyromidin, proserin), vitamins B (milgamma, neurorubin). After discharge from the hospital, most drugs should continue to be taken orally (through the mouth) courses. Of course, only the attending physician should prescribe and vary such treatment.

To medicamental methods carry also maintenance of arterial pressure within the limits of norm, without essential fluctuations. To do this, use a constant intake of antihypertensive drugs (angiotensin converting enzyme inhibitors or angiotensin receptor blockers - lisinopril, perindopril, ramipril, losartan, irbesartan; calcium channel blockers - nifedipine, corinfar, amlodipine, etc.; β-adrenoblockers - concor, bisoprolol, nebivalol, etc.).

If the patient suffers from diabetes, it is mandatory to correct the level of glycemia by using drugs that reduce blood sugar.

If the cause of hemorrhagic stroke is any disease (systemic lupus erythematosus, kidney disease, coagulopathy etc.), it is necessary to treat this disease as a prophylaxis of the occurrence of a repeated hemorrhage.

Non-pharmacological correction methods

This group of measures includes preventive actions for changing the way of life, the purpose of which is to increase restorative capacity of the body as a whole and reducing the risk of repeated hemorrhagic strokes:

• quitting smoking - it is reliably proven that even with prolonged smoking experience, giving up smoking leads to a reduction in mortality and an improvement in vital signs. If smoking cessation is immediately impossible, then a gradual decrease in the number of cigarettes smoked per day, the transition to more "light" cigarettes;
• refusal from the use of alcohol - the risk of hemorrhagic stroke after a single intake of alcohol is increased. Many drugs used to restore after a brain hemorrhage are not compatible with alcohol;
• rational nutrition - in the diet must prevail fruits and vegetables, dairy products, lean meat, to provide the body with enough vitamins and protein in the recovery period. Decreased salt intake;
• weight loss in excess weight.

Restoration of motor and sensory functions

The work on restoring the motor functions of the limbs must be carried out from the first days after the stroke. At first, this laying of the affected limbs in a certain position with fixation with the help of longi or sandbags. Regular changes in the position of the body and limbs help to reduce the tone and improve peripheral circulation, which serves as a prophylaxis of stagnant phenomena in the lungs and pneumonia. If the patient is immobilized, it is necessary to turn the patient every 1.5-2 hours to prevent pressure ulcers.

Already on the second day after a stroke, if the patient's condition allows, you can passive gymnastics - smooth slow passive limb movements with the help of a LFK instructor or relative. Such actions should not cause pain in the patient, otherwise it is necessary to stop these manipulations and resume them in a few days.

Treatment "corrective" position is determined individually. The correct position of the limbs is indicated by a doctor or rehabilitologist. Such "styling" is advisable to be carried out 2-3 times a day after physical exercises. Treatment of the situation is not carried out during meals, massages and therapeutic gymnastics, during sleep and after-dinner rest.

When the patient's condition stabilizes, he is allowed to sit in bed (alone or with help) for only a few minutes, but every day this time will increase.
When the sitting process is fully developed, the patient is offered to try to stand up. This must be done only with the permission of the doctor. Required support in the form of a headboard and the presence of medical staff. When the standing is mastered, you can try "shifting" from foot to foot. And only then try to walk. "First steps" are always implemented in support and even if everything does not turn out right away, it is necessary to cheer the patient, pointing to his success. Sometimes independent first steps are the result of several months of painstaking work. Walking is mastered gradually, with the help of additional devices (walkers, special canes). Until the patient learns to walk for long distances with a support, for the use of a wheelchair, including for walking.
A major role in the restoration of limb movements belongs to therapeutic physical training. To her methods, in addition to treatment by position, passive gymnastics and walking training, include exercise complexes for different muscle groups: active gymnastics (developed individually, with a gradual increase in the load, including exercises for stretching spasmed muscles), mechanotherapy using special simulators for the muscles of the hands and fingers, special devices for reducing the tone, pendulum and block simulators.

Active use of the entire arsenal of therapeutic gymnastics at different stages of recovery after hemorrhagic stroke allows effective to struggle with the development of contractures and pathological synkinesis, allows to gradually expand the volume of movements in the affected limbs.

Equally important is the use of massage. In the first months after a stroke, only a local massage involving the affected limbs is used. In the early stages of bed rest, spastic muscles only use stroking techniques, and for muscles with a reduced tone, stroking and rubbing. Preliminarily to achieve a better effect, it is necessary to warm the extremities with a warmer. The duration of the massage is increased gradually from 5 to 20 minutes. In the late recovery period, it is already possible to carry out a general massage, "active" massage of the affected limbs. Between repetitive courses you need to take breaks.

