The prognosis for survival in the second vascular accident depends on many factors, one of which is the speed: the faster the patient gets into the hands of specialists and the resuscitation measures begin, the more chances he has to survive with minimal consequences.
What to do in the second stroke? To call an ambulance. While waiting for the brigade to arrive, it is necessary to help the patient to lie down (sit down), providing an elevated position of the head (try not to move the patient any more). Measure (if possible) blood pressure and give the antihypertensive medication available with it. To help get rid of dentures, contact lenses, remove glasses, unbutton the collar, loosen the belt.
If the patient has lost consciousness, they turn their heads to one side and slightly open their mouths, watch the breath, avoiding the stumbling of the tongue, which can block the flow of air into the respiratory tract. Do not try to bring the patient back to life. It is advisable to put a cold compress or ice on the forehead.
Usually a specialized brigade comes to the patient with a sharp stroke, who can provide the necessary help at home and on the road. You can use the services of a paid ambulance, then it will be guaranteed that the patient will be transported reliably after the second stroke. Therapy after the second acute attack is no different from the previous time. Entered by an ambulance with a repeated vascular accident is usually sent to the intensive care unit or resuscitation. Make the necessary diagnostics to determine the type of lesion.
In the first hours with ischemic stroke, the efforts of the medical staff are focused on the following tasks:
- the maximum restoration of the ability of the arteries to transport blood to the brain tissues through drip infusions of saline solutions;
- use of thrombolytics, to reduce blood viscosity, dilute it and activate microcirculation;
- protection of neurons and prevention of cerebral edema.
In the first hours, they try to restore blood flow, using vasodilating drugs, thus removing the spasm of blood vessels and forcing the work of spare collateral arteries. Intravenously injected No-shpu, drugs based on nicotinic acid and others.
But-spa, the active ingredient of which drotaverina hydrochloride has the ability to reduce the concentration of calcium ions in cells, permanently inhibiting contractile activity and relaxing the musculature of the arteries, thereby widening the blood vessels and increasing blood flow in them. The mechanism of its action is based on inhibition of the enzymatic activity of phosphodiesterase IV, with no effect on the activity of the same type of enzymes of type III and V, which releases No-shpu from spasm of cerebral vessels from other antispasmodics by the absence of a significant therapeutic effect on the activity of the heart muscle.
Nicotinic acid is an enzymatic agent that transports to the tissues and organs of hydrogen and participates in oxidation and reduction reactions. It has the ability to expand blood vessels, lowers the content of lipoproteins in the blood. Intravenously, nicotinic acid preparations are administered very slowly, as it causes painful sensations. Preference is given to Nicotinat sodium or nicotinamide as not causing irritating effect. The recommended dose is 1 ml of a 1% solution.
The anti-shock solution of Reopoliglyukin is injected drip to restore capillary blood flow.
If the patient is conscious and is able to take pills, he may be prescribed the following anticoagulants: Ticlopidine, Warfarin, Clopidogrel and all known Aspirin. The dosage of these drugs is determined by the doctor according to the symptoms, since the situation is urgent. If the patient has taken medications that dilute the blood, relatives should inform the doctor about this, as the dosing will be adjusted.
Ticlopidine - inhibits the process of "gluing" of platelets caused by ADP (adenosine diphosphate), adrenaline, collagen, arachidonic acid, thrombin and platelet activating factor. Entering the body, the drug causes dysfunction of the cell walls of platelets to bind, diluting the blood and prolonging the time of bleeding.
Warfarin refers to indirect anticoagulants. It inhibits the action of vitamin K, thereby preventing the process of blood clotting and the formation of blood clots.
Clopidogrel is a selective inhibitor of the binding process of ADP with the same receptor of platelets. The drug has an irreversible effect by blocking the ADP-receptors of blood cells, so coagulability is restored after discontinuation of admission after platelet renewal (about a week).
