Massage for acute circulatory disorders. Massage for the consequences of cerebrovascular accident

One of the consequences is damage to the motor centers of the brain and, as a result, paresis - a violation of the motor function of various parts of the body. For the purpose of rehabilitation, restoration of sensitivity and motor ability, massage is prescribed. Sessions with the patient must be conducted by a competent specialist. With the right technique, the patient’s chances of recovery are quite high.

Massage is carried out in combination with drug treatment and exercise therapy. Therapeutic massage techniques differ from classical massage techniques: they are far from the same thing.

Is it possible to have a massage during a stroke?

Massage directly during a stroke is prohibited. You need to switch to it in the recovery phase. The timing of the start of classes depends on the patient’s well-being, as well as on what type of stroke he suffered. However, the earlier massage sessions are started, the better the treatment prognosis.

In case of hemorrhagic stroke, restorative massage should be started on the 6-7th day after the injury. If the stroke is ischemic, then this can be done already on the 2-3rd day. The main condition is the absence of any contraindications for the procedure. Each patient must have a comprehensive individual approach, in which the attending physician and massage therapist work together strictly according to the indications for a particular patient.

Goals of massage after a stroke

A stroke is an acute disorder of cerebral circulation. Massage after a stroke is needed in order to improve blood flow, activate tissue nutrition, and the functioning of internal organs. At the same time, the transmission of nerve impulses from the brain to various organs is significantly improved.

Massage helps relax muscles during spasms. This, in turn, reduces possible muscle pain.

Since patients lie a lot, losing the ability to move to one degree or another, the issue of preventing bedsores also becomes relevant. In addition, restoring movements through massage helps to avoid muscle atrophy and phenomena in the joints that reduce their mobility.

It is also important to improve the patient’s psychological mood. The massage itself is a pleasant procedure. And the beginning of restoration of body functions, positive dynamics during the course of the disease give a person strength to further fight for health.

Where to start: general rules of massage

You need to start with a light massage lasting no more than 5 minutes. Before starting the session, you need to determine the condition of the muscles in different parts of the body. If muscles are in spasm, relaxation techniques are used. For weak muscles with insufficient tone, on the contrary, a tonic massage is needed.

The massage therapist's movements should be light and gentle. Strong rubbing of the skin is contraindicated, especially with a history of arterial hypertension. First, massage movements are performed on the healthy side of the body, and then gradually move to the affected side. It is important to remember that the massage therapist’s hands should never be cold. Each movement is repeated three times, then the number of repetitions increases with each session.

It is necessary to carefully monitor the patient's condition. If he turns pale or complains of pain or other unpleasant sensations, the massage should be interrupted immediately. If after a pause the patient’s well-being becomes better, you can continue, carefully ensuring that the movements are as gentle as possible.

How often to conduct sessions

The best option is to conduct massage sessions little by little and daily. As practice shows, in this case, the restoration of motor activity occurs faster. This schedule is the most optimal. If it is impossible to do a massage every day (for example, at home after discharge), you should do it as often as possible, at least every other day. How quickly and completely the patient recovers depends on how the treatment is carried out.

Most often, sessions are held every day or every other day. From 5 minutes at the first session, the duration gradually increases to 20 minutes. The number of sessions, as a rule, ranges from 12 to 20 procedures, but may be different, selected individually, depending on the condition.

A more precise number of sessions, as well as their duration, can only be determined by the attending doctor. The massage therapist is obliged to closely monitor the patient’s condition during the procedure, and at the slightest sign of deterioration, stop the session.

How to organize a massage at home

Massage after a stroke at home can be performed by both a specialist and the patient’s relatives, having mastered special techniques and agreed on a set of exercises with a neurologist or attending physician. A reasonable solution is to invite a trained massage therapist home after discharge for the first one or several sessions. Then you can watch his work, remember the movements and their order in order to continue the sessions yourself. When a patient is discharged from the hospital, you can discuss these issues with his or her attending physician in advance. The frequency of sessions should not be too infrequent.

It is important to maintain a positive, friendly atmosphere in the home where the sick person is. With the moral support of his family and friends, his recovery will be much faster.

Correct positioning of the patient during a stroke

The patient should lie on his back, with the upper part of the body slightly higher than the lower part. During the first sessions, he is prohibited from turning over on his stomach. If one half of the body is paralyzed, lying on it in the first days after an attack is contraindicated.

Massage gives the best effect if done with warm hands on slightly warmed skin. To warm up, you can use heating pads and warming ointments. The room should be warm enough so that the patient does not feel cold. If this is an elderly person who experiences cold even at 20-22 degrees Celsius, then you can cover him with a blanket, leaving only the areas to be massaged uncovered.

The patient's body position should allow him to relax his muscles as much as possible. You can place a comfortable cushion or pillow under your limbs and joints. If the patient's heart function is impaired, he should not be placed on his stomach. In this case, the best position would be on the back or on the right side (taking into account the paralysis of the sides of the body and the patient’s condition).

After the massage session, let the patient rest for 20-30 minutes, covering him with a blanket.

Massage techniques and techniques

It is necessary to start the massage from the upper body. The general rule for hypertensive patients: the limbs and back are massaged from the center to the peripheral part. You can move the massage in the direction from the periphery to the center if the patient does not suffer from hypertension (accordingly, there is no risk of increased blood pressure).

It is recommended to massage along the blood flow. First, massage the limbs of the healthy side of the body, then the muscles of the neck and chest. The first movements should be carried out to relax the muscles, including the affected areas of the body.

Strong rubbing of the skin, sudden movements, for example: chopping with the edge of the palm, tapping are prohibited. First of all, these prohibitions concern paralyzed areas of the body.

When massaging the hand, it is usually necessary to restore both motor ability and skin sensitivity. Begin the hand massage by stroking the palm. Light stroking promotes relaxation, deeper stroking improves blood supply to tissues. Gradually, they also begin to perform light rubbing and kneading - techniques that affect the deeper muscles of the limb.

Massaging the limbs begins with the palm or foot, gradually moving to the forearm (shin), then to the shoulder (thigh).

By analogy, the muscles of the neck, shoulders, and chest are massaged in approximately the same way. Before starting a foot massage, it is recommended to first work on the areas on both sides of the spine in the thoracic region.

If a patient has paralysis of the left or right side of the body after a stroke, then to massage it, the person needs to be laid on the opposite (i.e. healthy) side. In some cases, the doctor may allow the patient to be placed on his stomach for massage.

If you need to do a massage after a stroke on the right side, then you need to warm it up with a heating pad. Then massage movements are made along the flow of blood and lymph. If there is no osteochondrosis, they start from the collar area. The next direction of the massage is from the ear to the chin. After this, massage the arm from the hand to the shoulder and from the ribs to the right armpit and to the thigh - the side. Move on to the leg massage: starting from the lower leg towards the thigh, then from the ankle to the knee, then the foot. Finish with a foot massage with your fingers. The massage of the right side ends with an impact on the back, except for the spinal column. Movements are made to the right side.

After this, you need to turn the patient over and massage the healthy side of the body. Massage is done in a similar way after a stroke with a paralyzed left side.

Indications and expected results

Despite all the benefits of massage after a stroke, there are still a number of contraindications for its implementation. Massage is not prescribed for high blood pressure (180/100 and above), the risk of blood clots (venous thrombophlebitis, etc.), elevated temperature, exacerbation of chronic diseases of internal organs, as well as cardiac, pulmonary, and renal failure. You should not massage if you have skin diseases, the presence of purulent lesions on the skin, infections, blood diseases, or tumors.

However, in most cases, massage is recommended as one of the main rehabilitation procedures after a stroke.

If during an attack the patient was provided with timely medical assistance, and restorative procedures were started in the first days after the stroke, then the chances are high that he will return to his previous life. Time cannot be wasted here, since restoration of muscle elasticity depends on this.

How long the rehabilitation period will last depends on the degree of brain damage. If the patient has impaired not only movements, but also speech, then in parallel with the massage of the facial muscles, a speech therapist usually works with him.

In each specific case, an individual training program is developed, aimed at speedy recovery of the patient and maximum preservation of his physical capabilities.

Objectives of massage: improve blood and lymph circulation, promote restoration of function, counteract the formation of contractures, help reduce increased muscle tone, reduce friendly movements, as well as trophic disorders in the limbs, promote general health, strengthen the body, reduce pain.

Methodology. A classic massage is performed. It is more rational to start the massage with the patient in the supine position (under the knee - a roller, if necessary, then a fixing bag of sand on the foot, if synkinesis appears on the non-massaged limb). They start with stroking, light rubbing and continuous labile vibration on the front surface of the thigh (for relaxation), then the same relaxation techniques on the inner surface of the thigh. On the back of the thigh, techniques can be carried out more energetically, with kneading, pressing, and spiral rubbing.

