Strokes. First aid, treatment at the stage of home rehabilitation.

Stroke - an acute violation of cerebral circulation, characterized by a sudden (within a few minutes, hours) appearance of focal and / or cerebral neurological symptoms that persist for more than 24 hours or leads to the death of the patient in a shorter period time due to cerebrovascular pathology (cerebrovascular disorders).

Strokes include cerebral infarction, cerebral hemorrhage and subarachnoid hemorrhage, which are etiopathogenic) and clinical differences (different causes, mechanisms of occurrence and manifestation of symptoms). The so-called transient (transient) cerebrovascular accidents, which are associated with short-term circulatory disorders due to vasospasm, are also distinguished. In this case, the symptoms of loss of functions last no more than a day and are fully restored.

Ischemic stroke or cerebral infarction is caused by impaired blood flow to an area of ​​the brain due to a blockage of the artery feeding the area, a blood clot or atherosclerotic plaque. It most often occurs in patients over 60 years of age with a history of myocardial infarction, rheumatic heart defects, cardiac arrhythmias and conduction disorders, diabetes mellitus. An important role in the development of ischemic stroke is played by violations of the rheological properties of blood, pathology of the main arteries. The development of the disease at night without loss of consciousness is characteristic.

Hemorrhagic stroke or "nontraumatic intracerebral hemorrhage" is caused by a cerebral hemorrhage, which is usually associated with a rupture of a vessel deeply altered by an atherosclerotic process. In a stroke, a region of the brain dies, and the functions that this region controls become impossible.

Most often occurring at the age of 45-60 years. The history of such patients - hypertension, cerebral atherosclerosis or a combination of these diseases, symptomatic arterial hypertension, blood disease, etc. Harbingers of the disease (feeling of heat, increased headache, visual impairment) are rare. Usually a stroke develops suddenly, during the daytime, against the background of emotional or physical stress.

Subarachnoid hemorrhage (hemorrhage into the subarachnoid space). Most often, hemorrhage occurs at the age of 30-60 years. Among the risk factors for the development of subarachnoid hemorrhage are smoking, chronic alcoholism and single consumption of alcohol in large quantities, arterial hypertension, overweight. Regardless of the nature of the stroke, emergency hospitalization is indicated, in severe condition, observation in the intensive care unit. Refusing to hospitalize a stroke patient due to old age (usually over the age of 70-80) is a gross mistake. In this situation, the persistence of the patient's relatives is necessary.

Symptoms of cerebrovascular accident (stroke)

Manifestations of cerebrovascular accident (stroke) depend on which part of the brain tissue is affected.

Motor functions may be impaired:

• in one arm or leg;
• both arms or legs;
• in the arm and leg on one side;
• in the hand on one side and in the leg on the other;
• in all limbs at once;
• tactile sensations (feeling of touch, pain, temperature sensitivity) in different parts of the body may disappear, vision, hearing, speech, swallowing and breathing may be impaired.

Sometimes these phenomena are accompanied by symptoms common to severe brain damage - loss of consciousness, nausea and vomiting, convulsions.

What to do before the doctor comes

Put the patient to bed, lifting his head. Open the window and ventilate the room. Apply an ice pack or a towel dipped in cold water to the head (if the right side is paralyzed, then ice should be applied to the left, and vice versa). Apply a heating pad with hot water to the legs or put mustard plasters on the calves. Monitor the patient's breathing: a stroke victim may lose tongue or vomit, it is necessary to clear the passage for free breathing. If the patient can swallow, then it is necessary to give him sedatives and blood pressure lowering agents. It is useful to spray the face and chest with cold water.

Ambulance in acute stage with Lyapko applicators

In strokes in the acute stage, in order to eliminate complications, and sometimes to prevent the development of a stroke, it is advisable to make alternately (starting from the sore side) deep punctures of the tips of the fingers and toes using a scarifier or a sterile needle. After each of two or three punctures, carry out milking movements of the fingers, trying to squeeze out as much blood as possible. This procedure reflexively prevents bleeding from burst cerebral vessels, making it possible to eliminate bleeding from them, lowering the pressure in them by redistributing blood to the periphery (hands, feet) and subsequent abundant release of blood from the fingers.

