Stroke is a vascular pathology of the brain. It occurs due to thrombosis or bleeding, which almost irreparably damages brain cells. The consequences of a stroke are neurological in nature. They can be different: paresis, paralysis, problems with speech, swallowing.

The nature of the symptoms and consequences depends on the location of the damage. After all, each area of ​​the brain is responsible for certain actions and the work of organs and systems. A stroke can happen anywhere in the brain. In this article, we will consider the features of vascular catastrophes and ways to restore the cerebellum.

For ease of understanding, the brain can be divided into 3 parts:

• The cerebral cortex - contains grooves and convolutions, is responsible for higher nervous activity (what distinguishes humans from other mammals).
• The cerebellum is responsible for movement, balance of the body in space, partially for vision.
• Brain stem - coordinates reflexes, mediates the transmission of impulses between different parts of the nervous system.

The main functions of the cerebellum are coordination of complex multicomponent movements. For example, walking. With the help of the cerebellum, a person, raising one leg to take a step, simultaneously pushes the trunk forward. In parallel, the muscles of the back are involved.

For damage to the cerebellum after a stroke, the lack of the necessary order in movements is characteristic. A person cannot follow several simple steps in succession to turn on one side in bed. Therefore, restoration is necessary.

The fact is that a person reflexively does not perform practically any movements. An example of a congenital motor reflex is sucking in newborns. All other activities, such as walking, speaking, writing, are acquired with life experience. The accuracy and coordination of such actions depends on the cerebellum.

According to statistics, the cerebellum is more often involved in a hemorrhagic stroke, a vessel ruptures and hemorrhage occurs in this part of the brain. However, ischemic episodes caused by thrombosis of the feeding arteries are also common.

Consider the most typical symptoms that manifest in patients after cerebellar stroke:

Symptoms may appear partially, the severity depends on the extent of the stroke and the timing of treatment initiation.

Therapy after circulatory disorders in the cerebellum depends on the cause of the stroke. As with other strokes, the earliest possible treatment is essential for full recovery. Optimally - 3–6 hours from the moment of illness.

Treatment principles:

• Fighting thrombosis after ischemic stroke. Perhaps this is by dissolving the thrombus that blocked the lumen of the artery with drugs - thrombolytics. The widespread use of the method of treatment is limited by the time frame and contraindications to the use of this group of drugs. Invasive removal of a blood clot from a vessel with a special catheter is possible. Indications for such an operation are determined only by the attending physician.
• Sometimes, after a hemorrhagic stroke of the cerebellum, the patient needs neurosurgical surgery. This is due to the large volume of intracerebral hematoma and compression of delicate structures. Removing it or stopping the ongoing intracerebral bleeding is possible only by an operative method.
• Drug therapy is aimed at preventing the formation of other blood clots, activating cerebral circulation after a stroke, and improving metabolism in nerve cells. Indications, drug treatment regimens are determined by a neurologist.

Recovery and rehabilitation after damage to the cerebellum is of paramount importance and should be started immediately after stabilization of the general condition. Patients, as a rule, find it very difficult psychologically to understand and accept problems with the motor sphere and coordination of movements. The task of the therapist is to choose the most effective classes. The effect does not come immediately, but a stubborn comprehensive recovery is sure to bear fruit.

The main groups of rehabilitation classes:

• Physical recovery - include kinesiotherapy (movement therapy), physiotherapy exercises. People who have completely lost their coordination of movements are gradually taught to live again, to perform simple movements, to sit or walk. Special devices are used, for example, verticalizers, exercise bikes.
• Classes with a speech therapist are necessary for speech disorders. It trains weakened pharyngeal muscles and facial muscles. Explains to patients how to pronounce certain sounds correctly.
• Physiotherapy and massage are an important part of the recovery program. The use of various currents, laser, magnet, acupuncture helps to send a large number of impulses to the brain. Training damaged nerve cells leads to their early recovery. The massage helps to relax toned muscles and stiff joints.
• Swallowing disorders require special attention. If they are not very pronounced, it is enough to follow a special diet, eat chopped semi-liquid foods, do not rush during the meal. In severe swallowing disorders, a tube is inserted into the stomach (thin soft plastic tube). Liquid food is administered to a person in this way. However, the probe is a temporary measure. If swallowing is not restored for a long time, a gastrostomy tube is installed. It is a tube on the surface of the abdominal wall that leads to the stomach. Semi-liquid food is introduced through it.
• Most stroke patients need counseling. Many people who are depressed do not find the strength for full-fledged recovery activities. Treatment sessions with a psychotherapist help to understand the disease and begin to fight it.

Circulatory disorders in the cerebellum have severe motor consequences. Only full-fledged rehabilitation and faith in recovery can help stroke victims overcome the disease.

Cerebellar stroke is a dangerous pathology caused by impaired blood supply. It is rare, however, complete recovery from this disease is possible only with proper drug treatment, timely rehabilitation. This type of stroke poses the greatest threat to the human body. Not only complete paralysis is possible, but also death.

The cerebellum is necessary to improve coordination, restore the optic nerve, and maintain the balance of the body in space. With a stroke, the main functions of the organ suffer, which disrupts human activity. The cerebellum is located in the occipital lobe and consists of two hemispheres. In case of a violation of the blood supply to its part, there may be an insufficient supply of oxygen to the brain, multiple hemorrhages.

Ischemic stroke. Appears when a large blood clot forms inside a vessel. Initially, a blood clot looks like a small growth, but if it grows strongly, it can break off, affecting important arteries or veins that feed the cerebellum. When the blood vessels are blocked, nutrients and oxygen are supplied in insufficient quantities or are completely blocked, which affects the functions of a certain part of the brain.

If patients suffer from atherosclerosis for a long time, blood clots may appear in the bed of the cerebellar artery, which is a rather rare pathology. In this case, damage to the organ is largely possible with an increase in pressure.

Hemorrhagic cerebellar stroke occurs when there are disorders in the structure of the blood vessels. In most cases, patients suffer from rupture of small capillaries, aneurysms of the arteries located near this organ.

There is a large list of symptoms that can determine the onset of the development of a cerebellar stroke:

1. Coordination disorders associated with the development of ataxia.
2. Inability to stand for a long time without support.
3. Weakness in the arms and legs.
4. Pain in the back of the head.
5. In some cases, patients cannot swallow properly.
6. The effect of dryness in the mouth.
7. Speech disorders.
8. Uncontrolled movement of icons.
9. Loss of hearing and other important functions of the body.

There are factors leading to cerebellar stroke.

Pathologies in the patient's body:

1. Sharp jumps in blood pressure that are not controlled by drugs.
2. Strong increase in cholesterol and blood sugar levels.
3. Signs of atherosclerosis.
4. Diseases leading to the development of pathologies in the structure of the myocardium.
5. Instability of metabolic processes.

Wrong way of life:

1. Unbalanced diet.
2. Taking narcotic drugs, other bad habits.
3. Physical inactivity due to a sedentary lifestyle and factors that contribute to insufficient physical activity.
4. The constant influence of stress on the body.
5. Hormone therapy.

General health:

1. History of hemorrhages.
2. Heart attacks in the past.
3. Ischemia.
4. Elderly age.
5. Pathologies associated with blood clotting.

When cerebellar stroke begins to appear, a number of important steps must be taken:

1. To stop a headache attack, pills are needed to prevent vasospasm. If symptoms of impaired swallowing function are pronounced, anti-inflammatory drugs are administered intravenously.
2. A guarantee of complete rest. Move the patient to a horizontal position, oxygen must be available in the room.
3. Ensure that the limbs are correctly fixed, do not forget to call the ambulance.

Initially, doctors perform diagnostic measures in order to accurately determine the features of the patient's vascular condition. Further, rehabilitation measures are carried out.

