Werbow's symptom
It is characterized by a synergistic unilateral contraction of the gluteal muscles when causing the symptom of Lasegue, as a result of which the buttock on the affected side rises. It is noted with a unilateral lesion of the sciatic nerve. On the healthy side, as a rule, is absent.
Vernet-Sycorecolle (villare) syndrome
It consists in the defeat of the IX, X, XI and XII cranial nerves and the upper cervical sympathetic ganglion.
Vernet torn hole syndrome
It is characterized by damage to the IX, X, XI cranial nerves exiting through a torn hole. Damage symptoms: difficulty swallowing dense food; the back wall of the pharynx is moved to the healthy side; violation of taste on the back of the root of the tongue; decreased sensitivity of the soft palate, mucosa of the posterior pharyngeal wall and larynx; urge to cough, pseudoasthma and salivation; on the side of the focus of paresis of the soft palate, larynx, sternocleidomastoid and trapezius muscles.
The syndrome is most often caused by diseases of the submandibular salivary glands, phlegmon, phlebitis, meningitis, tumor and other processes on the base of the skull in the region of the laceration. Described by YVernet in 1916.
Werner syndrome
It is characterized by small stature, a relatively large skull, a beak-shaped nose, a small mouth with a large chin ("bird's face"), thin upper and lower limbs, especially in the distal sections, early atherosclerosis, cataracts, skin atrophy (especially of the legs and feet) with development of trophic ulcers, mask-like face (scleroderma type), hypogenitalism phenomena (menstrual irregularities, sterility, high voice, delay or absence of secondary sexual characteristics), dysfunction of the parathyroid glands (calcium metabolism disorder), thyroid gland (osteoporosis), sometimes dementia .
Premature graying and baldness are noted. The syndrome is caused by congenital endocrine insufficiency. Described by the German physician O. Werner in 1904.
Werinke-Mann (type of contractures, Wernicke-Mann position) syndrome
It is observed in pyramidal lesions. On the upper limb, the muscles that raise the girdle of the upper limb, abduct and rotate the muscles of the shoulder, extensors and supinators of the forearm, extensors of the hand and fingers of the hand are more often affected, on the lower - muscle groups that abduct and adduct the thigh, muscle groups that flex the knee and foot.
When the flaccid stage of heminlegia is replaced by a spastic one, the antagonists of these muscle groups are especially hypertonic. Spasticity, if it is sufficiently pronounced, leads to the formation of contractures.
As a result, the upper and lower limbs assume the following position: the belt of the upper limb is lowered, the shoulder is adducted and rotated inwards, the forearm is pronated and bent at the elbow joint, the hands and fingers are bent, the thigh is extended and adducted, the lower leg is extended, the foot is in the position of pes varoquinus, therefore, the paralyzed lower limb, as it were, becomes somewhat longer than the healthy one. In order not to touch the floor while walking, the patient, not being able to raise the limb up, “mows” it, that is, takes it to the side, describing a semicircle with the foot (“the hand asks, the leg mows”).
The Wernicke-Mann position is often observed with lesions of the pyramidal tract in the region of the posterior crus of the internal capsule. Described by German neuropathologists K. Wernicke in 1889 and L. Mann in 1896.
"Handbook of Neurological Semiology",
G.P. Lip
Schwabach test It is carried out using a sounding tuning fork, which is placed on the mastoid process on the side of the investigated vestibulocochlear organ and the duration of bone conduction of sound is determined. The obtained value in seconds is compared with the bone conduction of an unaffected vestibulocochlear organ of a patient or with the conduction of a healthy person. When the sound-conducting apparatus is damaged, bone conduction is lengthened, and when the sound-receiving apparatus is damaged, it is shortened. Shvetsova…
Schilder's test During the test, the examiner, standing with his eyes closed, stretches his upper limbs forward. With a sharp turn of the head to the side, the lower limb slightly rises on the same side, and both upper limbs deviate somewhat in the same direction. The change in the position of the upper limbs is especially pronounced in cerebellar processes. Described by the German psychiatrist P. Schilder in 1912 ....
Barbell test (test for the duration of breath holding) It is determined by the following method: after two deep breaths and exhalations, a calmly lying patient is offered to take an intensified breath and hold his breath for as long as possible, holding his nose with his fingers. The duration of breath holding is determined by a stopwatch. Similarly, the time of holding the breath during exhalation is noted. Between determining the duration of the delay on inhalation and exhalation ...
