Analysis

Therapeutic exercise for diseases of the nervous system. Physiotherapy

According to experts, movement is life. And for various diseases, proper physical activity can become a real panacea for the patient - they can speed up recovery, prevent relapses, and improve general physical condition. So, for diseases of the nervous system, gymnastics is the most important part of complex treatment. And all patients with such problems, without exception, are advised to systematically perform a set of individually selected exercises. The topic of our conversation today on this page www.site will be exercise therapy for diseases of the central nervous system and peripheral.

Exercise therapy for diseases of the nervous system

Therapeutic exercise for diseases of the central nervous system helps to activate the vital functions of the body: respiratory, cardiovascular, etc. Gymnastics effectively prevents the occurrence of motor and other complications, including contractures, stiffness in the joints, bedsores, congestive pneumonia, etc.

Exercises, when performed systematically, help restore lost functions or create temporary or permanent compensation. Physical therapy also helps restore walking and grasping skills. Gymnastics also perfectly improves the overall tone of the body and optimizes the mental state of the patient.

Exercise therapy for diseases of the peripheral nervous system

Gymnastics for such diseases is aimed at optimizing blood circulation processes, as well as trophism in the affected area; it helps prevent adhesions and scar changes, eliminate or reduce vegetative-vascular and trophic disorders (promoting nerve regeneration).

Exercises for diseases of the peripheral nervous system help strengthen paretic muscles and ligaments, and weaken muscle dystonia. This effect can prevent or eliminate muscle contractures, as well as stiffness in the joints.

Therapeutic exercise also helps to improve substitution movements and coordinate them with each other. Such activities cope with limited mobility of the spinal column and its curvature.

Exercises for diseases of the peripheral nervous system have a pronounced general health-improving, as well as general strengthening effect on the patient, contributing to the overall restoration of performance.

Features of exercise therapy for diseases of the nervous system

For patients with diseases of the nervous system, early initiation of exercise therapy is indicated. At the same time, physical activity must be relevant: it is selected individually and must gradually increase and become more complex.

Even a slight complication of the exercises already at the psychological level makes the previous versions of the exercises easier. However, overload for patients with diseases of the central nervous system and peripheral nervous system is strictly contraindicated; in this case, their motor disorders may worsen. To speed up progress, it is extremely important to finish classes on those exercises that patients do best. This ensures the most positive psychological preparation of the patient for the next sessions.

Simple exercises must be alternated with complex ones: to ensure complete training of higher nervous activity. In this case, the motor mode should be steadily expanded: from lying in bed, to sitting in bed, and then standing.

Doctors strongly recommend the use of all means, as well as physical therapy methods. Patients are recommended to undergo therapeutic exercises, positional treatment, and massages. Extension therapy is also an excellent effect - mechanical straightening or stretching along the longitudinal axis of certain parts of the body that are characterized by a violation of the correct anatomical location.

However, the classic and most popular method of physical therapy for diseases of the nervous system is various exercises.

What exercises are used for diseases of the nervous system?

Patients are advised to perform isometric exercises designed to improve muscle strength. Doctors also recommend exercises that alternate tension and relaxation of muscle groups. You should also perform exercises with acceleration and deceleration, various exercises for deceleration and balance.

Alternative medicine specialists also advise paying attention to ideomotor activities, during which mental impulses are sent.

Some examples of exercise therapy for diseases of the nervous system

Quite often, patients with focal brain lesions are treated with positioning. In this case, the affected limbs (usually the arm) are fixed in a stationary position using various devices (a roller with sand, etc.). The duration of positioning treatment can vary from a quarter of an hour to four hours, depending on the type of disease and the patient’s condition.

For diseases of the peripheral nervous system, the patient is advised to perform exercises aimed at optimal contraction of paretic muscles, as well as stretching their antagonists. Particular attention is paid to the development of the necessary motor skills: walking and running, the ability to write, hold and throw small objects.

Therapeutic exercise promotes the speedy recovery of patients with diseases of the nervous system, both peripheral and central.

Ekaterina, www.site

P.S. The text uses some forms characteristic of oral speech.

Physical strength exercises increase the functional restructuring of all key elements nervous system, providing a stimulating effect on both efferent and afferent systems. The basic basis of the mechanism of action of strength physical exercises is the exercise process, therefore the dynamic restructuring of the nervous system also affects cerebral cortex cells, and peripheral nerve fibers. When performing physical exercises, all kinds of reflex connections increase (cortico-muscular, cortico-visceral, and also muscular-cortical), which contributes to a more coordinated and harmonious functioning of the main functional systems of the body.

Actively involving the patient in the process of conscious and clearly dosed exercise is a powerful stimulator of the formation of subordination influences. The plasticity of the central nervous system allows by systematic complexes of physical therapy exercises develop a dynamic stereotype that determines accuracy, coordination and impressive economization of reactions.

Exercise therapy for diseases of the nervous system has a normalizing effect on imbalances in inhibition and excitation. An important role in neurohumoral regulation during strength exercises is played by the autonomic nervous system, which innervates muscle fiber tissue, regulates the metabolic process in them, and adapts it to functional activity. The function of the cardiovascular system, respiratory and other body systems is also stimulated, which improves the nutrition of working muscles, eliminates congestion, and accelerates the resorption of foci of inflammation. Positive emotions when performing physical exercises develop in the patient against the background of unconditional and conditional connections. They help mobilize various physiological mechanisms and distract the patient from painful experiences.

Stroke.

In the rehabilitation of patients who have suffered a stroke, there are 3 stages: early (3 months), late (up to 1 year) and the stage of compensation for residual motor function disorders. Therapeutic exercise for strokes is aimed at reducing pathological tone, reducing the degree of paresis (increasing muscle strength), eliminating synkinesis, recreating and developing the most important motor skills. Therapeutic exercises and massage are prescribed when the patient’s condition has stabilized (no increase in symptoms of cardiac and respiratory disorders). Treatment by positioning begins from the first day of illness, passively turning the patient every 1.5-2 hours during the day and 2.5-3 hours at night from the healthy side to the back and to the affected side. When placing the patient in a horizontal position (lying down), you should ensure that the hand of the affected arm is always in the mid-physiological phase, and that the leg does not rest against anything. The upper limb is abducted by 90", extended in all joints and rotated outwards. When the tone of the carpal flexor muscles increases, a splint must be applied to the hand with extended and spread fingers. Pressure applied to the surface of the hand and sole leads to an increase in muscle tone and the formation of vicious attitudes. A little is allowed. Elevate the patient's position (no more than 30°) head (for mild to moderate ischemic stroke) for 15-30 minutes 3 times a day already on the 1st day of the disease.

It is necessary to try to activate the patient as early as possible - transfer him to a sitting position. The patient can be seated on a bed with his legs down on the 3-5th day from the start of treatment. Transfer to a sitting position is done passively, the patient is provided with sufficient support. The duration of sitting is from 15 minutes to 30-60 minutes or more with good tolerance. The question of the period of expansion of the motor regime during hemorrhagic stroke is decided individually.

Motor rehabilitation for strokes includes a number of successive stages. Preference is given to functional exercises.

Restoration of some components of the motor act - methods of active muscle relaxation, training in dosed and differentiated tension of muscle groups, differentiation of the amplitude of movements, training in minimal and isolated muscle tension, training and mastering the optimal speed of movements, increasing muscle strength.
Increasing proprioception - overcoming dosed resistance to the movement being performed, using reflex mechanisms of movement (reflex exercises).
Restoration of simple friendly movements - training of various options for inter-articular interaction with visual and kinematic control.
Revival of motor skills - restoration of individual links of a motor act (skill), learning transitions (connections) from one motor element to another, revival of a motor act as a whole, automation of a restored motor act.