Massage of the affected lower limb is carried out from the proximal part to the distal parts, i.e., having massaged the thigh, then massage the lower leg area, on the back surface all gentle techniques are used: stroking, rubbing, continuous labile vibrations, on the front surface all techniques can be carried out more energetically (comb-shaped stroking, spiral-shaped, comb-shaped rubbing, pincer-shaped kneading, pressing, vibration, shading, planing). When massaging the foot on the back, all techniques can be carried out more energetically than on the sole, where light stroking, rubbing, pressing, and continuous labile vibration are required. Gently massage the heel tendon. Avoid causing Babinski's sign (sharp dorsal extension of the first toe).

After massage of the lower limb, they move on to massage the upper limb on the affected side. The procedure begins with the area of ​​the pectoralis major muscle; most often its tone is increased, so all techniques are carried out using a gentle technique - light stroking, rubbing, relaxing vibration. Then the area of ​​the shoulder girdle, back, trapezius muscles, deltoid is massaged - here the tone is low and manipulations can be carried out more energetically, using stroking, comb-shaped spiral rubbing, forceps kneading, pressure, vibration with the use of shading, alternating them with other types of techniques. After this, they move on to a shoulder massage, on the front surface of which all techniques are carried out in a gentle way, and on the back surface more energetic effects can be used. Begin the massage from the back of the shoulder - stroking, rubbing, kneading, vibration. Specially affects the shoulder joint. Then a forearm massage is carried out, where the inner surface is gently affected, and on the outer side of the forearm and on the hand, all techniques can be carried out more energetically.

When massaging the hand, you should identify painful points (usually on the palmar surface), trying to have a relaxing effect on them. When the patient has the opportunity to lie on his side or stomach, the back, lumbar region, and pelvis are massaged. All techniques are carried out sparingly.

Guidelines.

1. In each procedure, repeat massage techniques 3-4 times.
2. During the 1st-2nd procedures, the area of ​​influence is insignificant (only the proximal limbs, do not turn the patient on his back).
3. From the 4th-5th procedure, if the patient has a good response to manipulation, expand the area of ​​influence to the distal limbs, chest, with a turn to the healthy side - massage of the back, collar area.
4. From the 6th-8th procedure, the back and lumbar region are fully massaged (the patient lies on his stomach). Combine massage with other types of influence (position treatment, balneotherapy, electrical procedures, aeroionization, etc.). Massage can be prescribed both before and after these procedures, in consultation with your doctor.

Timely treatment with the use of various therapeutic methods has a beneficial effect on the patient’s condition. There are 3 stages of treatment: early recovery (up to 3 months), late recovery (up to 1 year) and the stage of compensation for residual motor function disorders (over 1 year).

The most beneficial effect is exerted by therapeutic exercises in combination with acupressure.

Spot.

Acupressure helps regulate the processes of excitation and inhibition in the cerebral cortex, as well as normalize the reciprocal relationships of antagonist muscles.

The starting position of the patient during acupressure is lying on his back. Massage always begins with the upper limbs, preferably in combination with passive movements in the corresponding joints of the massaged limb.

Methodology, sequence of influence (Fig. 128). To relax or stimulate the muscles of the shoulder girdle, the following points are affected:

1. jian-ching - on the line corresponding to the middle of the shoulder girdle, in the center of the supraspinatus fossa;
2. jian-yu - on the shoulder between the acromion and the greater tubercle of the humerus (downward and anterior to the acromion);
3. zhou-rong - in the second intercostal space, along the 3rd line of the chest, on the pectoralis major muscle;
4. nao-shu - posterior to the fossa of the shoulder joint in a vertical line with the armpit (well defined when raising the arm);

Rice. 128. Topography of “points of influence” for acupressure during the rehabilitation of post-stroke patients.

a - on the chest, on the back; b - on the upper limbs; c - on the lower extremities.

1. fu-fen - between the II and III thoracic vertebrae on the 2nd line of the back, at the inner upper edge of the scapula (D 2-3/2);
2. gao-huang - at the level between the IV and V thoracic vertebrae on the 2nd line of the back, at the inner edge of the scapula (D 4-5/2);
3. bi-nao - on the outer side of the humerus at the posterior edge of the deltoid muscle and at the outer edge of the triceps brachii muscle:
4. Chi Quan - on the shoulder at the level of the axillary fold, directly at the lower edge of the pectoralis major muscle:
5. pian-zhen - down and behind the shoulder joint along the posterior axillary line, between the humerus and scapula.

To relax the flexors and pronators of the upper limb, the following points are affected:

1. qu chi - in the area of ​​the elbow joint at the end of the fold formed when bending the elbow joint, on the side of the first finger;

Rice. 128. in (continued)

1. chi-tse - in the fold of the elbow at the outer edge of the tendon of the biceps brachii muscle;
2. shao-hai - in front of the internal condyle of the ulna in the cavity, here the ulnar nerve is palpated with deep pressure;
3. nei-guan - 2 cun above the middle of the wrist fold towards the elbow joint;
4. da-lin - in the center between the wrist folds on the inner surface of the wrist joint;
5. lao-gong - in the middle of the palm, when bending the fingers between the third and fourth fingers (end phalanges);
6. shi xuan - the tips of all 10 fingers (their distal phalanges);
7. shou-san-li - on the back of the forearm 2 cun below the elbow fold, towards the first finger;
8. he-gu - at the top of the mound, formed by squeezing the 1st and 2nd fingers of the hand together, on the back of it.

To stimulate the abductors and other muscles, the hands act on the points:

1. xiao-le - in the middle of the back surface of the triceps brachii muscle, 5 cun above the elbow joint, in the direction of the shoulder joint;
2. yang-chi - on the dorsum of the wrist joint, in the center of the wrist fold;
3. wai-guan - 2 cun above the yang-chi point, between the tendon of the common extensor of the fingers and the extensor of the fifth finger;
4. e-men - on the dorsum of the hand between the metacarpophalangeal joints of the fourth and fifth fingers, at their base;
5. shi xuan - at the tips of all 10 fingers of the hand;
6. yang-si - between the tendons of the long and short extensor of the first finger, in the anatomical snuffbox;
7. yang-gu - in the cavity between the styloid process of the ulna and the triquetral bone of the wrist;
8. tian-ching - above the olecranon process, in the depression of the olecranon fossa.

To relax the muscles that extend the thigh and lower leg, the following points are affected:

1. bi-guan - on the front surface of the thigh, in the middle of the inguinal fold below it, 1 cun towards the knee joint;
2. huan-tiao - in the depression in the middle of the gluteal muscle, when bending the leg at the knee joint, the heel is pressed against the point area;
3. fu-tu - on the front surface of the thigh 6 cuns above the upper edge of the patella;
4. du-bi - in the depression outward from the patella, at the level of its lower edge;
5. he-din - in the middle of the upper edge of the patella, where it is clearly visible when the leg is bent at the knee joint;
6. cheng jin - below the middle of the popliteal fossa, folds 5 cun, between the bellies of the gastrocnemius muscle;
7. Cheng Shan 3 cun below the Cheng Jin point, or in the center of the back surface of the lower leg, in the depression at the junction of both bellies of the gastrocnemius muscle;
8. kunlun - behind and below between the outer ankle and the heel tendon.

To stimulate active contractions of the leg flexors, the following points are affected:

1. cheng fu - in the center of the subgluteal fold;
2. yin-men - in the middle of the back of the thigh between the biceps and semitendinous muscles, 6 cun below the subgluteal fold.

For stimulation (and more often for relaxation, depending on the patient’s condition), the following points are applied on the inner surface of the thigh:

1. yin-bao - in the middle of the lateral surface of the thigh, its inner side, 5 cun above the knee joint;
2. Chi Men - on the inner surface of the thigh, in the cavity at the inner edge of the quadriceps muscle, in the middle of the distance, 6 cun above the upper edge of the patella.

To stimulate the muscles that extend the foot and toes, the following points are affected:

1. yin-ling-quan - on the inner surface of the lower leg, at the posterior edge of the inner condyle of the tibia;
2. Yang Ling Quan - at the front lower edge of the head of the fibula, in line with the Yin Ling Quan point, on the sides of the knee joint;
3. tzu-san-li (longevity point) 3 cun below the lower edge of the patella and 1 cun outward from the midline of the lower leg, under the joint of the fibula and tibia;
4. jie-si - in the middle of the dorsum of the ankle joint, in the center of the fossa formed when the foot bends towards itself;
5. shan-qiu - on the inner surface of the foot, in front and below the inner ankle;
6. qiu-xu - on the dorsum of the foot in front and below on the outside of the ankle;
7. pu-shen a series of points (5-6) along the outer edge of the foot, starting from the toes;
8. yongquan - in the center of the plantar surface between the second and third toes of the foot, when the fingers are compressed on the sole, a fold is formed, in the center of which a point is located.