Shcherbak's (thermoregulation) reflex Method of inducing the reflex: the patient's rectal temperature is determined, after which his upper limb is immersed for 20 minutes in water at a temperature of 32°C. Then, over 10 minutes, the water is gradually heated to 42°C and the rectal temperature is measured again immediately after heating and after 30 minutes. With the preserved function of thermoregulation immediately after warming the limb ...
Edelman's symptom Is a painful topical reflex. It consists in extension of the big toe when causing Kering's symptom. It is observed in diseases accompanied by irritation of the membranes of the brain and spinal cord. Eddie's syndrome It is characterized by peculiar reactions of the pupils: when illuminated, the pupil does not narrow, but expands in the dark; under the influence of light, it slowly narrows again (moreover, it becomes narrower than before the test) and ...
Karl Wernicke (1848-1905)
Ludwig Mann (1866-1936)
Specific pathological changes in muscle tone in the affected limbs in the pathology of the pyramidal system. Acute unilateral lesion of the pyramidal tracts on the upper limb the muscles that raise the belt of the upper limb, the muscles of the shoulder that abduct and rotate outward, the extensors and arch supports of the forearm, the extensors of the hand and fingers, are more often affected; on the lower limb- muscle groups that abduct and adduct the thigh, flex the knee and foot. When the flaccid stage of hemiplegia is replaced by spastic, the antagonists of these muscle groups are especially hypertonic. Spasticity, if it is sufficiently pronounced, leads to the formation of contractures. As a result, the upper and lower limbs assume the following position: the belt of the upper limb is lowered, the shoulder is adducted and rotated inwards, the forearm is pronated and bent at the elbow joint, the hand and fingers are bent, the thigh is extended and adducted, the lower leg is extended, the foot is in the pes equino-varus position. , as a result of which the paretic limb becomes, as it were, longer than the healthy one.
Described by the German neurologist and psychiatrist Carl Wernicke (1848-1905) in 1889. ( Wernicke K. Zur Kenntnis der cerebralen Hemiplegie // Berliner clinic Wochenschrift, 1889. – bd.26. – S.969-970 ) and his student, the German neurologist and physiotherapist Ludwig Mann in 1896. ( Mann L. Klinische und anatomische Beiträge zur Lehre von der spinalen Hemiplegie // Deutsche Zeitschrift für Nervenheilkunde, Berlin, 1896. - Bd.10. – S.1-66).
Source: www.neurosar.ru
Great Encyclopedia of Psychiatry. Zhmurov V.A.
Gait- posture and character of body movements while walking. Some types of gait have diagnostic value, their names indicate the nature of the disorder causing them or the psychological state of the individual:
Dictionary of psychiatric terms. V.M. Bleikher, I.V. Crook
Gait- a set of features of the posture and movements when walking. Some types of gait have diagnostic value, for example, atactic gait (see Ataxia); hemiplegic (see. Hemiplegia, Hemiparesis) gait (the paretic leg is retracted to the side and, without bending, produces a semicircle - hence: squinting, circulating gait). With parkinsonism, a puppet gait is observed - with small steps, without synergistic hand movements, with a frozen and unbent torso. With damage to the frontal lobes of the brain - fox P. (setting the feet in one line). In hysteria, there is a gait of a flying feather - large steps, jumps, the patient stops only when he stumbles upon an obstacle. Senile gait - small shuffling steps with uncertain, insufficiently coordinated friendly movements of the hands.
sweeping gait- observed in hysterical pseudohemiplegia. The paralyzed leg is dragged with a broom, and does not "rake", describing the arc with the toe, as happens with true hemiplegia.
Neurology. Complete explanatory dictionary. Nikiforov A.S.
Gait- a set of features of the posture and movements when walking. It can be essential in determining the topical diagnosis.
Oxford Dictionary of Psychology
there is no meaning and interpretation of the word
subject area of the term
back to section: glossary of terms / glossary / table
Wernicke - Manna Pose
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A massive cerebral stroke is more likely to occur in people who have already had a local stroke or have experienced recurrent ischemic attacks.
CVA can be caused by blockage or rupture of a vessel
Violation of the blood supply to the brain causes damage to neurons, and this leads to neurological disorders, sometimes to disorders of vital functions, which can lead to the death of the patient. The prognosis for a major stroke is not good, death occurs in 15–25% of cases in the first hours of the disease, after a major stroke, 65–70% of patients remain disabled.