Patients who are in an unconscious state are prescribed drip infusions of Heparin. Has a direct effect preventing blood clotting, as it is a natural component that provides fluidity of blood. In addition, it inhibits the enzymatic activity of hyaluronidase, prevents the formation of thrombi, activates the blood flow in the coronary artery. Heparin activates the cleavage of lipids, reducing their content in the blood serum. With intravenous administration it acts instantaneously, but for a short time, from four to five hours.
This preparation is usually combined with enzymatic fibrinolytics, for example, fibrinolysin or plasmin derived from human blood plasma, or streptodecase, which activates the transformation of plasminogen into a natural plasmine blood ingredient. These drugs provide the dissolution of fibrous fibrin protein, the clots of which are the basis of thrombus. Their deficiency is systemic action and the possibility of bleeding.
The most effective for today in ischemic stroke is the drug Aktilisse, a second-generation thrombolytic that is used during the "therapeutic window" and has the ability to destroy the blood clot that clogged the artery. The so-called tissue plasminogen activator, introduced in the first hours after a stroke, is fully capable of restoring blood supply to the ischemic site. Actilize selectively only converts fibrinogen, which is related to the formed thrombus, without having a systemic effect. This drug is intended for intravenous administration. It is recommended to inject no more than 90 mg, first a jet intravenous injection is made in the amount of 10% of the dose prescribed by the doctor, the rest is injected into the drip for an hour.
The treatment regimen followed by the use of heparin (intravenous) and acetylsalicylic acid (orally) has not been studied enough, therefore, especially in the first day of treatment with Actylize, it should not be used. In cases where it is necessary to use Heparin (because of other pathologies), it is administered subcutaneously and no more than 10,000. IU per day.
The most dangerous consequence of thrombolytic therapy is bleeding and / or hemorrhage in any part of the body, including - life-threatening. In this case, it is recommended to transfuse fresh whole blood (freshly frozen plasma) or use synthetic antifibrinolytic agents.
If the resuscitation measures were successful and positive dynamics was noted, Cavinton was appointed to restore vascular tone. The vegetable alkaloid derivative corrects mental and neurological post-stroke disorders. Under the action of the drug, the cerebral arteries expand, the blood flow increases and the amount of oxygen in the brain tissues increases, glucose metabolism improves. Inhibiting the enzymatic activity of phosphodiesterase, Cavinton promotes the accumulation in the tissues of cyclic adenosine monophosphate, a universal mediator that transmits signals of certain hormones to neurons. Also, the drug has an antiaggregant effect, preventing the formation of thrombi, increases the plasticity of red blood cells. Cavinton does not have a significant hypotonic effect.
In neurological practice, the drip introduction of the drug is used, then they switch to taking the tablets. They are taken continuously for one or two units three times a day.
Emergency measures for repeated hemorrhagic stroke are primarily aimed at stopping bleeding and reducing the pressure of hematoma and displaced brain areas on its trunk. Conservative treatment of hemorrhages is carried out only in the most uncomplicated cases with small hemorrhages. The patient is provided with conditions that limit noise and light.
Normalization of blood pressure, stop taking vasodilating and antiaggregant drugs (if they are the cause of hemorrhage), use haemostatic agents. The second hemorrhagic stroke is rarely subject to therapeutic treatment, however, in these cases, injections of antihypertensive medications and diuretics are used to reduce pressure. For this, different drugs are used: β-blockers (Atenolol, Bisoprolol, Nebivolol, Anaprilin, Timolol), antispasmodics (No-sppa, Otilonium bromide, Atropine, Buskopan), calcium antagonists (Corinfar, Anipamil, Clentiazem), drugs inhibiting enzymatic activity angiotensin (Benazepril, Captopril, Enalapril, Fosinopril).
Emotional lability is stopped by sedatives - Elenium, Diazepam. Often appoint Phenobarbital, because it has an anticonvulsant effect, not more than 90 mg per day, divided into three doses.
Laxatives are used to prevent hampered bowel movements, for example, Pikolax drops that stimulate the peristalsis of the large intestine and move to the exit of stool. Take once a day, in the evening, from 13 to 27 drops.