Guidelines. The starting position of the patient is lying on his back. The massage therapist is always on the side of the paretic limbs. From the proposed points in a given area, select the most effective for this procedure. Strive to achieve the desired effect (relaxation or stimulation), while using the appropriate acupressure technique - with stimulation - tonic, with relaxation - soothing, relaxing. Use combinations of certain points to increase the effectiveness of the impact: on the shoulder joint Nao-Shu and Zhou-Rong, on the elbow joint Shao-Hai and Qu-Chi, on the wrist joint He-Gu and Lao-Gong, or Yang-Chi and Da-Ling , yang-xi and yang-gu, wai-guan and nei-guan, on the lower extremities - kun-lun and jie-si, yang-ling-quan and yin-ling-quan. In combination with passive movements, the effectiveness of acupressure is much higher; rehabilitation time is reduced.

In some conditions, it is more rational to start a massage not with classical techniques, but with acupressures and passive movements. The advantage of the acupressure technique is that this method in practice, when performed correctly, has no contraindications.

Acupressure can compete with acupuncture in terms of the speed of relaxation, which gives it an advantage during various gymnastic exercises.

It should be remembered that it is not always possible to achieve complete relaxation in the first procedure, especially in patients with a relatively long history of stroke, so you should not increase the intensity of the impact and especially frequently change selected points. One course consists of 20 procedures, 25-30 minutes each. The courses are repeated at intervals of 15-30 days or more.

Massage for the consequences of acute cerebrovascular accident

Purpose of massage

Techniques

Massage sequence

1. Massage of the lower limb.

b) Massage of the gluteal muscles.

2

4. Back massage.

Treatment by position

Massage for the consequences of acute cerebrovascular accident

The cause of acute cerebrovascular accidents is most often ischemic (a consequence of vascular thrombosis or embolism) or hemorrhagic (hemorrhage) stroke. Residual effects of strokes are manifested by paresis (decreased muscle strength) or paralysis (complete lack of muscle strength). Paresis and paralysis are called central. They are caused by damage to motor centers and pathways. The tracts are called pyramidal (spastic). Paresis and paralysis are characterized by increased muscle tone, high tendon reflexes, and pathological signs. The first time after a stroke, muscle tone may be reduced, but then it increases.

With pyramidal paresis, the arm is brought to the body and bent at the elbow. The hand and fingers are bent. The leg is extended at the hip and knee joints. The foot is bent and the sole is turned inward.

In paretic (weakened) limbs, synkinesis (cooperative movements) occurs. They can be imitative and global. With imitative synkinesis, movement occurs on one limb while the other moves; when the healthy limb moves, the diseased one also moves. With global synkinesis, when trying to perform isolated movements, flexion contracture (muscle tension) in the arm and extension contracture in the leg intensify: when trying to straighten the arm, the arm bends even more, and in the leg it unbends. Because The attachment points of individual muscles are brought closer together for a long time; these muscles shorten over time. Prolonged rest leads to joint stiffness. Movement is worsened by cold, excitement, and fatigue.

Purpose of massage– reduce the reflex excitability of spastic muscles, weaken muscle contractures, activate stretched muscles, promote the restoration of movement, trophic disorders (cold skin, swelling, discoloration).

The massage area is paretic limbs, back with lower back and chest on the affected side.

Techniques– stroking, spiral rubbing. For the antagonist of spastic muscles - kneading, best of all gentle longitudinal, felting and pressure. Intermittent vibration is contraindicated. If tolerated, continuous vibration can be used.

Starting position: lying on your back, with a bolster under your knees. If synkinesis appears, the non-massaged limb is fixed with a bag of sand. The outer surface of the leg can be massaged on the healthy side, and the back surface on the stomach. A pillow is placed under the stomach and a bolster is placed under the ankle joint.

Massage sequence. First, massage the front surface of the leg, then the pectoralis major muscle on the affected side, the arm, the back surface of the leg, and the back. The limbs are massaged from the proximal parts.

Before the massage, it is necessary to relax the muscles by shaking, passive exercises at a slow pace (for example, rolling a rolling pin with your palm or sole), light shaking of the muscles of the thigh and chest, and warming the limb. To relax the foot muscles, use a light massage and shaking the Achilles tendon.

1. Massage of the lower limb.

a) First, continuous light superficial planar and grasping stroking, spiral rubbing of the thigh are performed, then selective massage of the muscles of the anterior, internal and posterior groups, because The muscle tone is high, then massage them gently.

b) Massage of the gluteal muscles.

c) Calf massage. General impact, stroking and rubbing, then selective muscle massage. The muscles of the front and outer surface of the lower leg are stroked, rubbed and kneaded. The back surface of the lower leg is massaged with gentle stroking and rubbing. The Achilles tendon should be massaged carefully.

d) Foot massage. On the back of the foot, stroking, rubbing, and kneading are used. The tone on the sole is high, comb-like kneading is used, preventing extension of the first toe (Babinsky's symptom).

2. Massage of the pectoralis major muscle. Carry out a gentle massage, superficial planar stroking, you can use light rubbing and shaking.

3. Massage of the upper limb.

a) Shoulder massage begins with the trapezius, latissimus, deltoid and pectoral muscles. When massaging the back, a special effect is applied to the trapezius and latissimus muscles.

A preparatory shoulder massage is carried out, stroking and rubbing, and then a selective muscle massage.

b) Forearm massage. A general effect is performed (stroking and rubbing), then a selective massage. First, the extensors are massaged (stroking, rubbing, kneading), then the flexors (stroking and rubbing).

c) Hand and fingers. First, massage the fingers, then the back and palmar surfaces of the hand. On the back side - stroking, rubbing and kneading, on the palmar surface - stroking and light rubbing.

4. Back massage. They use all known techniques, but gentle ones.

1. Each technique is repeated 3-4 times.

2. In the first three procedures in the early stages after a stroke, only massage of the proximal limbs is performed, without turning onto the stomach.

3. In the 4th – 5th procedure, massage of the chest, distal parts of the extremities (lower leg with foot and hand with forearm) is added with a turn to the side.

4. From the 6th to 8th procedure, add a massage of the back and lower back. At a later stage, the prone position is used.

5. After two months or more, during the first three procedures, massage of the limbs is carried out, after the third, massage of the back and lower back is added.

6. When massaging the hand, keep the 3rd – 5th fingers extended, and the first one abducted. When massaging the legs, lift the outer edge of the foot and place the foot at an angle of 90 degrees to the shin.

7. If you complain of heaviness in the head, headache. dizziness is added by massage of the head, neck and collar area. The technique depends on blood pressure.

8. On the day of an epileptic seizure, massage is not performed.

9. Massage is combined with exercise therapy and positional treatment.

Treatment by position carried out from the first days of the disease to counteract the formation of contractures or to reduce them.

ü The foot is fixed at an angle of 90 degrees, pronated, and a board, box, etc. is placed at the foot end of the bed to support the foot.

ü Extend your arm from your body to an angle of 90 degrees or as far as possible.

ü The shoulder is positioned outward, the forearm is supinated, the fingers are almost straightened. A bag of sand is placed on the palm, the first finger is retracted, and the hand is placed on a chair next to the bed.

Treatment by position is carried out 3-4 times a day depending on the patient’s condition. In a state of sleep, position treatment is not carried out.

10. Passive movements are included in the early stages of the disease.

There should be only one exercised joint between the massage therapist’s hands. Before passive movements, active movements are performed on the healthy limb, the same as the subsequent passive ones. Subsequently, active movement on the healthy limb is performed simultaneously with passive movement of the diseased limb. Subsequently, these movements are performed alternately: during active movement, the healthy limb is flexed, and the diseased limb is passively extended.

11. It is better to start active movements with movement in the horizontal plane, when you do not need to overcome gravity. It is better to bend and straighten your leg on your side.

You should strive for flexion and external rotation of the shoulder, extension and supination of the forearm, extension of the hand and all five fingers, abduction and adduction of the bent hip, flexion of the hip at the hip joint during internal rotation, flexion of the shin, dorsiflexion of the foot when while simultaneously lifting its outer edge.

12. When it is allowed to sit, passive movements are carried out for the upper limbs - raising and lowering the scapula, adducting and abducting the scapula to the spine. The forearm and hand are extended.

13. When walking, pay attention to the position of your foot, do not move it to the side, and do not touch the floor with your toe. Place your foot correctly. It is enough to bend your leg at the hip and knee joint.

14. The duration of the procedure is from 5-10 minutes (according to Mashkov - up to 25 minutes). Course of procedures. The break between courses is 14 days.

Kinesiotherapy and massage in the rehabilitation of patients with acute cerebrovascular accident

Acute cerebrovascular accident (ACVA) should be considered as a common disease, as a result of which many patients become disabled.

The lack of specialized rehabilitation centers for this category of patients leads to the fact that in almost all neurological and therapeutic hospitals one can meet patients with the consequences of a stroke.