Contributing factors for the occurrence of a massive stroke are:
Damage to brain cells during a stroke occurs due to impaired cerebral circulation. This can happen for various reasons, the table shows the types of extensive stroke and the pathogenesis of their development:
Symptoms of stroke of various localization
Symptoms vary depending on which part of the brain is affected. The table shows the symptoms that occur when different parts of the brain are affected. The clinical picture for each patient may be different, but there are some signs that correspond to a certain localization of circulatory disorders:
When the process covers both lobes (which is very rare), then both types of symptoms and complete paralysis of the body on both sides can be observed, often the patient develops a coma.
One of the types of extensive stroke is the stem, hemorrhagic type almost always leads to the death of the patient, if resuscitation measures are not urgently provided, but even in this case the prognosis is unfavorable. A coma usually develops, impaired breathing requires artificial ventilation of the lungs. The consequences of a stem stroke affect all functional areas of a person: hearing, vision, speech, and the functions of internal organs. Most often, the patient remains immobilized and becomes disabled.
Coma is a fairly common complication of a major stroke.
A massive stroke is often accompanied by a coma, and coma can occur immediately or gradually. Coma in stroke also affects the prognosis of the disease. The longer the coma continues, the worse the prognosis and the more likely the consequences develop.
Coma is a violation of consciousness, when a person stops responding to external stimuli, he seems to fall into a dream, this condition can be observed from several hours to several months. Coma is accompanied by involuntary urination or defecation, impaired breathing and cardiac activity.
Before the onset of a coma, the patient may experience incoherent speech, confused consciousness.
Coma is characterized by a lack of response to bright light, sound, a change in body position, and some of the patient's reflexes, such as reaction to light, swallowing and corneal, can be saved.
Coma in stroke has 4 degrees of severity. A coma of 1-2 degrees gives a significant chance of getting out of it and recovering. At 3-4 degrees, the probability of removing the patient from this state is low, respiratory and cardiac disorders lead to undesirable consequences or death.
Drugs used to treat stroke
The principles of treatment for extensive stroke are the same as for local ones:
If the patient has a massive stroke, the prognosis is often poor, only 40% of patients can recover, but they still have certain neurological disorders. In other patients, the consequences of a stroke may be as follows:
Wernicke-Mann Pose and Facial Distortion
Of great importance for such patients is long-term rehabilitation and training in simple self-care skills.
Rehabilitation after a stroke
Useful is physiotherapy, therapeutic exercises, massage. This helps reduce the effects resulting from damage to neurons.
Patients in whom an extensive cerebral stroke caused complete immobility require constant supervision and care. Such patients, in the absence of normal care, quickly die from concomitant complications (pressure sores, congestive pneumonia). Accession of infection, its generalization lead to sepsis and death.
An extensive stroke is much more severe than a local one, and patients who have had a local stroke subsequently develop an extensive one in 30% of cases. Therefore, you need to follow preventive measures: monitor blood pressure, get rid of bad habits, lead a healthy lifestyle.
I remember my promises from the videos. But for now, it really sucks, I would like to bring down the temperature for at least a couple of days. But for now: "work-home, work-grave." Until then, catch it.
Another chapter. Stroke.
Today we will talk about rehabilitation after a stroke.
The article is not addressed to specialists (they are specialists because they themselves know everything), but to those whose relatives and friends, or themselves, have suffered from a stroke. (I will not consider speech therapy and cognitive problems within the framework of the note - this is not my profile at all.)
A stroke is an acute violation of cerebral circulation. It happens hemorrhagic and ischemic, that is, with or without hemorrhage in the brain tissue. More information is easy to find on the Internet.
Standard stroke patient looks like this -
This is the Wernicke-Mann pose (with great difficulty I dug up this classic sketch). "The hand - asks, the leg - mows."
What do we see in this picture. The leg does not bend at the knee, due to the hypertonicity of the quadriceps muscle, on the arm there is hypertonicity of the biceps and flexors of the fingers. It is clear that in this situation a person cannot effectively interact with the outside world.
Rehabilitation consists of three equivalent components. These are support for muscle tissue (solved by massage and other methods of physiotherapy), restoration of motor functions (massage and exercise therapy) and ergonomic support (usually, exercise therapy specialists deal with these issues).
