One of the most severe conditions in neurology is stroke. What is it, what are its consequences and how to help patients who have had it?
What is a stroke?
Stroke is now understood as an acute violation of cerebral circulation, developing as a result of thrombosis or narrowing of cerebral vessels.
Two main forms of stroke are distinguished - hemorrhagic and ischemic.
Hemorrhagic stroke is characterized by cerebral hemorrhage. It is developing acutely. Most often, the cause of its development is hypertension. It is characterized by acute onset, rapid loss of consciousness. The volume of brain tissue damage depends on the massiveness of the hemorrhage (the faster the bleeding stops, the more favorable the prognosis).
Ischemic stroke, in turn, develops gradually, against the background of cerebral arteriosclerosis and coronary heart disease. It proceeds more favorably than the hemorrhagic form.
The rehabilitation period after a stroke is quite difficult for the patient. If appropriate assistance is not provided to him, the risk of an irreversible violation of all the functions of the patient's body is high.
The rehabilitation period after a stroke
As you know, no matter how severe the stroke, with properly organized care for the patient, there is a chance of a complete restoration of the patient's life activity with his return to the sphere of society.
The most important thing in this period is the observance of certain rules, principles and norms in communicating with the patient.
First of all, it should be borne in mind which stroke a person developed and what part of the brain is damaged, because the clinic of lesions of different hemispheres is different from each other.
It should be remembered that all activities and exercises must be carried out sequentially, according to the plan. Only then will the patient care after a stroke be the most complete and allow the victim to get back on their feet as quickly as possible.
You should always remember that the treatment of stroke is not a one-day or a week-long process; only persistent and proper treatment will be effective and will lead to proper recovery.
Drug therapy
Medication after a stroke is prescribed already in intensive care. The accuracy and correctness of the dose allows you to remove the patient from a coma and limit the affected area for hemorrhagic stroke (for ischemic stroke - restore cerebral circulation).
After the patient is transferred to the department, maintenance therapy is assigned to him, which allows to consolidate the achieved results. Care should be taken to ensure that the patient regularly takes all the medicines prescribed to him. If he cannot take them on his own, you need to help him with this (sometimes support his head, help swallow, grind the tablet to a powder state).
Treatment after a stroke at home begins after discharge. Assistance to the victim should be the same as in the hospital (support the patient, tilt him, give water). In no case should the patient be allowed to miss medication.
Food
This factor is one of the most important in the period when active rehabilitation after a stroke occurs.
It should be remembered that due to the developed disease, most patients lose the ability to self-feed. They should actively help them with food intake (at the initial stages, maintain a plate and spoon, prevent choking of patients). Subsequently, when he himself will be able to try to serve himself, it is necessary to monitor how the patient eats, and, if necessary, help him.
Patients after a stroke need a proper healthy diet. The human diet should be filled with vegetables and fruits, meat. Only then is the most effective restoration of the affected areas of the brain ensured.
From everyday use should be excluded all foods that increase blood pressure, as well as acute, smoked. Do not feed patients with bulk products, as there is a high risk of them getting into the respiratory tract.
Infectious Disease Prevention
As you know, bedridden patients are classified as severe and are at risk for the development of infectious diseases. Such patients often have pressure sores - local areas of inflammation and necrosis. Especially in the case when the patient for a long time lies in one position. Because of this, stagnation of blood and lymph occurs in places of bone protrusions, which leads to maceration, infection and necrosis.
Care for patients after a stroke in this situation should include daily hygienic wipes (if possible, use of a bath or shower). The patient’s bed is recommended to be changed as often as possible, to prevent the formation of folds on it. After each meal, it is advisable to shake it to remove fallen crumbs.
Another fairly common complication in bedridden patients is pneumonia. To prevent its development, it is recommended to avoid overcooling of patients (as well as overheating). Periodic airing of the room, thorough cleaning are shown. For the purpose of prevention, you can ask your doctor for a prescription for injectable or oral antibiotics.
Recovery of motor functions
This group of measures is assigned in the case when certain motor impairments occur.
Care for patients after a stroke, complicated by impaired limb functions, includes assistance in the development of affected hands and feet, restoration of the full volume of active movements.
At the initial stages of the patient, they are taught to hold objects. Over time, it is possible to work with fine motor skills (sorting out coins or keys, opening locks).
It is not always possible to completely restore movements. Despite this, all efforts should be aimed at returning the patient to society.
If the lower extremities were affected, recovery from a stroke begins with training steps. It is best to spend it lying in bed.
Begin exercises with imitation of steps. Over time, when the patient is able to “walk in bed”, if he cannot sit, they help him to get up, and he conducts further training in a sitting position.
Speech Recovery
Quite often, stroke patients have speech disorders. They can be insignificant (light lisp or swallowing letters), or completely depriving the patient of speech (up to the issuing of individual sounds).
