RU2609997C2 - Method of rehabilitation of patients with acute stroke - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, rehabilitation, neurology, exercise therapy and can be used in integrated treatment of patients with acute stroke. Graduated physical activity are carried out, involving unidirectional and opposite directional movements, active and passive ones by means of healthy extremity, general tonic exercises, respiratory, exercises on coordination and accuracy, balance and articulation under supervision of doctor with explanation and showing of movements, control and considering health and clinical presentation of patient. Wherein all patient movement are performed in form of complex, including homolateral, heterolateral and cross movements, active movements for healthy hand, passive movements for paralyzed hand, which are carried out by means of healthy hand in lock. Wherein complex of exercises is built in form of dance and is carried out using musical accompaniment with varying dance rate and rhythm. Complex ends with respiratory exercises with speaking out of affirmations revitalizing nature, while breathing out. Duration of each exercise is 1–2 minutes, whole complex takes 7–10 minutes. Exercises are performed daily 2–6 times a day in initial positions depending on capabilities of patient standing with support, sitting on chair or lying. Therapeutic course is 20–60 procedures.

EFFECT: method provides restoration of paralyzed extremity motor function, equilibrium, coordination of movements, support ability of feet, speech and cognitive functions, improving mood and quality of life, social contacts and level of communications, reduction of fatigue, increasing life activity, extends range of rehabilitation of patients with acute stroke.

1 cl, 1 ex

Description

The invention relates to medicine, in particular to medical rehabilitation, neurology, physiotherapy exercises, and can be used in medical rehabilitation in patients who have had a stroke in the acute period.

There is a method of treating patients in the acute period of stroke with vascular nootropic drugs (phenotropil, lobster) that have a complex effect on metabolic processes and blood circulation of the brain (Gusev E.I., Gekht AB, Gaptov VB, Tikhopoy E.V. Rehabilitation in neurology. Textbook. - M., 2000, 327 pp.).

The disadvantage of this method: with medical treatment, for all its importance, the patient takes only a passive part in the recovery process, while the active participation of the patient in the recovery process creates positive motivation for recovery. Many drugs require long-term use, have side effects and unpredictable long-term effects. In addition, patients often do not have the opportunity to use expensive drugs, especially when multi-month maintenance therapy is required.

There is a method of neuropsychological training through physical exercise "Brain Gym", which is used in the field of education to improve the learning ability of children. It uses a set of exercises aimed at improving interhemispheric connections (Dennison, R. Brain Gym - Teachers Edition / P. Dennison, G. Dennison // Ventura, CA: Edu-Kinesthetics, 1994. - 91 p.).

Disadvantages: the known method is not used in the practice of restoring cognitive functions in sick people, but is used in primary and special school education. In addition, the general state of health is not taken into account, the above complex uses exercises without taking into account the phylogenetic and ontogenetic organization of the brain with its gradual complication, in addition, the exercises in it are given as a general recommendation and may not always be understood by elderly patients, especially after a stroke .

A known method of neuropsychological rehabilitation of patients with cerebrovascular disease with discirculatory encephalopathy and strokes (RF patent for the invention No. 2246971 C1, IPC A61M 21/00, published on 02.27.2005, further D2). According to method D2, against the background of rehabilitation treatment, the dominant hemisphere is determined by standard tests, then a complex of homo- and heterolateral exercises, cross limb movements, unidirectional movements for coordination, accuracy, balance are performed with these exercises performed in the form of a dance to music, slower and faster pace, in the initial position corresponding to the patient's capabilities - standing, sitting or lying down. Under the guidance of a doctor, instructor, with an exercise duration of 1-2 minutes, the entire complex 15-20 minutes a day, a course of 15 days (2 weeks or more).

The main disadvantage of this method is its use already in the recovery period, that is, 3-6 months after a stroke, which in many respects postpones the healing process of the patient.

There is a known positive effect on the health of patients after a stroke of various music, vocal singing, including the performance of favorite songs by the patient himself, with kinesitherapy to music (Bogdanova L.P. Music therapy in the rehabilitation of patients // Vestnik SUSU, 2006, No. 3, S. 192-194, further D4).

