Gymnastics after a stroke - a set of passive and active exercises

The importance of physical therapy in rehabilitation

Stroke is a pathology caused by an acute circulatory disorder in the brain. There are two varieties of it, namely:

• ischemic;
• hemorrhagic.

After a stroke occurs, the patient must undergo a rehabilitation course of treatment. In addition to drug therapy, therapeutic exercises are required. It is aimed at correcting and restoring the normal functioning of the musculoskeletal system, memory, and speech apparatus.

Our reader's experience

We work with a speech therapist to restore speech after a stroke. Classes last almost two years. We have to methodically restore speech. We read aloud a lot. We learn to pronounce individual sounds and syllables. The speech therapist selects tasks. In addition to training and restoring pronunciation, we restore the functioning of the ligaments, rhythm, and breathing.

We are so accustomed to the fact that we do not make any effort when talking. The speech “itself” flows and we can talk for a long time. If necessary, we can easily change the intonation or volume. Everything happens automatically. After the stroke I lost this almost completely. It was impossible to pronounce simple sounds, syllables and words.

To restore proper breathing, we do the following exercises:

The benefits and effects of charging at home

The main task that therapeutic exercises cope with is the complete restoration of the body’s functioning .
In addition, it performs many secondary functions:

1. If a patient experiences paralysis after a stroke, this indicates muscle tone . You can remove it with the help of special exercises;
2. Restoring coordination of movements;
3. Blood supply to tissues increases , as a result of which metabolic processes are activated, the condition returns to normal faster;
4. Preventing bedsores. Prolonged stay in the same position disrupts blood microcirculation. Gymnastics helps prevent the formation of bedsores.

Important! Exercise therapy is the main component of rehabilitation after a stroke.

What is memory loss after a stroke?

The patient may encounter the following types of disorders of mnestic function in the following aspects:

• Verbal – memory for names, heard stories and information related to speech activity.
• Visual – memory of shapes, faces, routes and things seen
• Informational – memory for learned information, previously existing skills, problems in acquiring new knowledge.
• Vascular dementia is a common post-stroke condition involving deterioration or loss of thinking abilities.

Symptoms of memory loss after a stroke may include:

• confusion in the interpretation, analysis, systematization of received signals and their comparison with previously acquired information;
• problems with short-term memory;
• tendency to wander or the possibility of getting lost in familiar places, disorientation in space;
• difficulty following the instructions received;
• problems with making money transactions.

Memory loss can be a direct result of a stroke, but can also be caused or worsened by medications, alcohol, tobacco and drug use, lack of sleep, depression and stress, and poor nutrition.

Memory can improve over time, both spontaneously and as a result of rehabilitation. However, sometimes symptoms of mnestic disorders can be observed for years. For memory loss, medications used to treat related problems such as anxiety, depression, or sleep disorders may be helpful.

Home exercise equipment

The use of home exercise equipment after a stroke is advisable only when the patient’s well-being has improved. They help strengthen various muscle groups and relieve tension. It is also an excellent prevention of a recurrent attack.

For home use, it is useful to purchase the following exercise machines:

1. Exercise bike. Exercises with an exercise bike are aimed at accelerating the recovery process. It improves the functioning of the lower extremities;
2. Verticalizer. It is intended for patients whose motor system has been affected and who are unable to stand up on their own. The essence of the verticalizer is to lift a person, preparing him to be able to take a vertical position;
3. Lokomat simulator. Helps those people who have lost the ability to walk. With its help, the patient learns to move again;
4. Active-Passive simulators. Promote the restoration of the upper and lower extremities, hip and knee joints;
5. Mini exercise equipment for limbs. They develop and train their fingers and hands. as well as the lower limbs.

Important! The use of simulators allows you to more quickly restore the normal functioning of the musculoskeletal system, as well as prevent a recurrent stroke.

What exercise machines are used after a stroke at home?