Restoration of impaired motor functions during central paresis occurs in a certain sequence: first, reflex movements and muscle tone are restored, and then friendly and voluntary movements appear, which are restored from the proximal to the distal sections (from the center to the periphery); restoration of motor function of the flexors is ahead of the restoration of movements in the extensors; arm movements appear later than legs; specialized hand movements (fine motor skills) are especially slowly restored. In the process of practicing physical therapy with the patient, the skills of motor activity in a lying position (raising the head, pelvis and body, movements in the limbs, turns) and independent transition to a sitting position are gradually practiced. While maintaining static and dynamic balance (equilibrium) while sitting, the patient learns to move to a standing position (on average on the 7th day for uncomplicated ischemic stroke). Learning to walk independently requires the patient to be able to stand up and sit down independently, maintain a standing posture, transfer body weight and place the supporting leg correctly. Training begins with walking with support, however, prolonged use of walking aids inhibits defensive reactions and develops the patient's fear of falling. Gait training includes training in direction of movement (forward, backward, sideways, etc.), step length, rhythm and speed of walking, and walking on stairs. Active and passive movements should not cause increased muscle tone or pain.

PH classes with stroke patients are carried out individually due to the significant variability of motor and sensory disorders. The duration of the LH procedure is 20-25 minutes with bed rest and 30-40 minutes with free rest. In addition to special exercises, the complex of exercise therapy for strokes must include breathing exercises (static and dynamic), general strengthening exercises, exercises with objects, exercises on simulators, sedentary and active games. As a rule, an additional small-group or group lesson lasting 15-20 minutes is conducted.

The achieved functionality must be applied in self-service activities. Manipulations with household items, clothing, eating skills, personal hygiene, housekeeping, and behavior in the city are trained. To develop daily activity skills, separate additional training should also be carried out with an occupational therapist lasting 30-40 minutes.

The choice of exercises and planning of individual complexes depend on the severity and degree of movement disorders, the presence of accompanying symptoms (spasticity, synkinesis, aphasia) and diseases, the patient’s behavior, his general development and exercise tolerance.

The massage is carried out in a differentiated manner: on muscles whose tone is increased, only gentle methods of stroking and rubbing are used, and on stretched (weakened) muscles all massage techniques are allowed. The duration of the massage is 20-25 minutes, 30-40 sessions per course, with breaks between courses of 2 weeks.

Contraindications for activating patients are signs of cerebral edema, depression of consciousness; The rate of increase in exercise intensity may be limited in patients with cardiopulmonary problems (failure) and atrial fibrillation.

Spinal cord injuries and diseases.

The main task of exercise therapy for spinal cord lesions is to normalize the patient’s motor activity or develop adaptive capabilities. The complex of therapeutic measures includes exercises that stimulate voluntary movements, exercises aimed at strengthening the muscular corset, weakening increased muscle tone, and teaching the skills of independent movement and self-care. In case of injuries and diseases of the spinal cord, the nature of motor disorders depends on the location of the lesion. Spastic paresis and paralysis are accompanied by increased muscle tone and hyperreflexia. Flaccid paresis and paralysis are characterized by hypotonia and muscle atrophy, hypo- or areflexia. In this regard, for various forms of movement disorders, the sets of physical exercises differ significantly. The main task of LH in case of flaccid paralysis is to strengthen muscles, and in case of spastic paralysis, it is to develop skills to control them.

Exercise therapy classes begin 2-3 days after admission to the hospital; before that, only positional treatment is carried out. The starting position of the patient is lying on his back. LG Provo

do 2-3 times a day from 6-8 minutes to 15-20 minutes. Forms and means of exercise therapy are selected taking into account motor modes and depending on the objectives of treatment, both strengthening and special physical therapy techniques are used.

Developing voluntary movements in segments, increasing muscle strength - active movements for the affected limbs with relief (on suspensions, in a horizontal plane, in water, after resistance of antagonists), exercises with overcoming resistance, isometric exercises with low exposure, reflex exercises using natural synkinesis , special LH techniques (method of proprioceptive facilitation, method of neuromotor retraining, etc.). If it is impossible to make active movements, use ideomotor exercises and isometric exercises for healthy limbs.
Prevention and treatment of muscle atrophy, contractures, deformities - training in active muscle relaxation techniques, passive movements in joints involving paretic muscles, anti-conjugate and ideomotor training, correction of the position of paretic limbs, orthopedic prevention.
Recreation and compensation of coordination of movements - complex vestibular gymnastics, a series of exercises for precision and accuracy of movements, training and teaching fine differentiation and dosage of efforts, speed and amplitude of movements, exercises for maintaining balance in a variety of starting positions, a combination of isolated movements in several joints.
Restoration and compensation of movement skills - development of support ability of the lower extremities, special exercises to strengthen the ligamentous-muscular apparatus of the feet, restoration of the spring function of the feet; exercises that restore the direction of movements in space; gradual restoration of gait kinematics, dynamic coordination gymnastics; exercises in a variety of starting positions (lying, kneeling, on all fours, standing), learning to walk independently with and without support.
Improving respiratory and cardiovascular activity - static breathing training with dosed resistance, dynamic breathing exercises, passive exercises for the limbs, rotations and rotations of the torso (passive and active), exercises aimed at intact muscle groups.
Developing self-care skills - restoring the skills of personal hygiene, nutrition, dressing, moving and housekeeping, handwriting and typing, classes in ego therapy rooms, training behavior skills in the city.
Labor skills training - classes in occupational therapy rooms and workshops.
All of the listed physical therapy methods are closely interrelated and are used in different combinations depending on the patient’s individual treatment plan.

In case of spastic paralysis, movements that bring the attachment points of spastic muscles closer together or are associated with forceful tension, as well as massage techniques that increase muscle tone, are contraindicated. In case of flaccid paralysis, you should not use exercises associated with stretching the paretic muscles.

Lesions of the peripheral nervous system.

The objectives of exercise therapy in cases of damage to the peripheral nervous system are considered to be: improvement of blood circulation and trophic processes in the affected limb, strengthening of paretic muscle groups and ligamentous apparatus, prevention of the development of contractures and stiffness of joints, promotion of regeneration of the damaged nerve, development and improvement of replacement movements and coordination of movements, general strengthening effect on the patient's body.

The method of using exercise therapy is determined by the volume of movement disorders (paresis, paralysis), their localization, the degree and stage of the disease. They use positioning treatment, massage, LH. Treatment by position is indicated to prevent overstretching of already weakened muscles with the help of splints, stacking, and corrective positions, with the exception of the time of gymnastics. LH uses active movements in the joints of a healthy limb, passive and ideomotor movements of the affected limb (for paralysis), friendly active exercises, active exercises for weakened muscles. Muscle training is carried out in facilitated conditions of their functioning (support on a smooth surface, the use of blocks, straps), as well as in warm water. During classes, it is necessary to monitor the occurrence of voluntary movements, selecting optimal starting positions, and try to maintain the development of active movements. If muscle function is satisfactory, active exercises with additional load (resistance to movement, weighting of the limb) are used, aimed at restoring muscle strength, exercises with gymnastic apparatus and equipment, applied sports exercises, and mechanotherapy. LH is carried out for 10-20 minutes with fractional loads throughout the day due to the rapid depletion of the damaged neuromuscular system. Prevention and treatment of contractures includes performing physical exercises that help increase the volume of motor activity in the joints and balance the tone of the flexor and extensor muscles.

Treatment and rehabilitation of patients with various diseases and injuries of the central and peripheral nervous system are one of the pressing problems of modern medicine, requiring an integrated approach using a wide range of therapeutic agents, including therapeutic physical training. Diseases and damage to the nervous system manifest themselves in the form of motor, sensory, coordination disorders and trophic disorders. In diseases of the nervous system, the following movement disorders can be observed: paralysis, paresis, and hyperkinesis. Paralysis, or plegia, is a complete loss of muscle contraction, paresis is a partial loss of motor function. Paralysis or paresis of one limb is called monoplegia or monoparesis, respectively, two limbs of one side of the body - hemiplegia or hemiparesis, three limbs - triplegia or triparesis, four limbs - tetraplegia or tetraparesis.

