Beginning >> Diseases >> Cardiovascular >> Stroke




Stroke — an acute disorder of cerebral circulation which reasons are atherosclerosis more often, an idiopathic hypertensia, thrombosis — obstruction by a clot of the turned blood of vessels of a brain or their embolism (obstruction by the come-off clot). Weight of a stroke depends on extensiveness of hemorrhages. Illness symptoms: loss of consciousness of disturbance of cardiovascular activity, breath, motive function, damage of extremities. 

After a stroke specific disorders of the movements are noted. Most often at spastic paresis or paralysis are broken or completely there are no movements in a shoulder joint, from it the shoulder is pressed to a trunk and turned inside; the hand is bent in an elbow joint or (in rare instances) hangs down; it is impossible to turn a hand palm up, to straighten (if the hand does not hang down) fingers — they are usually bent in a fist; the tone of razgibatel of a hip, shin and sgibately foot is raised — the leg is not bent, the sock is delayed or hangs down therefore the person when walking takes out a leg circular forward
the movement through the party. At these defeats mental deviations (the patient cries or laughs, malokontakten), at many — the synkinesis phenomenon (the involuntary movements) arising along with autokinesias of extremities are quite often observed.

Strokes are followed by paresis of face muscles: it is warped as at paresis of a facial nerve, the corner of a mouth is lowered, the active movements on all struck half of the face are absent: the eyebrow does not move, an eye either is not always closed or does not open, lips are not closed, the speech is quite often violated, hypersalivation amplifies.

The patient is stacked on a back, under a knee of the extended leg enclose the roller with a diameter of 10 cm, and under foot — any support (foot has to be bent at right angle). On hip length, and sometimes and shins put sacks with sand that the leg did not turn knaruzh. To avoid an excessive muscle tension of a hand, it is stacked on the pillow filled by cotton wool with shaving or sawdust (the hand is bent in a shoulder joint at right angle, the palm is turned up, fingers are straightened). For saving this provision from fingers to an elbow joint impose a splint, and on a forearm — a sack with sand. In 2 — 3 h it is necessary to change position of a hand — to put the straightened hand along a trunk. For the period of occupations by physiotherapy exercises all fixers are removed.

Despite a serious condition of the patient, on 2 — the 3rd day appoint physiotherapy exercises. The passive movements carry out in the direction from the center to the periphery and from the periphery to the center in all joints: the movements in humeral, elbow, radiocarpal joints and fingers of a brush; in coxofemoral, knee, talocrural joints and fingers of foot. Each movement is repeated by 2 — 4 times. The movements for a shoulder joint: a hand take a little aside, bend, straighten, do roundabouts, turn of a palm outside (the hand is bent in an elbow at right angle). Exercises for fingers if they are bent in a fist, do in the provision of the maximum bending in a radiocarpal joint. The movements for a hip joint, and also for foot and toes carry out in all directions the leg bent in a knee. In process of improvement of the general state the dosage of each exercise increases to 8 — 10 times.

At sluggish paralyzes the hand is suspended on a kerchief (in order to avoid extension of sheaves and a capsule of a shoulder joint, and also the subsequent incomplete dislocation of a head of a humeral bone), at spastic paralyzes — stack in a special splint (the hand is unbent in an elbow, the thumb is taken away, other fingers are straightened and recorded by special fastening).

It is possible to sit down only towards the paralyzed extremity, otherwise it is possible to fall. It is allowed to stand only in the presence of orthopedic footwear or a splint on the paralyzed leg, with any footwear which is put on from above.

It is necessary to go with a stick or other support which is held in healthy hand. At first kick downstairs a sore leg, put healthy to it; when lifting on a ladder at first rearrange a healthy leg and to it bring up the patient. Turn on site or during walking is done only towards the paralyzed leg.

Begin to do gymnastics in water after the patient is able to stand. In process of emergence of active movements include exercises with objects, for development of fingers learn to hold at first large objects, then small. The same physical exercises, as at traumatic injuries of fingers.