Drugs that stop bleeding:
- Dicinone - accelerates the formation of tissue thromboplastin, which helps stop hemorrhage, inhibits the enzymatic activity of hyaluronidase, blocking the metabolism of mucopolysaccharides, which increases the strength of the vascular walls. However, this ability does not affect the duration of the prothrombin period, nor does the drug cause hypercoagulability. From the time of parenteral administration to the onset of action, a period of time from five minutes to a quarter of an hour passes, from ingestion - an hour or two. Provides a four-six-hour effect. The recommended dose for a four-time application is 250 mg.
- Gordoks (aprotinin) - well tolerated by most patients with a primary use of a hemostatic drug for drip infusions. Oppresses the enzymatic activity of proteases, promotes the activation of the coagulation process and reduces the fluidity of the blood. Assign four droppers per day, each for 100 000 units. In the secondary course within half a year the probability of anaphylaxis or allergy is 5%.
- Γ-aminocaproic acid - stimulates blood clotting processes by inhibiting the action of enzymes that catalyze fibrinolysis. In addition, it has an antiallergic effect. The daily dose is not more than 30 g, in droppers 100-150 ml (5% solution). It can be combined with a small amount of Reopoliglyukin, which improves blood circulation in the capillaries.
The appearance of the symptoms of the penetration of the brain substance into the openings of the cranium of different locations, the patient's inhibition requires anti-edematous therapy - the appointment of osmotic diuretics. Usually prescribed drugs with the active substance mannitol (Aerosmosol, Mannitol, Mannistol, Osmosal, Renitol and eponymous drug). This is a very effective diuretic, its action is accompanied by significant losses of water and sodium chloride. It is injected intravenously, calculating the dose per kilogram of the patient's weight from 500 to 1500 mg, preparing a 10-20% isotonic solution.
Either the furosemide-based drug is Lasix, which five minutes after the intravenous quickly reduces blood pressure and has a marked diuretic effect. Forced diuresis with this drug is carried out twice a day, adding 20-40 mg in a dropper. Then, taking into account the water-electrolyte equilibrium and the patient's condition, the dosage is corrected.
Intravenous injections of hormonal drugs (dexamethosone) may be prescribed.
When symptoms of spasms of the cerebral arteries (approximately on the seventh day), calcium antagonists are prescribed, for example, drip infusions of Nimotone (10 mg each) against the background of correction of dosages of drugs that lower blood pressure.
When the acute period has passed and the bleeding is safely stopped, further therapy is performed symptomatically. The patient must necessarily adhere to bed rest and diet.
Vitamins and vitamin-mineral preparations reduce the permeability of vascular membranes, make them elastic and durable. Ascorbic acid and rutozide are indispensable in this respect, especially their combination in many vegetables and fruits, as well as in the Ascorutin preparation. Patients after the second stroke to strengthen blood vessels are recommended calcium preparations:
- calcium pantothenate - removes intoxication, participates in the metabolism of fats and carbohydrates, the production of cholesterol, steroid hormones, acetylcholine, is indicated for patients with a neurological deficit and weak brittle vessels;
- intramuscular injection of calcium gluconate;
- intravenous - calcium chloride, which in addition to strengthening the vessels has an anti-allergic effect.
Vitamin-mineral complex Berokka Plus contains eight vitamins of group B (thiamine, riboflavin, nicotinamide, pantothenic acid, pyridoxine hydrochloride, biotin, folic acid, cyanocobalamin), vitamin C, calcium, magnesium and zinc. It is indispensable for healing the vessels, normalizing the process of hematopoiesis and the functions of the central nervous system. Take one tablet a day.
Restore the body after the second stroke will help physiotherapy. Ultrasound therapy can be prescribed already in an acute period in ischemic stroke, and also during rehabilitation to reduce muscle tone or vice versa in muscular dystrophy, treatment of concomitant pathologies. With hemorrhages, ultrasound treatment is prescribed after at least two months from the onset of the disease.
Post-stroke patients are shown electroprocedures - amplipulse therapy; electrophoresis; darsonvalization; diadynamic therapy; electrosleep. With the help of such procedures, metabolic processes are activated, the trophism of the vessels improves, the ischemic areas and edema decrease, the motor activity of the parietal muscles increases. Procedures are appointed already in the early recovery period (from the third week).