There are two types of paralysis and paresis: spastic and flaccid. Spastic paralysis is characterized by the absence of only voluntary movements, increased muscle tone and all tendon reflexes. It occurs when the cortex of the anterior central gyrus or pyramidal tract is damaged. Flaccid paralysis is manifested by the absence of both voluntary and involuntary movements, tendon reflexes, low tone and muscle atrophy. Flaccid paralysis occurs when peripheral nerves, spinal roots, or the gray matter of the spinal cord (anterior horns) are affected.

Hyperkinesis refers to altered movements that lack physiological significance and occur involuntarily. These include convulsions, athetosis, tremors.

Cramps can be of two types: clonic, which are rapidly alternating muscle contractions and relaxations, and tonic, which are prolonged muscle contractions. Seizures occur as a result of irritation of the cortex or brain stem.

Athetosis is slow worm-like movements of the fingers, hand, and torso, as a result of which it twists in a corkscrew fashion when walking. Athetosis is observed with damage to the subcortical nodes.
Trembling is an involuntary rhythmic vibration of the limbs or head. It is observed with damage to the cerebellum and subcortical formations.

Loss of coordination is called ataxia. There are static ataxia - imbalance when standing and dynamic ataxia, manifested in impaired coordination of movements, disproportion of motor acts. Ataxia most often occurs with damage to the cerebellum and vestibular apparatus.

With diseases of the nervous system, sensitivity disorders often occur. There is a complete loss of sensitivity - anesthesia, a decrease in sensitivity - hyposthesia and an increase in sensitivity - hypersthesia. with violations of surface sensitivity, the patient does not distinguish between heat and cold, does not feel injections; with deep sensitivity disorder, he loses the idea of the position of the limbs in space, as a result of which his movements become uncontrollable. Sensory disturbances occur when peripheral nerves, roots, pathways and spinal cord, pathways and the parietal lobe of the cerebral cortex are damaged.

With many diseases of the nervous system, trophic disorders occur: the skin becomes dry, cracks easily appear on it, bedsores form, affecting and underlying tissues; bones become brittle. Bedsores are especially severe when the spinal cord is damaged.

Mechanisms of therapeutic action of physical exercises

The mechanisms of the therapeutic effect of physical exercises for traumatic injuries and diseases of peripheral nerves are varied. The use of various forms of therapeutic physical culture: morning hygienic gymnastics, therapeutic exercises, gymnastics in water, walks, some sports exercises and sports games - helps restore nerve conduction, lost movements and develop compensatory motor skills, stimulates regeneration processes, improves trophism, prevents complications ( contractures and deformities), improves the mental state of the patient, has a general health-improving and restorative effect on the body.

General principles of therapeutic physical culture methods

Therapeutic physical training for lesions of peripheral nerves is carried out according to three established periods.

I period - the period of acute and subacute condition - lasts 30-45 days from the moment of injury. The objectives of therapeutic physical culture in this period are: 1) removing the patient from a serious condition, increasing mental tone, and having a general strengthening effect on the body; 2) improvement of lymph and blood circulation, metabolism and trophism in the affected area, resorption of the inflammatory process, prevention of the formation of adhesions, formation of a soft, elastic scar (in case of nerve injury); 3) strengthening of peripheral muscles, ligamentous apparatus, combating muscle atrophy, preventing contractures, vicious positions and deformities; 4) sending impulses to restore lost movements; 5) improving the functioning of the respiratory system, blood circulation, excretion and metabolism in the body.

Therapeutic physical education classes in the first period are carried out 1-2 times a day with an instructor and 6-8 times a day independently (a set of exercises is selected individually). The duration of classes with an instructor is 20-30 minutes, independent classes are 10-20 minutes.
The second period begins from the 30-45th day and lasts 6-8 months from the moment of injury or damage to the peripheral nerve. The objectives of therapeutic physical culture in this period are: 1) strengthening paretic muscles and ligamentous apparatus, combating atrophy and flabbiness of the muscles of the affected area, as well as training the muscles of the entire limb; 2) restoration of full range, coordination, dexterity, speed of performing active movements in the affected area, and if impossible, maximum development of compensatory motor skills; 3) prevention of the development of a vicious position of the affected area and related concomitant disorders in the body (impaired posture, gait, torticollis, etc.).

Therapeutic physical education classes in the second period are carried out 1-2 times a day with an instructor and 4-6 times independently (individual complex). Duration of classes with an instructor is 40-60 minutes, independent classes - 25-30 minutes.

III period - training - the period of final restoration of all functions of the affected area and the body as a whole. It lasts up to 12-15 months from the moment of injury. The objectives of therapeutic physical culture of this period are: 1) final restoration of all motor functions of the affected area and the body as a whole; 2) training of highly differentiated movements in complex coordination, speed, strength, agility, endurance; 3) restoration of complex labor processes and general ability to work.

Therapeutic physical education classes are conducted in the third period once with an instructor and 4-5 times independently (a set of exercises prescribed by a doctor or a therapeutic physical education instructor is performed). Duration of classes with an instructor is 60-90 minutes, independent classes - 50-60 minutes.

Therapeutic gymnastics in water is carried out during all periods of treatment. Water temperature 36-37°. In case of damage to the peripheral nerves of the upper limb, the duration of the lesson is
Period I -8-10 minutes, period II-15 minutes, period III -20 minutes. To generate impulses for active movements in paretic muscles, all kinds of finger movements are performed with both hands (spreading, bending, matching all fingers with the first finger, “claws,” clicks, etc.), grasping large rubber and plastic objects with your fingers: a ball, a sponge, and etc.; all kinds of exercises for the wrist joint, including pronation and supination. By the end of the first period and in the second period, active exercises with the paretic hand are supplemented and directed by the patient’s healthy hand. In the third period, exercises are performed in water to develop a grip (for example, with a paretic hand, grasp and try to hold a towel, and with a healthy hand, tear it out, etc.), to grasp small objects and hold them, i.e., to overcome resistance. In case of damage to the peripheral nerves of the lower limb, the duration of exercise in the first period is 10 minutes, in the second - 15 minutes, in the third - 25 minutes. If possible, it is advisable to perform physical exercises in the pool. In the first period, much attention is paid to sending impulses to produce active movements in the paretic muscles in combination with friendly movements with the healthy leg, as well as with the help of the patient’s hands. Exercises are performed in a bath or in a pool in the starting position while sitting, standing and walking. Exercises for the toes and ankle joint are carried out on weight, in support of the heel and on the entire foot. A lot of time is devoted to movements in the ankle joint in all directions. In periods II and III, these movements are supplemented by exercises with objects, on a ball (rolling the ball, circular movements), on a gymnastic stick, in flippers, in different walking options (on the entire foot, on the toes, on the heels, on the outer and inner edges of the foot ), with a rubber bandage (it is held by the patient himself or the methodologist), swimming with the participation of the legs. During surgical interventions, therapeutic physical training in water is prescribed after the sutures are removed.

For any damage to the peripheral nerves, active movements (especially at their first manifestations) are performed in a minimal dosage: 1-2 times in the first period, 2-4 times in the second and 4-6 times in the third. If a muscle is overstrained, it will lose the ability to actively contract for several days, and the recovery of active movements will be slow. Therefore, active movements are performed in this dosage, but are repeated several times during the lesson.
In case of any damage to the peripheral nerves, to prevent contractures, vicious positions and deformations, a fixing bandage must be applied, which is removed during exercise. At each lesson, the instructor of therapeutic physical education passively works all the joints of the paretic limb in all possible directions.

If, with damage to the peripheral nerves of the lower limb, foot drop is noted, great attention is paid to teaching the patient how to properly support the leg and walk. A drooping foot must be fixed with an elastic cord to regular shoes or a special orthopedic boot (Fig. 46). Before teaching a patient to walk, he must be taught to stand correctly, leaning on his sore leg, using an additional point of support: the back of a chair, crutches, a stick; then teach walking in place, walking with two crutches or sticks, with one stick, and only then without support.