What are the common problems.
First, at the initial stage, the patient has a sharply reduced muscle tone, then hypertonicity begins to increase in certain muscle groups.
Second, the patient has a sharp decrease in volitional impulse. Usually, this occurs against the background of a sharp decrease in blood pressure, which in itself is uncomfortable and causes weakness.
So, we begin to work with the patient.
Rehabilitation should, ideally, begin immediately after transfer from intensive care.
And, yes, I perfectly understand the distance between a conditional 40-50 year old man who was "hit" at work and a 90 year old grandmother who has a history of Alzheimer's and obesity of the III degree.
It is clear that in the first case there is a very good chance for a full rehabilitation, and in the second - no hope. However, even with a "conditional grandma" you can work quite effectively. I had 70+ patients who managed to fully rehabilitate at least to the level of self-service.
The first stage, the development of initial coordination. The problem is that against the background of extremely low muscle tone, there is a global impairment of motor functions. The patient is literally unable to balance even while sitting.
The first task of massage at this stage (and at all subsequent ones) is to restore the conduction of the nerve impulse. This is achieved by means of acupressure. We work on the exit points of the nerve. intense stimulation. No "energetics", just squealing on the nerve. You need to understand that this is not osteochondrosis or there is plexitis - the nerve is quite conductive to ourselves - you need to establish a neural response in the brain. Well, we also remember that in 2-3 minutes the neurotransmitters at the point will “burn out”. Therefore…
The second task is to restore tissue nutrition. Roughly speaking, "pump" the muscles. There is nothing complicated here, the main thing is to catch the moment of increasing hypertonicity, and, accordingly, do a relaxing massage on toned muscles. However, there is a tricky move, you can squeeze the tendon in the upper third, activating the Golgi organ. It works by bypassing the CNS so that the muscle can be temporarily relaxed.
The tasks of exercise therapy for this period are to restore muscle functions as much as possible. Here both medical calculations and supporting positions are used. The minimum task is to teach them to roll over on their own, the maximum is to sit.
The main problem is that I am now describing a certain "vanilla" version.
Very often, the patient enters rehabilitation very late, after 3-6 months. Relatives and friends believed that “it will somehow resolve itself,” and when this did not happen, we get practically a “vegetable” that wants nothing and secretly hates everyone.
The first stage of treatment here is always work with relatives. Miracles do not happen, any recovery is the result of work. Often, teamwork. In the event of a stroke, the involvement of relatives is extremely important. The patient is in dire need of support, but due to the peculiarities of the course of the disease, he is not able to correctly describe his condition.
Then we go on the way of fixing the result. To be honest, I read about ergonomics on Wikipedia. Previously, this by itself was included in exercise therapy. That is, each mastered movement was interpreted as useful. As a matter of fact, it is so. I was able to straighten my arm - you can dress yourself.
Although, of course, some ergonomic assessment of living space is useful. Especially if we have a case with partial restoration of functions. It also happens, unfortunately.
Let me draw some conclusions.
A stroke is not a death sentence. You can restore everything to normal (my father had three strokes - after each he fully recovered).
There are extremely difficult cases. But even there restoration and partial social rehabilitation is possible.
Sometimes they die from it. Two people died of a stroke in the most direct sense before my eyes. And there was simply nothing that could be done. Repeated hemorrhagic strokes, there is a 100% mortality, although resuscitation ... Rather, than a bullet in the head.
Well, the general result.
Stroke is a complex, combined pathology. There is no “uniform” course, as, in fact, there is no treatment. A number of points remain at the discretion of the attending physician, who daily observes the development of the disease.
Perhaps this article is absolutely useless, perhaps it will help someone.
I will reiterate my position. The most effective is early rehabilitation. But there may be categorical restrictions from the attending physician.
Late recovery is a pain! Reimbursement for insurance.
Hello, dear readers and guests of the site dedicated to neurorehabilitation. Let's talk today and take a closer look consequences of a stroke- ischemic and hemorrhagic, as well as everything connected with this.
Consequences of a stroke.
Violations of any functions after a stroke are directly dependent on its severity, and severity, in turn, on the size of the focus and its location in the brain.
Of course, it would be fair to note that the size of the focus and its localization are far from all factors that determine the persistence of the depth of neurological disorders caused by a stroke, the consequences of which (the nature and severity) can vary greatly, depending on the specific case. What does it depend on?