The disadvantage of this method is the use already in the recovery period, and kinesitherapy to the music is not enough to restore the patient in the near future.

Comprehensive recovery of patients in the acute period of a stroke is known, using, along with exercises to restore motor, coordination functions, articulation exercises, breathing exercises in alternation with motor, with pronouncing positive phrases of self-hypnosis (affirmations). (After a stroke, part 2, 05/04/2012, see Passive movements and massage, active gymnastics http: doctor.kz/healt/news/2012/05/04/13188 further D5).

The disadvantages of this method are: there are practically no exercises for the development of interhemispheric interaction and exercises to improve the functioning of the limbic system, which significantly affects the patient's recovery time.

There is a method of rehabilitation of cognitive functions in patients after stroke in the early recovery period (patent No. 2392916, IPC А61Н 1/00, publ. 06/27/10), which consists in the use of dosed physical activity, including homolateral, heterolateral and cross movements, auto-training, unidirectional and multidirectional movements of the eyes, tongue and limbs when the patient is daily subjected to a set of physical exercises of “cognitive gymnastics”, consisting of the following types of exercises: general developmental exercises, energy physical exercises, exercises that stretch the muscles of the neck in the mode of post-isometric relaxation, ending with a set of exercises for relaxation using the elements of auto-training and self-massage techniques; the duration of each exercise is 1-2 minutes, the pace of the exercises is slow, smooth, the classes are carried out daily 2 times a day, in accordance with the motor mode - in the gentle mode, the training time is 10-15 minutes, in the gentle-training - 15-20 minutes, in the trainer for 25-30 minutes, and the starting position - standing, sitting on a chair, and for patients with persistent dizziness - lying down; the course of treatment is 15-18 procedures.

The disadvantages of this method are as follows: it is used to restore cognitive functions in the recovery period, that is, 3 months after a stroke, which in many respects postpones the patient’s recovery process.

The closest to the method of achieving the result is the rehabilitation of neurological patients in the acute period of stroke (Kadykov A.S. et al. Rehabilitation of neurological patients. M .: MEDpress-inform, 2009, p. 68-75, correction of speech disorders in combination with a complex of kinesitherapy - p. 384, 386-389, further D1), including a set of dosed physical activities in the form of limb movements - active for healthy limbs and in isometric mode for a paretic limb, breathing exercises, exercises to restore speech, in astnosti articulation, as well as health-building actions under the guidance of a doctor or an instructor explaining, showing the movements, the control of their execution.

The main disadvantage of the known method was the fact that for a paretic limb exercises in isometric mode were recommended, lightweight exercises using various suspensions, hammocks and blocks, exercises with light dosed resistance, which prevented the use of damaged and undamaged hemispheres from the undamaged parts of the brain. due to cross-paths and the interaction of a healthy limb with a paretic one. There are also no exercises for the development of interhemispheric interaction and exercises for improving the functioning of the limbic system, which significantly affects the patient's recovery time.

The authors of a method for the recovery of stroke patients in the acute period offer a highly effective method of non-drug treatment, which allows paralyzed limbs to be included in the work, increase the range of motion in them and the total motor volume in general, improve support ability, coordination, balance, restore speech and cognitive functions, relieve anxiety, improve mood and quality of life, increase the possibility of social contacts and the level of communication. It is based on specific physical exercises conducted to music, contributing to the integration of brain activity. The proposed method is lightweight and can be used to treat patients after a stroke in the acute period immediately after stabilization of vital functions.

The basis of the invention is the task of increasing the effectiveness of the treatment of stroke patients in the acute period.

The task is achieved due to the fact that in the acute period of a stroke, dosed physical activity is applied, including unidirectional and multidirectional movements, active and passive with the help of a healthy limb, general tonic exercises, breathing, coordination and accuracy, balance and articulation under the supervision of a doctor with an explanation and showing movements, monitoring and taking into account the general state of health and the clinical picture of the patient, while the patient undergoes all movements in the form of a complex, including homolateral, heterolateral and cross movements, active movements for a healthy hand, passive movements for a paralyzed hand, which are carried out with the help of a healthy one with the hand grabbed into the lock, the set of exercises is built in the form of a dance and is performed using musical accompaniment with a changing dance tempo and rhythm, moreover the complex ends with breathing exercises with pronouncing on exhalation an affirmation of a healing nature, the duration of each exercise is 1-2 minutes, the whole complex is 7-10 minutes, classes are conducted daily 2-6 times a day in the starting positions, depending on the capabilities of the patient, standing with support, sitting on a chair or lying down, the course of treatment is 20-60 procedures.