On the other hand, the patient may not be aware of what they are told, what is written on a piece of paper. In this case, sensory aphasia occurs, which is much more difficult to cope with than with speech impairment.
Recovery from a stroke accompanied by loss of speech should begin with conversations with the patient. If the patient understands what they are saying, he can try to answer on his own or simply reproduce the same words. However, when sensory aphasia has developed, the patient must be taught everything anew - to explain the letters of the alphabet, to show how they are written.
Over time, speech after a stroke will begin to recover gradually. The main thing is not to give up attempts and persistently go to the end.
Psycho-emotional disorders
Unfortunately, many stroke survivors are at risk for developing these complications. After all, any disease for a person is stress, and here a person is almost completely turned off from society. Against this background, many patients who are aware of their condition become isolated in themselves and are protected from relatives seeking to help them.
All this adversely affects the ongoing treatment and leads to a delay in complete cure.
In this case, recovery from a stroke should be combined with active communication with the patient. It is necessary to periodically tell him something fun, to help unwind. Only then does a person cease to shut himself in, seeing that someone else needs him. His mood improves, interest in life appears.
Do not try to cheer up the patient with medication - there is a risk of developing severe post-medication depression. It is much easier to show the patient that they care about him, love him, and then the person will recover better after a stroke.
Neurological disorders
Many strokes are accompanied by a violation of the sensitivity of the affected limbs. Sometimes only a decrease in the pain threshold is observed; anesthesia (a complete violation of sensitivity) and paresthesia (a feeling of goosebumps or chills) can be noted quite rarely.
In this case, rehabilitation after a stroke can be useless, and the manifested violations will have to be put up for the rest of your life. In order to increase sensitivity, physiotherapy is recommended - a Bioptron lamp, pulse currents. In some cases, a restoration of sensitivity was observed (if the lesion in the brain was not extensive).
Sometimes the appearance of pathological reflexes can be observed (for example, the grasping reflex, which is present in newborns up to 4-5 months, should not appear in an adult). If you notice that the patient’s hand after a stroke began to shrink when you touch it, you should either wait a while (the reflex may disappear with treatment) or seek advice from a neurologist. Sometimes this reflex can remain for life.
Physiotherapy
To restore muscle activity immediately after the acute period has passed and the patient has already begun to stand up and sit down on his own, special exercises should be performed after a stroke.
Physiotherapy exercises include gymnastics (flexion and extension of arms and legs, warming up fingers, trying to weave or folding small mosaics) and massage.
Restorative massage has a special effect. It is recommended to be carried out daily, starting from the periphery of the limb and rising to the body. It allows you to restore blood circulation in the affected limb, restore former muscle tone.
It is best to carry out exercises in the pool together with the patient. Water helps reduce the load on the affected limbs, as a result of which motor rehabilitation after a stroke occurs much faster.
After exercise, relaxing baths and hypnotherapy are recommended.
Treatment in rehabilitation centers
No matter how good the treatment in hospitals, and at home - care, patients are best restored after a stroke in specialized centers.
Many neurologists recommend immediately after discharge from the hospital to send the patient to a rehabilitation center. After a stroke, the first month is extremely important, since it is in this period that it is possible to restore the patient's activity with the right therapy.
It is there that the best specialists in the field of rehabilitation are gathered who will help to correctly draw up a treatment program with the achievement of the best effect in treatment.
The right combination of medical support, exercises and physiotherapy allows you to put the patient on his feet in the shortest possible time.
Care for patients after a stroke in such centers is carried out around the clock. Each patient has a nurse caring for him and monitoring his health.
Professional and social adaptation
Unfortunately, quite often after a stroke, a person loses professional skills. This condition can be stopped by trying to re-educate the patient of labor activity. If it cannot be restored, a person is assigned a disability group (usually a third). This applies to specialized skills (for example, it is not recommended to return to work by doctors - especially neurosurgeons, turners, jewelers). At the same time, the ability to common work and self-care can be maintained.
If the general labor skills are lost, the patient can apply for group 2.
If you lose the ability to self-service to a person, you need to put a nurse. In this case, rehabilitation after a stroke continues throughout life. In addition, one disability group is established (i.e., it is believed that a person is not adapted to exist in society and needs an assistant).
Where to treat a patient after a stroke?
For many people, caring for a stroke patient is extremely hard work. Not everyone is ready to look after a seriously ill person, because in this way all his free time is lost. Many people who remain bedridden change their character (quite often - for the worse). Because of this, no one wants to deal with the patient (even if it is the closest relative). In this case, sending the patient to a rehabilitation center after a stroke is the best way out . However, not everyone can afford the services of such institutions. In this case, the only way out is to restore the patient at home.
Some especially irresponsible people send the patient to a boarding school, abandoning him. Nevertheless, it should be remembered that in these institutions the patient does not receive much-needed care, because of which, in most cases, he becomes disabled.