Rehabilitation for hand damage after a stroke or traumatic brain injury

A little background

Pavel himself achieved everything in life. He has his own business - a company producing medicines and herbal remedies, a wonderful wife and children.

At the age of 40, he went on vacation with his family to Spain. The holiday was wonderful: the bright sun and warm sea made us happy and relaxed.

Suddenly Pavel felt unwell. Speech became slurred, the smile became crooked, weakness appeared in the left arm and leg, and it became impossible to walk.

an ischemic stroke developed . Then the terrible experiences began: an ambulance, doctors who do not understand strokes, insurance that does not cover all expenses, flights and treatment in a stroke department in Russia.

Risk factors for stroke and heart attack

Planning a preventative treatment regimen is based on addressing risk factors that are largely similar for heart attack and stroke.

Metabolic risk factors include:

• dyslipidemia (impaired lipid metabolism - organic compounds, including fats and fat-like substances);
• arterial hypertension;
• obesity;
• metabolic syndrome;
• diabetes mellitus and other endocrinopathies;
• coagulopathies (diseases that develop as a result of disorders of the blood coagulation and anticoagulation systems).

Common markers of heart attack and stroke are:

• previous cardiovascular diseases;
• peripheral vascular pathology;
• calcium index;
• stress test results;
• hypertrophy (thickening of the wall) of the left ventricle.

Atherosclerotic stenosis of the carotid arteries and brain tumors increase the risk of stroke. The provoking factors of a heart attack are:

• atrial fibrillation;
• dysplasia (developmental disorder) of connective tissue;
• arteritis;
• diabetes.

Although the incidence of stroke is higher in men, it is more severe in women, and about half of deaths from stroke occur in women.

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Causes of brain stroke on the right

A right-sided stroke is different from a left-sided cerebral blood flow disorder because the functions of the two hemispheres are different. In the right - the centers that are responsible for sensitivity, motor skills, coordination are localized; with the help of the right hemisphere, a person understands words, uses hearing, touch, intuition, evaluates the surrounding space, perceives music, reads, writes, recognizes geometric shapes. In addition, the entire left side of the body is monitored and the information is analyzed together with data from the left hemisphere to completely solve any problem.

During a stroke, any of the listed functions are disrupted, and the trigger can be either an endogenous or an exogenous factor. The most dangerous:

• alcoholism, smoking, drugs;
• blood pressure surges, high ICP;
• binge eating;
• obesity;
• atherosclerosis;
• increased blood clotting;
• stress, psycho-emotional and physical stress;
• brain injuries;
• congenital pathologies;
• chronic somatic diseases of the heart and blood vessels;
• uncontrolled use of contraceptives.

Children with heart defects, genetic blood diseases, and endocrine disorders are at particular risk for right-sided stroke.

Signs of a stroke

To diagnose cerebral blood supply disorders, it is necessary to use stroke recognition techniques:

• When trying to smile, you need to pay attention to the corners of the mouth - in case of a stroke, it can be directed downwards, the smile looks crooked and asymmetrical;
• When trying to speak, it may be difficult to pronounce even the simplest words and sentences;
• When trying to raise both arms, asymmetry is observed;
• The protruding tongue falls to the side.

If at least one of the symptoms is positive, you must immediately call an ambulance. Under no circumstances should you give him water, feed him, lift him, or take him by handy transport to the nearest hospital, as this can cause harm.

Help in the acute period

Which doctors are needed in the treatment of stroke depends on the period of the disease, but in any case, they must be experienced, highly qualified specialists who know how to properly provide assistance in this situation.

When diagnosing an ischemic stroke in a patient, the doctor’s goal is to restore blood supply with subsequent rehabilitation. This may require blood thinning medications or mechanical removal of the clot using a catheter. To remove atherosclerotic plaques, endarterectomy is performed, and to increase the diameter of blood vessels, plastic surgery with stenting is performed.

How long to stay in hospital if you have a stroke

Poor blood circulation in the brain, in other words, stroke, treatment involves three stages:

• prehospital;
• stay in the intensive care unit;
• treatment in a general ward.

The length of stay of a patient in a hospital, according to treatment standards, is 21 days, provided the patient has no violations of vital functions, and 30 days in case of serious violations. When the length of a patient’s stay in a hospital is insufficient, a medical examination is carried out followed by the development of an individual course of rehabilitation.

All patients diagnosed with stroke are subject to hospitalization. The length of stay in intensive care depends on a number of factors, including:

• depression of vital functions;
• degree of damage to brain tissue. With a major stroke, patients stay in intensive care longer;
• the need for constant monitoring if there is a high risk of recurrent stroke;
• severity of the clinical picture;
• level of depression of consciousness and others.