When a person gets used to active loads during exercise therapy, he can begin training on special exercise machines. Their use will help strengthen the muscle corset and almost completely restore motor function. The following simulators can be used:

• Mini exercise machines. Helps restore fine motor skills of the fingers. Examples of simulators: “Shagonog”, “Bud”.
• "Active-liability". This is the name of simulators designed for active and passive development of the upper or lower extremities. They provide active training with variable resistance generated by a motor.
• Exercise bikes. Improves motor functions of the legs, increases endurance in general.
• Verticalizer. Also called a stander. The simulator is a device for giving a person an upright position. It can support the patient from the front or back and even move on wheels. By giving the body a vertical position, it is possible to redistribute blood in the body and improve blood supply.
• "Lokomat", or exoskeleton. This is the name of a robotic orthopedic simulator designed to restore walking skills. It is used in conjunction with a treadmill. The simulator helps to regain lost movement skills, “verticalize” and start walking again.

The initial stage of restorative gymnastics in a supine position

Therapeutic gymnastics in a supine position is carried out at an early stage of recovery, when the patient cannot yet rise independently. Let's look at the most effective exercises in this case.

Gymnastics for arms

It’s actually difficult to call such a manipulation an exercise, but the load on the patient is enormous. Its essence lies in the extension of the upper limbs , starting from the phalanges of the fingers to the forearm. Then the hand is completely wrapped around a board with a straight surface. You need to remain in this position for about half an hour.

Video about gymnastics for arms:

Eye muscles

You need to move your eyes, looking up and down and left and right. Then close your eyes and make circular movements with them in different directions, repeat the same thing, only with your eyes open. As a form of rest between manipulations, it is useful to blink quickly for several seconds.

Phalanges of fingers

In any position that is comfortable for the patient, it is necessary to bend and straighten the fingers at least 10 times. You can do this on both limbs at the same time. If it's hard, then take turns.

For arms and legs

If one limb is paralyzed, hang a towel over the bed in a loop shape. Place your hand through it and swing it, increasing the amplitude. Like this. The same manipulation can be carried out with motionless lower limbs.

We invite you to watch a video about leg gymnastics:

Elbow joints

Stretch along the bed, upper limbs should lie parallel to the body. Bend your left arm, then lower it onto the bed. Do the same with your right hand. Perform the exercise alternately, 10 times for each limb.

Knee joints

While lying on your back, bend your right and left knees alternately. In this case, you should try not to lift your foot off the bed. Perform manipulations 10 times on each leg.

Pull-up

In the supine position, you need to grab the headboard of the bed. Try to pull up your whole body with your arms. Your shoulders should be straightened and your legs straight. The exercise should be done slowly, at least 6 approaches.

Important! During gymnastics, either a loved one or a nurse must be present with the patient in a lying position!

A set of exercises to perform independently

Therapeutic exercises after a stroke at home can be performed independently if the first stage of rehabilitation has been completed. After the restoration of the main muscle groups and the return of the ability to move, patients who have suffered a stroke can perform more complex exercises, which in most cases do not require the participation of assistants.

The complex of such exercises includes classical movements.

For example:

• Turn the torso to the right and left with the hands placed on the belt. Movements are performed smoothly, without jerking.
• Pull up and stand on your toes for 2-3 seconds.
• Rotations and swings of arms and legs.

Later, when the patient begins to easily cope with such tasks, it is recommended to introduce walking in place or jogging, “mill”, lunges and other exercises that involve asymmetrical movements of the limbs into the complex.

To prevent a stroke, it is important to know what causes a stroke and what precipitating factors are.

You will learn how to determine your risk group for stroke in this article.

Exercises in a sitting position

If the patient already has the physical ability to sit independently, you can proceed to the next stage - gymnastics in a sitting position. It is aimed at improving the functioning of the limbs, strengthening the back muscles and preparing for walking. Let's look at recovery exercises:

1. Sit on the bed, lower your feet to the floor. Hold onto the bed with your hands. Bend your back, pushing your chest forward. In this case, the deflection should be while inhaling, you need to relax while exhaling;
2. In a sitting position, place your legs on the bed. Lift each limb up in turn. The legs should be straight;
3. Lean your back on the pillow, stretch your legs forward, arms up. Bend your leg at the knee, clasp it with your hands. In this case, you must try to touch the knee joint with your chest. Hold for a couple of seconds, tilt your head forward, and exhale. Then raise your head and slowly return to the starting position. Do the same manipulation with the second leg;
4. Lean back on the pillow, taking a comfortable position. Grasp the edges of the bed with your hands. Throw your head back, trying to bring your shoulder blades together. Remain in this position for a few seconds, return to the starting position;
5. Sit on the bed with your legs dangling. Turn your head in different directions, then make circular movements. Manipulations should be slow;
6. It is also useful to simply sit on the bed with your legs down. But the main condition is to not hold on. This exercise helps restore coordination and prepare for walking.