The degree of dysfunction after a stroke is not always persistent. With a small stroke, the consequences may be minimal or even absent, but this does not happen so often. We will discuss cases when these consequences are present and they are persistent. We will analyze in more detail what exactly the consequences of a stroke are and how they are expressed. Below are the most significant violations of body functions that occur after a stroke.
One of the most common persistent consequences of a stroke is a decrease in strength in half of the body - hemiparesis. As a rule, after a stroke, there is a decrease in muscle strength in one of the sides of the body, which is opposite to the damaged hemisphere of the brain: if hemiparesis of the left side of the body is a persistent consequence, the stroke occurs in the right hemisphere. By the same principle, hemiparesis of the right side of the body, in which a stroke is observed in the left hemisphere. That is, the focus of infarction in the brain is located in the opposite hemisphere of the affected half of the body.
It also happens that a stroke leads to a complete lack of muscle strength in half of the body, which is called hemiplegia. With hemiparesis, a person experiences difficulty in moving, with hemiplegia, the difficulties are even more significant. Simply put, hemiplegia is paralysis in half of the body (complete lack of movement).
Habitual movements in the body are disturbed, many people have to learn to perform normal daily activities again in order to be able to take care of themselves, be able to eat, change clothes and walk. In general, to do everything that before the illness was considered extremely simple and ordinary to perform. It is the decrease in muscle strength in half of the body that is the main reason for the disability of a person after suffering a violation of cerebral circulation. It is because of this that patients lose the ability to move independently - or lose this ability completely or it is significantly impaired.
As you have already described, gait after a stroke can often be disturbed, while a person begins to move with great difficulty. In some cases, assistive devices may be needed - special walkers, a support cane or a crutch. The characteristic Wernicke-Mann posture develops when walking. Individual parts of the body may be affected without involving the entire half of the body. Depending on the affected half of the body, there are left-sided and right-sided hemiparesis.
The next, one of the most common consequences, is the so-called central prosoparesis, in which the mimic muscles suffer, resulting in facial asymmetry, as in Figure 1. At the same time, a decrease in strength is observed not in the entire half of the face, but only in its lower part, capturing the mouth, cheek, lips.
The eyelids and eyes with this paralysis of the mimic muscles remain unaffected, despite this, the distortion is quite noticeable and causes discomfort not only during meals or liquids. Central prosoparesis regresses with recovery from stroke.
With central prosoparesis, food intake and fluid intake are difficult. A person experiences obvious discomfort when performing some actions with facial muscles. Habitual emotions are more difficult to express, due to a decrease in strength in facial muscles, sound production is disturbed and speech begins to suffer.
The defect itself brings a tangible inconvenience purely from the cosmetic side. Distortion of the face causes great emotional discomfort, especially when communicating with other people. This can cause isolation and renunciation of communication with others and cause deep depression.
Speech disorders after a stroke are also quite common, at the same time it is one of the very first signs of an onset (upcoming) cerebrovascular accident. Speech impairment is the result of damage to the speech centers of the brain, which is a partial or complete loss of the ability to speak and perceive someone else's speech, called aphasia.
According to statistics, such violations are observed in a quarter of all people who have experienced a stroke, their consequences can be quite persistent. Sometimes it is difficult for a person to speak, due to a violation of the possession of the speech apparatus, and the speech of such people is fuzzy, as if “porridge in the mouth”, and such a violation is called dysarthria . dysarthria more common in stem stroke or localization of this focus in the cerebral cortex. The next speech disorder is aphasia.
Aphasia is the complete absence of speech. Aphasia can be of several types, to name some of them - with the defeat of the speech center responsible for the pronunciation of speech, motor aphasia develops. When the focus of the stroke is located in the center of speech, which is responsible for its perception, the so-called sensory aphasia develops. With sensory aphasia, a person does not understand what is being said to him and does not understand what he needs to answer. If both centers are affected, mixed or sensory-motor aphasia. The "pure" form of aphasia is extremely rare, and with a stroke, it is the mixed form that most often occurs.
There are other types of speech disorders after a stroke, which we will discuss in detail in the following articles on speech disorders. And now let's move on ... In addition to the violations listed above, there are the following consequences of a stroke.
