Stroke is an acute disorder of cerebral circulation, one of the most serious diseases of the cardiovascular and nervous systems. Every year in Russia there are about half a million patients with stroke, more than half of them lose their ability to work. Therefore, it is very important not only to see a doctor as soon as possible, but also to rehabilitate a person who has suffered a stroke within several months after discharge from the hospital.
If someone you love is in the hospital with this serious illness, you need to know what to do when they are discharged.
Situation
The room where the patient is located should not resemble an isolation ward or hospital ward. It should be light and fresh (ventilate several times a day, avoiding drafts); it is advisable to carry out wet cleaning every day. You can place fresh flowers in the room if the patient does not have allergies. Hang his favorite paintings and photographs on the wall opposite the bed.
Strong noise effects are best avoided. The mattress on which the patient lies should be soft but elastic. It is better to lay linen not new, but washed many times (it is softer), without seams and buttons (to avoid skin irritation).
Time to Heal
This is a very pressing issue that occupies both the victim himself and his relatives. Time is determined by many factors, which include:
- degree of brain damage;
- the body's individual ability to recover;
- program of rehabilitation measures that were applied;
- the patient's desire for recovery.
Very often, treatment gives good results within a couple of months. However, it is possible that it will be possible to restore the simplest skills only after several years.
General rules of care
You will need to monitor all the vital functions of your family member who is bedridden. Regularly measure your blood pressure and monitor the frequency of bowel movements and urination. If the bedridden person does not control physiological functions, get a urine bag and a bedpan. You can use adult diapers or put oilcloth under the sheet.
Another important point is hygiene and prevention of bedsores. Wash the patient in the morning and evening, and, if necessary, wipe the body with special sanitary napkins or a damp soft sponge dipped in soapy water (after wiping, be sure to dry the skin by blotting it with a towel). Pay special attention to the hygiene of the oral cavity, perineal area, inguinal and axillary folds.
The main condition for healthy skin is natural, but not excessive moisture (wet skin, like overly dry skin, is more susceptible to injury). Check your body daily for redness and bedsores. To avoid circulatory disorders, the body of the person lying down must be carefully turned over; this must be done at least once every 2-3 hours (and at night too).
There are also a lot of devices for the prevention of bedsores - special pillows, mattresses, circles, etc. If bedsores do form, they are treated with wound-healing ointments (Solcoseryl, Levomekol, etc.) and covered with sterile hydrocolloid dressings.
As for the patient’s diet, it should be regular (4-5 times a day), not very high in calories (up to 2500 kcal). It is advisable not to include salty, fried, fatty foods in the diet, reduce the consumption of flour and sweets, and give preference to vegetables, fruits, lean meats, fish, and poultry.
The first days after the attack
First of all, after a stroke, a set of therapeutic measures is carried out, the purpose of which is to maintain the cardiovascular and respiratory systems. In the first few days, the patient should be in the intensive neurology department or acute stroke department.
Measures will be taken here to monitor the functioning of the heart, blood vessels and respiratory organs. First of all, the following is performed:
- correction of water and electrolyte balance;
- elimination of cerebral edema.
The patient must observe strict bed rest. To prevent the formation of bedsores from prolonged lying, it is necessary that the mattress is flat and the sheets do not form wrinkles. The body must be treated with camphor alcohol and talc, which absorbs moisture well.
If it is impossible to swallow food, feeding is done using a tube. If a person is able to swallow, they are given juices and sweet tea on the first day. From the second day, the diet expands and you can eat light foods, for example, yoghurts, broths, vegetable and fruit purees.
The length and quality of life will depend on how many intact nerve cells remain around the lesion in the early period after a stroke, and the speed and professionalism of doctors will determine how effective the patient’s further recovery and rehabilitation will be.
To limit the size of the lesion, the following drugs are prescribed:
- diuretics : Mannitol, Furosemide - reduce swelling in the area of the affected tissue;
- neuroprotectors : Actovegin, Cerebrolysin.
Movement rehabilitation
After discharge from the hospital, doctors continue to work with the patient for a long time. And they give him and his relatives homework. To restore mobility to the patient, you need to slowly go a long way.
First, the so-called “postural treatment” is used, when several times a day the arms and legs of an immobile person are given special poses that help stretch the muscles. At the same time, they perform passive gymnastics - carefully bend and straighten all joints in turn, and light massage. They also practice breathing exercises.