Emergency medical care consists of the following methods:

1. Destruction of blood clots.
2. Procedures required to reduce blood density.
3. Emergency elimination of bleeding.

Various medications are used to restore the body after a stroke. First of all, they try to eliminate blood clots from the structure of the vessels, which are responsible for optimal nutrition of the cerebellum and other parts of the brain. They use the means necessary for thinning the blood, in which the pressure level can be stabilized at the same time. These drugs are used not only for adults but also for children.

If the patient has undergone a hemorrhagic stroke, it is necessary to normalize blood density, as well as restore the work of nerve fibers. Often, doctors prescribe reflexology, which involves the use of a point effect on areas in which violations are noticeable. It is possible to restore tissue trophism, increase motor activity. If the patient does not have any reflexes, acupuncture helps to restore and normalize motor function. Also, during rehabilitation, massage is used, in which the prevention of blood clots is performed. If the patient does not have the opportunity to rise on his own, he must be regularly turned over so that bedsores do not form.

Drugs prescribed for the diagnosis of ischemic stroke:

1. Thrombolytics, which determine the likelihood of new blood clots forming.
2. Preparations required to stabilize the consistency of the blood.
3. Medicines to minimize pressure surges.
4. Medicines that support the work of the cardiovascular system.

Medications required for the treatment of hemorrhagic stroke:

1. Medicines that ensure timely blood clotting.
2. Neuroprotective agents that promote the restoration of nerve cells in the event of their destruction.
3. Funds required to normalize blood pressure indicators.

When a cerebellar stroke is detected, surgical intervention is often indicated. During a surgical operation, the consequences of a stroke can be eliminated. The blood flow is redirected through the affected vessel, if necessary, the thrombus is removed, if necessary, the lipid layer is removed if it accumulates excessively on the walls of the arteries.

To ensure an optimal blood supply to the cerebellum, angioplasty is performed. An increase in the lumen of the vessel is made, which has become narrower due to the development of atherosclerosis. In some cases, stenting is performed, in which a stent is placed in the most narrowed part of the vessel, which ensures uninterrupted blood flow to the affected part of the brain.

With a hemorrhagic stroke, surgery involves craniotomy. It is necessary to resect the foci of pathology, eliminate the signs of aneurysm, so that bleeding in the affected area can be completely stopped.

Possible complications, long-term disorders appear depending on the degree of damage to the cerebellum. In some cases, patients lose the ability to complete physical activity. Sometimes patients are unable to accurately coordinate their movements, have problems when trying to sit on a chair.

After a stroke, patients acquire a characteristic unstable gait, since the cerebellum is responsible for the ability to control coordination of movements. When undergoing rehabilitation, patients experience various disorders, pathologies in the work of individual muscles or their groups are possible. If the hemorrhage occurs in the left hemisphere of the cerebellum, speech impairment is possible.

After a stroke, the risk of developing cerebral edema, disruption of the functioning of the heart and its parts increases. If such violations occur, it is necessary to provide emergency assistance under the supervision of a physician. The most common complications are thromboembolism, pneumonia, and various cardiac pathologies.

If the patient managed to avoid the most dangerous complications in the acute stage of stroke, problems may occur that can greatly affect the quality of life. This is a violation of coordination, paresis, speech pathology, which develop a few months after first aid, can last more than 2 years. If it was not possible to return physical activity in the first year of rehabilitation, it will become even more difficult to restore it in the future.

To prevent an ischemic stroke of the cerebellum from occurring suddenly, it is necessary to regularly measure blood pressure indicators. To restore the optimal state of the body, you should lead a healthy lifestyle, use the drug therapy prescribed by the doctor, which is necessary to restore pressure. Also pay attention to the level of cholesterol in the blood, as when it rises, the formation of atherosclerotic plaques is possible. To stabilize the performance of organs and systems, one should lead an active lifestyle, devote time to sports, give up dangerous and bad habits.

To quickly recover from a cerebellar stroke, you must promptly seek medical help, as well as undergo a course of rehabilitation measures. After being discharged from the hospital, people recover their health by seeking help from specialists, for example, a speech therapist, a fitness trainer. To restore the body after a stroke or prevent the onset of this disease, it is necessary to devote time to a correct lifestyle, to eliminate disorders and diseases that are predisposing factors to the occurrence of hemorrhages.

Cerebellar stroke occurs less frequently than other forms of cerebrovascular pathology, but presents a significant problem due to insufficient knowledge and difficulties in diagnosis. The proximity of the location of the brain stem and vital nerve centers make this localization of strokes very dangerous and requiring fast qualified assistance.

Acute circulatory disorders in the cerebellum are infarctions (necrosis) or hemorrhages, which have similar mechanisms of development with other forms of intracerebral strokes, so the risk factors and main causes will be the same. Pathology occurs in middle-aged and elderly people, more often found among men.

Cerebellar infarction accounts for about 1.5% of all intracerebral necrosis, while hemorrhages account for a tenth of all hematomas. Among the strokes of cerebellar localization, about ¾ falls on heart attacks. The mortality rate is high and in other cases exceeds 30%.

The cerebellum, as one of the parts of the brain, needs good blood flow, which is provided by the vertebral arteries and their branches. The functions of this part of the nervous system are reduced to coordinating movements, ensuring fine motor skills, balance, writing ability and correct orientation in space.

In the cerebellum, the following are possible:

• Heart attack (necrosis);
• Hemorrhage (hematoma formation).

Violation of blood flow through the vessels of the cerebellum entails either blockage, which happens much more often, or rupture, then the result will be a hematoma. The peculiarities of the latter are not considered to be the soaking of blood in the nervous tissue, but an increase in the volume of convolutions that push apart the cerebellar parenchyma. However, one should not think that such a development of events is less dangerous than brain hematomas, which destroy an entire area. It must be remembered that even if some of the neurons are preserved, an increase in the volume of tissue in the posterior cranial fossa can lead to death due to compression of the brain stem. Often it is this mechanism that becomes decisive in the prognosis and outcome of the disease.

types of strokes

Ischemic cerebellar stroke, or heart attack, occurs due to thrombosis or embolism of the vessels feeding the organ. Embolism is most common in patients with heart disease. So, there is a high risk of clogging of the cerebellar arteries by thromboembolism in atrial fibrillation, recent or acute myocardial infarction. Intracardiac blood clots with the flow of arterial blood enter the vessels of the brain and cause their blockage.

Thrombosis of the cerebellar arteries is most often associated with atherosclerosis, when there is an overgrowth of fatty deposits with a high probability of plaque rupture. With arterial hypertension during a crisis, so-called fibrinoid necrosis of the arterial walls is possible, which are also fraught with thrombosis.

Cerebellar hemorrhage although it is less common for a heart attack, it brings more problems due to tissue displacement and compression of the surrounding structures with excess blood. Usually, hematomas occur due to the fault of arterial hypertension, when, against the background of high pressure figures, the vessel “bursts” and blood rushes into the cerebellar parenchyma.

Among other reasons, arteriovenous malformations, aneurysms that form during the period of intrauterine development and remain unnoticed for a long time, since they are asymptomatic, are possible. There have been cases of cerebellar stroke in younger patients associated with dissection of a portion of the vertebral artery.

The main risk factors for cerebellar strokes are also highlighted:

1. Diabetes;
2. Arterial hypertension;
3. Lipid spectrum disorders;
4. Old age and male sex;
5. Physical inactivity, obesity, metabolic disorders;
6. Congenital pathology of the vascular walls;
7. Vasculitis;
8. Pathology of hemostasis;
9. Heart disease with a high risk of blood clots (heart attack, endocarditis, prosthetic valve).

The manifestations of a cerebellar stroke depend on its scale, therefore, the clinic distinguishes:

• Extensive stroke;
• Isolated in the area of ​​a specific artery.

An isolated stroke of the cerebellar hemisphere, when the blood supply from the posterior inferior cerebellar artery is affected, is manifested by a complex of vestibular disorders, the most common of which is dizziness. In addition, patients experience pain in the occipital region, complain of nausea and gait disturbance, speech suffers.