Basic and differentiated therapy

Treatment of a patient in the intensive care unit involves basic and differentiated therapy.

Basic treatment is aimed at:

• fight against cerebral edema;
• restoration of normal functioning of the respiratory system;
• patient nutrition;
• maintaining hemodynamics at an acceptable level.

Differentiated therapy involves:

• normalization of arterial and intracranial pressure, elimination of cerebral edema after hemorrhagic stroke. In the first two days, a decision is made regarding the need for surgery. Neurosurgeons at the Yusupov Hospital daily perform surgical interventions to eliminate the consequences of stroke and save the lives of hundreds of patients. All manipulations are carried out using modern medical equipment using effective proven techniques;
• accelerating metabolic processes, improving blood circulation and increasing the resistance of brain tissue to hypoxia when diagnosed with ischemic stroke. The length of stay in intensive care directly depends on the timely and adequate course of treatment.

In most cases, young people recover much faster than older patients.

It is possible to transfer a victim from the intensive care unit to a general ward after meeting a number of criteria:

• the patient can breathe independently, without the support of devices;
• the patient is able to call a nurse or doctor for help;
• there is a stable level of heart rate and blood pressure;
• the possibility of bleeding is excluded.

Only after the patient's condition has stabilized can the doctor transfer the patient to the ward. In a hospital setting, various rehabilitation procedures are prescribed to quickly restore lost functions.

In the neurology department of the Yusupov Hospital, patients are not only developed an individual course of rehabilitation therapy, but also given psychological support.

If necessary, psychologists work with loved ones and relatives of the patient to teach them the basics of caring for a person who has suffered a stroke.

Disorders after right-sided stroke

Apoplexy on the right side of the brain can cause disturbances in:

• establishing connections;
• motor activity;
• vision and touch;
• thinking;
• perception;
• behavior.

With a right-sided stroke, pathological phenomena usually do not affect the person’s ability to speak. He also most often understands the information he hears and sees. However, the patient may have problems initiating and maintaining conversations. It is difficult for him to consistently express his thoughts, since he cannot correctly formulate the order of speech structures. Often the victim’s speech is perceived as nonsense. A person has problems writing words and sentences, making spelling and lexical errors, and not correctly connecting individual elements of a phrase.

With right-sided brain damage, a person may have problems with motor activity. Paralysis or paresis may occur. The patient feels muscle weakness on the left side of the body. A characteristic phenomenon is the inability to maintain balance. A common consequence of right-sided stroke is loss of the ability to plan the sequence of complex motor acts. A symptom of the disease is poor coordination of movements. Muscle tone may be too high (spasticity) or too low (flaccidity). The patient indicates constant physical fatigue and reduced endurance. Movements are performed at too fast a pace; individual motor acts are characterized by impulsiveness and inappropriateness.

A person may have problems in the sensory system. There is either increased sensitivity to touch or decreased or loss of sensation on the left side of the body. Deterioration or loss of left-sided vision occurs. The patient can see things on the right side better. Ignoring objects located on the left and the phenomenon of tunnel vision are detected. The victim indicates double vision or blurring of visible objects. Nystagmus is often recorded - uncontrolled eye movements. A characteristic symptom is impaired perception of distance and depth: the patient has difficulty judging how far or deep something is.

A typical sign of a right-sided stroke is being easily distractible. Although there is no problem concentrating on a given stimulus, the person has difficulty maintaining attention and is unable to complete tasks that require prolonged concentration on a topic. Difficulties arise with remembering and storing received information, and there are problems with learning new material. A standard symptom of damage to the right hemisphere of the brain is impulsiveness of judgment: the patient often makes hasty conclusions without subjecting the information to the required analysis.

The consequences of a stroke are disorientation in time: five minutes seem like an hour to the patient. There is confusion regarding the current day, month, year, time of day. He cannot recognize the time on the watch. It is difficult for the patient to follow the established daily routine.

Disorientation in space may appear: a person cannot indicate the place where he is, does not know in which direction he needs to go. He easily gets lost even while on well-explored streets. Can't show where his home is. There are problems estimating the distance, size and position of an object.

A common sign of stroke on the right side of the brain is meaningless speech persistence: the patient repeats the same thing over and over again. It is not easy for him to isolate and process important components from the flow of information. Sequence of actions suffers: the individual is unable to complete tasks in the correct order. A person cannot plan events, draw correct conclusions and make logical decisions. He gets lost when conducting monetary transactions, is unable to solve simple mathematical problems, or dial a phone number without errors.