Treatment of lesions of peripheral nerves is carried out in a hospital, on an outpatient basis, in sanatoriums, at resorts and is complex. At all stages, the complex of treatment procedures includes therapeutic physical training, massage, electrical stimulation of paretic muscles, therapeutic exercises in water, physiotherapy and drug therapy.

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Therapeutic exercise for diseases of the nervous system

Introduction

1. Physical therapy for neuroses

2. General principles of the methodology of therapeutic physical culture

2.1 Neurasthenia

2.2 Psychasthenia

2.3 Hysteria

Conclusion

Bibliography

exercise physical education neurosis psychasthenia hysteria

Introduction

Therapeutic physical culture (or exercise therapy for short) is an independent medical discipline that uses the means of physical culture to treat diseases and injuries, prevent their exacerbations and complications, and restore working capacity. The main means (and this distinguishes exercise therapy from other methods of treatment) are physical exercises - a stimulator of the vital functions of the body.

Therapeutic exercise is one of the most important elements of modern complex treatment, which means an individually selected set of therapeutic methods and means: conservative, surgical, medicinal, physiotherapeutic, therapeutic nutrition, etc. Complex treatment affects not only pathologically altered tissues, organs or systems organs, but also for the entire body as a whole. The proportion of various elements of complex treatment depends on the stage of recovery and the need to restore a person’s ability to work. A significant role in complex treatment belongs to therapeutic physical culture as a method of functional therapy.

Physical exercise affects the reactivity of the whole organism and involves the mechanisms that participated in the pathological process in the overall reaction. In this regard, physical therapy can be called a method of pathogenetic therapy.

Exercise therapy involves patients consciously and actively performing appropriate physical exercises. In the process of training, the patient acquires skills in using natural factors of nature for the purpose of hardening, physical exercises - for therapeutic and preventive purposes. This allows us to consider therapeutic physical education classes as a therapeutic and pedagogical process.

Exercise therapy uses the same principles of using physical exercises as physical culture for a healthy person, namely: the principles of comprehensive impact, application and health-improving orientation. In terms of its content, therapeutic physical culture is an integral part of the Soviet system of physical education.

1. Therapeutic exercise for neuroses

Neuroses are functional diseases of the nervous system that develop under the influence of prolonged overstrain of the nervous system, chronic intoxication, severe trauma, long-term illness, constant consumption of alcohol, smoking, etc. A certain role in the occurrence of neuroses can be played by the constitutional predisposition and characteristics of the nervous system.

The following main forms of neuroses are distinguished: neurasthenia, psychasthenia and hysteria.

Neurasthenia is based on “a weakening of the processes of internal inhibition and is clinically manifested by a combination of symptoms of increased excitability and exhaustion” (I. P. Pavlov). Neurasthenia is characterized by: rapid fatigue, increased irritability and excitability, poor sleep, decreased memory and attention, headaches, dizziness, disruption of the cardiovascular system, frequent mood changes for no apparent reason, etc.

Psychasthenia occurs predominantly in people of the thinking type (according to I.P. Pavlov) and is characterized by processes of stagnant excitation (foci of pathological stagnation, the so-called sore points). Patients are overcome by painful thoughts, all sorts of fears (whether the apartment is locked, the gas is turned off, fear of some kind of trouble, darkness, etc.). With psychasthenia, nervous conditions, depression, immobility, autonomic disorders, excessive rationality, tearfulness, etc. are noted.

Hysteria is a functional disorder of the nervous system, accompanied by a failure of higher mental mechanisms and, as a consequence, a disruption of the normal relationship between the first and second signaling systems with a predominance of the first. Hysteria is characterized by: increased emotional excitability, mannerisms, attacks of convulsive crying, convulsive seizures, a desire to attract attention, speech and gait disorders, hysterical “paralysis.”

Treatment of neuroses should be comprehensive: creation of optimal environmental conditions (hospital, sanatorium), drug treatment, physical, psycho- and occupational therapy, therapeutic physical training.

Therapeutic physical culture has a direct impact on the main pathophysiological manifestations of neuroses, increases the strength of nervous processes, helps to equalize their dynamics, coordinate the functions of the cortex and subcortex, the first and second signaling systems.

2. General principles of therapeutic physical culture methods

The method of therapeutic physical culture is differentiated depending on the form of neurosis. With neurasthenia, it is aimed at increasing the tone of the central nervous system, normalizing autonomic functions and involving the patient in a conscious and active fight against his illness; with psychasthenia - to increase emotional tone and excite automatic and emotional reactions; in hysteria - to enhance inhibition processes in the cerebral cortex.

For all forms of neuroses, an individual approach to the patient is necessary. The instructor must be authoritative, evoke positive emotions, exercise a psychotherapeutic effect on patients during classes, distract them from difficult thoughts, develop persistence and activity.
Therapeutic physical education classes are conducted individually and in groups. When forming groups, it is necessary to take into account gender, age, degree of physical fitness, functional state of patients, and concomitant diseases.

In the first half of the course of treatment (period I), it is advisable to conduct classes individually to establish contact with patients. Considering their increased sensitivity and emotionality, at the beginning of classes you should not focus on mistakes and shortcomings in performing the exercises. During this period, simple and general developmental exercises are used for large muscle groups, performed at a slow to medium pace and not requiring intense attention. Classes should be quite emotional. Commands should be given in a calm, clear voice. For patients with neurasthenia and hysteria, the exercises need to be explained to a greater extent; for patients with psychasthenia, they need to be shown.

When treating hysterical “paralysis,” distracting tasks are used under modified conditions (in a different starting position). For example, with “paralysis” of the hands, exercises with a ball or several balls are used. It is imperative to draw the patient’s attention to the involuntary inclusion of the “paralyzed” arm in work.

As patients master exercises with simple coordination, classes include balance exercises (on a bench, balance beam), as well as climbing on a gymnastic wall, various jumps, and swimming. Walking, short-range tourism, and fishing during this period also help relieve the nervous system from common irritants and strengthen the cardiovascular and respiratory systems.

The duration of classes in the first period is initially 10-15 minutes, and as adaptation progresses - 35-45 minutes. If the patient tolerates the load of the first period well, then in the second period exercises are introduced into classes that help improve attention, coordination, increase the speed and accuracy of movements, develop dexterity, and speed of reaction. To train the vestibular apparatus, exercises are used with closed eyes, with sudden changes in movements on command while walking, running, circular movements of the head, and bending of the torso. Active and lightweight sports games, walking, short-range tourism, skiing, cycling, volleyball, tennis, etc. are widely used. The second period takes place mainly in the conditions of sanatorium-resort treatment.

2.1 Neurasthenia

As already mentioned, neurasthenia is characterized by increased mental and physical fatigue, irritability, deterioration of attention and memory, lack of a feeling of vigor and freshness, especially after sleep, and somatovegetative disorders. Pathophysiologically, these phenomena should be considered as a manifestation of the weakness of active inhibition and rapid exhaustion of the excitatory process. The objectives of therapeutic physical education classes are to train the process of active inhibition, restore and streamline the excitatory process. Therapeutic exercises (in addition to the mandatory morning hygienic exercises) should be carried out in the morning. The duration and number of exercises should be minimal at first and increase very gradually.

For the most weakened patients, it is recommended to begin the session with a general 10-minute massage, passive movements while lying in bed and sitting during the first few days. The duration of subsequent lessons is 15-20 minutes. Then it is gradually brought to 30-40 minutes. Starting from the 5th-7th lesson, elements of the game (including with a ball) are introduced into the lesson, and in winter - skiing.

Due to the abundance of somatovegetative disorders in patients, their preliminary psychotherapeutic preparation is required. During the exercises, the methodologist must take into account possible painful sensations (palpitations, dizziness, shortness of breath) and adjust the load so that the patient does not get tired, so that he has the opportunity to stop doing the exercises for a while and rest without any embarrassment. At the same time, it is necessary to involve him more and more in classes, to increase interest in them due to the variety of exercises and methods of conducting classes.