Heart attacks in the area of ​​the anterior inferior cerebellar artery are also accompanied by disorders of coordination and gait, fine motor skills, speech, but hearing impairment appears among the symptoms. With damage to the right cerebellar hemisphere, hearing is impaired on the right, with left-sided localization - on the left.

If the superior cerebellar artery is affected, then coordination disorders will prevail among the symptoms, it is difficult for the patient to maintain balance and perform precise targeted movements, gait changes, dizziness and nausea worries, difficulties in pronunciation of sounds and words arise.

With a large focus of damage to the nervous tissue, a bright symptomatology of disorders of coordination and motor skills immediately prompts the doctor to think about a cerebellar stroke, but it happens that the patient is only worried about dizziness, and then the diagnosis includes labyrinthitis or other diseases of the vestibular apparatus of the inner ear, which means that the correct treatment will not be started on time. With very small foci of necrosis, the clinic may not be at all, since the functions of the organ are quickly restored, but about a quarter of cases of extensive heart attacks are preceded by transient changes or "small" strokes.

Major stroke affecting the right or left hemisphere is considered an extremely serious pathology with a high risk of death. It is observed in the area of ​​blood supply to the superior cerebellar artery or the posterior inferior artery when the lumen of the vertebral artery is closed. Since the cerebellum is equipped with a good network of collaterals, and all three of its main arteries are connected with each other, then isolated cerebellar symptoms almost never arise, and stem and cerebral symptoms are added to it.

Extensive cerebellar stroke is accompanied by an acute onset with cerebral symptoms (headache, nausea, vomiting), disorders of coordination and motor skills, speech, balance, in some cases there are respiratory and cardiac disorders, swallowing due to damage to the brain stem.

If a third or more of the volume of the cerebellar hemispheres is damaged, the course of a stroke can become malignant, which is due to severe edema of the necrosis zone. The increased volume of tissue in the posterior cranial fossa leads to compression of the CSF circulation pathways, acute hydrocephalus occurs, and then - compression of the brain stem and death of the patient. The probability of death reaches 80% with conservative therapy, so this form of stroke requires an urgent neurosurgical operation, but in this case, a third of patients die.

It often happens that after a short-term improvement, the patient's condition again becomes severe, focal and cerebral symptoms increase, body temperature rises, coma is possible, which is associated with an increase in the focus of cerebellar tissue necrosis and involvement of the brain stem structures. The prognosis is unfavorable, even with surgical assistance.

Treatment of cerebellar stroke involves general measures and targeted therapy for ischemic or hemorrhagic damage.

Common activities include:

• Maintenance of breathing and, if necessary, artificial ventilation of the lungs;
• Antihypertensive therapy with beta-blockers (labetalol, propranolol), ACE inhibitors (captopril, enalapril) is indicated for hypertensive patients, the recommended BP is 180/100 mm Hg. Art., since a decrease in pressure can cause a deficiency of blood flow in the brain;
• Hypotensive patients need infusion therapy (sodium chloride solution, albumin, etc.), it is possible to administer vasopressor drugs - dopamine, mezaton, norepinephrine;
• For fever, paracetamol, diclofenac, magnesia are indicated;
• To combat cerebral edema, diuretics are needed - mannitol, furosemide, glycerol;
• Anticonvulsant therapy includes relanium, sodium oxybutyrate, with the ineffectiveness of which the anesthesiologist is forced to enter the patient into anesthesia with nitrous oxide, sometimes muscle relaxants are required for severe and prolonged convulsive syndrome;
• Psychomotor agitation requires the appointment of relanium, fentanyl, droperidol (especially if the patient needs to be transported).

Simultaneously with drug therapy, nutrition is being established, which in the case of severe strokes is more expedient to be carried out through a probe, which allows not only to provide the patient with the necessary nutrients, but also to avoid food entering the respiratory tract. Antibiotics are indicated at risk of infectious complications. The clinic staff monitors the condition of the skin and prevents bedsores.

Specific therapy for ischemic strokes is aimed at restoring blood flow with the help of anticoagulants, thrombolytics and by surgical removal of blood clots from an artery. For thrombolysis, urokinase, alteplase are used; among antiplatelet agents, acetylsalicylic acid (thromboASC, cardiomagnyl) is the most popular, the anticoagulants used are fraxiparin, heparin, sulodexide.

Antiplatelet and anticoagulant therapy contribute not only to the restoration of blood flow through the affected vessel, but also to the prevention of subsequent strokes, therefore, some drugs are prescribed for a long time. Thrombolytic therapy is indicated at the earliest possible date from the moment of vessel occlusion, then its effect will be maximal.

In case of hemorrhages, the above drugs cannot be administered, since they will only increase bleeding, and specific therapy implies maintaining acceptable blood pressure figures and prescribing neuroprotective therapy.

It is difficult to imagine a stroke treatment without neuroprotective and vascular components. Patients are prescribed nootropil, cavinton, cinnarizine, aminophylline, cerebrolysin, glycine, emoxipin and many other drugs, vitamins of group B are shown.

Surgical treatment and its effectiveness continue to be debated. There is no doubt the need for decompression in case of the threat of dislocation syndrome with compression of the brainstem. With extensive necrosis, trepanation and removal of necrotic masses from the posterior cranial fossa are performed, with hematomas, blood clots are removed both during open operations and by means of endoscopic technology, it is also possible to drain the ventricles when blood accumulates in them. To remove blood clots from the vessels, intra-arterial interventions are performed, and to ensure blood flow in the future, stenting is performed.

Recovery after a cerebellar stroke should be started as early as possible, that is, when the patient's condition stabilizes, there will be no threat of cerebellar edema and repeated necrosis. It includes medication, physiotherapy, massage, and special exercises. In many cases, patients need the help of a psychologist or psychotherapist, support from family and loved ones is important.

The recovery period requires diligence, patience and effort, because it can take months and years, but some patients manage to regain their lost abilities even after several years. To train fine motor skills, exercises such as tying a lace, knotting threads, rotating small balls with your fingers, crocheting or knitting can be helpful.

The consequences of cerebellar strokes are very serious. In the first week after a stroke, there is a high probability of cerebral edema and dislocation of its parts, which most often causes early death and determines a poor prognosis. In the first month, among the complications are thromboembolism of the pulmonary vessels, pneumonia, and cardiac pathology.

If it is possible to avoid the most dangerous consequences in the acute phase of a stroke, then most patients are faced with such problems as persistent impairment of coordination, paresis, paralysis, speech disorders, which can persist for years. In rare cases, speech is still restored within several years, but the motor function, which could not be restored in the first year of the disease, most likely will not recover.

Rehabilitation after cerebellar strokes includes not only taking medications that improve the trophism of nervous tissue and repair processes, but also exercise therapy, massage, and speech training classes. It is good if there is an opportunity for the constant participation of competent specialists, and even better if the rehabilitation is carried out in a special center or sanatorium, where experienced personnel work and there is the appropriate equipment.

Cerebellar stroke is a very dangerous type of brain stroke. It can lead to paralysis or even death of the patient as a result of a malfunction of the circulatory system.

It is the cerebellum that is the department responsible for the coordination of human movements, therefore, its defeat almost always affects the physical activity of the patient.

There are two types of cerebellar stroke:

• Ischemic cerebellar stroke.
• Hemorrhagic stroke.

The most common form of cerebellar stroke is ischemic stroke... According to experts, the main cause of this disease is blood clots in blood vessels. A thrombus that has torn off the wall reaches the cerebellum of the brain, where it blocks the access of oxygen to this area. The result is the death of cerebellar tissue and the loss of its functionality.

Among other causes of this disease, one can single out sharp drops in blood pressure. They can also cause the cerebellum to malfunction.

If we talk about the causes of hemorrhagic stroke, then here, first of all, experts call mechanical damage to the blood vessels of the brain. These can be capillary ruptures and aneurysms that are near the arteries.