Important! At this stage, fine motor skills should be developed by sorting small objects.

We invite you to watch a video on how to exercise in a sitting position:

Recovery after a stroke at home

The acute period of a stroke is the first six months after the attack. During this period, some brain cells die irrevocably, while others retain their abilities, but need help to fully restore their functions. This is why exercises are needed. When the patient is conscious, gymnastics begin to be performed on the third day after the attack. In order not to harm the body, rehabilitation is carried out gradually and methodically. Scheme for introducing certain exercises into the patient’s daily routine:

1. At the initial stage, care for bedridden patients is carried out by a whole team of doctors in a hospital setting. At the first stage, only passive types of loads are used. Almost from the first day, specialists provide massage and turn the patient over every 2-3 hours to avoid the formation of bedsores.
2. Next, passive gymnastics is carried out by third parties, close ones at home. Using a massage, the patient's skin is heated to ensure blood flow to the tissues. The impact should not be too strong. The procedure should be easy and pleasant. As for exercises, with passive loads, flexion/extension of the limbs - arms and legs - is allowed. The patient is placed on his back, after which the arm or leg is raised and bent. Such actions are carried out 2 times during the day for 40 minutes in the first week, and then 3 times a day. Additionally, it is allowed to perform exercises to restore speech, memory, and articulation.
3. After passive exercise, breathing exercises are added to normalize gas exchange, saturate tissues with oxygen and improve muscle function. Additionally, it improves mood and increases endurance, which prepares a person for further active loads.
4. Physical therapy (physical therapy) is prescribed when the patient has the first positive results and already has confidence in his own abilities. This period often coincides with discharge from the hospital. A change of environment has a beneficial effect on mood and subsequent rehabilitation. First, exercises are performed in bed, then in a sitting position, and then standing.

Gymnastics in a standing position

Such gymnastics is carried out after the patient has completed the entire range of previous exercises and can confidently stand on his feet. Depending on the person’s condition, standing exercises are divided into 2 types: simple and increased load.

Simple therapeutic exercises that are suitable for patients who have not yet fully recovered from a stroke include:

1. Place your arms along your body, feet shoulder-width apart. Stretch your arms up, palms should be directed outward. Stretch, take a deep breath. Slowly lower your arms while exhaling. Repeat the exercise 6 times;
2. Squats are another effective method during stroke rehabilitation. You need to squat carefully, while trying not to lift your heels off the floor. Repeat the exercise 4 times;
3. Place your feet shoulder-width apart and place your hands on your waist. Bend to the right side, raising your left arm in parallel, and vice versa. 4 repetitions of this exercise are enough;
4. Place your hands on your belt and point one leg forward. Make circular movements with the lower limbs one at a time - 4 times for each;

Increased load involves performing the following exercises:

1. Spread your legs slightly, lower your arms down. Then fold the hands into a lock and place them in front of you. Raise your clasped hands, stretching your whole body upward. Return to starting position. Repeat 5 times.
2. Place your feet together. Raise one hand up, leave the other down. Swap them for each count. Do 10 times.
3. Place your hands on your belt, legs slightly apart. As you inhale, bend forward slightly, and as you exhale, return to the starting position. Repeat 10 times.
4. Squats with increased load are performed a little differently: one hand should be on the belt while squatting, and the other behind the head. After each manipulation, hands need to be changed. Do 10 reps.
5. It is also useful for an already stronger person to jog in place during the recovery period, but not more than 6 minutes.

Important! If exercises cause severe discomfort or pain, they should be stopped immediately!

We invite you to watch a video about exercises while standing in a chair:

Basic rules of passive gymnastics

The exercise therapy complex recommended for recovery after a stroke is a multi-stage involvement in the activity of different parts of the brain. The main goal of physical therapy for such a disease is not to strengthen muscles and develop joint flexibility. First of all, the emphasis is on the gentle and sustained involvement of damaged nerve cells into active activity.

Despite the fact that exercises are passive in 90% of cases, their implementation can lead to fatigue of the patient. It is worth paying special attention to this, since the recovery process is not advisable to involve excessive stress for the patient.