Musical accompaniment should be an important element of classes. Recommended music is soothing, moderate and slow tempo, combining major and minor sounds. Such music plays the role of a healing factor.

2.2 Psychasthenia

Psychasthenia is characterized by anxious suspiciousness, inactivity, and focus on one’s personality and experiences. The pathophysiological basis of these features of patients with psychasthenia is the pathological predominance of the second signaling system, the presence in it of foci of stagnant excitation, and the inertia of cortical processes. The obsessive states that are often observed in this case (obsessive thoughts, actions, desires) are a reflection of excessive inertia of the foci of excitation, and obsessive fears (phobias) are a reflection of inert inhibition.

The objectives of physical therapy exercises are to “loose” the pathological inertia of cortical processes and suppress foci of pathological inertia through the mechanism of negative induction.

These tasks can be solved by exercises that are emotional in nature, fast in pace, and performed automatically. The music accompanying the classes should be cheerful, performed at a tempo that moves from moderate to faster, up to allegro. It is very good to start classes with marches and marching songs. It is necessary to widely include game exercises, games, relay races, and competition elements into the complex of physical exercises.

In the future, to overcome feelings of inferiority and low self-esteem, shyness, it is recommended to include exercises in overcoming obstacles, balance, and strength exercises in your classes.

When forming a group for classes, it is advisable to include several recovering patients, emotional ones, with good plastic movements. This is important because patients with psychasthenia are characterized by non-plastic motor skills, clumsiness of movements, and clumsiness. They usually do not know how to dance, so they avoid and do not like dancing. In case of obsessive states, appropriate psychotherapeutic preparation of the patient and explanation of the importance of performing exercises to overcome feelings of unreasonable fear are of great importance.

To increase emotional tone, resistance exercises performed in pairs, mass game exercises, and medicine ball exercises are used; to overcome feelings of indecision, self-doubt - exercises on apparatus, balance, jumping, overcoming obstacles.

During classes, the methodologist must by all means help to increase the patients’ contact with themselves and with each other.
The goal is to excite automatic reactions and raise the emotional tone of patients - is achieved by accelerating the pace of movements: from the slow pace characteristic of these patients of 60 movements per minute to 120, then from 70 to 130 and in subsequent classes from 80 to 140. In the final part of the classes, exercises that help to slightly reduce emotional tone. It is necessary that the patient leaves the therapeutic gymnastics room in a good mood.

An approximate set of exercises for psychasthenia

1. Formation in a circle facing inward. Pulse rate counting.

2. Movement in a circle alternately in one direction and the other, holding hands, with acceleration.

3. Move in a circle on your toes, alternately in one direction and the other, with acceleration.

4. I. p. - main stand. Relax, take the “at ease” position.

5. I. p. - main stance. Alternately raise your arms up (starting with the right) with acceleration from 60 to 120 times per minute.

6. I. p. - feet shoulder-width apart, hands clasped. 1--2 - raise your arms above your head - inhale, 3--4 - lower your arms to the sides - exhale. 4--5 times.

7. I. p. - hands forward. Squeeze and unclench your fingers with acceleration from 60 to 120 times per minute. 20--30 s.

8. I. p. - feet shoulder-width apart, hands locked, 1 - raise your hands above your head - inhale, 2 - sharply lower your hands between your legs shouting “ha”. 4--5 times.

9. I. p. - legs together, hands on the waist. 1--2 - sit down - exhale, 3--4 - stand up - inhale. 2--3 times.

10. I. p. - standing on tiptoes. 1 - lower on your heels - exhale, 2 - rise on your toes - inhale. 5--6 times.

11. Resistance exercise in pairs:

a) standing facing each other, hold hands, bending them at the elbow joints. Alternately, each person resists with one hand and extends the other at the elbow joint. 3--4 times;

b) standing facing each other, holding hands. Resting your knees on your friend’s knees, squat down, straightening your arms, then rise. 3--4 times.

12. Exercises with medicine ball:

a) standing in a circle one after another. Passing the ball back behind the head. 2--3 times;

b) throwing the ball to each other with two hands at a distance of 3 m.

13. I. p. - standing in front of the ball. Jump over the ball and turn around. 4--5 times.

14. Exercises on apparatus:

a) balance - walk along a bench, log, board, etc. 2-3 times;

b) jumping from a gymnastic bench, from a horse, etc. 2-3 times;

c) climb up the wall bars, grab the top rail with your hands, and while hanging, move your legs away from the wall to the right and left, 2-3 times. Lower yourself down, holding on with your hands and leaning on your legs.

15. I. p. - main stance. 1--2 - rise on your toes - inhale, 3--4 - lower to a full foot - exhale. 3--4 times

16. I. p. - main stance. Alternately relax your arms, torso, and legs.

17. I. p. - main stance. Pulse counting.

2.3 Hysteria

Hysteria, as already mentioned, is characterized by increased emotiveness, emotional instability, frequent and rapid changes in mood. The pathophysiological basis of hysteria is the predominance of the first cortical signaling system over the second, the lack of balance and mutual coherence between the subcortical system and both cortical systems. The task of therapeutic physical culture for hysteria is to reduce emotional lability, increase the activity of conscious-volitional activity, remove the phenomena of positive induction from the subcortex and create differentiated inhibition in the cerebral cortex.

The implementation of these tasks is achieved through targeted physical exercises. The pace of movements should be slow. It is necessary to calmly but persistently demand the precise execution of all movements. Classes should include a specially selected set of simultaneous (but different in direction) exercises for the right and left sides of the body. An important methodological technique is to perform memory exercises, as well as as explained by the methodologist without showing the exercises themselves.

The training group should include no more than 10 people. Commands should be given slowly, smoothly, and in a conversational tone. All errors must be noted and corrected. Classes are held in the absence of outsiders.

A decrease in emotional tone is achieved by slowing down the pace of movements. The first lessons begin with the accelerated pace characteristic of this group of patients - 140 movements per minute and reduce it to 80, in subsequent lessons - from 130 movements to 70, then from 120 to 60.

Differentiated inhibition is developed with the help of simultaneously performed but different tasks for the left and right hands, left and right legs. The inclusion of active-volitional acts is achieved by performing strength exercises on apparatus at a slow pace with a load on large muscle groups.

Conclusion

“If you want to live, know how to spin.” Life in the modern world is akin to an endless race. The time we live in is a time of accelerated pace of life. Quickly take a shower, quickly eat a sausage, and run to work. Everyone runs at work too. Time must be saved, time is money.

In the modern world there are many factors that have a negative impact on the human psyche. These could be problems at work that are systematic and persistent, the lack of an established personal or family life, and many others. Against the background of constant worries about the problem area, many people develop neuroses.

Physical exercises influence the emotional sphere of the patient, they make him feel cheerful, joyful, distract him from various painful experiences, help eliminate uncertainty, anxiety, fear, various “neurotic” manifestations and create a more balanced state. Raising the mood of a sick person is half curing him (S.I. Spasokukotsky). In addition, positive emotions that arise especially during the game method of conducting physical exercises stimulate the functional activity of the body and create favorable conditions for resting the nervous system from monotonous physical and mental work.

The systematic use of physical exercises in the treatment of patients with functional disorders of the nervous system increases their resistance of the neuropsychic sphere to various environmental stimuli. Physical exercise helps balance the internal properties of the body with environmental conditions, and the central nervous system plays a leading role in this balancing. The use of therapeutic physical culture enriches the conditioned reflex activity of the nervous system of patients.

In conclusion, it should be emphasized that patients with various types of neuroses are recommended to continue exercise at home in the form of morning hygienic gymnastics (the complex should be compiled by a doctor taking into account the characteristics of the impaired functions of the patient), attend health groups, play volleyball, walk more, ride a bike, ski and skate.