It is important to note that the symptoms of cerebellar stroke appear suddenly and acutely, which makes it possible to recognize this disease rather quickly. These include:

• Tremor of the limbs or even the entire trunk.
• Very severe headache.
• Movement coordination disorder.
• Nausea or vomiting
• Dryness of the oral mucosa.
• Slurred and meaningless speech, sometimes with permutation of letters and syllables.
• Hearing impairment.
• Chaotic eye movement.
• Loss of consciousness.

Important! When these symptoms appear in a patient you must immediately consult a doctor for help... Brain tissue dies off very quickly, so it is imperative not to waste time.

If there is a question about first aid to a patient with a stroke, then first of all it is necessary to remove the headache and relieve the spasm with the help of analgesics and anti-spasm drugs. In the case when the patient is unable to take the pills, the drugs are administered intravenously.

Further, the patient must be placed horizontally and provide access to fresh air in the room where he is located. It is recommended to give the person water and try by all means to keep him conscious until the arrival of the specialists. It will also be useful to fix the limbs to keep them at rest.

Neuropathologists argue that there are risk factors that accelerate the onset of stroke. These include:

• The presence of atherosclerosis.
• Frequent drops in blood pressure.
• Increased blood sugar.
• Increased blood cholesterol levels.
• Diseases of the heart muscle.
• Alcohol addiction.
• Constant stressful situations.
• Addiction.
• The use of hormonal drugs.
• Previously transferred heart attacks.
• Age over 60.
• Ischemic disease.

With this type of stroke, as a rule, there is a noticeable impairment of coordination of movement. The consequences can be slightly mitigated if treatment is started on time. With proper and timely treatment in combination with the recovery process, long-term and severe consequences can be avoided. But nevertheless, it is worth noting that, unfortunately, it is impossible to completely return the lost functions after such a disease.

Often in the case of cerebellar stroke muscle tone is disturbed, it is very difficult for the patient to keep his body in balance. Patients are characterized by a gait in which their body sways from side to side.

The body's motor function must be restored with the help of occupational therapy and physiotherapy. These activities are aimed at ensuring that the patient can take care of himself and perform basic daily tasks. Speech therapy or classes with a speech therapist can be helpful to improve speech and swallowing functions, which are often affected by stroke.

Many patients need serious psychological adjustment after an illness. In this case, psychological therapy is simply necessary.

In any case, a complex of restorative procedures should be developed only by the attending physician, taking into account all the individual characteristics of the patient's body.

Many people wonder whether it is possible to avoid a cerebral stroke? Of course, it is absolutely impossible to exclude the possibility of the development of pathology, but you can try to minimize the risk. What do you need to do?

• First of all, you need to constantly monitor blood pressure in order to avoid sudden changes in it.
• Try to lead a healthy lifestyle, including proper nutrition and avoiding bad habits.
• Periodically get tested for cholesterol in order to control its level.
• Play sports regularly and lead an active life.
• Get an MRI scan of the brain once a year.
• If possible, visit health resorts every year.
• Monitor your weight so that obesity does not develop.
• Control chronic diseases, if any.

So, cerebellar stroke is, without a doubt, a very serious disease. But you should not despair in any case... For the patient, the positive attitude of others and the care of relatives and friends are very important. But excitement and stress are absolutely contraindicated. If you follow all the recommendations of doctors, you can eventually return to normal life. The main thing is not to lose heart and not lose heart. Be healthy!

Impaired motor function is one of the most common consequences of a cerebral stroke. It manifests itself in the form of paralysis of one or both legs, sometimes they lose their functions and arms. This most often occurs with an ischemic stroke that occurs in the right side of the brain. When the patient receives first aid, normalizes blood circulation and is discharged from the hospital, he will need long-term rehabilitation. The most difficult thing to do after a stroke is to restore walking. it will be very difficult to achieve the result, and it will not be possible to cope without outside help at all.

Impaired motor function

Paralysis of the lower extremities in ischemic stroke is observed in 80% of cases. Also, the legs can be paralyzed with hemorrhagic hemorrhage, but most often it disrupts the functioning of only one leg. Such consequences are explained by the fact that after a failure of blood circulation, the parts of the brain that respond to movement remain without power. At the same time, all the impulses that the brain sends to the limbs cannot reach the goal. The result is the inability to control some or all of the muscles.

How violations can manifest themselves:

• The gait becomes very wobbly, the person can swing to the sides;
• The leg does not straighten or bend;
• When moving, the injured leg describes a semicircle, reminiscent of the turn of a compass;
• A person stands on tiptoes, it is difficult for him to hold on to his entire foot.

Restoring contact between the brain and muscles, learning to walk, restoring the ability to control the legs are the main tasks for the rehabilitation period. This can take a lot of time and patience. In most cases, it takes 3 to 4 months to restore motor function. Sometimes this period can last even longer, because everything is hampered by the patient's fear of not achieving results, lack of motivation and decreased cognitive functions.

- a very strong blow not only to the body, but also to the psyche. Therefore, the patient's support is very important. Their task will be to provide comfortable conditions for the rehabilitation of the victim. It is important to try to rid him of his fear, to convince him that there is no need to be afraid, to constantly communicate with him and help in everything.

Movement impairment can occur even if the stroke has affected the spinal cord rather than the brain.

Occupational safety

It is impossible to sharply restore motor function. Everything should happen gradually, the patient should be monitored in order to help in a timely manner, if necessary. But even with the right approach to rehabilitation, it can be extremely difficult to achieve a positive result. It is very important to follow a number of simple rules:

1. Warming up muscles. Before any exercise, the muscles should be warmed up so that they work better and are not damaged.
2. Help from loved ones. During any physical activity of the patient, close people should be nearby who will help if he falls or gets injured.
3. Safe conditions. Attempts to walk should only be started in a room where the patient is not injured when falling and does not stumble over any things.
4. Exit to the street. You can transfer your walking workouts to the street only in good weather. If it is hot, cold or very windy, the patient will feel bad.
5. The right shoes. The feet should be worn in shoes that are high and close to the skin, while being light, comfortable and easy to put on.

It is equally important to dose the load. You should not go for a long walk without good preparation. It is recommended to always start small. In this case, you need to give the body to recuperate, and not start training immediately after leaving the hospital.

Almost everyone after a stroke while walking shakes on different sides. To get rid of this problem, you need to strengthen the muscles of the lower extremities. This can be partially achieved with the help of simple gymnastics, but the main recovery will occur in the process of re-learning to walk. For a while, while a person is unstable, you should use a special support. 3 options will do:

1. Cane. A familiar attribute for older people can help out all those who have suffered a stroke. Using a cane, you can make your walking workouts safer and more effective. The advantage of this option is its low cost and simplicity.
2. Walkers. A special vehicle will create support from both sides at once. There are several types of walkers, which allows you to choose the most suitable option. The main advantage of this method is the increased safety for the patient.
3. Crutches. This is a very safe option, but the least effective. It will not be possible to achieve a quick recovery of motor function with crutches, because their use interferes with walking training.

You can try to train even without support, but then physical support from other people will be very important. If it is not there, then the patient will fall, which can not only cause pain, but also throw the result back several stages, while a complete loss of motivation will be possible.

Passive gymnastics

The restoration of walking should begin with passive gymnastics. It is carried out with the help of a rehabilitation physician or a loved one who is familiar with this technique. Movements must be performed in all joints of the legs. Classes are very simple: the patient lies, and the rehabilitation therapist takes him by the limbs and performs certain movements.

Workouts can include:

1. Circular rotations in the joints 5 times each. After execution, they should be repeated in the opposite direction.
2. Stretching all joints. It is necessary to stretch out all the joints one by one, and then press it back with a slight movement. Repeated several times.
3. Flexion and extension of each joint. Bend and unbend each of them at least 7 times.