The following can be considered passive exercises:

• flexion and extension of the limbs in the joints - first on the healthy side, and then on the paralyzed side;
• rotational movements of the limbs with a gradual increase in amplitude;
• clenching and unclenching of the hands;
• adduction and abduction of legs bent at the knees;
• breathing exercises.

At the initial stage, passive exercises also include forced extension of paralyzed limbs.

This must be done extremely delicately so as not to damage muscle fibers and ligaments! It is recommended to start extension from the fingertips.

To ensure that the benefits of exercise therapy are maximized and the risk of deterioration of the patient’s condition does not suddenly increase, the following rules must be followed:

• A set of exercises used after a stroke should be compiled by a physical therapy doctor. In this case, the choice of individual exercises will depend on which areas were damaged and how severely they were damaged.
• It is necessary to start with the simplest exercises that will require minimal stress on the patient. At the initial stage, the number of approaches should also be minimal. You can then gradually increase the load on your brain cells (but not your muscles!) by introducing a wider range of passive exercises.
• Systematicity is the key to the successful use of exercise therapy for recovery after a stroke. Exercises should be done daily, and their duration should be at least 40 minutes. It is recommended to work through each exercise as much as possible so that the brain cells can record the data received.
• Persistence is an important quality for those who help a patient during recovery. After a stroke, patients tend to become depressed and may react negatively to exercise therapy. It is important, despite the lack of desire, to carry out recovery sessions day after day until positive dynamics occur.
• Before performing the exercises, the patient must be prepared, that is, slightly “warm up” the receptors located in his skin. This can be done with a simple stroking massage.

When implementing a therapeutic gymnastic complex, it is necessary to closely monitor the patient’s physical condition. Even passive exercises can provoke headaches, increased blood pressure and other dangerous phenomena for the patient.

During the exercises, especially at the initial stage, it is recommended to monitor indicators such as heart rate, state of the eye pupil, blood pressure level and others.

Therapeutic gymnastics for the face

The following exercises will help strengthen the facial muscles and normalize the functioning of the speech apparatus:

1. Show your tongue, try to stretch it forward as much as possible;
2. Licking your lips in a circular motion;
3. Gently bite your upper and lower lips alternately;
4. Curl your lips into a tube;
5. Clicking your tongue.

Pronounce simple rhymes or tongue twisters. If this process causes difficulties, then you need to start with individual sounds, continuing them with words consisting of two syllables.

Important! One of the main conditions for recovery is that the patient should hear human speech as much as possible!

Goals of rehabilitation measures

The goal of post-stroke rehabilitation is to reduce the number of complications after acute cerebrovascular accidents, achieve complete or partial restoration of lost neurological functions and maximize the patient’s ability to return to everyday activities.

The main objectives of exercises for recovery after a stroke:

1. Acceleration of recovery processes.
2. Prevention of disability and reduction of complications.

The human body is created for movement, and thanks to it, the nervous system develops in the first years of life. Therefore, functional recovery is impossible without kinesiotherapy. Therapeutic gymnastics, massage, and mechanotherapy remain the main components of rehabilitation. Restoring physical performance is the main criterion for the success of activities. The concept includes:

• independence in daily activities;
• returning to the workplace or retraining for another job.

The rehabilitation program is drawn up individually depending on the nature of the disorders and the patient’s condition. The main directions can be presented as follows:

1. The use of physical exercises, massage, kinesiotherapy to overcome movement disorders.
2. Restoration of speech and memory.
3. Psychological and social rehabilitation in the family and society.
4. Prevention of delayed complications and re-risk, taking into account individual factors.

Physical therapy (physical therapy) after a stroke

Exercise therapy after a stroke is one of the important components of rehabilitation, which, like drug therapy, affects the prognosis. Restorative measures after an ischemic or hemorrhagic stroke must be early and aggressive. They should begin immediately after the patient’s condition has stabilized (usually on days 2-3) and be carried out daily for several months.

Regular physical exercise not only allows you to restore or improve motor functions, but also helps reduce the risk of complications (congestive pneumonia, bedsores).

The main tasks of exercise therapy after a stroke:

A stroke often leaves the right or left side of the body paralyzed. Regular exercise therapy helps to activate reserve neurons of the brain and thereby compensates partially or completely for the manifestations of neurological deficit.