Physiotherapy techniques also contribute to the restoration of movements and sensitivity in the limbs. In order to improve cerebral circulation, an alternating or permanent magnetic field is used; electrophoresis of vascular agents on the cervical collar zone; pearl, oxygen, coniferous baths (with the duration of the stroke more than 3 months), the differentiated assignment of local physiotherapy procedures to the paretic limbs, taking into account the muscle tone (with a pronounced increase his - thermal procedures, with a moderate - a combination of them with selective electrical stimulation of the muscles), local pain relief procedures for pain in the joints. Selection of procedures is very individual, it is always necessary to take into account contraindications in each specific case.

Speech Recovery

Speech is one of the few functions that after a stroke can be restored after a year. Sometimes this process lasts 2 or more years. Persons who are in contact with a patient with a speech disorder should be patient and take into account some recommendations on communication: talking with the patient should be slow, clear and clearly, be patient and give time to think and formulate the answer, try to ask questions that can be answered monosyllably ("yes", "no").

Classes with a speech therapist will help the patient strengthen the muscles of the tongue and face, help learn how to re-pronounce sounds and syllables. For patients with dysarthria, exercises in front of the mirror will be useful.

Gradually, as speech is restored, the patient needs to be transferred to the usual "speech mode", to encourage its to the development of speech and more complex lexico-grammatical constructions (subject to successful classes). Serious attention should be given to the formation in the family of proper communication skills with the patient.

Restoration of acts of chewing and swallowing

When a disturbance of consciousness or the act of swallowing is fed on the probe by special mixtures. If, as far as treatment is concerned, swallowing problems persist, then a gradual transition from probe feeding to routine (it is necessary to learn how to eat again).

To facilitate chewing and ingestion of food, it must be prepared in a special way. Food should be warm, if possible homogeneous, not liquid and not solid, tasty to smell (to improve the production of saliva). For food intake, you need to allocate 30-40 minutes, do not rush the patient, help him in every way (hold the plate, if necessary hold a spoon), offer to chew the food on the unaffected side. After eating, the mouth must be cleaned of leftovers.

There are special exercises that help to restore the strength of the muscles involved in chewing and swallowing. The main condition, as for other complexes of curative gymnastics, is the regularity of performance.

Dysfunction of the intestine and bladder

Violation of urination and defecation often become one of the causes of depression in patients who have had hemorrhagic stroke. Control over these physiological functions usually returns on the background of drug treatment. When recovery is impossible, it is necessary to make it as easy as possible for the patient to perform acts of urination and defecation, making them as inconspicuous as possible to those around them. To this end, use diapers, urine and kalopriemniki, cleansing enemas.

If the control over physiological secretions is preserved, but the patient due to motor disorders is not able to go to the toilet, you need to equip a comfortable stool near the bed or use a special vessel.

Violations of the processes of thinking and behavior

Such neurological symptoms should be restored only with the use of medicines. The courses of nootropic and neurometabolic drugs in some cases allow improving the cognitive functions of the brain.

The treatment of psychological problems is carried out with the help of psychologists. Psychotherapy is effective both as a group therapy and as an individual therapy. Very important are the patient's usual conversations with relatives, allowing him to feel needed and in demand.

What can be done to restore at home?

Recovery after a hemorrhagic stroke is more conducted at home than in a medical institution or rehabilitation center. After all, the time spent in the hospital is negligible compared to the time spent at home during the entire recovery period. Of course, a complex of medicamental and physiotherapeutic effects is fully realized in a medical institution, but nevertheless the palm Superiority in the rehabilitation process belongs to the patient and his family under the strict guidance of the attending physician. After all, if the lessons are not continued in the home, hopes for restoration are useless.

For a full recovery at home, the patient certainly needs outside help. It can be a native person or a nurse who will master the skills of therapeutic gymnastics, massage, will help in self-service. Many elements of curative gymnastics are performed independently by the patient (for example, active movements in the limbs, attempts to button up the buttons).

Some household activities in themselves are therapeutic gymnastics: the ability to use a spoon, brushing teeth, dressing, grooming, making stuffed pancakes, etc. The presence of a hobby psychologically and physically contributes to the restoration (making paintings from pasta, crafts from matches, drawing, etc.).

Classes with speech are also successfully conducted at home by the patient himself or with the help of relatives.
The main thing in the process of restoration is to support the patient in every possible way, to try to preserve its social significance. If you put maximum effort, then the rehabilitation process will definitely give its results.