Rehabilitation after stroke: modern approaches
I. Neuroplasticity and key principles of rehabilitation
Understanding neuroplasticity – the ability of the brain to reorganize and the formation of new neural connections – is fundamental for modern rehabilitation after a stroke. Stroke damages certain parts of the brain, violating motor, sensory, cognitive and speech functions. However, the intact or less damaged areas of the brain can take on the functions of lost neural chains. This ability to adapt is the basis for restoration, and rehabilitation is aimed at maximizing this plasticity.
The key principles of effective rehabilitation include:
- Early beginning: The beginning of rehabilitation as early as possible after a stroke, often in the acute phase, contributes to more effective restoration. Early mobilization and stimulation prevent secondary complications, such as muscle weakness and contracture.
- Intensity: The intensity of training is a key factor in success. The more repetitions and the more complex task, the stronger the stimulation of neuroplasticity. However, the intensity should be balanced with the patient’s tolerance and the prevention of overwork.
- Specificity: Training should be specific for those tasks that the patient wants to restore. For example, if the patient wants to write again, training should include exercises on fine motor skills of his arm, coordination of movements and the formation of letters.
- Relevance: Exercises should be significant and motivating for the patient. The activity that the patient considers important and interesting will contribute to more involvement and, therefore, the best results. For example, instead of abstract exercises, you can use an imitation of cooking or other everyday tasks.
- Repetition and practice: Multiple repetition of movements and practical tasks is necessary to consolidate new neural connections and automation of skills.
- Feedback: Providing the patient with constant feedback on his progress helps him adjust his movements and improve the results. This can be either visual feedback (for example, observation of yourself in the mirror), or tactile (for example, using weighting agents).
- Multidisciplinary approach: Effective rehabilitation requires teamwork of various specialists, including rehabilitologists, physical therapists, ergotherapists, speech therapists, neuropsychologists and social workers.
- Assessment and monitoring: Regular assessment of the patient’s condition allows you to track his progress and adjust the rehabilitation program in accordance with his needs and capabilities.
II. Physical rehabilitation: restoration of motor functions
Physical therapy plays a central role in restoring motor functions after a stroke. The goal is to improve strength, coordination, balance, mobility and general functionality. Modern approaches include:
- Traditional methods:
- Medical physical education (exercise therapy): It includes active and passive exercises aimed at restoring strength and amplitude of movements in the affected limbs. Active exercises are performed by the patient independently, and passive – using the therapist.
- Massage: It is used to improve blood circulation, reduce spasticity and relieve pain.
- Joint mobilization: Aimed at restoring joint mobility and prevention of contractures.
- Balance and coordination exercises: Important to restore stability and prevent falls.
- Training in movement: It includes training in walking using auxiliary tools (for example, canes, walkers) and without them.
- Modern technologies and methods:
- Robotized therapy: Uses robotic devices to help in performing exercises and increase the intensity of training. Robots can provide support, resistance or feedback, depending on the needs of the patient. Especially effective for restoring the function of the hand.
- Virtual reality (VR): Creates immersive virtual environments that allow patients to practice various tasks in a safe and motivating environment. VR can be used to train walking, balance, coordination of movements and cognitive functions.
- TREDMIL-TRAINING WITH SUCCESS (BWSTT): The patient goes on the treadmill, while part of his weight is supported by the suspension system. This allows you to train walking even in patients with pronounced weakness in the legs.
- Functional electrical stimulation (FES): Uses electrical impulses to stimulate muscles that have lost the ability to reduce. Fes can be used to improve the movements of the arm and leg, as well as to reduce spasticity.
- Constraint-Induced Movement Therapy (CIMT): “Restriction therapy” aimed at forced use of the affected hand by limiting the movements of a healthy hand. This stimulates the use of the affected limb and promotes neuroplasticity. Suitable for patients with a certain level of motor function in the affected hand.
- Mirror therapy: The patient looks at the reflection of a healthy hand in the mirror, creating the illusion that the affected hand moves normally. This helps reduce pain and improve motor functions, especially with phantom pains.
- Neuro-muscular re-education (NMES): Used to restore the correct motor patterns and improve coordination.