Bibliography

1. Moshkov V.N. “Therapeutic physical culture in the clinic of nervous diseases” - Moscow: Medicine, 1982.

2. Vinokurov D.A. “Private methods of therapeutic physical culture” - Moscow: Medicine, 1969.

3. Kirpechenko A.A. “Nervous and mental illnesses” - Textbook - Moscow: Higher school, 1998. Electronic edition.

4. Kozlova L.V. “Fundamentals of Rehabilitation” - Rostov-on-Don: “Phoenix”, 2003

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An approximate set of general developmental exercises for vegetative-vascular dystonia

Exercise 1. Starting position - lying on your back. Arms to the sides, in the right hand there is a tennis ball. Transfer the ball to your left hand. Return to starting position. Look at the ball. Repeat 10-12 times.

Exercise 2. Starting position - lying on your back. Hands to the side. Perform cross movements with straight arms in front of you. Repeat for 15-20 s. Watch your hand movements. arbitrary.

Exercise 3. Starting position - lying down. Hands forward. Swing your right leg towards your left hand. Return to starting position. Do the same with your left foot. Repeat 6-8 times. Look at the toe of your foot. The swing is performed quickly.

Exercise 4. Starting position - lying on your back. There is a basketball in his hands. Swing your foot - get the ball. Repeat with each leg 6 times.

Exercise 5. Starting position - lying on your back. In his raised right hand is a tennis ball. Make circular motions clockwise, then counterclockwise. Return to starting position. Repeat with your left hand. Look at the ball. Perform for 10-15 seconds.

Exercise 6. Starting position - sitting on the floor. Support with hands from behind. Straight legs raised slightly above the floor. Make cross movements with your legs, right on top, then change legs. Do not hold your breath. Look at the toe of your foot. Perform for 10-15 seconds.

Exercise 7. Starting position - sitting on the floor. Support with hands from behind. Swing with straight legs alternately. Amplitude is high. Perform for 10-15 seconds.

Exercise 8. Starting position - sitting on the floor. Swing your legs to the sides. Repeat alternately 6-8 times with each leg.

Exercise 9. Starting position - sitting on the floor. Support with hands from behind. Extend your right leg to the right as far as it will go. Return to starting position. Do the same with your left foot. Make movements slowly. Repeat 6-8 times.

Exercise 10. Starting position - sitting on the floor. Support with hands from behind. Raise your right leg slightly and draw a circle in the air clockwise, then counterclockwise. Initial position. Repeat the same with your left leg. Repeat 6-8 times with each leg.

Exercise 11. Starting position - sitting on the floor. Arm support - raise both legs above the floor and make circular movements in one direction, then in the other. Perform for 10-15 seconds.

Exercise 12. Starting position - standing. In the hands of a gymnastic stick. Raise the stick above your head - bend at the waist - inhale, return to the starting position - exhale. Repeat 8-10 times.

Exercise 13. Starting position - standing. Hands down, gymnastic stick in hands. Sit down, raise the stick up above your head - inhale. Return to the starting position - exhale. Repeat 6-8 times.

Exercise 14. Starting position - standing. Dumbbells in lowered hands. Hands to the sides - inhale, lower - exhale. Repeat 8-10 times.

Exercise 15. Starting position is the same. Raise your arms at shoulder level, to the sides. Make circular movements with your hands. The pace is slow. Repeat 4-6 times.

Exercise 16. Starting position - standing. Dumbbells in lowered hands. Raise your arms alternately. Repeat 6-8 times.

Special exercises (performed in pairs)

Exercise 1. Passing the ball from the chest to a partner standing at a distance of 5-7 m. Repeat 12-15 times.

Exercise 2. Passing the ball to a partner from behind from behind the head. Repeat 10-12 times.

Exercise 3. Passing the ball to a partner with one hand from the shoulder. Repeat with each hand 7-8 times.

Exercise 4. Throw the ball up with one hand and catch it with the other. Repeat 7-8 times.

Exercise 5. Hit the ball with force on the floor. Let it bounce and try to catch it with one hand, then with the other. Repeat 6-8 times.

Exercise 6. Throwing a tennis ball at a wall from 5-8 m. Repeat 10-15 times.

Exercise 7. Throwing the ball into a basketball hoop with one hand from a distance of 3-5 m, then with both. Repeat 10-12 times.

Exercise 8. Throwing a tennis ball at a target. Repeat 10-12 times.

Exercise 9. Starting position - sitting on a chair. Lower your head (assuming the fetal position) and breathe calmly and deeply.

Exercise therapy for paresis and paralysis

Paralysis and paresis are a consequence of damage to the spinal cord that occurs due to spinal injuries. The most common cause of spinal injuries are compression fractures of the vertebral bodies. In this case, wedging of the posterior surface of the vertebral bodies into the anterior part of the spinal cord occurs, which leads to its compression without destruction of the brain matter or with destruction, up to a complete anatomical break as a result of the introduction of bone fragments into the brain matter. Depending on the area of spinal cord injury, either the upper extremities or both the upper and lower extremities are affected, with paralysis of the respiratory muscles and anesthesia of the entire body. With timely removal of compression, in contrast to an anatomical break, these phenomena are reversible.

We do not set ourselves the task of telling about all the stages of treatment of paralysis and paresis, since the book is not a manual for doctors. One of the stages of treatment and restoration of the health of such patients is therapeutic exercises, which is a fairly effective means of preventing atrophy, strengthening and developing the muscular system. The approach to therapeutic exercises for this category of patients should be differentiated and focused directly on the degree of compensation of the patient, the type of paralysis and the timing of the injury. Depending on the severity of the case, this happens on the 3-5-12th day after the injury. The first gymnastics classes for a patient with a fracture of the lumbar or thoracic spine consist of light movements of the head, arms and legs and teaching proper breathing. All movements should be carried out without sudden muscular tension.

When performing exercises in paralyzed limbs, some facilitating positions, as well as various devices, should be used.

We would like to note that in the early period of illness, classes should be conducted only with an instructor, since such patients need constant assistance from a health care worker. Then, in the chronic and residual stages, the patient must work himself. Mobilizing gymnastics helps improve all general physiological processes, therefore, we see no contraindications for its implementation. This gymnastics is necessary for the patient at all stages of rehabilitation.

A set of exercises for patients with spastic paresis and paralysis (acute stage of the early period of traumatic disease of the spinal cord)

All exercises are performed lying on your back.

Exercise 1. Strong intake of air with expansion of the chest. Long deep exhalation. As you exhale, pull your stomach in, and as you inhale, push it out.

Exercise 2. Take a deep breath, squeeze your shoulder blades together, relax your shoulder blades - exhale.

Exercise 3. Arms along the body. Slide your palms along your body up - inhale, down - exhale.

Exercise 4. Inhale - bend your arms at the elbow joints, exhale - straighten them.

Exercise 5. Spread your legs to the sides - inhale, return to the starting position - exhale.

Exercise 6. Raise your straight right leg - inhale, return to the starting position - exhale, repeat the same with your left leg.

Exercise 7. Bend your right leg at the knee and pull it towards your chest - inhale, return to the starting position - exhale. Repeat the same with the left leg.

Exercise 8. Spread your arms to the sides - inhale, return to the starting position - exhale.

Exercise 9. Raise your arms up and behind your head - inhale, return to the starting position - exhale.

Exercise 10. Bend your right arm at the elbow, pull it to your shoulder, left straight - inhale, bend your left hand, pull it to your shoulder, straighten your right - exhale.

Exercise 11. Raise your right leg and draw a circle in the air with your foot - inhale, return to the starting position, repeat everything with your left leg.

Exercise 12. Counting fingers. Use your thumb to move your fingers and count. Perform the exercise first with your right hand, then with your left.

Exercise 13. Fiddle with your fingers as if you were playing the piano or working on a typewriter.

Exercise 14. Rest on your forearms and raise your pelvis - inhale, return to the starting position - exhale.

A set of exercises for patients with flaccid paresis and paralysis (acute stage of the early period)

Exercise 1. Raise your hands up - inhale, lower - exhale.

Exercise 2. Take dumbbells. Bend and straighten your arms while holding dumbbells. The exercise is performed with effort.