Magnetotherapy promotes a smooth decrease in blood pressure, improves the rheological properties of the blood.
Low-intensity laser irradiation improves the quality of erythrocytes - blood cells transporting oxygen to the neurons of the brain, as a result of the destruction of thrombi and reduces the likelihood of new ones.
Thermotherapy - paraffin and ozocerite applications, white light phototherapy, hydromassage and vacuum massage are recommended for patients with postinsult arthropathies.
To treat a stroke at home is life-threatening, especially the second, in this case urgent intensive therapy with the use of modern diagnostic equipment and medicines is required. But within the framework of restorative measures and as preventive measures, the recommendations of alternative healers can be included in the therapeutic scheme, after consultation with the attending physician.
To treat the consequences of stroke and prevent a recurrence, alternative medicine suggests using pine and fir cones. For therapeutic purposes, young cones with seeds are used. They need to be torn only from trees growing in the forest away from the main roads. Broken bumps are cleaned from damaged insects, necrotic parts. Pine is best collected in March, in extreme cases until the end of April, the collection of spruce begins on June 5.
Tincture of pine cones on vodka is taken twice or thrice a day in a teaspoon for three weeks, then a week break is made and the course of administration is repeated twice more. The next time this treatment can be done no earlier than six months.
Preparation of tincture: bumps rinse under running water and put in a clean one-liter jar, filling it to the top. Pour vodka, cover and insist in a closed locker or pantry for two or three weeks before getting a thick dark red color. Strain through gauze, folded twice. The infusion is ready for use.
An alternative non-alcoholic variant - a decoction of pine cones is prepared as follows: cut five young pine cones into smaller pieces, put them in an enamel saucepan, pour ½ liters of hot water and boil five minutes on a small flame. This broth is drunk about a quarter of a glass after eating one to three times a day.
Spirituous tincture of fir cones with apple (grape) vinegar. Five cones are rinsed, cut and poured with alcohol (vodka) in a volume of 250 ml. Within a decade, the mixture is left for infusion in a closed locker or pantry. Then filter well and add a teaspoon of vinegar (preferably home-made). Use, adding tea a teaspoon of tincture, for six months, then take a break.
Water infusion of spruce cones is used in a daily volume of not more than 30 ml, it is drunk several times a day. For cooking rinse the cones, cut and fill them in a three-liter jar to half the volume, pour over the cooled boiled water to the top and leave to infuse in the dark place for ten days. Then, after draining the liquid, fill the jar with water again. A week later, the medicine is ready. The entire prepared portion is drunk on the course and a break is taken.
After the second stroke, alternative healers recommend mouthwashes with a 3% solution of hydrogen peroxide with water in proportions of 1: 1 after eating for about a minute. This procedure normalizes metabolic processes and disinfects the oral cavity after eating.
Alternative medicine extensively practices herbal treatment of the effects of stroke. Paralyzed in whole or in part of the body is recommended to rub with alcohol tincture of thyme (50g of crushed dry vegetable raw material insist on a week for alcohol or vodka with a capacity of 500ml) or alcohol or ether mixed with vegetable oil in a ratio of 1: 2.
You can do a bath every two days with decoction from the roots of dog rose, the course is supposed to make from 20 to 30 baths.
The root of bryony (paralyzed herbs) in the volume of one tablespoon insists a week on vodka (300ml) in a warm place, filter. Tincture is taken inside in the morning and in the evening, dropping 25 drops in a quarter of a glass of water.
It is recommended to add black berries to tea or brew them instead of tea.
You can also normalize the pressure without medication. To do this, recommend in the morning before breakfast to drink half a glass of mint tea (you can of melissa). For its preparation, a teaspoon of grass is boiled with 200ml of boiling water, after half an hour, it is filtered and drunk. After waiting another half hour, you need to drink half a glass of pre-brewed infusion of two herbs - immortelle and yarrow. Taking a pinch of each herb, brew it with boiling water and leave to cool, then strain.