Brain stroke

The increase in the number of cardiovascular diseases, as well as vascular lesions of the brain, makes the problem of cerebrovascular pathology one of the most pressing neurological, general medical and social problems (N.V. Vereshchagin, 1996).

Brain stroke is one of the main causes of disability and mortality.

Every year, 3 out of 1000 people are affected by a cerebral stroke. In Western Europe alone, cerebral stroke occurs in 1 million people every year. Moreover, 25% of patients with acute cerebrovascular accident die on the first day, 40% within two to three weeks. About 50% of survivors die in the next 4-5 years. Only about 18% continue to work after recovery (A.M. Gurlenya, G.E. Bagel, 1989).

In the CIS countries, cerebral strokes account for more than two cases per 1000 healthy population. The mortality rate from them is 12% in the overall mortality structure. There is a tendency towards a significant “rejuvenation” of cerebral stroke. Thus, in one third of people it occurs before the age of 50 years. 70% of survivors become disabled (L. A. Shevchenko et al., 1996). In recent years, the incidence of cerebral stroke has continued to increase in the Republic of Belarus. According to statistical data, in 1995 the incidence of this nosology in the republic was at 261.9, and in 1996 - 302.9. At least 30% of patients in the acute stage of stroke die (E.I. Gusev et al., 1996).

In recent years, Belarus has seen an increase in mortality from cerebrovascular accidents: in 1995, the mortality rate was 171, and in 1996 it increased to 174.5. In the structure of mortality, patients with cerebral stroke occupy third place in the republic. Among the surviving patients, most cannot return to work and need constant care (E.I. Gusev et al., 1995). Disability from cerebrovascular accidents in Belarus in 1995 was 4.32 per population (L. S. Gitkina, 1995).

Ischemic stroke is the most common form of acute persistent cerebrovascular accidents, accounting for 60% to 90% of all strokes (V. E. Smirnov, 1991).

Based on the above, it is necessary to pay special attention to the rehabilitation of patients who have suffered a cerebral stroke.

Rehabilitation of patients who have suffered a cerebral stroke involves preventing the development of contractures, conducting active and passive gymnastics, prescribing CT in combination with muscle relaxants and anticholinesterase drugs, followed by occupational therapy, speech therapy classes, psychological and physical preparation of patients for a future lifestyle (A. E. Semak , E.N. Ponomareva et al., 1993).

As a result of acute cerebrovascular accident caused by hemorrhage, thrombosis of cerebral arteries or embolism of cerebral vessels, severe movement disorders come to the fore: hemiparesis or hemiplegia, muscle hypertonicity on the affected side or muscle atony, increased level of tendon reflexes; speech or spatial orientation disorders, mental lability, etc. may be noted.

CT plays an important role in the rehabilitation of patients with the consequences of cerebral stroke. Therapeutic gymnastics procedures, in addition to restoring the function of the pyramidal tract and directly affecting paretic limbs, have a general health effect, strengthen the cardiovascular system and respiratory system, and prevent pulmonary complications associated with prolonged bed rest.

Special physical exercises for post-stroke hemiparesis are aimed, first of all, at preserving motor acts of the healthy side, reducing the pathological tone of the muscles of the affected limbs, increasing muscle strength, training the combined work of synergists and antagonists, eliminating vicious conjugate movements, expanding adaptation to muscle loads, recreating and formation of the most important motor skills necessary in everyday activities.

CT in the rehabilitation of patients with stroke is prescribed in the acute period to prevent complications associated with hypokinesia or akinesia of the limbs of the affected half of the body. The most serious complications in this period include: peripheral vascular thrombosis and embolism, disorders of the respiratory and cardiovascular systems, hypostatic pneumonia, intestinal and bladder atony, bedsores, joint contractures.

Treatment by position

Treatment by position is of important preventive value in the first days of stroke. For this purpose, bolsters, rolled blankets, and pillows are used.

In the supine position, positions are used with abduction of the affected upper limb to an angle of °. When changing the position of the arm, it is necessary to alternately place it in the position of external and internal rotation. The elbow joint is periodically bent at an angle of 90°, while the hand is fixed to the ball - the position “big fist, 1st finger should be in opposition and opposed to the rest.” The lower limb is placed in the middle position of flexion at the hip joint and slight abduction (5°), while it is important to prevent external rotation of the leg. The foot should be in extension (dorsiflexion), this is achieved by placing a drawer between the foot and the headboard.

In the side-lying position, the head is placed on a high pillow parallel to the bed, the upper healthy limb is positioned so as to ensure balance while lying on the healthy side, the upper affected limb is slightly bent at the elbow joint, the hand is in the “big fist” position. The lower healthy limb is bent at an angle of 90°. In case of hemiplegia, especially in an unconscious state or with limited consciousness, positioning on the affected side is not recommended, since this significantly impairs blood circulation, and the mechanical pressure of body weight contributes to the development of bedsores.

In case of severe contracture, it is necessary to fix the limbs in a corrective position (using special splints or light splints) around the clock.

In the early period, along with positional treatment, passive exercises are used for the affected limbs from the initial position lying on the back and healthy side, as well as static breathing exercises of the chest and diaphragm type to prevent hypostatic pneumonia from the same position. Patients should be advised to repeat passive exercises several times a day.

When general cerebral phenomena are smoothed out and movement disorders, depending on the localization of the pathological process, come to the fore, active gymnastic exercises for healthy limbs are prescribed in combination with passive exercises for paretic limbs, therapeutic exercises and breathing exercises. During this period, it is very important to begin to position the patient vertically by actively moving to a sitting position with his legs dangling. The transition to a sitting position is carried out from a lying position on the healthy side, resting your hand on the bed. Next, the motor mode is expanded by including exercises in the therapeutic gymnastics procedure from the starting position while sitting on the bed, and then on a chair. In a sitting position, the functional capabilities of the lower extremities, the ability to lean on the affected limb and perform a support function are assessed.

If the patient cannot put weight on the affected leg, then before moving the patient to a standing position, it is recommended to fix the knee and ankle joint. This improves proprioceptive guidance and promotes correct walking patterns. The next stages are related to learning to walk, restoring the function of the upper limb, improving general condition and mastering everyday skills to achieve independence. To learn to move independently, aids are used: crutches, walkers, canes. The goal of transfer training is to make the patient as independent as possible (in the toilet, in the bathroom).

In the late recovery period, along with special physical exercises aimed at restoring motor functions, general strengthening exercises are used, from the simplest to the more complex and stressful, games and some types of daily activities are included (climbing stairs, carrying various things, rearranging books on high shelves ), exercises with elastic bands and isometric exercises.

It is very important to teach family members how to help the patient with exercises, since for a long period after discharge from the hospital he needs to do therapeutic exercises.

General strengthening exercises should maximally cover all muscle groups of the upper extremities, torso, and lower extremities.

For a long time, a generally accepted complex of therapeutic exercises was used for post-stroke patients, excluding any significant physical activity. At the same time, the commonality of pathogenetic mechanisms leading to damage to the heart and brain, the relationship between central and cerebral hemodynamics, especially in cases of violations of the physiological mechanisms of autoregulation of cerebral blood flow, are well known.

In general, the most beneficial in terms of training effects on the cardiovascular system and activation of cerebral hemodynamics for post-stroke patients are loads involving large muscle groups of the lower extremities. The duration of stroke development within the recovery and residual periods does not have a direct effect on exercise tolerance; the decisive factors are the severity of movement disorders and concomitant heart pathology (A. N. Belova, S. A. Afoshin, 1993).

One of the most effective methods of motor rehabilitation of patients with consequences of cerebrovascular accident is currently considered the method of neuromotor retraining, developed by K. and V. Bobat. The method is aimed at activating normal neurophysiological mechanisms of motor acts and suppressing pathological mechanisms resulting from a stroke (primarily the disinhibition of tonic reflexes of the brain stem).

Basic principles of neuromotor retraining (Bobat)

The first principle is postural adaptation. Normal voluntary movement can be formed only on the basis of normal muscle tone, which creates favorable preconditions for the development of targeted active movements. To suppress increased tone and pathological motor stereotypes, reflex-inhibitory postures are used. As a rule, this position is the opposite of the one the patient strives to occupy. The patient is taught to independently take these positions and maintain them for quite a long time.

The second principle is the gradual restoration, first of normal automatic, then of isolated volitional movements, based on reflex-inhibitory postures.

In this case, retraining of voluntary movements should be carried out in accordance with the ontogenetic sequence of human motor development:

• in the cranio-caudal direction;
• from the center to the periphery (from proximal to distal sections);
• flexion and adduction are restored to extension and abduction;
• first, movements are restored in large joints (gross motor skills), and then in small ones (fine motor skills);
• restoration of reflex movements precedes restoration of voluntary ones.