III. Ergotherapy: restoration of self -service skills and household activities
Ergotherapy is aimed at restoring self -service skills, household activities and labor. The goal is to help the patient return to the most independent life. Ergotherapists evaluate the patient’s functionality and develop individual programs that include:
- Assessment of self -service skills: Assessment of the patient’s ability to perform tasks such as dressing, swimming, eating, cooking and caring for himself.
- Teaching adaptive strategies and techniques: Patient training in new methods of completing tasks, taking into account his restrictions. For example, the use of special devices for dressing or cooking.
- Environmental modification: Adaptation of the home environment to make it more affordable and safe for the patient. For example, installing handrails in the bathroom or rearranging furniture.
- Loop motor skills: Exercises aimed at improving the coordination of the movements of the hands and fingers. For example, manipulating small objects, drawing, writing.
- Cognitive skills training: Exercises aimed at improving memory, attention, concentration and solving problems.
- Restoring the skills of writing and printing: Patient training to use the keyboard, mouse and other input devices.
- Training in the use of auxiliary tools: The patient’s training in the use of canes, walkers, wheelchair and other auxiliary tools.
- Assessment and adaptation of the workplace: Assessment of work requirements and adaptation of the workplace to facilitate return to labor activity.
IV. Speech therapy: recovery of speech and swallowing
A stroke often leads to speech disorders (aphasia), difficulties with pronunciation (dysarthria) and problems with swallowing (dysphagia). Speech therapy plays an important role in the restoration of these functions.
- Aphasia:
- Diagnosis: Determination of the type of aphasia (for example, expressive, receptive, global) and the severity of the violation.
- Individual therapy: Development of an individual program aimed at restoring the ability to speak, understand speech, read and write.
- Communicative strategies: Teaching the patient and his family alternative methods of communication, such as the use of gestures, pictures or electronic devices.
- Group therapy: Providing patients with the opportunity to practice their communicative skills in a supporting environment.
- Dysaria:
- Exercises for strengthening the muscles involved in speech: Exercises for the tongue, lips, cheeks and jaws.
- Articulation exercises: The practice of pronouncing individual sounds, words and phrases.
- Techniques to improve volume and voice modulation: Exercises for breathing control and vocal cords.
- Dysphagia:
- Swallowing rating: Determination of the risk of aspiration (food or fluid in the lungs). Clinical tests and instrumental methods are used, such as video fueloroscopy.
- Changing the consistency of food and liquid: Adaptation of the texture of food and liquid to facilitate swallowing. The use of thickeners may be required.
- Swallowing techniques: The patient’s training in the correct swallowing techniques, such as the tilt of the head, repeated swallowing and coughing after swallowing.
- Exercises for strengthening muscles involved in swallowing: Exercises for the tongue, lips, cheeks and throat.
- Positioning: Ensuring the correct position of the body during meals in order to facilitate swallowing.
V. Neuropsychology: restoration of cognitive functions
A stroke can lead to impaired cognitive functions, such as memory, attention, concentration, executive functions (planning, organization, decision -making) and spatial perception. Neuropsychological rehabilitation is aimed at restoring these functions or compensation for their loss.
- Neuropsychological assessment: Assessment of cognitive functions using standardized tests. This allows you to determine the strengths and weaknesses of the patient and develop an individual rehabilitation program.
- Individual therapy: Development of an individual program aimed at improving specific cognitive functions. For example, training, attention, executive functions.
- Compensatory strategies: Patient training strategies that will help him compensate for lost cognitive functions. For example, the use of notebooks, organizers or electronic devices to improve memory.
- Rehabilitation using a computer: Using computer programs for training cognitive functions. These programs can offer interactive exercises that adapt to the level of the patient.
- Group therapy: Providing patients with the opportunity to practice their cognitive skills in a supporting environment.
- Rehabilitation in everyday life: The use of cognitive strategies in everyday activity.
VI. Psychological support and social adaptation
A stroke is a traumatic event that can lead to depression, anxiety, irritability and other emotional problems. Psychological support and social adaptation play an important role in the restoration process.