Impairment of blood circulation in the parts of the central nervous system responsible for the coordination of movements and as a result of a stroke can lead to coordination of movements, which is called ataxia. Disturbances in coordination of movements often occur with stem stroke and this is due to the fact that in the stem part of the brain there are centers for coordinating movements in our body.
There are different degrees of expression. In the most favorable case, these vestibular disorders disappear within the first day after the acute cerebrovascular accident. In other, more severe cases, unsteadiness when walking and dizziness persist for a longer period and may last for months.
There may be visual impairments of the most diverse nature. Visual impairment depends on the location of the stroke and the size of the focus. Most often, visual impairment manifests itself in the form of loss of visual fields (hemianopia). In this case, as you may have guessed, half or a quarter of the visual picture falls out. If a quarter of the picture falls out, it is called a quadrant hemianopsia.
Depression- another consequence of a stroke that can cross out any efforts of a doctor and loved ones to restore lost functions. According to some reports, up to 80% of stroke survivors suffer from depression in varying degrees of severity. This is a rather serious consequence that can and should be treated.
In addition to the mood for recovery, an additional no less important “bonus” of eliminating depression will be an analgesic effect. It has long been proven that depression can increase pain in a person, and pain in a stroke is not uncommon. Prescribing antidepressants can help with this problem.
It is extremely important to prescribe the “correct” antidepressant, since some of them can cause an “inhibitory effect”, which in some cases can also reduce a person’s desire to follow the doctor’s recommendations and activate for better rehabilitation.
A stroke, the consequences of which remained after a course of treatment in a hospital, is a frequent phenomenon. Such people need a full-fledged rehabilitation course, which often begins already in the hospital. The rehabilitation course itself is prescribed individually, depending on the severity and persistence of the consequences, as well as on the time that has passed since the stroke and the general condition of the patient.
Read about an example of such a rehabilitation center in the article rehabilitation center after a stroke.
Wernicke - Manna Pose(K. Wernicke, 1848-1905, German psychiatrist and neuropathologist; L. Mann, 1866-1936, German neuropathologist) - a peculiar posture of a patient with central hemiparesis (paralysis), which developed as a result of damage to the internal capsule: bringing the shoulder to the body, bending forearms, flexion and pronation of the hand, extension of the thigh, lower leg and plantar flexion of the foot; due to an increase in muscle tone of the flexors of the arm and extensors of the leg.
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Virginity and the chicken egg. What is the connection between them? And such that the inhabitants of the Kuanyama tribe, which lives on the border with Namibia, in ancient times deprived girls of their virginity with the help of a chicken egg. not much
Body temperature is a complex indicator of the thermal state of the human body, reflecting the complex relationship between heat production (heat production) of various organs and tissues and heat exchange between
Small changes in diet and lifestyle will help change your weight. Do you want to lose extra pounds? Don't worry, you won't have to starve yourself or do exhausting exercises. research
Rice. 1. Treatment by position (posture opposite Wernicke-Mann position): 1 - laying the paretic limbs in the position of the patient on the back; 2 - laying paretic limbs in the position of the patient on a healthy side
Under the treatment of the position for the upper and lower limbs is understood the laying of the patient in bed so that the muscles prone to spastic contractures are stretched as much as possible, and the points of attachment of their antagonists are brought together.
A session of treatment of flaccid paralysis and paresis can last, if necessary, up to 3-4 hours, but care must be taken not to increase muscle tension. In case of flaccid paralysis and paresis, treatment with the position provides for the middle physiological position of the limbs, in which the muscles do not experience excessive stretching, and the joints do not lend themselves to deformation. During the day, it is desirable to carry out several sessions of treatment with the position, alternating them with therapeutic exercises, massage and physiotherapy procedures.
To avoid undesirable consequences of position treatment, it is necessary to determine the tonic state of muscle groups and mobility in the joints after removal of fixation, to prevent an increase in muscle rigidity or spasticity compared to the initial level, the occurrence of hypostatic edema, the appearance of pain, numbness, stiffness. Such symptoms indicate redundancy stretching, incorrect fixation, overdose in time. The optimal mode of treatment with the position is determined individually and depends on the general condition of the patient and his motor status. All methodological principles of treatment by position have a local character and special goals. After the end of the acute period, they switch to a more effective method of general activation of patients.