At asymmetry of the person from the first days appoint mimic gymnastics with pronouncing sounds, as at paresis of a facial nerve, and also massage: stroking, puddling, grinding, vibration. After massage of a back do a facial massage.

The brain bruise on the weight, symptoms and manifestations is similar to heavy concussion. The most frequent complications of a bruise of a brain — paresis and paralyzes of extremities, frustration of hearing, sight, sense of smell, taste, the speech and intelligence (traumatic weak-mindedness).

At the opened and closed traumatic injuries of a brain terms of the beginning of occupations by physiotherapy exercises are especially individual. The respiratory gymnastics and exercises for small and average muscular groups are appointed after the termination of nausea and vomiting, active remedial gymnastics — how it will be authorized to victim to sit down.

At paresis and paralyzes passive remedial gymnastics is shown, despite a serious condition of the patient, in the intensive care unit or an intensive care.

In the first period of exercise carry out from a starting position lying on spin. At all types of injuries of a brain exclude exercises for the head as they can make sick, vomiting, dizziness etc. Much attention is paid to breathing exercises (mainly static type and without movements by hands) and to exercises for small and average muscular groups of hands and legs. In the beginning include 5 — 10 exercises with the minimum number of repetitions in sets of exercises (respiratory on 2 — 3 times, the others on 2 — 4 times). Rate of performance slow. In the first 3 — 4 days of occupation carry out once a day, and in process of improvement of the general state — 3 — 4 times; their duration increases due to new exercises and by the end of the first period can be finished till 15 — 20 min.

In the second period in the minimum dosage carry out breathing exercises of dynamic type with the movements of hands and legs (1 — 2 time) and exercises by the head and at the same time a trunk — inclinations, turns, roundabouts (1 time) from starting positions lying on spin and sitting. In process of adaptation the number of repetitions increases. After development of movements the head and at the same time a trunk recommend the movements only by the head. These exercises are done between all-developing and respiratory at slow speed, on 1 — 2 time, with rest pauses. At emergence of unpleasant feelings of a pause increase.

Much attention is paid to walking (after traumatic injury of a brain gait is quite often broken), to various exercises on deduction of balance and on coordination of movements, on attention, accuracy, dexterity, gradually increasing their number and complexity, train memory. At paresis and paralyzes of exercise carry out by means of a healthy hand or special devices. At spastic paralyzes learn to relax muscles independently.
Classes after the second period are given by 3 — 4 times a day, duration of their 30 — 50 min.

In the third period if health was completely recovered, develop all motor movement skills. Exercises carry out from various starting positions, alternate 1 respiratory and 3 all-developing or special. Occupations join difficult coordination, balance deduction exercises, with objects, on shells, in situation headfirst (in hanging on rings), on wall bars, outdoor games. Jumps, jumpings up and run are resolved by the doctor, in each case individually. At incomplete recovery of the lost functions develop also compensatory and replaceable movement skills.

After removal of tumors of head severe headaches with nausea and deterioration in sight, motive frustration from coordination of movements,    sometimes gait (depending on localization of a tumor), an anesthesia are possible. If the tumor high-quality, then physiotherapy exercises is appointed after a removal of sutures and the same technique, as at sluggish and spastic paralyzes (depending on defeat process). At a malignant tumor the physiotherapy exercises are contraindicated.

From inflammatory diseases of a brain the arachnoiditis — an inflammation of an arachnoid membrane of a brain most often meets. The injury, an infection, complication after operation can become the reasons. The disease is characterized by a headache, an incoordination, vestibular frustration and other symptoms. Begin to go in for physiotherapy exercises when easing headaches. Carry out the all-developing, breathing and special exercises on recovery of the lost functions: on coordination, balance deduction, speed of reaction, etc. In the beginning include simple and easy exercises in occupations, and in process of improvement of a state complicate them.

"Myocardium dystrophy   Myocardial infarction"