- Individual psychotherapy: Providing the patient with the opportunity to discuss his feelings, thoughts and fears with a qualified psychologist or psychotherapist.
- Group therapy: Providing patients with the opportunity to communicate with other people who have experienced a stroke and share their experience.
- Family therapy: Involving family members in the process of rehabilitation and providing them with support and education.
- Learning skills to overcome stress: Patient training techniques for relaxation, meditation and other stress management methods.
- Social support: Assistance to the patient in restoring social ties and involving in public life. This may include visiting clubs, participating in volunteer activities or just communication with friends and family.
- Professional orientation: Assistance to the patient in returning to work or finding new opportunities for self -realization.
VII. Pharmacological support for rehabilitation
Pharmacological support can be useful to improve rehabilitation results after a stroke. Medicines can be used for:
- Reducing spasticity: Baclofen, Tizanidine, botulinum toxin.
- Depression and anxiety treatment: Antidepressants, anxiolytics.
- Improving cognitive functions: Cholinsterase inhibitors, nootropics (a further study of their effectiveness is required).
- Reducing pain: Analgesics, anti -inflammatory drugs.
- Sleep improvements: Snot -shaped drugs.
It is important to note that pharmacological support should be prescribed by a doctor and used in combination with other rehabilitation methods.
VIII. New areas in rehabilitation after stroke
Studies in the field of rehabilitation after a stroke are constantly developing, and new methods and technologies appear. Some promising areas include:
- Transcranial magnetic stimulation (TMS): Uses magnetic impulses to stimulate or suppress the activity of certain parts of the brain. TMS can be used to improve motor functions, speech and cognitive functions.
- Transcranial stimulation direct current (TDCS): Uses a weak direct current to stimulate or suppress the activity of certain parts of the brain. TDCS can be used to improve motor functions, speech and cognitive functions.
- Biological feedback (BOS): It provides the patient with information about his physiological parameters (for example, muscle activity, heart rate) to help him learn how to control these parameters. Bos can be used to improve motor functions and reduce stress.
- Exoskeletons: Robotized devices that are worn on the limbs and help the patient perform movements. Exoskeletons can be used to train walking and improve the motor functions of the hand.
- Using stem cells: Studies show that the introduction of stem cells can help restore damaged brain tissue and improve functions after a stroke. However, this method is at the study stage and is not yet available for widespread use.
IX. Home rehabilitation and care
Home rehabilitation plays an important role in maintaining progress achieved during stationary or outpatient rehabilitation. It is important that the patient and his family receive appropriate instructions and support to continue to engage in physical exercises, train cognitive skills and adapt to changes in life after a stroke.
- Development of a home exercise program: The physical therapist is developing an individual exercise program that the patient can perform at home independently or with the help of family members.
- Home environment adaptation: Adaptation of the home environment to ensure safety and accessibility for the patient.
- Training of family members of care: Teaching family members skills in patient care, including help in dressing, bathing, eating and moving.
- Support and consultations: Providing the patient and his family of constant support and consultations.
X. Factors affecting recovery after stroke
The recovery after a stroke is influenced by many factors, including:
- The severity of the stroke: The heavier the stroke, the more brain damage and the more complicated the recovery.
- The location of brain damage: Damage to certain areas of the brain can lead to specific disorders that are difficult to rehabilitate.
- Age: Young people, as a rule, are recovering better than the elderly.
- Related diseases: Related diseases, such as diabetes, cardiovascular diseases and depression, can slow down the recovery process.
- Patient motivation and participation: The motivation and active participation of the patient in the rehabilitation process are key success factors.
- Support for family and friends: Support for family and friends can significantly improve rehabilitation results.
- Quality and intensity of rehabilitation: High -quality and intensive rehabilitation contributes to more effective restoration.
- The timeliness of the beginning of rehabilitation: The early start of rehabilitation can improve recovery results.
- Genetic factors: Studies show that genetic factors can also affect recovery after a stroke.
Despite the fact that some factors affecting recovery after a stroke are not amenable to change (for example, severity of a stroke and age), other factors (for example, motivation, patient participation, quality and intensity of rehabilitation) can be controlled and used to improve results.