The sphere of perception undergoes changes - awareness of one’s own body, the environment and other people. The patient has problems with self-care. He has difficulty dressing, brushing his teeth, bathing, and combing his hair. Sometimes the patient indicates that the left arm or leg seems to belong to someone else. He is unable to understand the tone of voice or facial expression of the interlocutor. There are problems with separating a part from a whole object, for example, a door handle from a door.

Behavioral disorders are recorded. A person cries or laughs at inappropriate times (emotional lability). It shows a lack of interest in previously enjoyable activities (apathy). Doesn't want to complete the task (lack of motivation). He fails to start the process of solving the problem (initiation).

After a right-sided stroke, typical manifestations are changes in the characterological portrait. The patient is irritable and nervous. Has problems controlling impulses and emotions, displaying a short temper. He is distinguished by a pronounced depressive mood. Anxiety and anxiety intensify at night. He is self-oriented (egocentric). Shows a lack of sensitivity to the experiences of others.

Often the victim tries to do something without outside help. An additional threat is posed by lack of awareness of the consequences of stroke. The patient does not recognize the defects that have arisen and overestimates his own abilities. In such a situation, the person should not be left unattended to prevent actions that could cause harm.

Recovery period

The rehabilitation period is aimed at restoring lost functions and improving the quality of life of patients who have suffered a stroke. The doctor develops a rehabilitation program individually for each patient, taking into account the scale of the vascular accident, age, comorbid pathology, etc.

In case of strokes, doctors assign a special role to the prevention of recurrent strokes, which includes proper nutrition, giving up bad habits, eliminating excess weight, and regular monitoring by a doctor.

Is full recovery possible after a stroke?

The patient’s relatives play a significant role in the rehabilitation of a patient after a stroke. It depends on their attention, care, patience and correct actions whether the patient’s lost functions can return.

The recovery process after a stroke is a difficult period, both for the patient himself and for his loved ones. The rehabilitation time depends, first of all, on the degree of damage to brain tissue. Patients may have impaired coordination of movements, mobility of limbs, speech, memory, hearing, and vision.

The patient’s persistence and positive attitude can speed up the recovery time of lost functions.

An experienced team of doctors will speed up the rehabilitation process thanks to a well-designed individual treatment program.

Levels of recovery after stroke

After hemorrhagic and ischemic strokes, there are three levels of recovery:

• the first is the highest. We are talking about the complete restoration of lost functions to their original state. This option is possible in the absence of complete death of nerve cells in a region of the brain;
• the second level is compensation. The early stage of recovery, usually in the first six months after a stroke. Lost functions are compensated by the involvement of new structures and functional restructuring.
• The third level involves readaptation, that is, adaptation to the emerging defect. The patient’s relatives and friends play a significant role in this process. They are the ones who help the patient learn to live with the emerging defect.

Specialists at the Yusupov Hospital, if necessary, work with the patient’s relatives, teaching them the specifics of care, as well as providing them with psychological support.

Consequences of ischemia

With a small area of ​​necrosis of brain tissue or a micro-stroke on the right, the prognosis for the patient’s life is favorable: neurological changes are minimal and do not criminally impair brain function. An exception is trunk ischemia, since vital centers - respiratory and cardiovascular - are concentrated here. Therefore, even a microstroke of the brain stem almost 100% ends in death in the first hours.

The remaining patients will experience disability because, although they are not completely bedridden, they lose even a small ability to adequately, fully perceive the surrounding reality, understand what is happening to them, and the ability to think logically. For left-handed people it’s the other way around. For them, the consequences of a right-sided stroke are similar to ischemia of the left hemisphere in right-handed people.

The main consequences are presented in the table. We must understand that the consequences of ischemic stroke decrease over time with proper treatment. About a quarter of patients under 55 years of age recover fully from a microstroke without visible signs of any neurological impairment.

At the same time, no matter how many functions are rehabilitated in the first two years after a micro-stroke, so many will remain until the end of days. Nerve cells are practically not restored.

If the area of ​​brain necrosis is large (massive stroke), the prognosis is disappointing: up to 70% of patients die in the first few days, others become deeply disabled. The consequences are:

• persistent paralysis: patients cannot even sit;
• cerebral coma;
• complete lack of criticism and thinking;
• swallowing disorders.

Prognosis for recovery after stroke

Favorable factors for recovery after a stroke include:

• timely early start of rehabilitation therapy;
• spontaneous early recovery of lost functions.

Among the unfavorable factors of recovery after a stroke are:

• advanced age of the patient;
• large area of ​​brain tissue damage;
• poor blood circulation around the affected brain tissue;
• damage to cells in functionally important areas of the brain.