Physical therapy plays no less, and sometimes even more, important role in the patient’s recovery and prevention of stroke recurrences than drug therapy. It should become an integral part of the life of every stroke patient.

The main objectives of physical therapy after a stroke are:

• prevention of complications associated with prolonged bed rest (muscle atrophy, congestive pneumonia, thromboembolism, progression of heart failure, bedsores);
• normalization of muscle tone;
• improvement of microcirculation and metabolism in tissues;
• restoration of motor activity;
• prevention of the formation of muscle contractures;
• improving the functions of internal organs;
• restoration of speech function;
• restoration of fine motor skills of the hands.

It is advisable to combine exercise therapy with other rehabilitation methods, such as kinesiotherapy, massage, occupational therapy, social and psychological adaptation. Therefore, in a hospital, rehabilitation treatment is carried out by a team of specialists (psychologist, nurse, massage therapist, exercise therapy instructor, psychologist, speech therapist, kinesiotherapist), working under the guidance of a neurologist. Relatives of patients are actively involved in rehabilitation activities.

Exercise therapy and bed rest

The early recovery period lasts up to three months after the brain accident. Some patients spend this time, or part of it, on strict bed rest. First, you need to give them the correct body position and change it - this is necessary to prevent congestion and bedsores.

After a stroke, muscle tone is disrupted, causing the limbs to take an incorrect position. For example, a paralyzed leg turns outward and the foot begins to droop. Spastic paralysis of the upper limb leads to the fact that it bends at the wrist and elbow joint, and the fingers are clenched into a fist. If you do not give the patient the correct body position on the healthy side or back, then over time he will develop muscle contracture, which will be very difficult to correct, and in some cases impossible.

Regular classes using the Bubnovsky method help improve joint mobility and restore the elasticity of the ligamentous apparatus and muscles.

In the first days after a stroke, the left or right arm and leg do not work well. Therefore, the patient is practically unable to perform active movements with them. To correct the situation during this period, a set of exercises is performed for bedridden patients, based on passive movements, i.e., performed not by the patients themselves, but by an exercise therapy instructor or, under his guidance, by their relatives.

Depending on the type of joint, the following types of passive movements can be performed in it:

• rotation (rotation);
• adduction and abduction;
• flexion and extension.

At first, the volume of movements performed should be minimal. It is gradually increased, but does not exceed the physiological amplitude for the joint being developed. Each movement is repeated 10-15 times. Passive exercises for the arm are performed first in the shoulder joint, then in the elbow, wrist, and then in the small joints of the hand. For the legs, they should be performed starting from the hip joint, then moving to the knee, ankle and toe joints.

Breathing exercises are very important for the prevention of congestion in the lungs in bedridden patients. In addition, its implementation allows you to increase blood oxygen saturation and thereby reduce brain hypoxia and improve metabolic processes occurring in it. The main breathing exercises are:

• take a deep breath and then exhale slowly through tightly closed lips;
• exhale slowly through a cocktail straw into a glass of water;
• inflating balloons.

Patients should perform these exercises at least 10 times a day.

The Bubnovsky method helps relieve pain, improve trophism of soft and hard tissues, and gradually restore motor functions.

An important stage of physical rehabilitation is performing not only physical, but also mental exercises. Every movement has its own muscle memory. Therefore, if the patient’s right half of the body does not work, then it is necessary to mentally imagine how the right arm and leg bend, fingers and toes move. Repeated repetition of such exercises makes it much easier to restore movement of the paralyzed limb in the future. In addition, this technique allows the patient to form a clear goal, which also helps speed up recovery.

Moderately extended semi-bed rest

At the next stage, the rehabilitation program is expanded. In addition to passive ones, it also includes active exercises that the patient performs independently. If the patient is not yet allowed to sit down and stand up, then he performs a set of exercises while lying down:

• clenching and unclenching fingers;
• rotation of the fists in the wrist joints in one direction and the other;
• flexion and extension of the upper limbs at the elbow joints;
• raising straightened arms above the head and lowering them along the body, i.e. only the shoulder joints work;
• swing straight arms to the sides;
• flexion and extension of toes;
• pulling your feet towards you and lowering them down;
• slow flexion and extension of the legs at the knee joints, while keeping the feet on the bed;
• bending the legs at the knee and hip joints, spreading them to the sides and slowly returning to the starting position;
• slow rotation of the torso in one direction or the other while lying on your back;
• lifting the pelvis above the bed with emphasis on the feet, elbows, shoulder blades and the back of the head.