Prevent thrombosis and reduce the viscosity of the blood will help the following remedy:
Pharmaceutical tinctures for alcohol
- echinacea (10ml);
- eucalyptus (40ml);
- peppermint (40ml);
- motherwort (125ml);
- pion (125 ml);
- valerian (125ml);
- hawthorn (125 ml each).
Add to this mix eight mashed to powder state buds carnations (meaning the seasoning). Shake and put in a closed locker. A week later the product is ready. Every day in the morning, at lunch and in the evening dilute a teaspoon of medicine in ten milliliters of water and drink.
Alcohol-free composition, blood thinning and preventing the formation of blood clots: in the evening in a liter thermos, four tablespoons of boiling water are brewed with two tablespoons of herbal extract from mint, sage and the root of elecampane mixed in equal proportions. The next morning, strain and drink before eating 200 ml four times a day. Treatment lasts three weeks. The next course can be done by making an interval of at least a month.
The effect of homeopathic drugs has not been sufficiently studied by evidence-based medicine, they are not yet used in the acute period of the disease. However, in the period of rehabilitation and elimination of complications and consequences with the help of homeopathic remedies, it is possible to achieve very noticeable success in eliminating ischemic events and the effects of oxygen starvation of the brain, coping with what synthetic drugs do not yet cope with due to side effects and damaging effects on the tissue. The use of homeopathy sometimes leads to a significant improvement in the physical state after a stroke and a person returns to a full life.
The use of complex homeopathic remedies of the brand "Heel" can be included in the scheme of therapy practically at any stage of the disease. Injection of drugs to stimulate the respiratory function of cells Coenzyme compositum and Ubiquinone compositum can provide adequate oxygenation of neurons of the brain, strengthening immunity, restoring trophic and lost functions. They can be used simultaneously with other drugs that are used in emergency therapy and recovery period. As a rule, the catalysts for tissue respiration are prescribed alternately every other day by a course of 10-15 injections. Producers recommend, in some cases, to achieve greater efficiency, use drugs in combination with each other.
Parenteral cerebral protection Cerebrum compositum can also be included in the treatment regimen at any stage and for preventive purposes. The drug has a variety of effects, covering all parts of the brain and the processes that occur in them. When it is used, the body's immune status is increased, the strength of the vascular wall increases, its elasticity, and the blood flow becomes active. The drug is able to slightly dilate the blood vessels and eliminate spasms, activate metabolic processes and eliminate toxins. After the course of treatment, memory improves, neurological deficit decreases. Appointed one ampoule after one to three days. You can inject in any way, and also use it orally, having drunk within 24 hours, dissolving the contents of the ampoule into 50 ml of pure water.
The action stimulating the restoration of the nervous system is provided by injections of the placenta compositum, the complex of which expands the arteries and facilitates blood flow, tones and eliminates spasmodic phenomena, improves tissue nutrition and respiration. Normalization of blood circulation in the limbs is provided by components - organ preparations from placental tissue and embryonic tissue, which also contribute to cellular renewal and recovery. The state of the internal vascular membrane is positively influenced by organ preparations from the tissues of the artery, veins and umbilical cord. Stabilizes the pituitary and endocrine disorders of the organ ingredient from the pituitary gland, and the regulation of metabolic processes is corrected by sodium pyruvicum and muscle lactic acid. Herbal ingredients reduce the permeability of the walls of arteries, veins and capillaries, provide blood flow to the skin, have an anticonvulsant effect, eliminate paresthesia. Barium carbonate, copper sulfate and lead iodide clean the vascular walls and prevent the spread of cholesterol plaques. Dosage is similar to the previous preparation.
Stabilize the condition after a stroke and compensate for cerebral insufficiency by using oral drops
Eskulius compositum, taking them 10 drops under the tongue three times a day before meals for half an hour or diluting them in a tablespoon of water. Do not use the drug for various disorders of immunity, neoplasms, collagenoses, multiple sclerosis.