Such exercises are repeated not so long - about a week. They can be supplemented with an unusual method. It consists in the fact that a special loop is hung over the patient's bed, where he must stick his leg, catching his foot. The therapist will slowly swing the patient's leg. When a person's motor functions begin to recover, he can swing the limb on his own.

Gradually, the restoration of the leg after a stroke should be transferred from passive to active gymnastics, but a kind of preparation will be needed. The patient will need to show willpower and mentally try to achieve mobility of the limbs. You can achieve this goal using 2 methods:

1. Mental sending of impulses. The patient should imagine the movement with a paralyzed leg, then reproduce it with a healthy one, if only one has suffered, and then try to mentally transfer the received sensation to the first limb. Such impulses need to be sent multiple times.
2. Motivation from the outside. A rehabilitation therapist or a loved one should constantly talk with the patient, trying to motivate him to active movements. You need to ask him to help move the limbs, to convince that everything will work out soon, and also to praise for any successes achieved.

When he succeeds in performing the movements, you need to immediately move on to active gymnastics, which will lead to a speedy recovery and learning to walk.

Active gymnastics

The first active exercises should be performed in a supine position. They help to restore all the basic skills of limb movement, and in parallel with this, gymnastics will improve blood circulation. It is important to monitor the load so as not to overexert the weakened body. If the patient becomes hard, then you need to stop all training and give him a rest.

There are many different exercises you can do while lying down. A rehabilitation therapist or a loved one should make sure that all movements are correct and that the muscles are fully functional. The gymnastic complex for bedridden patients includes the following exercise options:

1. The direction of the feet to the outside and inside. This should be done with the legs bent at the knees, and the soles must be pressed against the bed surface.
2. Bending the knees. When bending, the foot should move along the bed. Can be supplemented with similar hand movements. First, you should train the right limbs, and only then the left.
3. Heel movement. You need to lie down straight, hold the feet of one leg along the front of the lower leg of the other. Then it should be repeated for the second limb.
4. Reverse leg curls. The person lies on his stomach and begins to slowly bend his legs at the knee joint, repeating the movement several times.
5. Raising and spreading the legs. First, you need to raise your legs up, slowly spread them in different directions, and then return to the starting position.
6. Raising the pelvis. You need to bend your knees, and then slowly raise your pelvis up. This should not be done too hard so as not to injure the joints and spine. Movements should be smooth and careful.
7. Raising the leg on the side. The patient lies on his side, begins to slowly raise and lower the upper leg. After several repetitions, do the same on the other side.
8. Throwing legs. You should bend your knees, resting your feet on the bed. The goal will be to throw one leg over the other. You need to perform the exercise alternately for both legs. If it seems difficult, then the leg can be thrown only up to the knee, fixing it on it and slowly moving it to the side.
9. Rolling over to the other side. It is done by bending the knee joints, throwing the bent legs to the side and independently turning the body in a given direction.
10. Pedaling. The well-known exercise "bicycle" requires raising the legs bent at the knees and slowly rotating them in such a way as if a person pedals on a bicycle. It is important not to overdo it, because quick movements can damage weak joints.

When the patient can perform these actions easily enough, you need to move on to the next stage. It consists of trying to get to your feet in order to move on to walking recovery exercises after a stroke.

When the patient learns to sit without assistance, the rehabilitation process can be considered successful. The main task then becomes the development of this skill and long-term retention of the position. Therefore, it is required to teach him to stay sitting for a long time. To do this, you need to help the person to sit up by lifting his hands. His feet must definitely touch the floor and be slightly parted. The body is tilted slightly forward to maintain position due to the center of gravity.

If a person can already sit, then it is worth moving on to full-fledged exercises that will strengthen this skill. All of them are performed at home. The most effective ones are:

1. Head rotation. It is required to perform circular movements of the head, capturing several cervical vertebrae with it (up to 7). Additionally, you should tilt it forward. The exercise is repeated up to 10 times.
2. Holding a position. You need to sit on the bed and hold your hands on a hard, reliable surface, gently arching your back. The exercise takes only a few seconds, but requires 10-15 repetitions.
3. Separation of the legs from the floor. The patient should sit on the bed and raise his feet 40 cm so that they do not touch the floor surface. It is required to hold out in this position for about 10 seconds. Repeat the exercise 10-20 times.

Additionally, you can alternately pull your legs to your chest while lying on your back to prepare your joints for future stress. After completing all the therapeutic exercises, you should try to learn to get up. It will be very difficult, but it will be possible to achieve results if you try hard and believe in yourself. It is the attempts to get up that are the main method to restore walking after a stroke. There are 2 training options in total:

1. Lifting. With the help of a rehabilitation therapist, the patient should rise a little while remaining on the bed. Gradually, the ascent level should be increased.
2. Movements on the bed. The patient needs to sit on the edge of the bed, and then slowly move from the top to the bottom, rearranging his legs on the floor.

When you can get up fully, you can move on to walking. The last stage will be the most difficult, so loved ones should show increased attention and care in relation to the sick person.

During exercises with lifting to his feet, there should be no solid objects near the patient, about which he could hit hard in the event of a fall.

Begin to walk very carefully. Almost everyone's first attempts to start walking end in falling to the floor. Therefore, the patient must first be physically supported to avoid accidental injury. It is important to consider that teaching walking will be very difficult and this stage can take a huge amount of time.

The rehabilitation therapist must ensure that the patient walks correctly. If this is not done, then it will be difficult to retrain, and the effectiveness of all classes will drop significantly. You need to monitor the implementation of the following points:

1. Legs rest on the heel. In most cases, people after a stroke stand on their toes, which should be avoided at all costs.
2. The feet move straight forward. Many patients rearrange their legs, describing a semicircle with their feet, which should not be in the learning process.
3. The knee is bent before placing the foot on the heel. If the patient leaves the leg straight, then attention should be paid to this and his mistake should be corrected.

You need to think about how to restore the leg only after memorizing the listed rules. When the patient is familiar with them, you can proceed to the first exercises in order to restore the ability to walk fully. Among them:

1. Trampling. You need to slowly transfer the weight from one leg to the other, and then back. You need to repeat such movements many times in a row. At first, the feet should be lifted off the floor only slightly, but later they should be lifted completely.
2. Rolls. You should stand up straight, keeping your feet together, and start rolling your weight from heels to toes, and then back. These rolls should be performed within a few minutes.
3. Stepping over. Any object should be placed in front of the patient. A pen or pencil will work for you, but then you should put in larger items. Its task is to step over the placed item.

If you can do the exercises without any problems, you should switch to normal walking. First you need to learn how to walk around the apartment. All steps should be small and careful, while limiting your speed.

A little later, you can move to the street. The patient must be accompanied by another person who can help if necessary. First, you need to take short walks, walk to the store or the nearest park, try to walk along the drawn line and rise alternately with both feet on the curb. Later, you can move on to training by walking up the stairs, and it is best to walk along it sideways.

Sports Techniques

When the anti-paralysis medications are used, you can move on to more advanced training. This will be helped by light sports, which is perfectly combined with rehabilitation after many diseases that impair motor functions.

The first option to help you regain the ability to walk easily is to use a treadmill. From it you can get benefits not only for the return of motor functions, but also for health in general. If you are not careful, there is a risk of harm. too active exercises will lead to increased blood circulation and increased pressure, which is categorically contraindicated after a stroke. The following rules must be followed:

1. Increase the speed gradually, taking into account your capabilities. Start only with a slow walk.
2. Hold on to the handrails while exercising. This will allow you not to fall in the event of an unforeseen violation of the movement of one of the legs.
3. Monitor your pulse. To do this, you can use a special sports bracelet or get readings from a sensor built into the simulator.

Additionally, you can use a special leg trainer. Do not choose too large weights, because it will harm joints and muscles. It is also not recommended to get carried away and perform too many approaches.