The development of a stable motor stereotype is achieved through repeated repetitions of voluntary movements. It must be remembered that the desire to layer normal movement on pathological one will lead to the formation of a pathological motor stereotype. Movements that increase pathological reflex activity should be avoided, as they increase muscle tone.

The third principle is the connection of voluntary isolated movements with normal sensory perception. The restoration of motor activity goes in parallel with the restoration of sensitivity and largely depends on it. For a faster and more complete restoration of motor skills, the patient needs to learn to feel his limbs, their position in relation to the body, the direction of movements, etc. This is achieved with the help of tactile stimulation, pressure, movements directed against gravity, and the use of key points.

The method of neuromotor retraining is used for all types of central paresis and paralysis, however, the choice of specific exercises depends on the motor, sensory, and intellectual disorders that each patient has. Balance exercises should be included in the complex, since this gradually reduces the role of reflex-inhibitory postures, allowing the patient to independently control muscle tone and correct balance. There is no need to achieve complete restoration of one motor function before moving on to training the next one.

The method of neuromotor retraining (Bobat therapy) is most effective with the so-called 24-hour activating care, when the work of all specialists (doctors, nurses, physical rehabilitation instructors, massage therapists, etc.) is based on common principles and approaches.

Treatment with Bobath position

The patient should be placed in the correct position as soon as possible. This must be done before the first signs of increased muscle tone appear.

When lying down, 3 main types of positions are used: on the affected side, on the healthy side, on the back. The position changes every 2 hours.

1. Lying position on the affected side:

• the patient's back is parallel to the edge of the bed and rests on a pillow to prevent rolling onto his back;
• the head is placed on the pillow in a neutral position (avoid excessive forward bending);
• the scapula on the affected side is pushed forward;
• the sore shoulder is abducted 90 degrees (since a smaller angle contributes to the development of spasticity);
• sore arm in supination position;
• the hand should lie on the bed (or stand), a slight droop of the supinated hand stimulates extension of the wrist joint;
• the pelvis is slightly turned forward;
• the affected hip is straightened;
• the sore knee is slightly bent;
• the healthy leg is bent 135 degrees at the hip, knee, and ankle joints and lies on a folded blanket or pillow.

2. Supine position:

• the head is supported by pillows along the midline (symmetrically);
• the torso is laid symmetrically to prevent future shortening of the affected side;
• a pillow is placed under the sore shoulder so that the shoulders are at the same level;
• the sore arm lies on the bed or slightly elevated on a pillow, the elbow is extended, the forearm is supinated;
• a small pad or rolled towel placed under the buttock on the sore side prevents the leg from turning outward;
• do not place a pillow (cushion) under the knees or a support under the feet, as this leads to flexion contracture in the knee joint and contributes to the formation of extensor synergy in the lower limb.

3. Lying position on the healthy side:

• back parallel to the edge of the bed;
• the head on the pillow in the midline is slightly bent forward;
• the scapula on the affected side is pushed forward;
• the affected arm is raised and straightened on the pillow;
• the sore shoulder is at an angle of 90 degrees to the body;
• the affected hand is supported (to avoid flexion at the wrist joint);
• the affected leg, bent at the hip and knee joints (135 degrees), lies on a pillow (or folded blanket);
• The foot is placed in a neutral position on the pad to avoid misalignment (inversion).

4. In a sitting position, the patient moves if he is conscious and able to maintain this position.

It is necessary to ensure that the torso is symmetrical and has sufficient support from the back (to shoulder level). While sitting on the bed, hips are bent, knees are extended, a folded towel or pillow is placed on the outside of the sore knee to prevent the leg from turning outward. A table is placed in front of the patient on which the hands rest. In a sitting position on a chair, the arms are extended forward, brought to the midline and rested on the table from the level of the elbow joints. The hip, knee and ankle joints are bent at an angle of 90 degrees. The feet rest symmetrically on the floor or other support.

Motor rehabilitation of post-stroke patients in accordance with the principles of Bobath therapy sequentially goes through a number of stages.

1. Motor activity (mobility) within the bed includes learning the technique of lifting the head and pelvis (“bridge” and “half-bridge”) and turning to the sore and healthy side. This training inhibits the influence of cervical tonic reflexes, stabilizes the supporting function of the torso and facilitates bringing the arms to the midline.

2. Active transition to a sitting position from a lying position. At the beginning, they train the transition to a sitting position by turning on its side to the painful side. The patient should sit down as follows:

• starting position - lying on your back, the sore side facing the free edge of the bed;
• lift your sore leg and lower it over the edge of the bed;
• raise your head and healthy shoulder;
• Turn the healthy shoulder to the affected side, at the same time bring the healthy arm forward diagonally across the body and lean on the palm in front of you;
• lower your healthy leg off the bed and sit down, leaning on the palm of your healthy hand.

First, the patient is helped, and gradually he learns to sit down on his own, without leaning on his healthy arm. The transition to a sitting position through the healthy side is trained in the same way. Then the patient can be taught to sit upright from a supine position, without turning to the side.

1. Transition to a standing position from a sitting position. Standing is a complex posture that requires the interaction of the abdominal muscles, gluteal muscles and hip extensors. They alternately train support on the left and right feet, uniform distribution of body weight on both legs, isolated flexion and extension in all joints of the limbs, control of the vertical position of the torso. Particular attention should be paid to training balance reactions, without which free walking is impossible.

2. Teaching (or retraining) functionally correct walking. They start with walking with support (parallel bars, crutches, poles, walkers, instructor’s hands). Normal walking is symmetrical in time and space, so the time of support on each leg should be the same, as should the length of the step. Walking training includes direction of movement (forward, backward, sideways), step length, rhythm, speed of movement, walking up and down steps. Additional stability on the affected side can be provided by using special shoes, an elastic bandage, or a peroneal splint.

Rehabilitation of patients with aphasia is based on the general principles of medical rehabilitation, but has specific features:

1. Early initiation, as soon as the patient's condition allows.

2. Complexity - in the process of rehabilitation, a single medical, psychological and speech therapy chain is established; speech therapy is an integral part of the rehabilitation program and is carried out only in combination with other methods.

3. Phase - there is an acute phase of aphasia, a stabilization phase and a chronic phase of aphasia; the rehabilitation program in different phases includes different approaches and methods.

4. Individuality - taking into account the type, severity of speech disorders, and the presence of other consequences of a stroke.

5. Duration – from several months to 2 years, on average 6 months (lack of effect after daily classes for 6 months is an indication to stop speech therapy).

Currently, a new original and highly effective method of rehabilitation of this group of patients has been proposed using the Adelie-92 medical suit, created on the basis of the Penguin load suit, which protects astronauts from the adverse effects of weightlessness. Due to the system of built-in elastic traction, it allows you to influence the implementation of locomotor acts and create new motor stereotypes (S. B. Shvarkov et al., 1996).

Despite the large number of methods for the rehabilitation of patients with the consequences of cerebrovascular accidents, the main methods remain kinesiotherapy and massage.

The purpose of massage in these patients is to normalize the muscle tone of the affected limbs, improve movements for coordination and balance, reduce synkinesis, prevent the development of contractures, and generally strengthen the body (A. E. Shterengerts, N. A. Belaya, 1994).

Objectives of massage: to promote the restoration of disturbed relationships between excitatory and inhibitory processes in the cerebral cortex; relieve or reduce pain; improve tissue nutrition; stimulate reparative processes; restore nerve conduction and function of the neuromuscular system; prevent atrophy and contracture; have a positive effect on psycho-emotional activity.

Contraindications for the use of massage for paresis and paralysis: severe and extremely serious condition of the patient, requiring intensive care or resuscitation measures; unconscious, comatose state of the patient; acute mental disorders; severe spontaneous pain; high body temperature (above 38° C); suppurative (concomitant) diseases: furunculosis, carbuncle, phlegmon, abscess; skin diseases; vascular thrombosis.

Massage plan

It is advisable to start the procedure with a massage of the paravertebral spinal segments: to influence the upper limb, massage segments C 3 - D 6, for the lower - S 5 - D 10, using the techniques of stroking, rubbing, kneading, vibration. Then the corresponding limb is massaged.

The massage technique for paresis and paralysis depends on the state of muscle tone. Central paralysis is usually spastic, and peripheral paresis and paralysis are flaccid.

Initially, shortened, spasmodic muscles are massaged to relieve their increased tone (relaxation and stretching). To do this, use the techniques of light, superficial stroking and rubbing at a slow pace. Massage of the upper limb begins with the flexors, the lower - with the extensors.

The next stage is massage of the stretched muscles (on the arm - extensors, on the leg - flexors). To do this, use deeper and more energetic techniques of stroking, rubbing, kneading and vibration.

After the massage, therapeutic exercises and positional treatment are performed.