A method of healing patients in the acute period of a stroke is carried out against the backdrop of a comprehensive rehabilitation that includes medical treatment, physiotherapy exercises and physiotherapy.

The method is simple and allows you to: relieve anxiety, improve mood, include paralyzed limbs in work, increase the range of motion in them and the overall motor load in general, improve coordination of movements and balance, restore movement and speech, increase communication level.

When the method is executed, conditions are created for activating the links between the centers controlling the movements of the limbs, the oculomotor nuclei of the brain stem, cerebellum, the visual, auditory and vestibular centers and the cerebral cortex of both hemispheres. To restore movements, the inclusion of the damaged and undamaged hemisphere of the brain of the brain, undisturbed by the disease, through the intersection of the pathways, for example: the upper part of the prefrontal cortex and limbic system (using music), the associative functions of the brain when listening and speaking words of affirmations (temporal lobe) are used.

General toning exercises that are active for a healthy arm and passive with a healthy arm for a paralyzed arm with a hand in the lock are performed in all possible directions and planes with the intersection of the midline of the body, for example, figure eight. Coordination movements are performed in the form of dance figures, which are divided into unilateral or homolateral movements, and versatile or heterolateral movements that intersect the midline of the body. In the initial position, standing on a healthy leg, the support ability of the paralyzed leg, the change of leg support, the step movements of the legs with the intersection of the midline of the body are trained. When performing movements, interhemispheric interaction develops, the lower parts of the brain stem and cerebellum are activated, involuntary, inadvertent movements and muscle clamps are removed.

Performing exercises accompanied by musical accompaniment allows you to reduce anxiety, fear and disbelief in your recovery, feel the rhythm of music and the body, wake up the preserved structures and functions of the brain, and include the patient in active treatment.

Saying affirmations of a healing nature helps to include in the resonance the muscular movements of the limbs and speech apparatus and get feedback by listening to your voice and adjusting sounds and movements.

The duration of each exercise is 1-2 minutes. The pace and rhythm of movements varies, depending on the dance character. Classes are held daily 2-6 times, the duration of classes is 7-10 minutes. The initial position, depending on the capabilities of the patient - standing with support, sitting and lying down.

At the beginning of the complex, breathing and general tonic exercises are performed; then active and passive for a paralyzed hand using a healthy “with the capture of the brush into the lock”, to coordinate movements, accuracy, balance, articulation, are built in the form of a dance to dance music with a changing tempo and rhythm, and movements of the limbs are combined with articulation. In conclusion, breathing exercises are included with the utilization of healing affirmations on the exhale. Classes are conducted by a doctor who doses the amount and complexity of the exercise in accordance with the general well-being of the patient and the clinical picture of the disease. The course of treatment is 20-60 procedures.

The criteria for the effectiveness of the therapeutic effect were a clinical neurological study, the level of physical condition, range of motion, reserve of adaptation, cognitive functions and general mood and anxiety (Belova A.N., Schepetova O.N. Guidelines for the rehabilitation of patients with motor disorders, part I. M .: Antidor, 1998, 225 pp .; Pustozerov A.I., Milovidov V.K., Sazonov Yu.I. Methods of the pre-medical health status of athletes and athletes. - Chelyabinsk: UralGAFK, 2004. 92 pp .; Bayevsky PM Measure Your Health. - Moscow: Sov. Russia, 1988. - 96 .; Luria AR Higher human cortical functions. M: Academic project. - 2000. - 504 p .; TA Kirdyashkina. Methods of attention research. Psychology workshop: study guide. Chelyabinsk: Publishing house of Ural State University. - 1999. - 72 pp., Mini-Mental State Examination (MMSE) Folstein, MF, Folstein, SE, McHugh, PR “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 1975, N 12. - P. 189-198).