Nordic walking after a stroke is the second option for sports recovery. This is a unique way to achieve the desired results without serious risk. Because all trainings are carried out using poles for support, it will be very easy for a patient who has suffered a stroke. This walking is good for the heart, blood vessels, muscles and joints. A number of rules apply to it:

1. Do not exercise if the weather is very hot outside. Also, do not go to practice in the rain or heavy snow.
2. Start walking slowly. This is necessary in order to achieve the most correct walking technique.
3. Choose the right clothes. After a stroke, dress only for the weather, avoiding hypothermia or overheating.

After the full return of motor function, you can move on to heavier loads on the legs. Even then, care should be taken to avoid injury.

Additionally, you can use the services of a massage therapist. The massage will help restore blood circulation in the legs and increase muscle tone, which will have a positive effect on the effectiveness of training.

Is it difficult to achieve the result

Restoring walking after a stroke at home is a complex process that requires not only a lot of effort, but also a lot of time. Only 20% of victims are able to achieve a good result, who are trying to treat a stroke and all its consequences. Still, don't give up. Only hard work will help restore motor function.

Ataxia is a type of movement disorder that occurs in stroke patients. This is a collective concept that includes several types of violations of coordination of movements. In clinical practice, cerebellar ataxia is most common, the cause of which is impaired blood circulation in the cerebellum. According to statistics, cerebellar stroke is not so common - about 10% of cases.

However, more than half of the episodes of this type of stroke are fatal, and a very large percentage of the loss of working capacity is recorded among the survivors.

Ataxia is a lack of coordination of movements and motor skills

Classification of ataxia

Normally, coordination of movements is regulated by the following parts of the brain:

• medulla oblongata and midbrain;
• cerebellum;
• vestibular apparatus;
• the frontotemporal cortex of the cerebral hemispheres.

In the back of the brain stem, the Gaul and Burdach bundles pass. They are responsible for deep muscle sensitivity. The main task of the cerebellum is to supplement and coordinate the work of the motor centers. Thanks to him, the movements become smooth, clear and proportionate. The cerebellar worm maintains normal muscle tone and balance. Thanks to the coordinated activity of the vestibular nuclei, balance is maintained during movements. The frontal cortex is responsible for voluntary movement.

It is difficult to say which of these departments is the most important in the coordination of movements. All of them are connected by numerous synaptic connections, which ensure normal motor activity. Depending on where the stroke occurred, clinicians distinguish between the following types of coordination disorders, or ataxias:

• sensitive;
• cerebellar;
• vestibular;
• cortical.

Sensitive ataxia

This type of ataxia develops after a stroke in the posterior columns of the spinal cord, the thalamus. It can manifest in both limbs, one arm, or one leg. This type of movement disorder is characterized by a loss of proprioceptive sensitivity. The patient cannot assess the position of his own body parts. There is a so-called stamping gait - the patient bends his legs excessively and steps very hard on the floor. Often complains of the sensation of walking on a soft carpet. The victim constantly looks at his feet, thus trying to alleviate the pathological symptoms. When the eyes are closed, the manifestations of ataxia intensify.

Cerebellar ataxia

It develops after a cerebellar stroke. There is unsteadiness when walking. The patient deviates towards the lesion, in severe cases falls. If the cerebellar vermis is affected, the fall is possible in any direction and back. Walking is wobbly, with legs wide apart. Walking with a side step is impossible or severely impaired. Hand movements are disproportionate, slowed down. The arm and leg are more affected from the side of the lesion. Speech slows down, becomes stretched, chanted. Unlike aphasias, where speech disorders are based on the death of neurons in the cortical centers, in patients after cerebellar stroke, coordination of movements is impaired. The handwriting is changing - the letters become sweeping, large.

Distinctive features of the gait of a patient with ataxia

Vestibular ataxia

Vestibular ataxia occurs with movement, sitting or standing. Symptoms are aggravated by turning the head, trunk, eyes. The person refuses to perform these movements, replaces them with others, or performs at a slow pace. Thanks to visual control, it is possible to significantly compensate for coordination disorders. With unilateral damage to the vestibular nuclei, unsteadiness and deviations of the body occur in the direction of the lesion. Movement disorders are especially noticeable when walking with closed eyes. Vestibular ataxia is accompanied by severe autonomic disorders - nausea, dizziness, nystagmus.

Cortical ataxia

A specific impairment of coordination of movements that develops in patients after a stroke in the frontal lobe of the cerebral hemispheres. Basically, in such situations, the legs are affected. The hands are not involved. The patient's gait is uncertain, wobbly, in one line. The body leans back. The patient is unable to stand or walk without showing signs of paresis or paralysis.

Clinical manifestations of cortical ataxia

Diagnostic tests

Diagnosis of impaired coordination of movements in patients after a stroke is based on the following points:

• patient complaints;
• inspection data;
• results of diagnostic tests;
• data of the results of additional research methods.

Coordination tests allow you to determine the type of ataxia, to establish the location of the stroke.

The first is static ataxia. The patient is placed in the Romberg position - legs together, arms forward, eyes closed. The patient's stability is assessed. After the usual Romberg test, a complicated one is carried out - the hands are asked to stretch in front of you at shoulder level, the fingers are spread out to the sides, the legs are placed so that the toe of one touches the heel of the second limb.

Study of cerebellar function

The gait is then assessed. The patient is asked to walk in a normal straight line with the heel to the toe and a flanking gait.

This is followed by diagnostics of dynamic ataxia. The patient is asked to extend his arms in front of him and reach with the index finger of the tip of the nose or hammer. The test is carried out with eyes open and closed.

It is possible to assess the symmetry and synchronization of movements using an asynergy test - the patient is asked to stretch his arms in front of him and make movements similar to screwing in light bulbs. Another diagnostic test is for dysmetria. The patient needs to raise both arms to shoulder level and extend them in front of him. After that, you need to raise one hand vertically up and lower to the level of the second. The test is repeated from the opposite side.

Heel-knee test - in the supine position, the patient should touch the heel of one leg of the opposite knee.

Asinegria Babinsky - the patient is asked to sit with his arms crossed over his chest. If the reason for the violation of coordination of movements in the cerebellum, it is not the body that rises, but the legs.

Treatment

In patients after a stroke, in the first hours after the disease, the resumption of blood circulation in the necrosis focus comes to the fore. Then nootropic and vascular agents are prescribed. Their main task is to reduce the size of the focus, to help the surviving neurons integrate into the general activity of the central nervous system.

As soon as possible, the patient begins movement exercises.

To improve coordination, it is necessary to perform complex purposeful actions - to pick up small objects from the floor, open locks, "catch up" with moving objects with your hands, and press buttons located at some distance from the patient. If it is necessary to coordinate the movements of two joints, then one of them is fixed and the movements are carried out without it.

With vestibular ataxia, exercises are carried out with an increase and decrease in the area of ​​support, with the elimination of visual control - in the dark, blindfolded, with headphones. It is recommended to walk on uneven terrain, back forward, on a stencil. It is very useful to combine these exercises with eye gymnastics.

An important role is played by massage, passive gymnastics, physiotherapy procedures.

Cardiologist

Higher education:

Cardiologist

Kuban State Medical University (KubSMU, KubGMA, KubGMI)

Education level - Specialist

Additional education:

"Cardiology", "Course on magnetic resonance imaging of the cardiovascular system"

Research Institute of Cardiology. A.L. Myasnikova

"Course in functional diagnostics"

NTSSSH them. A. N. Bakuleva

"Course in Clinical Pharmacology"

Russian Medical Academy of Postgraduate Education

"Emergency cardiology"

Geneva Cantonal Hospital, Geneva (Switzerland)

"Course in therapy"

Russian State Medical Institute Roszdrav

Movement disorders are the most common complications of stroke. They are observed in more than 80% of patients. Of these, only 20% are fully restored. The effectiveness of rehabilitation depends on the timeliness of medical care at the onset of the stroke, as well as on how early rehabilitation treatment began. It will be most effective in the first six months after a stroke and completion of intensive care.