For central spastic hemiparesis, segmental reflex massage of the paravertebral zones C 3 -D 6 is performed; massage of arm flexors, extensors and joints; segmental reflex massage of paravertebral zones S 5 - D 10; massage of leg extensors, flexors and joints. The duration of the massage should gradually increase (from 7-10 minutes), the number of procedures per course should be from 20 to 30, courses can be repeated every other day.

Flaccid paresis and paralysis require daily, regular, deeper massage compared to spastic paresis.

Objectives of massage: stimulate the conduction of impulses. neuromuscular fibers (by activating the mediator function of acetylcholine); improve muscle contractile function; restore muscle tone and tendon reflexes; stimulate blood and lymph circulation, trophic and metabolic processes in nervous and muscle tissue; prevent muscle atrophy.

The greatest effect of the procedure is achieved if the corresponding paravertebral segments are massaged before the massage of the limb.

According to the classical massage technique, stroking, rubbing, kneading and vibration techniques are performed on the flexor muscles, and then on the extensors. The techniques are performed quite deeply and at a faster pace.

However, an excessively strong and prolonged massage can cause overwork and, consequently, negative dynamics in the clinic. The duration of the massage in the first 5-7 days is 7-10 minutes, and then min. The number of procedures per course is 20. The course is repeated after 1.5-2 months.

Pirogova L.A., Ulashchik V.S.

Massage (from the French massage - to rub) is a set of scientifically based techniques of mechanical dosed influence on the surface of the human body, performed by the hands of a massage therapist, a device or a stream of water.

The sample is used in CT scans, during mass preventive examinations, and during stage-by-stage medical supervision of athletes and mass athletes. The subject sits at the edge of the table to the left of the doctor.

They suggest standing with your feet closed, your head raised, your arms extended forward and your eyes closed. The test can be made more difficult by placing your legs one after the other in one line, or you can test this position by standing on one leg.

Video about sanatorium Egle, Druskininkai, Lithuania

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MASSAGE FOR CEREBRAL CIRCULATION DISORDERS.

One of the unconventional methods of treatment after strokes and for hypertension can be called Dell massage.

Vladimir Dell developed this massage for himself during the period when he suffered a stroke. This helped him emerge victorious in this fight. Thanks to systemic massage, blood circulation in the vessels of the brain is restored. Now this technique is successfully used at the Moscow Institute of Physical Methods of Rehabilitation.

So: Hands. Remove all metal objects from yourself and wash your hands with warm water. Rub and stretch your fingers, palms, wrists, and forearms well. Shake your brushes. You can lubricate your hands with apple cider vinegar, lard, olive oil, or melted butter. But you can’t use cream! Hands need to be rubbed until a feeling of warmth and heaviness appears in them. Then move on to the second exercise.

Ears. With light movements, rub the edges of the ears with your fingers, slowly moving from above to the earlobe, just as slowly back and again to the earlobe. The edges of the ear should become warmer. After this, rub the middle part of the auricle, then pull the earlobes down several times until they become warm and red. Make “forks” with the index and middle fingers of both hands and rub them into the skin behind the ears and the indentations under them. Insert your index fingers into the ear canal (in both ears) and massage it. Then press firmly from the inside on the tragus - the tubercle in front of the auricle. Make the movement up and forward at the same time. Release and forcefully press the tragus up and forward again. They pressed for a second - released, started again - released, and so on for 5 minutes.

This is very useful for all hypertensive patients, because it reduces blood pressure, and in healthy people it prevents hypertension.

After resting, rub your ears, pull them to the sides, up, down, rub them and rub them again. If they become hot, stop rubbing.

By squeezing your middle fingers and thumbs, thoroughly stretch the muscles located on both sides of the cervical spine. Massage up and down the back of your neck until you feel warm. Then “remember” the neck with the edges of both palms and so on several times. Then massage the front and sides of the neck. Using a fork from your thumb and forefinger, stroke the front of your neck from top to bottom, grasping both carotid arteries on the right and left, for 2–3 minutes, alternately with your right and then with your left hand in only one direction - from top to bottom. Gently stroke the thyroid gland.

Now rise from the chair, clasp your fingers. Using the edges of your palms from the side of your thumbs, use strong movements from top to bottom, either with your right or left palm, to massage the base of your neck on both sides. After this, massage the back of your neck, alternately with one or the other palm, as if shaking something off it.

Start massaging your head.

Sit down, close your eyes, abandon all worries and worries. Relax! Hang your head freely towards your chest. Slowly, lightly stroke your face with your palms, then your head and neck. Gradually increase the pressure of your fingertips on the scalp. Press them against her. The fingers are bent and spread apart. Then, using circular movements clockwise, lightly rub your forehead, temples, and back of your head. Stroke your face again. Press the fingers of both hands to the forehead on the right and left where the border of the hairline passes - and very slowly move them towards the crown, to the place where the fontanel is located in children. At the same time, actively massage the skin, knead and move it - in all directions. When your fingers meet on the “fontanel,” press all the pads firmly against the skin and actively move it back and forth for 3–4 minutes, then lower your hands and rest. Repeat the procedure. Finish it by stroking your forehead.

Then connect your index, middle and thumb fingers into a pinch, press them to your temples and massage them clockwise with your pads. Attach the remaining fingers to the pinch and move from the temples to the crown on both sides. Knead and move the skin to increase blood circulation in the subcutaneous vessels. Move slowly, as if feeling every centimeter of skin. When your fingers meet on the top of your head, massage it thoroughly. Put your hands down, relax. Listen to your feelings. Lower your head to your chest, press the pads of your slightly spread and half-bent fingers to the sides of the occipital protuberance and begin to massage and move from bottom to top, kneading the skin. If you come across any unevenness on the skin, use screwing movements of the pads of your index or middle fingers to knead them better and proceed to massage the back of your head. In the place where the neck muscles are attached to the head, there are two symmetrical depressions on the sides. And in the center, under the occipital bone, there is a larger depression. It needs to be massaged well with your middle fingers, and your side fingers with your thumbs and index fingers. Do this with both hands at the same time, on both sides. Then lightly stroke the entire head and face. Lower your arms, rest, stroke them from your fingertips to your forearms. Place your hands on your knees, sit quietly, relax.

You need to start the spinal massage while standing. Hands behind in the “lock”. Using your finger bones, first rub the sacrum in a circular motion until heat appears. Then, moving the “lock” higher, rub your back with longitudinal and transverse movements.

Now you can relax, stretch, take a deep breath, exhale.

Sit on a chair, stroke your face, forehead, neck, head, shoulders with your palms, massage your hands. Take a coachman's pose: legs bent at the knees, back relaxed, body tilted forward and resting on your arms bent at the elbows, resting on your knees. Relaxed hands hang between the knees. The head hangs on the chest. Inhale deeply through your nose and mentally say: “I believe in the protective powers of my body.” Then purse your lips, exhale slowly and tell yourself: “I’m calming down, I’m calming down, I’m calming down.” Now you can lie down and relax. Massage should be done twice a day - morning and evening.