Passive gymnastics. One of the main methods of disinhibition is a system of passive movements for paretic limbs. With the help of passive movements, the lost scheme of normally carried out movements is preserved or restored, the appearance of pathological synkinesis is prevented. Particular attention should be paid to the patient's visual control of the exercise and the position of other parts of the body, which should be based on a deep awareness of the muscular-articular feeling.
When conducting passive exercises, it is important to correctly determine their amplitude and speed, which depend on the neurological status of the patient and the degree of tone increase, because high amplitude and speed can increase an already high tone.
Passive exercises with a favorable course of the disease can be prescribed in the first days after the disease or injury. Of great importance for the patient is the choice of starting position, which in itself contributes to the relaxation of spastic muscles. Passive exercises help to maintain normal mobility in the joints, prevent and reduce pathologically increased muscle tone, restore and preserve the patient's idea of normally performed movements. Passive movements should be performed smoothly, rhythmically, repeatedly. Each series of movements should be performed in one plane with a gradual increase in the amplitude of movements and constant visual control of the patient (Fig. 2).
Rice. 2. Passive gymnastics: 1 - passive abduction and adduction of the arm in the shoulder joint. 2 - passive extension and flexion in the elbow joint; 3 - passive flexion and extension of the hand in the promenade of the joint (forearm supinovane); 4 - passive flexion and extension of the leg in the knee and hip joints.
Before performing a passive movement, it is “learned” on a healthy side, and then active movements with a healthy limb are carried out simultaneously or alternately with passive movements in the paretic ending. The volume and pace of movements must be gradually increased, taking into account the sub-active sensation of the patient and the degree of resistance created.
Muscle relaxation. With spastic paralysis, muscle relaxation should be considered one of the first special training exercises (first on a healthy limb, and then on paretic limbs). After the patient has mastered the relaxation of the entire limb, it is necessary to master the relaxation of individual muscle groups.
In addition, stop the techniques of vibrating local shaking along the course of a certain muscle and some techniques of relaxing massage.
Suppression of pathological synchsandnezandth. A set of exercises to suppress pathological synkinesis is aimed at eliminating strong friendly movements that occur in patients with spastic paresis (for example, simultaneous flexion of the hip, lower leg and foot; rotation of the thigh outward, straightening is recommended to accompany the flexion of the foot during walking; elbow and adduction of the shoulder during flexion hands and fingers). For this, the following methods are used:
Teaching the patient conscious suppression of synkinesis; for this, the patient needs to be explained what synkinesis is and in which muscle groups there are friendly movements in response to one or another basic movement;
Orthopedic fixation (using splints, elastic bandage or orthopedic shoes) of one or two joints, in which synkinesis is most pronounced. For example, fixation of the elbow joint in a straightened position, and the wrist and fingers in the position of dorsal extension during the implementation of flexion and retraction movements in the shoulder joint; wearing orthopedic shoes with a high heel and reinforced external and internal arches to prevent supination and excessive pi-dosuture flexion of the foot while walking in patients with spastic hemiparesis;
The use of special antispivdruzhnyh passive and active-passive exercises performed with the help of a methodologist.
There are 3 stages of rehabilitation of stroke patients: 1st - early recovery (up to 3 months), 2nd - late recovery (up to 1 year), 3rd stage of residual motor function disorders (over 1 year). Determining the tasks, means and methods of LH at these stages of rehabilitation, the intended motor mode and the degree of impairment of motor functions are taken into account. They use strict and extended bed modes, napіvlіzhkovy (ward) and free motor modes. There are 1st degree of motor dysfunction (mild paresis), 2nd (moderate paresis), 3rd (paresis), 4th (deep paresis) and 5th degree (plegia or paralysis).
At the early recovery stage of treatment, the patient is consistently prescribed strict bed, extended bed (2a-26), ward and free regimen. The duration of each motor mode depends on the state of illness and the degree of impairment of motor functions. The more impaired motor functions are detected, the slower the modes of motor activity expand.
If the patient is prescribed strict bed rest (for 1-3 days), exercise therapy is contraindicated, the patient must be provided with rest, medication and treatment by position. The patient is placed in a position opposite to the Wernicke-Mann position. This reduces elasticity, prevents the development of muscle contractures. The patient is placed in the supine position for 1.5-2 hours, on the side for 30-50 minutes ... The patient's position is changed several times a day (every 2 hours)
Clinicalshownand I to start exercise therapy for strokes: no increase in symptoms, improvement in vascular and vascular activity, blood pressure not higher than 170/100 in hemorrhagic stroke.