Why is walking disturbed?

During an ischemic stroke, areas of the brain that are responsible for motor functions remain without nutrition. These are sections of the pyramidal system, with the help of which a person makes conscious (voluntary) movements. Depending on the place of ischemia and the degree of damage, complete paralysis or paresis of certain muscles develops.

Special brain cells generate impulses to initiate movement, which are conducted to the muscles using a complex system of neurons. When some of them are turned off from the process, the muscle does not receive commands "from above" and remains motionless. In this case, all possible motor programs are stored in the "card index" of the lower motor system.

The goal of motor rehabilitation is to restore the lost connections between the brain and muscles, help the body "remember" the necessary motor programs and restore the brain's ability to control them.

Start recovery with it?

The first thing that is done after a stroke to prevent loss of movement in joints and tendons is posture treatment. To do this, the leg is fixed in a straightened position with a slight turn inward and the foot resting on the headboard. Fixation is carried out within 1.5 - 2 hours.

Passive exercise

Recovering from a stroke begins with training individual muscles and joints. Stroke usually affects an area of ​​one hemisphere of the brain. In this case, they speak of hemiparesis or hemiparalych - a unilateral impairment of motor functions. Restoring movement in a sore leg begins with passive exercises.

They are performed by an exercise therapy specialist, gradually including the patient himself in the process, that is, gradually transferring passive movements into active (controlled) ones. The set of exercises includes:

• flexion, extension and rotation of the feet;
• flexion and extension of the knee;
• flexion, extension and abduction in the hip joint.

If the patient understands well what is required of him, it is necessary to involve his consciousness in the process. He must learn to send an impulse to an immobile muscle. To do this, the exercise is done independently with a healthy leg, and then the movement is mentally transferred to the injured leg. The use of muscle memory is perhaps the most important component of the entire rehabilitation process.

Transfer of movements to the active phase

The mental message should not fit only in the time allotted for gymnastics. A person striving for the fastest recovery and gaining lost skills should engage in training throughout the day with short breaks for food, toilet, procedures and sleep.

As the muscle regains strength through passive exercise, the patient should be encouraged to move independently. The assistant sets the amplitude of movement, and the patient himself must perform it. The movement should be slow and done in parts.

Walking after a stroke is restored with the following exercises:

1. Flexion and extension of the knees. In this case, the feet slide along the bed. It is performed alternately with a sick and a healthy leg.
2. Shifting the legs. The legs are bent at the knees, the feet are resting on the bed. A healthy leg needs to be thrown over the diseased one, and then vice versa.
3. A similar exercise, only one leg needs to be put on the knee, taking it to the side, then repeat the exercise with the other leg.
4. Exercise "bike".
5. Turns of the feet. The legs are bent at the knees, the feet are on the bed. Turning the feet outward and inward.
6. Lying with straightened legs, alternately draw the heel of one leg along the front of the lower leg of the other.
7. Raising and abducting the legs of the side.
8. Raising the pelvis while lying with bent knees.
9. Lying on your stomach, bend and unbend your knees.
10. Lying on your side, raise your leg.
11. Turns on the side (restores the skill of turning over in bed). Lying on your back, first lower your bent knees to the side, then complete the turn with your torso.

All exercises begin with a healthy leg. You should not immediately ask many approaches for performing one exercise. The number of repetitions depends on the patient's condition and is increased with great care.

Transfer to a sitting position

The ability of the patient to sit on the bed independently, and most importantly, to maintain this position is considered a great achievement. It should be moved to an upright position gradually and carefully to avoid dizziness and pressure build-up.

After mastering the skill of overturning, the patient lying on his side must be slowly seated - the legs fall out of bed, the healthy hand is repelled from it. His feet should be flat on the floor and slightly spaced, his body tilted slightly forward to maintain balance.

Getting up

The next step is getting up. Several exercises are used for training:

• lifting on the bed - first with the help of an instructor, then - a gradual transition to self-lifting;
• movement along the edge of the bed from the back to the back - moving the legs on the floor and transplanting the patient away from the point of support of the legs so that he pulls them up on his own.

After prolonged training, the patient's muscles and consciousness are ready to stand up and hold the body in an upright position. It is important to ensure his safety, as a fall can be frightening and make the patient abandon the next attempt for a long time. Standing up should take place with additional support and the help of a stranger. Workouts are accompanied by explanations of how certain movements are performed correctly. The patient will mentally recall them, stimulating the brain to send impulses.

Before the patient takes the first steps, standing skills are consolidated with exercises:

1. Trampling - shifting the center of gravity from one leg to the other, as if a person is shifting from foot to foot. First, the exercise is performed without taking the feet off the floor, then they need to be slightly raised.
2. Rolling from toe to heel.
3. Stepping over an obstacle - at first it can be a pencil, then the height is increased. When performing, the knee should rise high. Steps are taken back and forth.
4. Leading the legs back (the leg is placed on the toe).

Walk recovery

The assistant helps his ward, supporting him from a healthy side. He, as it were, makes a jerky movement, prompting the patient to rearrange the injured leg, and then lean on it.

If it is difficult for one to cope with teaching a post-insulin patient to walk, the help of another person will be needed to move the patient's diseased leg. This happens when the patient is not entirely adequate or has a lot of weight.

It is good to alternate daily walking workout with exercises on the carpet:

• turning over from side to side;
• rolling from one edge of the carpet to the other;
• head lifts;
• getting up on all fours and moving in this position;
• crawling on bellies.

The instructor will also need an assistant for these exercises.

Walk recovery massage

It is difficult to overestimate the role of massage in restoring all body functions after a stroke. This is especially true for motor injuries. An experienced massage therapist does not use certain strictly limited techniques. He always proceeds from the patient's condition and finds empirically an individual way of massage.

It is not only the paralyzed leg or arm that is being massaged. The entire damaged side of the body is massaged, from the scalp to the toes. The procedure effectively restores blood circulation in numb skin and muscles, as well as the sensitivity of nerve endings. Massage courses begin from 3 to 4 days after the stroke and should continue over the next year or even two years. The usual manual massage will be successfully complemented by a hydromassage and an underwater shower.

How to ensure safety while walking recovery?

Falling after a stroke can result in injury. Most often, such patients break the thigh of the sore leg. The reasons may lie not only in the insufficient stability of the patient, but also in the imperfection of the environment. This could be a slippery floor, too long pile on carpets, poorly installed handrails in the bathroom and toilet, or simply insufficient supervision of a sick person.

At the initial stage, when the patient does not feel very confident, special devices will help - a three- or four-support crutch, a walker. To avoid back flexion of the knee joint, an orthosis is used to fix the knee in the desired position.

Usually, the attending physician prescribes the aids. He will also determine the terms of refusal from them. Some fixtures can be used constantly, such as handrails in the bathroom.

How long will it take to recover?

The possibility of walking rehabilitation after a stroke and the recovery time depend on many factors - the initial severity of a movement defect (for example, paralysis in the acute stage of stroke), increased muscle spasm or, on the contrary, their wasting, concomitant muscular-articular disorders.

Impaired cognitive functions, decreased mental activity, loss of interest in life and depressive conditions significantly inhibit recovery. And vice versa, a timely started and regularly carried out complex of rehabilitation measures significantly accelerates the restoration of lost functions. The specific terms of the recovery period are individual.

Why is walking important for overall stroke recovery?

Having regained the ability to walk independently, a person is ready for further social rehabilitation. Further, a gradual restoration of the ability to self-service is carried out, and then everyday skills.

The restoration of movement gives impetus to the restoration of other body functions. The successes that the patient makes and which must be emphasized by the people surrounding the "stroke", contribute to the restoration of the psycho-emotional state. And this, in turn, gives an incentive to volitional efforts, without which full-fledged rehabilitation is simply impossible.

Hello dear readers and guests of the site dedicated to neurorehabilitation. Let's talk today and take a closer look consequences of a stroke- ischemic and hemorrhagic, as well as everything connected with it.