MASSAGE FOR THE CONSEQUENCES OF CEREBRAL CIRCULATION DISORDERS Cerebrovascular accidents can result from skull injuries, thrombosis, cerebral embolism, as a result of hemorrhage in the brain, dynamic cerebral circulatory disorders (cerebral vasospasm). A characteristic symptom of an acute period of cerebrovascular accident is paralysis of the muscles of the limbs and trunk on the side opposite to the lesion. This is accompanied first by a decrease and then an increase in muscle tone. The functions of breathing, blood circulation, and metabolism are impaired. During this period, general flaccid paralysis with areflexia (absence of tendon reflexes) appears. This phenomenon is explained by the development of inhibition in the spinal cord. Decreased muscle tone and areflexia on the side of paralysis last longer than on the healthy side. An increase in muscle tone and the appearance of tendon reflexes are observed when the cerebral phenomena end. At this point, symptoms of focal brain damage appear with disinhibition of the spinal cord. 12-15 days after the acute period of cerebrovascular accident, atonic phenomena are replaced by spastic ones as a result of the absence of the inhibitory influence of the cerebral cortex and the manifestation of reflex activity of the spinal cord. Spastic phenomena on the affected limbs increase and gradually turn into contracture with a characteristic type of its distribution (Wernicke-Mann contracture). In this case, with spastic paralysis, all the muscles of the affected limb suffer. During the transition period from hypotension to spasticity, strong and functionally developed muscles prevail over their antagonists. Thus, the antagonists are stretched, and the limb freezes in a certain position. Due to impaired blood and lymph circulation, edema and cyanosis occur in the affected limb. As a result of prolonged forced inactivity, muscle atrophy and scoliosis develop. Increased reflex excitability is observed in the muscles of the affected limbs. Tendon reflexes are sharply increased, which must be taken into account by the massage therapist when performing a massage procedure. During the first one and a half to two weeks, rest is prescribed. Then, when the condition improves, selective massage is used on the affected limbs. It must be prescribed in a timely manner to restore the function of the affected limbs as quickly as possible. The purpose of massage in the treatment of patients with central (spastic) paresis and paralysis: reducing reflex excitability and increased tone of shortened muscles, strengthening stretched and weakened muscles, improving joint function and preventing their stiffness, preventing contractures, improving blood and lymph circulation in the affected limbs. On shortened, tense muscles, light stroking and rubbing are first used, and later, as the functional state of these muscles improves, gentle, light kneading can be used. Intermittent manual vibration is excluded, as it can further increase muscle hypertonicity. Massage of muscles with increased tone precedes massage of stretched muscles. On stretched muscles, light stroking and rubbing are first used, and then, in subsequent procedures, the pressure of the massage therapist’s hands is gradually increased when performing the indicated massage techniques and includes felting, and then semicircular, longitudinal and transverse kneading. However, too strong and energetic massage techniques can cause overwork of stretched muscles. Massage is carried out daily, initially lasting 6-10 minutes for each limb, and then for 15-20 minutes. Considering the rapid fatigue of the affected muscles, after doing therapeutic exercises it is advisable to carry out a light short-term restorative massage, consisting mainly of stroking techniques. In addition to massaging the muscles, it is also necessary to massage the joints of the affected limbs to prevent or eliminate their stiffness. In this case, joint massage is carried out, guided by a general plan for joint massage, taking into account their anatomical and topographical features and using mainly rubbing techniques in combination with passive gymnastics. For a reflex effect on the affected limb, it is advisable to massage the healthy limb according to a general plan using all massage techniques. Before massaging the upper limb, it is first advisable to massage the shoulder girdle, scapula area and pectoralis major muscle. Before massaging the lower limb, massage the lumbosacral region and buttock. At the beginning of treatment, when the patient is still on bed rest and is not allowed to turn on his stomach, it is necessary to temporarily limit himself to only massage of the limbs. The limb should be warmed up before the massage, and the massage should be done only with warm hands. A course of massage for spastic paralysis should consist of fifteen to twenty procedures and be regularly repeated every one and a half to two months until the function of the affected limbs is fully restored. Spastic paresis and paralysis can develop with diseases and injuries of the spinal cord. When the upper cervical segments of the spinal cord (C1-C4) are damaged, diaphragmatic paralysis occurs. Shortness of breath, hiccups, spastic paralysis of the muscles of all four limbs, loss of all types of sensitivity below the level of the lesion appear. Disturbance in urination. Radicular pain appears, radiating to the back of the head. When the cervical enlargement of the spinal cord is affected at the level of segments C5-D2, flaccid paralysis of the upper limbs and spastic paralysis of the lower limbs develop. All types of sensitivity are lost, urination is disrupted. There may be radicular pain radiating to the upper limb. When thoracic segments D3-D12 are affected, spastic paralysis of the lower extremities develops, urination is disrupted, and sensitivity below the level of the lesion is lost. Radicular pain is girdling in nature. If a patient develops flaccid paralysis of the upper extremities and spastic lower extremities, a massage technique is used on the upper extremities, as for flaccid paralysis, and on the lower extremities a technique that will be described in the next chapter is used.

Cerebrovascular disorders

Cerebrovascular accidents can be chronic or acute.

Chronic disorders can be reversible and, as a rule, with treatment do not lead to loss of health.

Signs of chronic cerebrovascular accident (seek medical help immediately!):

Sudden loss of sensation in the face, arm or leg;

Sudden vision loss;

Difficulty speaking or understanding speech;

Dizziness, nausea, retching, loss of balance and coordination, especially in combination with the above symptoms;

Swallowing problems, choking;

Sudden, unexplained intense headache.

Prevention:

Lead a healthy lifestyle;

Exercise daily;

Go for a walk with friends, try to make walking a habit. Remember that walking for 30 minutes. may improve your health and reduce your risk of stroke;

If you don't like walking, choose other types of physical activity: cycling, swimming, dancing, etc.;

Perform water procedures regularly. The most affordable way is to shower daily for 10–15 minutes;

Perform self-massage of the body. Consistency and regularity are also necessary here;

Do breathing exercises, it will help relieve mental and physical stress and help normalize blood circulation.

Acute cerebrovascular accidents

Diseases of the central nervous system caused by cerebrovascular accidents are caused by various reasons, including infection, atherosclerosis, and hypertension.

Lesions of the brain and spinal cord are often accompanied by paralysis and paresis. With paralysis, voluntary movements are completely absent. With paresis, voluntary movements are weakened and limited to varying degrees. Exercise therapy is an obligatory component in complex treatment for various diseases and injuries of the central nervous system; it stimulates protective and adaptive mechanisms.

Exercise therapy for strokes

Stroke is an acute disorder of cerebral circulation of various localizations. There are two types of strokes: hemorrhagic (1–4%) and ischemic (96–99%).

Hemorrhagic stroke is caused by hemorrhage in the brain, occurs with hypertension, atherosclerosis of cerebral vessels. Hemorrhage is accompanied by rapidly developing cerebral phenomena and symptoms of focal brain damage. Hemorrhagic stroke usually develops suddenly.

Ischemic stroke is caused by impaired patency of cerebral vessels due to blockage by an atherosclerotic plaque, embolus, thrombus, or occurs as a result of spasm of cerebral vessels of various locations. Such a stroke can occur due to atherosclerosis of cerebral vessels, weakened cardiac activity, decreased blood pressure, and for other reasons. Symptoms of focal lesions increase gradually.

Cerebral circulation disorders during hemorrhagic or ischemic stroke cause paresis or central (spastic) paralysis on the side opposite to the lesion (hemiplegia, hemiparesis), sensory disturbances, and reflexes.

Objectives of exercise therapy:

Restore movement function;

Prevent the formation of contractures;

Help reduce increased muscle tone and reduce the severity of conjugal movements;

Promote overall health and strengthening of the body.

The method of therapeutic exercises is based on clinical data and the time period that has passed since the stroke.

Exercise therapy is prescribed from the 2nd to 5th day after the onset of the disease after the disappearance of the symptoms of a coma.

A contraindication is a severe general condition with impaired cardiac and respiratory activity.

The method of using exercise therapy is differentiated in accordance with three periods (stages) of restorative treatment (rehabilitation).

I period - early recovery

This period lasts up to 2–3 months (acute period of stroke). At the beginning of the disease, complete flaccid paralysis develops, which after 1–2 weeks is gradually replaced by spastic paralysis, and contractures begin to form in the flexors of the arm and extensors of the leg.

The process of restoring movement begins a few days after the stroke and lasts months and years. Movement in the leg is restored faster than in the arm.

In the first days after a stroke, treatment with position and passive movements is used.

Treatment with positioning is necessary to prevent the development of spastic contractures or eliminate or reduce existing ones.

By positional treatment we mean placing the patient in bed so that the muscles prone to spastic contractures are stretched as much as possible, and the attachment points of their antagonists are brought closer together.

In the arms, spastic muscles, as a rule, are: muscles that adduct the shoulder while simultaneously rotating it inward, flexors and pronators of the forearm, flexors of the hand and fingers, muscles that adduct and flex the thumb; on the legs - external rotators and adductors of the thigh, extensors of the leg, gastrocnemius muscles (plantar flexors of the foot), dorsal flexors of the main phalanx of the big toe, and often other fingers.

Fixation or placement of limbs for the purpose of prevention or correction should not be prolonged. This requirement is due to the fact that by bringing the attachment points of antagonist muscles closer together for a long time, you can cause an excessive increase in their tone. Therefore, the position of the limb should be changed during the day. When laying the legs, occasionally give the leg a bent position at the knees; with the leg straightened, place a cushion under the knees. It is necessary to place a box or attach a board to the foot end of the bed so that the foot rests at a 90° angle to the shin. The position of the arm is also changed several times a day, the extended arm is abducted from the body by 30–40° and gradually to an angle of 90°, while the shoulder should be externally rotated, the forearm should be supinated, and the fingers should be almost straightened. This is achieved with the help of a roller, a bag of sand, which is placed on the palm, the thumb is placed in a position of abduction and opposition to the rest, that is, as if the patient is grasping this roller. In this position, the entire arm is placed on a chair (pillow) standing next to the bed.

The duration of positioning treatment is determined individually, guided by the patient’s feelings. If complaints of discomfort or pain appear, the situation is changed.

During the day, positioning treatment is prescribed every 1.5–2 hours. During this period, positioning treatment is carried out in the IP lying on the back.

If fixation of the limb reduces the tone, then passive movements are carried out immediately after it, constantly bringing the amplitude to the limits of physiological mobility in the joint. Start with the distal limbs.

Before the passive one, an active exercise is carried out on the healthy limb, that is, the passive movement is first “unlearned” on the healthy limb. Massage for spastic muscles is light, superficial stroking is used, for antagonists - light rubbing and kneading.