Contraindications: severe general condition with impaired activity of the heart and respiration. Tasks
Passive gymnastics - movements in the joints of paretic limbs, which are carried out by a methodologist of exercise therapy or a person replacing him: - carried out without active muscular assistance of the patient, performed carefully, at a slow pace, if possible in full, isolated in each joint (for this, the one that engages with the patient on one arm, clasps the paretic ending of the joint, which is developed above, and the other - below this joint). The development is carried out in the following sequence: shoulder, elbow, wrist and wrist joints and fingers, hip, knee, ankle joints and toes.
The volume and pace of movements gradually increase, their number for each joint can be from 5 to 10. Passive movements in the first days after a stroke are recommended to be carried out 2-3 times a day for all joints of the limbs. Before the passive, an active exercise of a healthy limb is carried out, that is, the passive movement is “learned” in advance on a healthy limb. Massage for spastic muscles - light, superficial stroking is used, for antagonists - light rubbing and kneading
Active exercises for developing isolated movements in paretic limbs begin with exercises for healthy limbs, alternating them with gymnastics for paretic, as well as with breathing exercises, exercises in isometric mode:
They begin to put the patient in bed as soon as his state of health and the state of the cardiovascular system allow: the terms can vary from 3-5 days to 2-3 weeks from the onset of the disease. Sitting time is increased from 10-15 minutes. Up to 1-2 hours.
When the patient is able to sit in bed with his legs down, exercises are prescribed to strengthen the muscles of the legs.
To eliminate the movements of the commonwealth of movements (for example, when bending the leg at the knee, the hand and elbows bend at the same time, the same can be observed when coughing, sneezing), a number of special exercises are performed with the maintenance or fixation of paretic limbs.
To restore movements in the distal parts of the lower extremities, passive and active imitation of walking in the prone position is performed.
The patient should stand straight, evenly distributing body weight on the patient and healthy sides, starting from 1 minute. up to 5-7min. Then they move on to learning how to alternately transfer the weight of the body to a healthy and sore leg.
Management of the installation of the foot, leg movements during learning to move
To consolidate the skill of the correct setting of the foot, it is advisable to walk along the path, on which the traces of the training steps are applied. For the same purpose, another method is used - overcoming obstacles 5-15 cm high (for example, boards that are placed in front of footprints on the same track).
To restore the function of fine finger movements, it is also recommended: flipping through books, tightening and unscrewing screws with nuts (preferably plastic ones from children's designers, as they are larger and lighter), sculpt from plasticine, in the future, the patient should learn to fasten and unfasten a button with a paretic hand, untie ribbons , use a zipper, stir tea with a spoon, etc.
With a good recovery of movements, the hands move on to learning more difficult practical everyday actions:
For early activation of patients by gradual transfer from a horizontal position to a vertical one. Mechanotherapy is effectively used - rehabilitation complexes and verticalizers.
Ludwig Mann (1866-1936)
Specific pathological changes in muscle tone in the affected limbs in the pathology of the pyramidal system. Acute unilateral lesion of the pyramidal tracts on the upper limb the muscles that raise the belt of the upper limb, the muscles of the shoulder that abduct and rotate outward, the extensors and arch supports of the forearm, the extensors of the hand and fingers, are more often affected; on the lower limb- muscle groups that abduct and adduct the thigh, flex the knee and foot. When the flaccid stage of hemiplegia is replaced by spastic, the antagonists of these muscle groups are especially hypertonic. Spasticity, if it is sufficiently pronounced, leads to the formation of contractures. As a result, the upper and lower limbs assume the following position: the belt of the upper limb is lowered, the shoulder is adducted and rotated inwards, the forearm is pronated and bent at the elbow joint, the hand and fingers are bent, the thigh is extended and adducted, the lower leg is extended, the foot is in the pes equino-varus position. , as a result of which the paretic limb becomes, as it were, longer than the healthy one. In order not to touch the toe of the floor while walking, the patient, not being able to raise the limb up, “mows” it, i.e., takes it to the side, describing a semicircle with the foot (“the hand asks, the leg mows”). The Wernicke-Mann position is more often observed in capsular hemiplegia (damage to the pyramidal tract in the region of the posterior leg of the internal capsule).
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