The consequences of a stroke.

Violations of any functions after a stroke are directly dependent on its severity, and the severity, in turn, on the size of the focus and its location in the brain.

The nature and persistence of the consequences of a stroke depends on the size of the focus in the brain and its localization.

Of course, it will be fair to note that the size of the focus and its localization are far from all the factors that determine the persistence of the depth of neurological disorders to which the stroke has led, the consequences of which (the nature and their severity) can vary greatly, depending on the specific case. What does it depend on?

The persistence of the consequences is strongly correlated with the time and volume of treatment and rehabilitation performed, but we will talk about this a little later, read on.

The degree of functional impairment after a stroke is not always persistent. With a minor stroke, the consequences may be minimal or even absent, but this does not happen so often. We will discuss the cases when these consequences exist and they are persistent. Let's take a closer look at what exactly the consequences of a stroke are and how they are expressed. The following are the most significant disorders of body functions that occur after a stroke.

Right-sided and left-sided hemiparesis

One of the most common persistent effects of a stroke is a decrease in strength in one half of the body. As a rule, after a stroke, there is a decrease in muscle strength in one of the sides of the body, which is opposite to the damaged hemisphere of the brain: if hemiparesis on the left side of the body is a persistent consequence, the stroke occurs in the right hemisphere. By the same principle, hemiparesis of the right side of the body, in which a stroke is observed in the left hemisphere. That is, the focus of a heart attack in the brain is located in the opposite hemisphere of the affected half of the body.

It also happens that a stroke leads to a complete lack of muscle strength in the half of the body, which is called hemiplegia. With hemiparesis, a person experiences difficulty in moving, with hemiplegia, the difficulties are even more significant. Simply put, hemiplegia is paralysis in half of the body (complete lack of movement).

Habitual body movements are disrupted, and many people have to re-learn how to perform normal daily activities in order to be able to take care of themselves, be able to eat, change clothes and walk. In general, to do everything that before the illness was considered extremely simple and common to perform. It is the decrease in muscle strength in half of the body that is the main reason for the disability of a person after suffering a cerebrovascular accident. It is because of this that patients lose the ability to move independently - or lose this ability completely or it is significantly impaired.

As yours has already described, gait after a stroke can often be disturbed, while a person begins to move with great difficulty. In some cases, auxiliary devices may be needed - special walkers, support canes or crutches. The characteristic Wernicke-Mann posture develops when walking. Individual parts of the body may suffer without involving the entire half of the body. Depending on the affected half of the body, left-sided and right-sided hemiparesis are distinguished.

Central prosoparesis

Fig. 1. Central paresis of the facial muscles (central prosoparesis)

The next, one of the most frequent consequences is the so-called central prosoparesis, in which the facial muscles suffer, as a result of which the asymmetry of the face is observed, as in Figure 1. At the same time, a decrease in strength is observed not in the entire half of the face, but only in its lower part, capturing the mouth, cheek, and lips.

With this paralysis of the facial muscles, the eyelids and eyes remain unaffected, despite this the skew is quite noticeable and causes discomfort not only when eating or drinking. Central prosoparesis regresses with recovery from stroke.

With central prosoparesis, food and fluid intake are difficult. A person experiences obvious discomfort when performing some actions with mimic muscles. It is more difficult to express habitual emotions, due to a decrease in strength in the facial muscles, sound production is disturbed and speech begins to suffer.

The defect itself brings a tangible inconvenience purely from a cosmetic point of view. Facial distortion causes great emotional discomfort, especially when communicating with other people. This can lead to isolation and detachment from communication with others and cause deep depression.

Speech impairment

Speech impairment after a stroke also occurs quite often, at the same time it is one of the very first signs of an onset (impending) cerebrovascular accident. Speech impairment is the result of damage to the speech centers of the brain, which is a partial or complete loss of the ability to speak and perceive someone else's speech, called aphasia.

According to statistics, such disorders are observed in a quarter of all stroke survivors, their consequences can be quite persistent. Sometimes, it is difficult for a person to speak, due to a violation of the speech apparatus and the speech of such people is indistinct, as if "porridge in the mouth", and such a violation is called ... Dysarthria more common with stem stroke or localization of this focus in the cerebral cortex. The next speech disorder is aphasia.

Aphasia- this is a complete lack of speech. Aphasia is of several types, let's name some of them - when the speech center responsible for the pronunciation of speech is affected, motor aphasia develops. When the focus of a stroke is located in the center of speech, which is responsible for its perception, the so-called sensory aphasia develops. With sensory aphasia, a person does not understand what is being said to him and does not understand what he needs to answer. If both centers are affected, mixed or sensorimotor aphasia. The “pure” form of aphasia is extremely rare, and in stroke, it is the mixed form that is most often found.

There are other types of speech disorders after a stroke, which we will discuss in detail in the following articles on speech impairment. And now we go further ... In addition to the listed violations, there are also the following consequences of a stroke.

Movement coordination disorders

Disruption of blood circulation in the parts of the central nervous system responsible for coordination of movements and as a result of a stroke can lead to a coordination of movements called ataxia. Impaired coordination of movements more often occurs with a stem stroke and is due to the fact that the centers of coordination of movements in our body are located in the stem of the brain.

It can be of varying degrees of severity. In the most favorable case, these vestibular disorders disappear within the first day from the moment of acute cerebrovascular accident. In other more severe cases, unsteadiness when walking and dizziness persist for a longer period and can last for months.

Visual impairment

There may be visual impairments of the most varied nature. Visual impairment depends on the location of the stroke and the size of the focus. Most often, visual impairment manifests itself in the form loss of visual fields(hemianopsia). In this case, you guessed it, half or a quarter of the visual picture falls out. If a quarter of the picture falls out, it is called quadrant hemianopsia.

Other consequences

• Hearing impairment (hypoacusia), smell (hypo-, anosmia), loss of movement skills with retained strength (apraxia) and other disorders that can and should be treated, rehabilitation in this case is very important and should be carried out in a timely manner.
• Sensory impairment after a stroke. Sensory impairment after a stroke can be of a different nature, but most often it is a loss of the ability to feel pain, recognize heat, cold and a part of the body as such. It is also possible the appearance of a pain syndrome, which is of the most diverse nature and localization. Most often, there is a decrease in sensitivity in any parts of the body, this phenomenon is called hypesthesia.

These dysfunctions may well manifest themselves as the first signs of a stroke in the very onset of the disease and persist for an indefinitely long time in the absence of active recovery of impaired neurological functions.Please note that the severity of all these changes and their resistance directly depend on the size of the focus and the nature of the stroke. Read more about the factors that play the main roles in the development of ischemic stroke and the formation of its consequences.

Depression

Depression Is another consequence of a stroke that can negate any efforts of a doctor and loved ones to restore lost functions. According to some reports, up to 80% of stroke survivors suffer from depression in varying degrees of severity. This is a rather serious consequence that can and should be treated.

In addition to the mood for recovery, an additional equally important "bonus" of eliminating depression will be an analgesic effect. It has long been proven that depression can exacerbate pain in a person, and pain in stroke is not uncommon. Prescribing antidepressants can help alleviate this problem.

It is extremely important to prescribe the “correct” antidepressant, as some of them can cause an “inhibitory effect”, which in some cases can also reduce a person's desire to follow the doctor's recommendations and activate for better rehabilitation.

Stroke, the consequences of which remained after a course of treatment in a hospital, is a frequent phenomenon. Such people need a full-fledged rehabilitation course, which often begins at the hospital. The rehabilitation course itself is prescribed individually, depending on the severity and persistence of the consequences, as well as on the time that has passed since the stroke and the general condition of the patient.

If the hospital did not manage to fully recover a person after a stroke, then further treatment should preferably be carried out in a specialized rehabilitation center.

Read about an example of such a rehabilitation center in the article.