II period - late recovery

During this period, the patient is hospitalized. Treatment is continued with the position in the PI lying on the back and on the healthy side. The massage is continued and therapeutic exercises are prescribed.

Therapeutic gymnastics uses passive exercises for paretic limbs, exercises with the help of an instructor in lightweight IP, holding individual segments of the limb in a certain position, basic active exercises for paretic and healthy limbs, relaxation exercises, breathing exercises in changing position during bed rest.

Approximate diagram of the procedure for therapeutic exercises for hemiparesis in the early period for patients on bed rest (8–12 procedures)

Familiarization with the patient’s well-being and correct position, counting the pulse, removing the splint.

Exercise for a healthy arm (4–5 times) involving the wrist and elbow joints.

Exercise in bending and straightening the sore arm at the elbow (3-4 times).

Extension with the healthy arm.

Exercise for a healthy leg (4–5 times). Involving the ankle joint.

Exercise to raise and lower your shoulders (3-4 times).

Alternating option: bringing and spreading, hands are passive. Combine with breathing phases.

Passive movements in the joints of the hand and foot (3–5 times). Rhythmically, with increasing amplitude. Combine with stroking and rubbing.

Active pronation and supination in the elbow joints with the arms bent (6–10 times). Help with supination.

Rotation of the healthy leg (4–6 times). Active, with large amplitude.

Rotation of the affected leg (4–6 times). Assist and enhance internal rotation as needed.

Breathing exercise (3–4 min.). Medium depth breathing.

Possible active exercises for the hand and fingers with the forearm in a vertical position (3-4 times). Support, help, strengthen extension.

Passive movements for all joints of the paralyzed limb (3–4 times). Rhythmically, in increasing volume depending on the condition.

Legs bent: abduction and adduction of the bent hip (5–6 times). Help and facilitate the exercise. Option: abduction and abduction of bent hips.

Breathing exercise (3–4 min.).

Active circular movements of the shoulders (4–5 times). With the help and regulation of breathing phases.

Arching the back without lifting the pelvis (3–4 times). With voltage limitation.

Breathing exercise (3–4 min.).

Passive movements for the hand and fingers (2-3 times).

Duration: 25–30 min.

NOTES

1. During the procedure, take rest breaks of 1–2 minutes.

2. At the end of the procedure, ensure the correct position of the paretic limbs.

To prepare for getting up, you should use an imitation of walking while lying down, and gradually transfer to a vertical position. All active exercises are carried out while exhaling. In the initial sitting and standing position, light exercises are added to exercises with a gymnastic stick using a healthy arm, exercises for the torso - turns, slight bends forward, backward, to the sides.

Control movements to assess the function of hand movement in central (spastic) paresis

Raising parallel straight arms (palms forward, fingers extended, thumb abducted).

Abduction of straight arms with simultaneous external rotation and supination (palms up, fingers extended, thumb abducted).

Bending the arms at the elbow joints without moving the elbows away from the body with simultaneous supination of the forearm and hand.

Extending the arms at the elbow joints with simultaneous external rotation and supination and holding them in front of you at a right angle to the body (palms up, fingers extended, thumb abducted).

Rotation of the hands at the wrist joint.

Contrasting the thumb with the rest.

Mastering the necessary skills (combing your hair, bringing objects to your mouth, fastening buttons, etc.).

Test movements to assess the function of movement of the legs and trunk muscles

Bending the leg with sliding of the heel on the couch in a supine position (uniform sliding of the heel along the couch with gradual lowering of the foot until the sole completely touches the couch at the moment of extreme bending of the leg at the knee joint).

Raising straight legs 45–50° from the couch (position on your back, feet parallel, not touching each other) - keep your legs straight with some extension, without hesitation (if the severity of the lesion is checked, the possibility of raising one leg is checked, if blood circulation is impaired, do not check) .

Rotation of the straight leg inward while lying on your back, feet shoulder-width apart (free and complete rotation of the straightened straight leg inward without simultaneously adducting and bending it with the correct position of the foot and toes).

“Isolated” flexion of the leg at the knee joint; lying on the stomach - full straight flexion without simultaneous lifting of the pelvis; standing - full and free flexion of the leg at the knee joint with an extended hip with full plantar flexion of the foot.

“Isolated” dorsiflexion and plantar flexion of the foot (full dorsiflexion of the foot with the leg extended in the supine and standing positions; full plantar flexion of the foot with the leg bent in the prone position and standing).

Swinging the legs while sitting on a high stool (free and rhythmic swinging of the legs at the knee joints simultaneously and alternately).

Walking up the stairs.

Approximate diagram of the therapeutic exercises procedure for hemiparesis in the late period

IP - sitting, standing. Elementary active exercises for healthy muscle groups, performed by patients without difficulty (3–4 minutes). You can include exercises using your healthy arm. Introductory part of the procedure with moderate general stimulation of the neuromuscular system.

IP - sitting, lying down. Passive movements in the joints of paretic limbs; relaxation exercises using a healthy limb; rolling on a roller (5–6 min.). With warm hands, calmly, smoothly, with a large amplitude, avoid synkinesis accompanying the movement. Increase the range of motion in the joints, reduce the manifestation of muscle rigidity, and counteract the manifestation of pathological concomitant movements.

IP - standing. Walking in various variations (3–4 min.). If necessary, insure; use the pattern on the floor, carpet. Monitor the placement of the foot and posture of the patient. Teach walking both on level ground and overcoming basic obstacles, as well as walking up stairs.

IP - sitting, lying, standing. Active exercises for paretic limbs in lightweight starting positions, alternating with core and breathing exercises, exercises to improve friendly and counter-friendly movements, alternating with muscle relaxation exercises (7–8 min.). If necessary, provide assistance to the patient, achieve differentiated movements. To relax muscles and reduce stiffness, introduce passive shaking of muscles, massage, rolling on a roller. Development of precise coordinated and differentiated movements in the joints of paretic limbs.

Exercises in walking, throwing and catching balls of different sizes (4–5 min.). Include swing movements with the ball. Carry out posture correction.

Teaching the process of walking. Increase the emotional content of the procedure.

IP - sitting. Exercises with balls, cubes, plasticine, ladders, rollers, balls, as well as exercises for developing practical skills (fastening buttons, using a spoon, pen, etc.) (8 min.).

Particular attention should be paid to the development of hand and finger function, as well as practical skills needed in everyday life. Total: 30–35 min.

III period of rehabilitation

In the third period of rehabilitation - after discharge from the hospital - exercise therapy is used constantly in order to reduce the spastic state of the muscles, joint pain, contractures, and friendly movements; help improve movement function, adapt to self-care and work.

The massage is continued, but after 20 procedures a break of at least two weeks is required, then the massage courses are repeated several times a year.

Exercise therapy is combined with all types of balneophysiotherapy and medications.

Exercise therapy for cerebral atherosclerosis

The clinical picture is characterized by complaints of headache, decreased memory and performance, dizziness and tinnitus, poor sleep.

Objectives of exercise therapy in the initial stage of cerebral circulatory failure:

Provide a general health and restorative effect;

Improve cerebral circulation;

Stimulate the functions of the cardiovascular and respiratory systems;

Increase physical performance.

Contraindications:

Acute cerebrovascular accident;

Vascular crisis;

Significantly reduced intelligence.

Forms of exercise therapy: morning hygienic exercises, therapeutic exercises, walks.

Section I of the procedure

Patients aged 40–49 years in the first section of the therapeutic gymnastics procedure should use walking at a normal pace, with acceleration, jogging, alternating with breathing exercises and exercises for the muscles of the arms and shoulder girdle while walking. Section duration is 4–5 minutes.

Section II of the procedure

In section II, exercises are performed in a standing position for the muscles of the arms and shoulder girdle with elements of static force: bending the torso back and forth, to the sides, 1–2 s; exercises for large muscles of the lower extremities, alternating with exercises to relax the muscles of the shoulder girdle and dynamic breathing in a 1:3 combination, and also use dumbbells (1.5–2 kg). Section duration - 10 minutes.

III section of the procedure

In this section, it is recommended to carry out exercises in a lying position for the abdominal muscles and lower extremities in combination with head turns and alternating with dynamic breathing exercises; combined exercises for arms, legs, torso; Resistance exercises for the muscles of the neck and head. The pace of execution is slow, you should strive for a full range of movements. When turning your head, hold the movement in the extreme position for 2-3 seconds. Section duration - 12 minutes.

IV section of the procedure

In a standing position, perform exercises with the torso tilted back and forth, to the sides; exercises for the arms and shoulder girdle with elements of static effort; leg exercises combined with dynamic breathing exercises; balance exercises, walking. Section duration - 10 minutes.

The total duration of the lesson is 40–45 minutes.

Therapeutic gymnastics is used daily, increasing the duration of classes to 60 minutes, using, in addition to dumbbells, gymnastic sticks, balls, exercises on apparatus (gymnastic wall, bench), as well as general exercise equipment.

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