At the same time, a very intense effect on the surface of the feet and hands is carried out for 30 - 50 minutes. The applications are carried out with flat applicators with strong pressure for 5 - 10 minutes, alternating with an intensive impact of a roller for 3-7 minutes alternately between the sick and healthy sides. The effect is applied on other parts of the body (forearm, lower leg, spine, head, neck) with less intensity and less time.

More time should be applied to the affected (affected) side. Since a stroke usually occurs in one half of the brain, there is a loss of functions in the opposite half of the human body (due to the crossing of nerve pathways from the brain to the human body). For example, if the right side of the brain is affected, there is a decrease in strength and sensitivity in the left side of the body.

In addition, it must be remembered that in humans, the left half of the brain is responsible for the mental functions. If a stroke has occurred in the left half, it leads to a gross violation of the patient's speech (slurred speech or its complete absence) and understanding of the speech of others.

Recovery (rehabilitation) after a stroke

The recovery period after a stroke begins on the first day (usually several days later) of the illness.

First of all, it is necessary to determine the amount of possible physical and psycho-emotional stress. The most important component of the early recovery period is physiotherapy exercises. It is especially important to work with the affected limbs. If the arm or leg does not move, passive flexion of the limb in the joints is necessary, an early start of light massage (stroking, light rolling with a universal roller).

In a more distant recovery period (1-2 weeks from the onset of the disease), patient self-care training is necessary. Visual and auditory loads are required: music, conversations with relatives, watching TV, walking in the street in a sitting chair.

More active physiotherapy exercises, therapeutic massage, especially of the affected limbs, continue. It is very important to prevent immobilization of the affected limbs in the joints (the so-called contracture): drooping of the foot, flexion of the hand, etc.

Recommendations for the use of the applicator

In case of strokes at the stage of rehabilitation at home, the applicator is used alternately on all the affected parts of the spine and limbs.

• It is necessary to start from the healthy side. The applicators are placed along the spine, on the cervical region or, for example, on the lumbar;
• At the same time, a sore arm or leg is rolled out with a roller, starting from the fingertips, then rising higher (to restore nerve conduction). The break-in should be carried out easily, blood circulation on the affected side improves - capillaries expand - the skin turns pink;
• They also carry out manual massage and subsequent rolling of the head with a roller. It is advisable to complete the procedure by applying the applicators to the feet, sitting or standing;
• Exposure time 7-10 minutes on the healthy side, 10-20 on the sick side;
• Since patients get tired quickly, such procedures can be performed 2 times a day for 30-40 minutes.

Frequency

Usually in a hospital and at home twice a day every day. The likelihood of improvement in motor functions in paralyzed limbs is highest in the first 6 months.

Improvement in speech can last up to 2 years. Movement in the arm usually recovers worse than in the leg. The absence of any movement in the arm within 4 weeks after stroke is a poor prognostic sign for the restoration of motor function. According to statistics, 50% of patients with an ischemic stroke (ACVA) can achieve good effects from rehabilitation.

For patients with hemorrhagic stroke, this figure is lower. About a third of patients who have had stroke and survived for a year remain dependent on outside help. This proportion remains stable for 5 years after a stroke.

Mortality

Mortality in patients with stroke largely depends on the conditions of treatment in the acute period. The early 30-day mortality rate after stroke is 35%. In hospitals, mortality is 24%, and in those treated at home - 43%. About 50% of patients die during the year. In general, stroke is the second leading cause of death (after acute heart disease), and mortality in men is higher than in women.

Examination of working capacity

Stroke is currently one of the main causes of disability in the population. 70-80% of stroke survivors become disabled, and about 20-30% of them require constant outside care.

Conclusions

If a stroke has occurred, early hospitalization and the beginning of treatment, as well as further full rehabilitation of the patient, is the key to the most favorable outcome of the disease.