This complex should be performed 3-4 times a day. The number of approaches depends on the patient's condition. Initially, each exercise is repeated 3-5 times. With good tolerance to physical activity, the number of repetitions, gradually increasing, is brought to 15-20.

It is advisable to combine exercise therapy with other rehabilitation methods, such as kinesiotherapy, massage, occupational therapy, social and psychological adaptation.

After the patient can take a sitting position, and this is allowed by the attending physician, physical therapy becomes even more active. To the above exercises add the following, performed in a sitting position:

• tilting the head from side to side;
• rotation in the cervical spine, first in one direction and then in the other direction;
• sitting on the bed without support under your back and with your legs down (the duration of this exercise is initially 1-3 minutes, then gradually increases);
• bending your back back, leaning on the bed rails;
• sitting on the bed with legs extended forward and resting with hands, alternately lift legs above the surface of the bed and slowly return to their original position;
• in a reclining position (several pillows are placed under the back), slowly pull one or the other leg to the chest (if necessary, you can help with your hands).

In addition, patients should exercise their hands as often as possible. It is quite simple and is based on sorting through small children's toys, assembling and disassembling figures from a construction set like Lego, and practicing with mosaics. Also, to improve fine motor skills of the hand, drawing, modeling, origami, and embroidery are recommended.

The proposed complex of exercise therapy after a stroke is general. If necessary, it may include other exercises aimed at restoring speech, friendly eye movements, writing and other functions.

Exercise therapy after a stroke: a set of exercises at home

Physical therapy started by a patient who has suffered an acute cerebrovascular accident in a hospital must be continued after discharge from the hospital. You can ask the instructor to record a video of exercise therapy after a stroke on a disk or USB drive (flash drive) - such a video will help you perform exercises at home in the correct technique, in the right order and without skipping.

The prognosis after an ischemic or hemorrhagic stroke largely depends on the timeliness of treatment, which includes not only medication, but also a whole range of rehabilitation measures.

The exercise therapy complex after a stroke at home includes exercises performed lying down, sitting and standing. All exercises in a standing position must be performed with the patient being supported by an instructor, a relative, or with the use of additional support. An approximate set of such exercises:

• the patient tries to maintain balance in a standing position with his arms down;
• swing your arms;
• circular movements of the head;
• squats;
• tilting the body back and forth and left and right;
• turns the body to the right and left;
• swing your legs.

After the patient learns to stand and maintain balance for a long time, and his muscles become stronger, the motor load is expanded again by adding walking.

Initially, the patient walks lengths of no more than 10-15 meters with the obligatory assistance of other persons or additional support. Then this distance gradually increases, and the support is weakened as much as possible.

In the future, patients who have suffered a stroke are recommended to take long walks in the fresh air with a gradual increase in walking pace. Such physical activity is very beneficial for the cardiovascular system and can be practiced for as long as desired, preferably for life - daily walking in the fresh air, counteracting physical inactivity, serves as an effective prevention of many diseases.

Bubnovsky method

The basis of rehabilitation treatment according to Dr. Bubnovsky’s method is kinesiotherapy, i.e. treatment with movement. In this case, unique simulators with anti-gravity and decompression functions are used, making it easier for patients with limited functions after a stroke to perform movements.

Bubnovsky’s method consists of creating an individual training program for each specific patient, which takes into account the necessary parameters - general health, stage of the disease, features of impaired motor function, personality characteristics, motivation.

Every movement has its own muscle memory. Therefore, if the patient’s right half of the body does not work, then it is necessary to mentally imagine how the right arm and leg bend, fingers and toes move.

Regular classes using the Bubnovsky method help improve joint mobility and restore the elasticity of the ligamentous apparatus and muscles. This helps relieve pain, improve trophism of soft and hard tissues, and gradually restore motor functions.

Physical therapy plays no less, and sometimes even more, important role in the patient’s recovery and prevention of stroke recurrences than drug therapy. It should become an integral part of the life of every stroke patient.

Video

We offer you to watch a video on the topic of the article.