Exercise 3. Raise dumbbells, with outstretched arms - inhale, return to the starting position - exhale.

Exercise 4. Lean on your shoulder joints and raise your pelvis - inhale, return to the starting position - exhale.

Exercise 5. Raise and lower your legs using a block and traction. Raise your legs - inhale. Return to the starting position - exhale.

Exercise 6. Bending the legs at the knee and hip joints using a block and traction.

Exercise 7. Rotate the body to the right side while throwing your leg behind your left leg. Then turn the body to the left, throwing the left leg over the right.

Exercise 8. Support on the forearms. Bend in the thoracic region (“bridge”).

Exercise 9. Hand movements. Imitate the movements of the breaststroke style of swimming.

Exercise 10. Hand movements - imitation of boxing.

Exercise 11. Leg movements - imitation of swimming on the back.

Exercise 12. Raise your leg and draw a circle in the air with your toe. Change the position of your legs.

Exercise 13. Place one hand on your chest, the other on your stomach. Inhale - inflate your stomach, exhale - draw in.

Exercise 14. In the hands of an expander. Stretch in front of the chest. Stretch - inhale, return to the starting position - exhale.

Exercise 15. Spread and bring together the elbows with your hands behind your head. Bring your elbows together - inhale, spread them - exhale.

Exercise 16. Stretch the expander with your arms extended forward.

Exercise 17. Stretch the expander over your head.

Exercises are performed at a slow pace. If you feel unwell, you should not cancel classes, you just need to reduce the dosage. To perform passive exercises, blocks, hammocks, and loops are used; for strength exercises, dumbbells and expanders are used. The duration of classes should not exceed 15-20 minutes, in weakened patients 10-12. Repeat exercises from 3-4 times to 5-7 times.

Exercise therapy after a stroke

A stroke is an acute violation of the coronary circulation. This disease is the third leading cause of death. Unfortunately, a stroke is a very serious and extremely dangerous vascular lesion of the central nervous system. It is caused by a violation of cerebral circulation. Most often, older people suffer from this disease, although recently this disease has begun to overtake young people as well. Fluctuations in blood pressure, excess weight, atherosclerosis, overwork, alcohol and smoking - all these factors can cause cerebral vascular spasm.

Conventionally, a stroke is divided into cerebral infarction and cerebral hemorrhage. Thus, young people most often have a cerebral infarction, that is, a hemorrhagic stroke. The elderly suffer from the so-called ischemic stroke, which is caused by a violation of the oxygen supply to nerve cells. This disease has a much more severe course and more serious complications.

Hemorrhagic stroke is a complication of hypertension. It usually occurs after a busy day at work. Nausea, vomiting and severe headache are the first signs of a hemorrhagic stroke. Symptoms appear suddenly and increase rapidly. Speech, sensitivity and coordination of movements change, the pulse is rare and tense, and the temperature may rise. The person turns red, sweats, and a kind of shock occurs in the head. Losing consciousness is already a stroke. From the ruptured vessel, blood enters the brain tissue, which can be fatal.

External signs of hemorrhagic stroke: increased pulsation of blood vessels in the neck, hoarse and loud breathing. Sometimes vomiting may occur. The eyeballs sometimes begin to deviate to the affected side. Paralysis of the upper and lower extremities on the opposite side of the affected area is possible.

Ischemic stroke does not develop so rapidly. The ailments that the patient may experience during this period may last for several days. The blow most often occurs either at night or in the morning. And if ischemia is not caused by a blood clot or atherosclerotic plaque (embolus), which can be carried with the bloodstream, then the onset of the disease is quite calm. The patient may not lose consciousness and, if he feels a deterioration in his health, consult a doctor. Signs of a “shock”: the face is pale, the pulse is soft and moderately rapid. However, paralysis of the limbs on any side may soon occur, depending on the area of the brain damage.

Despite this calm, the consequences are quite serious. An area of the brain deprived of blood dies and cannot perform its functions. And this, depending on which part of the brain is affected, leads to impaired speech and memory, coordination of movements and paralysis, recognition and even muteness. The patient either speaks in separate words and phrases, or becomes completely mute.

Based on certain symptoms, an experienced doctor can accurately tell which part of the brain is affected by a stroke, which makes it possible to predetermine the course of the disease and a possible prognosis. It contains three options: favorable, average and unfavorable. Lost functions and abilities are restored - this is the first case. The course of the disease is complicated by additional chronic diseases, which worsens and prolongs the course of the disease - this is the second option. The third option, as a rule, does not bode well. A large area of the brain is affected or the patient experiences repeated strokes. The probability of repeated strikes is very high and reaches 70%. The most critical days after the first strike are the 3rd, 7th and 10th.

Urgent hospitalization in a specialized neurological department is an indispensable condition for stroke, since in case of hemorrhagic stroke it is necessary to urgently reduce blood pressure and reduce cerebral edema, and in case of ischemic stroke it is necessary to control blood clotting.

Timely provision of medical care, attention to the general care of the patient, and physical therapy exercises are the ways to bring the patient back to life. An important role in the victory of a stroke is played by the patient’s awareness of his current condition. Negative emotions will not do any good and can lead to a second blow, so focus on restoring your health. Your goal is to restore mobility to your limbs. All together will help you restore your health.

It is an important effective method of rehabilitation, since it affects various systems of the body: cardiovascular, respiratory, musculoskeletal, nervous. It is also an effective method in the recovery period.

Therapeutic exercises for stroke are, in fact, physical exercises that affect motor and sensory functions. Not the least place in rehabilitation is occupied by breathing exercises. Its objectives are to improve pulmonary ventilation and train external respiration.

Breathing exercises are carried out for 3-6 minutes 8-12 times a day. It is necessary to breathe deeply and evenly. If there is sputum, it must be coughed up. Breathing exercises are used with prolonged inhalation and exhalation (diaphragmatic breathing).

The motor set of exercises includes exercises for small and medium muscle groups of the arms and legs, as well as movements in the shoulder girdle. In case of severe disorders of the cardiovascular system and unstable blood pressure, as well as arrhythmias that are accompanied by heart failure, active breathing exercises are not recommended.

In the early stages of the disease and when the patient is insufficiently active, passive breathing exercises are used, which are carried out by a physical therapy instructor.

The instructor stands at the side of the patient. His hands are located on the patient’s chest; during the patient’s exhalation, he begins to compress the patient’s chest with a vibrating movement and adjusts to the patient’s breathing, thereby activating exhalation. The degree of impact on the chest increases with each exhalation. Every 2-3 breathing movements, the position of the health worker’s hands on the patient’s body changes. This allows increased irritation of the respiratory apparatus. Hands are alternately placed on different parts of the chest and abdomen. The number of forced breathing exercises is 6-7, then the patient performs 4-5 normal cycles. Then the breathing exercise is repeated again. To achieve greater effect from breathing exercises, it is advisable to perform it 5-6 times a day. Duration 10-15 minutes.

In a later period, the patient takes an active part in performing breathing exercises with a combination of semi-passive and active movements of the upper and lower extremities. In order to do breathing exercises correctly, it must be controlled. Hands should be placed one on the chest, the other on the stomach. We inhale calmly and smoothly.

A complex of breathing exercises for stroke survivors

Exercise 1. Inhale until you feel your stomach rise. The hand on the chest should remain motionless. This indicates that there is no chest breathing. Exhale more fully, so that the stomach seems to retract.

Exercise 2. Inhale - the chest rises, along with the arm. The stomach does not rise. This indicates that there is no abdominal breathing. The exercise is performed calmly and slowly.

Exercise 3. Inhale with abdominal breathing, and then continue breathing with your chest. Fill your chest as if to capacity. Start exhaling with your stomach, followed by a chest exhalation. This exercise is called "full breathing."

Exercise 4. Inhale with significant tension in all respiratory muscles. Then take 2 quiet breaths in and out.

Exercise 5. Repeat exercise 4.

Having mastered breathing exercises, you will help yourself and your body by performing a kind of ventilation of the lungs. This reduces the likelihood of pneumonia and congestion in the lungs and bronchi.