Nervocheel - stabilizes the nervous system, has antidepressant and anticonvulsant properties. It consists of Ignacy, Sepia, Potassium bromide which are used to normalize cerebral circulation as monopreparations, Phosphoric acid, which is called homeopathic nootropic. Tablets dissolve under the tongue, dosing: for patients from the age of three - one unit per reception three times a day. Acute seizures are cured by resorption of a single dose every quarter of an hour, while you can take no more than eight single doses.
The duration of therapy with complex homeopathic preparations can last up to several months.
Monopreparations, appointed by a specialist individually, will most effectively work.
With left-sided symptoms: Arnica (Arnica) - the most effective remedy for regenerating remedy, can be used to provide emergency care; Lachesis (Lachezis) - normalizes blood circulation in small arteries, works well for hemorrhages.
Right-sided lesions well restores Bothrops (Bottrops) - thrombolytic, improves blood circulation, regenerates paralyzed muscles;
Bufo rana (Bufo rana) - speech defects, bulbar syndrome, aphasia, aggressive reaction in case of misunderstanding.
Ambra Grisea (Ambra griseya) and Phosphorus (Phosphorus) - homeopathic nootropics, effectively restore cognitive functions.
Lathyrus sativus - the post-stroke patient walks, but with difficulty (drags his legs, knees, feet are bent).
Gingko biloba (Ginkgo biloba) - effective in the aftermath of hemorrhages, restores vascular patency, compensates for neurologic insufficiency.
Helleborus niger (Hlebborus niger) - is used to treat apathetic patients with inhibited reactions or their absence.
Nux vomica (male vomica) is a male drug used for paresthesias, seizures, motor ataxia.
Baryta carbonica and Baryta iodata are mainly prescribed after ischemic stroke, selectively has a positive effect on cerebral vessels, it removes the oppressed state, forgetfulness, and improves the concentration of attention.
Aurum iodatum (Aurum iodatum) - normalizes blood pressure, suppresses hypertensive crises and cerebrovascular disease, is effective in atherosclerotic vascular changes.
Conium (Conium) - effectively cures neurological symptoms, speech disorders, paresis and paralysis of the lower limbs.
Crataegus (Krategus) - is indispensable in the prevention of strokes, has soothing, vasodilating, strengthening their wall properties.
Patients with a second hemorrhagic stroke are most often subject to surgical treatment. The exception is patients with small volumes of hemorrhages and in a state whose lethality is estimated from 90% to 100%. These are patients with medial hemorrhages, the size of which does not matter, and staying in a deep coma with impaired stem functions.
Indication for surgical intervention are lateral, the most common localization (about 40% of cases), and lobar hemorrhages, large and medium in volume (more than 20-30ml); negative dynamics of sequentially made tomograms; stem and cerebellar hemorrhages, accompanied by a pronounced neurological deficit.
Surgical treatment is performed to reduce pressure on the medulla and to minimize its dislocation, as well as to reduce intracranial pressure, local and total, and the number of neurotoxins released from the hematoma.
Classical open microsurgery is used in about a quarter of cases of hemorrhage, when the hematoma is localized near the surface. In this case, the possibility of causing additional brain injury to the patient is minimized. Also, open surgery can be performed according to vital indications in patients with deep cerebellar hematomas, or hemorrhages localized in the cerebral hemispheres and causing severe neurologic symptoms.
Minimally invasive endoscopic surgery is performed by most patients: a small diameter instrument (from two to seven millimeters) is inserted into a blood clot and then it is removed by aspiration. Operations are carried out under the control of a computer and modern navigation technology using ultrasonic, infrared or electromagnetic radiation.
In ischemic stroke, thrombus removal or treatment of a damaged artery is performed with the help of special medical minimally invasive procedures, which, strictly speaking, are not yet related to surgery, but also conservative treatment, too, because catheter penetration in the brain to the place of thrombosis through the femoral artery and delivery thrombolysis directly to the thrombus. Intraarterial selective thrombolysis is a rather complicated procedure that is carried out in stroke centers with modern equipment and round the clock access to angiography of cerebral vessels. This procedure is performed by patients with a severe form of acute cerebrovascular accident of the ischemic type within the time of the "therapeutic window" or with ischemia developed in the vertebrobasilar basin during the first 12 hours. Infusion of thrombolytics is carried out long enough, approximately up to two hours under the control of angiographic equipment.