Basics of Stroke Recovery

In the process of rehabilitation, the positive attitude of the patient himself and his desire to return to independent life are important. Psychological support and assistance from the patient’s relatives plays a huge role. You can make an appointment with a neurologist by phone.

Memory recovery after stroke

Treatment of patients after a stroke takes place in the neurological department. Memory restoration depends on many factors: the size of the area of ​​brain damage, the location of the damage, and the timeliness of medical care. The faster blood circulation in the brain is restored, the greater the chance of memory recovery after a stroke.

Memory restoration after a stroke is possible with the participation of several specialists - a neurophysiologist, psychologist, neuropsychologist, neuropsychiatrist. Help for a patient after a stroke is provided at the rehabilitation clinic of the Yusupov Hospital. In the hospital, the patient is treated according to an individual recovery program; many specialists take part in the development of such a program. When developing the program, the patient’s health condition, the severity of brain damage, and memory impairment are taken into account.

In some cases, it takes several years to restore memory and speech; during recovery, the doctor prescribes medication, a special diet, various trainings - color therapy, rhythm therapy, music therapy and others. Memory restoration at home is not always successful due to the lack of a training program and knowledge in the field of rehabilitation of patients after a stroke.

You can make an appointment with a neurologist at the Yusupov Hospital by phone. Consultation with a specialist, full patient care, rehabilitation using innovative equipment, massages and exercises will help the patient regain full memory.

Restoring a hand after a stroke

A positive attitude and support from family have an impact on rapid recovery from illness. Partial paralysis of the arm is a common occurrence after a stroke and is characterized by stiffness of movement and limited motor ability of the arm. Functional paresis (partial paralysis) refers to neurological syndromes, caused by disruption of the nervous system, damage to the nervous system pathway due to damage to the cerebral cortex after a stroke. Paralysis of the arm is the complete absence of voluntary movements of the limb.

Recovery from a stroke may involve the hand or the entire limb. With partial paralysis, the ability to move the arm or hand freely is impaired; the person cannot fully care for himself or perform basic actions. To restore motor ability, the patient must perform daily exercises for finger motor skills and limb motor skills.

The rehabilitation process of restoring motor activity of the limbs requires patience from the patient and a lot of work - this will allow you to return to a full life after a stroke. You can make an appointment with a neurologist by phone. The rehabilitation doctor will develop individual exercises for the patient, the patient will be under constant medical supervision and receive qualified assistance from specialists.

Rehabilitation methods

As soon as the patient’s condition has stabilized, it is necessary to begin rehabilitation of the immobilized limb. Bedridden patients will need the help of nurses and physical therapists who know how to develop an arm after a stroke. An individual course is selected for each patient, which includes therapeutic exercises, reflexology, acupuncture, hydrotherapy, diet, modeling, medication, and treatment of chronic diseases.

How to restore an immobilized limb:

• stimulate the desire to move with the help of simple exercises (bend and straighten your fingers, clench a fist, take small objects, grab a hanging towel, raise your arms up, spread them to the sides, write, sculpt, draw);
• the patient should try to eat, cover himself, dress, wash himself;
• massage is performed to avoid blood stagnation and blockage of blood vessels (the procedure is combined with rubbing and various warming compresses);
• using special devices, acupuncture is performed to send electrical charges from the brain to the hand and make it move;
• in the morning, do exercises using exercise equipment to strengthen muscles and develop joints (lift dumbbells, bend your elbows with them), it is recommended to swim in the pool;
• conduct electrical stimulation to increase muscle tone, the procedure improves blood circulation and relieves pain.

Rehabilitation exercises are carried out 2-3 times a day, physiotherapeutic procedures - once a day for 2-4 months. The duration of each rehabilitation session should be a minimum of 10 and a maximum of 60 minutes.

Factors influencing the speed and quality of rehabilitation

There are many factors that influence the speed of recovery after a stroke, so predicting the duration of rehabilitation and likely results is quite difficult.

How long rehabilitation after a stroke will last depends on the individual parameters for each person, as well as on other factors:

• volume of damage: an extensive stroke significantly worsens the severity of the patient’s condition, and also causes many neurological complications that adversely affect the timing of recovery and its quality;
• patient’s age: the older the victim, the longer the recovery;
• localization of damage: circulatory disorders of deep structures are difficult to treat;
• type of stroke: hemorrhagic strokes are less common, but occur in a more aggressive form, and also have a high mortality rate, although the prognosis for rehabilitation is more favorable than for ischemic stroke;
• caused by disorders: the presence of multiple cerebral symptoms, comatose states, severe paralysis and sensory disturbances give an unfavorable prognosis for recovery;
• timeliness of therapy: the most positive results of therapy can be achieved by starting treatment measures in the first 4 hours after the onset of the first symptoms; seeking help at a later time worsens the prognosis;
• compliance with medical recommendations: after the patient is discharged from the medical institution, the patient is given recommendations that can improve the quality of life, prevent the formation of relapse and negative complications.