In case of motor deficit - paresis - it is necessary to start with exercises primarily to overcome resistance to movement. Thanks to regular exercise, the affected limbs will gain greater mobility. At the same time, you will not only restore mobility to your limbs, but also strengthen them. Of great psychological importance for the patient is the opportunity to see how, with the help of simple, but purposeful and deliberate techniques, the desired effect is achieved with little effort.

An approximate set of exercises to overcome resistance

Exercise 1. With your healthy hand - thumb and index finger - squeeze the hand of the other hand. At the instructor’s command, make stepwise efforts “weakly, a little stronger, more, very strong, maximum.”

Exercise 2. Then gradually teach the patient to hold a slice of bread, a comb and other small household items.

Exercise 3. Rotating the telephone dial, whipping soap foam, stirring a glass with a spoon brings the patient closer to performing familiar and important skills.

In addition to such exercises, it is advisable to perform motor exercises under the supervision and with the help of an instructor.

An approximate set of motor exercises

All exercises are performed from a lying position.

Exercise 1. Movement of the hands without taking your hands off the bed. Raise the brush, lower the brush. If it is impossible to perform movements with a sore hand, then the help of an instructor is required. Repeat 4-6 times.

Exercise 2. Circular movements with the hands. The exercise is performed at a slow pace.

Exercise 3. Lying down, bend and straighten your toes. Try to do this consistently, i.e. start bending from the little finger. When extending, try to spread your fingers (the help of an instructor or relatives is useful).

Exercise 4. Pull your feet towards you. Return to starting position. Repeat 4-6 times.

Exercise 5. Turn your feet to the sides: to the left - return to the starting position, then to the right, and vice versa.

Exercise 6. Without lifting your head from the pillow, turn it to the right and left. The amplitude of movement depends on the extent of the lesion.

Exercise 7. Lying on the bed, place your hands with your palms up. Bend your fingers, trying to make a fist. Squeeze, unclench.

Exercise 8. Hands lie on the bed. Fingers closed. Spread your fingers, bring your fingers together.

Exercise 9. Hands lie on the bed. Bring your fingers into a fist with one hand, the other lies quietly. Then change hands (an instructor or relatives help with movements on the affected limb).

Exercise 10. Flexion and extension of the legs at the knee joint. The pace is slow.

Exercise 11. Place a tennis ball in the patient’s hand. Squeeze the ball. Do more repetitions with your healthy hand, and if possible with your sore hand.

Simple and familiar everyday activities are quite difficult for the patient. The most difficult period is the early stages of recovery. But in order for the patient to learn, he needs the help of not only medical personnel, but also the active help of relatives.

Since coordination of movements is impaired, among the exercises to increase the coordination of actions between two or more muscle groups there should be exercises to train balance in a standing position and while walking. For small and medium-sized lesions, patients are transferred to a vertical position from the 5-7th day.

As soon as the patient has been put on his feet, he needs to begin learning how to walk correctly. To do this, he is taught to bend his lower leg. The methodologist sits next to the patient on a bench and helps him fix his hip and creates a support for him. Once the patient has mastered this, he is taught to move the hip forward while simultaneously extending the lower leg while dorsiflexing the foot.

During the same period, the patient is taught accuracy and coordination of hand actions.

An approximate set of exercises for developing fine motor skills of the hand

Exercise 1. Injection with a needle. Repeat 6-8 times with one hand, then with the other (if the patient is unable to grasp the needle with the affected hand, the help of an instructor or relatives is needed).

Exercise 2. Give the patient scissors. On command, he must transfer them from hand to hand. The pace is slow.

Exercise 3. The patient has a pen in his hands. At the instructor's command, he must try to fix the position of the pen, as for writing.

Exercise 4. The patient cups his palms. The instructor lightly tosses him a tennis ball. The patient tries to pass the ball to the instructor with the affected hand (if this fails, the ball is passed with the healthy one).

Exercise 5. Starting position - sitting on the bed. Bend one leg at the knee, then the other.

Exercise 6. Starting position - sitting on the bed. Do not lift your feet off the floor, raise your socks, lower them. Repeat 4-6 times.

Exercise 7. Starting position - sitting on the bed. Bend your arms at the elbows, straighten them. Repeat 4-6 times.

Exercise 8. Starting position - lying on the bed. Bend your arms at the elbows (with your elbows resting on the bed). Turn the closed hands towards you with the palm, away from you. Repeat 3-4 times.

Exercise 9. Starting position - lying on the bed. Hands are in the same position as in the previous exercise. Make a fist with one hand, then with the other. Repeat 3-4 times.

Exercise 10. Starting position - lying on the bed. Hands in position of exercise 8. Bend your hands (depict a “duck”). Turn your hands away from you, towards you. Repeat 4-6 times.

Exercise 11. Starting position - lying down. Hands in exercise position 8. Make circular movements with your hands. The elbows are motionless, resting on the bed.

Exercise 12. Starting position - lying down. Bend your legs at the knees. Hands along the body. Place one leg on the bent knee of the other leg. Bend and straighten the shin of the “hanging” leg. Repeat 3-4 times. Then change the position of your legs.

Exercise 13. Starting position - standing by the bed and leaning on it. The instructor rolls the ball to the patient's foot. He must push him away from him.

Exercise 14. Starting position - standing by the bed and leaning on it. The instructor places a matchbox on the floor in front of the patient. Raise your leg a little higher than the box and step over it. Perform with one leg, then change the position of the legs.

Exercise 9. Starting position - sitting on the bed. The patient rolls a round block with his foot.

Motor self-care skills are one of the most important tasks in rehabilitation. Therefore, they need to train the patient using special exercises. Efficiency is achieved by a sequence of exercises, moving from simple to complex and gradually increasing the load.

Children's games with a ball are very effective in the rehabilitation of the patient, where there are exercises with the ball bouncing off the wall, off the floor, upward throws and elements of football. All of these exercises help restore joint movement and muscle strength.

Approximate set of exercises

Exercise 1. Starting position - sitting on a chair or bed. Hands on knees. Tilts the head forward and backward. Movements are blurry. Repeat 3-4 times.

Exercise 2. Starting position - the same. Tilts of the head to the sides. Repeat 3-4 times.

Exercise 3. Starting position - the same. Raise your arms in front of you and shake your hands. Then bend your elbows and shake them.

Exercise 4. Starting position - the same. Hands extended in front of you. Clench your fists, unclench your fists. Spread your fingers as wide as possible. Repeat 3-4 times.

Exercise 5. Starting position - sitting on a chair. Grab your leg under the knee and lift it with your hands. Repeat the same with the other leg. Repeat 3-4 times.

Exercise 6. Starting position - sitting on a chair. Extend your arms in front of you and lean forward slightly. Repeat 3-4 times.

Exercise 7. Starting position - sitting on a chair. Bend your arms at the elbows, place your hands on your shoulders. Pull your elbows towards each other.

Exercise 8. Starting position - lying on the bed. Bend your arms at the elbows. The palms are turned towards the patient's face. Lower your arms, turn your palms away from you. Repeat 4-6 times.

Exercise 9. Starting position - lying down. Hands along the body. Bend one arm at the elbow and reach your shoulder with your hands. Change the position of your hands. Repeat 4-6 times.

Exercise 10. Starting position - sitting on a chair. Raise your legs above the floor and make cross movements with your legs. Repeat 3-4 times.

Exercise 12. Starting position - lying on the bed. Pull the foot of one leg towards you, pull the other away from you. Repeat with alternating legs 3-4 times.

Exercise 13. Starting position - sitting on a chair. Hands on knees. Tilt your torso to the right, then to the left. When changing position, return to the original position. Repeat 4-6 times.

Exercise 14. Starting position - sitting. Hands on the belt. Turn your body to the left, return to the starting position, then turn to the right. Repeat 4-6 times.

The pace of execution is slow. If you experience discomfort while performing, do not perform the exercise or perform it with a smaller range of motion.