Similarly, mechanical removal of the thrombus can be performed when it is captured by a special device inserted into the carotid artery and removed.
Prophylactic surgical procedures - carotid endarterectomy (removal of atherosclerotic formations) on the walls of the carotid artery, and also - stenting and angioplasty, as a result of which the lumen of the artery increases and the blood flow is activated. With atherosclerosis, such procedures reduce the risk of developing a second vascular accident of an ischemic type.
Rehabilitation after a second stroke
The main restoration of all the functions that were present in the patient before a repeated vascular accident occurs in the first two to three months - they are considered peak for neurologic recovery. At this time, half of the basic functions are restored, then by the end of the year - the second half. The evaluation of the quality of recovery includes indicators characterizing the return of self-service skills, motor and cognitive functions.
Often the consequence of the second stroke is a disorder of motor functions, so the activation of the post-stroke patient begins as soon as the patient's condition stabilizes. In general, the ability to move in paralyzed limbs is restored in the first six months.
The patient, who is still on bed rest, starts to activate for the prevention of muscular contracture in the joints of the paralyzed limbs - to do static exercises, i.e. Give the hands and feet positions that the patient himself is not yet able to take. For example, unbend the arm in the elbow joint, laying it on the chair, which is attached to the bed, while opening the wrist and maximally flexing the fingers. The leg is bent at the knee joint at an acute angle, the foot is bent. Fix the limbs in the desired position with rollers, pillows, towels, pouches with sand for at least two hours every day.
In addition passive gymnastics is carried out by paralyzed limbs. First, the exercises are performed by a specialist in curative physical education. At the same time there are close patients who have studied the sequence of exercises will continue to do them on their own after discharge. Passive gymnastics is supplemented by breathing exercises. Gradually, the pace and number of exercises are increasing.
Physical recovery of the post-stroke patient begins with giving it a semi-sitting position under the supervision of medical staff with pulse and blood pressure measurement, and assessing the subjective feelings of the patient who gradually learns to sit, then stand and move with support in the ward. The patient is supported from the paralyzed side, substituting the shoulder for the paretic limb. Then the patient begins to use the support of special devices - walkers. At the same time, they restore their everyday habits - they suggest taking items with a paralyzed hand, dressing themselves unaided, fastening, tying shoelaces and the like.
In addition to physiotherapy exercises, the patient is given a massage. It should be done by a specialist who is familiar with the peculiarities of carrying out this procedure to post-stroke patients, since lack of qualification can lead to complications after massage in the form of muscle spasms, contractures. With expressed spasms of the musculature, the patient is prescribed muscle relaxants whose treatment regimen is prescribed by the doctor in each specific case. Warn the occurrence of movement restrictions in the joint acupressure, physiotherapy procedures, acupuncture.
Special activating massage is also used with reduced muscle tone in paralyzed arms and legs, drugs are prescribed that activate muscle contractions, facial devices.
If relatives have the opportunity to place a post-stroke patient in a specialized rehabilitation center, then qualified specialists will quickly restore all the functions to be restored.
Speech disorders are most effectively corrected during systematic sessions with a speech therapist-aphasiologist. At first these sessions are short-lived, not more than a quarter of an hour. Over time, relatives can actively participate in the restoration of speech, writing, reading skills, dealing with the patient at home. Usually, the patient is assigned nootropics that help restore speech and other cognitive functions.
The diet should contain vegetable products, cereals, cereals, lean meat and fish. Oily, fried foods, smoked products, pickles, cakes, cakes, baked pastries should be excluded. Dishes nedosalivayut. The daily caloric content of the diet should be 2000-2500 kcal. Food is taken in small portions, 5-6 times a day.
A second stroke leads to the death of a significant number of neurons. Therefore, a full rehabilitation is very doubtful, in many cases, recovery takes a long time, requires modern and effective medicines, and the application of greater efforts by the medical staff, the patient and the people close to him. A huge role in this is played by the patient's positive attitude toward recovery.