The severity of the lesion has the greatest impact on the likelihood of restoration of lost functions and the timing of rehabilitation. With extensive strokes, violations of the most important functions are observed, even if the prescribed rehabilitation program is followed, the prognosis is rather disappointing. The greatest difficulties arise with the complete return of speech and motor functions. Close relatives who will devote a lot of time to special activities with the patient can positively influence the situation.

Rehabilitation

The recovery period begins approximately a week after intensive therapy, it is developed by doctors of different specialties: rehabilitation specialists, neurologists, psychologists, physiotherapists, speech therapists, reflexologists, occupational therapists (specialists in the restoration of social, everyday, functional, motor skills), neurodefectologists.

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The first stage is inpatient, the second is sanatorium, but the full course is carried out at home, which can last for several years. The set of measures includes: medications, exercise therapy, acupuncture, reflexology, physiotherapy, kinesiotherapy (exercise therapy based on oriental practices), massage, diet. The treatment regimen is strictly individual.

At home you need:

• eliminate all physical and psycho-emotional stress;
• balance the drinking and food diet with limiting lipoproteins;
• master a course of exercise therapy, including breathing;
• Constantly massage, especially in areas that have lost sensitivity;
• sanitize chronic foci of infection, somatic pathologies;
• eliminate all bad habits.

Particular attention to the prevention of bedsores, purulent corneal ulcers, hypostatic pneumonia, and contractures. To do this, special exercises are performed, the upper respiratory tract is cleaned, and if necessary, parenteral nutrition and bladder catheterization are provided.

The duration of rehabilitation can be only a month (for a mild form) or up to two or more years (for a severe form). Average rehabilitation is six months.

Stroke Prevention

Prevention of heart attack and stroke in women and men are links in one chain of measures that prevent disability and death in people suffering from cardiovascular diseases.

Cardiologists and neurologists at the Yusupov Hospital use modern diagnostic methods to examine patients, allowing them to identify risk factors for vascular diseases and take measures aimed at preventing diseases. Medicines for the prevention of stroke and heart attack allow you to control the course of the disease, reduce the incidence of acute cardiovascular crises, and the likelihood of complications.

Chance of full recovery after stroke

The rehabilitation period is individual; for some, a few months are enough; for others, it will take years to achieve a positive result. The earlier restoration procedures are started, the more favorable the prognosis. At the same time, the patient’s attitude and focus on results is important; The greater a person’s desire to return to a full life, the more effective the classes and exercises.

At the Yusupov Hospital, a well-coordinated team of professionals (neurologists, rehabilitation specialists, therapists, cardiologists, speech therapists, psychologists) takes part in the rehabilitation of patients after a stroke. Doctors create an individual program for each patient, aimed at the best possible result, observing the following principles:

• early start of restorative procedures;
• systematicity and duration of events;
• complexity of procedures;
• multidisciplinarity of classes;
• compliance of procedures with the patient’s condition;
• active interaction between doctors and the patient and his family.

You can make an appointment with the doctors at the Yusupov Hospital and find out how much rehabilitation after a stroke costs by calling.

What is ischemic and hemorrhagic stroke

Based on etiology, right-sided stroke is divided into ischemic and hemorrhagic. The first develops due to impaired cerebral blood flow on the right due to narrowing of blood vessels or their complete blockage; the speed of blood movement and its viscosity also play a role. As a result, hypoxia of brain cells is provoked with their death and necrosis of a certain area of ​​the brain. Symptoms of ischemic stroke increase gradually, so ischemia develops over several hours or even days, which makes it possible to consult a doctor in a timely manner and avoid fatal consequences. The prognosis for this form of the disease is affected only by the extent of the lesion (necrosis).

Hemorrhagic stroke is a hemorrhage in brain tissue due to rupture of blood vessels. Often this situation leads to cerebral edema, coma and death. Vascular rupture occurs much less frequently, but has more severe consequences, since there is no time to “build up”. The spilled blood permeates the tissues, compresses vital structures, sometimes completely destroying them. Regardless of the size of the affected area of ​​the brain, nerve cells are restored slowly; not all lost functions of the nervous system can be restored.