The study was conducted in 2 stages: the 1st - at the beginning of treatment and the 2nd - 1 day before discharge.

According to clinical tests, the improvement observed in patients had objective confirmation. After a course of complex treatment with the inclusion of a method of healing patients in the acute period of a stroke, patients observed improvement in mood and overall well-being, increased range of motion, support ability, improved coordination and balance, and the ability to walk in patients with motor aphasia — speak.

The reaction of the cardiorespiratory system improved: the pulse and blood pressure values changed slightly, the level of physical condition tended to normalize. According to cardiointervalography, the adaptation reserve improved to indicators of healthy people. This picture lasted more than an hour.

According to psychological testing, the results of the study showed a significant improvement in indicators of short-term verbal memory and voluntary attention. Improved mood, increased social contacts and level of communication. Patients began to memorize more words, solve more problems in the allotted time interval, make fewer mistakes when performing tests. An analysis of the results of a study of attention on the Schulte Tables test showed that the minimum time required for patients to solve problems was reduced and the number of pauses for “jams” was reduced.

Clinical example

Patient L., 58 years old, was admitted to the neurological department for an ischemic stroke with complaints of headaches, impaired sleep and cognitive functions, lack of movement in the right limbs, inability to walk and speak,

At a neurological examination: signs of gross right-sided hemiparesis, the third degree of violation of social activity, inability to walk, move your arm, speak; memory loss, impaired thinking (slowing its pace).

A patient undergoing comprehensive rehabilitation, including drug therapy, physiotherapy, biological feedback, exercises with a speech therapist, underwent a course of exercises on the method of healing patients in the acute period of stroke in the amount of 28 procedures. Classes were held individually and then by the small group method for 7-10 minutes, twice a day. Starting positions are sitting and then standing with support. All exercises were carried out under the supervision of a physician of physiotherapy exercises, who accompanied all explanations of the movements with a demonstration of exercises and, if necessary, helped the patient.

After a course of treatment, the patient noted an improvement in well-being, mood, increased activity, decreased anxiety. He was able to get up, maintain balance while standing on both legs, then walk independently. The patient was able to independently raise the paralyzed arm in full. It became possible to pronounce the words: first “brain”, “brain wake up”, and then everyone else. The study of memory and attention showed an increase in the volume of memorized images and numbers, which indicates an increase in the volume of short-term memory, as well as an improvement in voluntary attention.

The favorable dynamics of the functional state, the expansion of the range of movements, motor capabilities, speech, cognitive functions under the influence of the method of healing patients in the acute period of stroke indicates distinct positive changes in the process of recovery of the body after the disease.

Thus, the claimed method of healing patients in the acute period of a stroke is highly effective in restoring motor functions, speech and cognitive functions, is easy to use, which allows it to be used in the complex treatment of stroke patients. The method can be applied in stationary, outpatient, spa treatment conditions, and can also be used for self-study at home.

Claims (1)

A method of healing patients in the acute period of a stroke, which consists in the use of dosed physical activity, including unidirectional and multidirectional movements, active and passive with the help of a healthy limb, general toning exercises, breathing, for coordination and accuracy of execution, balance and articulation under the supervision of a doctor with an explanation and display movements, monitoring and taking into account the general well-being and clinical picture of the patient, characterized in that the patient undergoes all movements in the form of a complex, including homolateral, heterolateral and cross movements, active movements for a healthy arm, passive movements for a paralyzed arm, which are carried out with the help of a healthy arm with a grip of the hand into the lock, while the complex of exercises is built in the form of a dance and is performed using musical accompaniment with a changing dance tempo and rhythm, and the complex ends with breathing exercises with pronouncing on exhalation affirmations of a healing nature, the duration of each exercise is 1-2 minutes, about the complex for 7-10 minutes, classes are conducted daily 2-6 times a day in the starting positions, depending on the capabilities of the patient, standing with support, sitting on a chair or lying down, the course of treatment is 20-60 procedures.