As the patient's condition improves, they begin to sit down on the bed for a while, and he tries to keep his back in an upright position. Afterwards you need to start getting up and walking around the apartment. The assistant stands up on the paralyzed side, throws the patient’s arm over his shoulder and, supporting him behind his back, slowly, step by step, leads from room to room, controlling the advance (it should not happen with dragging the leg).
At the same time, they try to develop other muscles of the body. To develop hand motor skills, for example, there are a lot of exercises, ranging from grasping objects and turning pages to drawing, sculpting and video games.
Gymnastics
Caring for patients after a stroke does not imply a complete renunciation of active actions. If the person caring for the patient has no idea what kind of physical therapy can be carried out, then he should consult with a rehabilitation specialist.
If the limbs are paralyzed, then they resort to so-called passive gymnastics. This technique involves the caregiver making movements with paralyzed limbs.
The patient must do breathing exercises without fail. The simplest exercise is inflating a balloon.
Learning to speak
Often after a stroke, the patient loses speech skills. All that comes out is a hum. To learn to speak again, you need to do a little every day to develop articulation (curl your lips into a tube, puff out your cheeks, purse your lips, roll your tongue, etc.).
Be sure to talk with the patient, tell him about the events of the past day, and, if possible, involve him in the speech process. Many educational games have been developed to restore speech. For example, you pronounce a phrase and do not finish the last word in it: “Mom washed ra...” - “... mu,” adds your still passive interlocutor.
Singing gives good results. Just sing while sitting next to the patient, and he will sing along with you as much as possible. When speech begins to recover, you can move on to tongue twisters.
Work of the fund on compulsory medical insurance
The law on compulsory medical insurance has been in force since 2011. The choice of medical insurance organization is left to the citizen independently. The policy has a single sample and gives the right to receive assistance throughout the Russian Federation. The medical insurance organization is required to provide a list of rehabilitation centers and hospitals that provide free services based on the policy.
Compulsory medical insurance is implemented through the work of special funds. Typically, such centers accept patients who are registered in a specific city or region. Their activities are aimed at restoring lost functions, treating concomitant pathologies, and reducing the risk of recurrent strokes.
The centers operating under insurance policies use the following methods:
- Physical therapy under the supervision of a doctor and a physiotherapist who guides the process helps the patient. The load is selected individually depending on the condition, the severity of the neurological deficit, heart function and the presence of other diseases.
- Mechanotherapy or robotic rehabilitation is represented by a set of simulators to stimulate the step and work of individual muscles.
- Working with a psychologist is necessary to overcome depression, stimulate the patient to work and motivate him.
- The massage is aimed at relaxing cramped and toning weakened muscles. The complex may include osteopathy and reflexology.
- Speech therapy work teaches the patient to re-feel the movements of the tongue, lips, and puff out the cheeks to reproduce sounds.
- Physiotherapy is aimed at stimulating muscles, relieving spasms, and restoring blood supply to tissues. Magnetic therapy, transcutaneous electrical neurostimulation, and amplipulse are used.
Important! Approximately 80% of activities should be active, and only 20% should be passive. Physiotherapy and massage methods cannot restore neurological functions. There is no special technique that relieves spasticity or paralysis without human intervention.
Memory recovery
Unfortunately, a common complication of stroke is a sharp decrease in the ability to remember. To restore this function, a variety of games are used, which become more complex during the recovery process. At the initial stage, the so-called finger games (such as “Soroka-magpie cooked porridge”). They help to activate a person’s speech center, since there are points on the fingers that stimulate its work.
In the future, memorizing small poems and songs gives good results. Read short stories to the patient and ask them to retell them. Let's listen to music, it helps speed up the recovery process. Other techniques and games can be found in books on the development of preschool children.
Favorable factors and not so...
Speaking about recovery after a stroke, it should be noted that there are favorable and unfavorable factors that play an important role.
Unfavorable factors include:
- large lesion of the brain;
- localization of the lesion in areas responsible for speech and motor skills;
- poor blood circulation around the lesion;
- elderly age;
- emotional disturbances.
Favorable factors:
- timely initiation of restoration activities;
- previously spontaneous restoration of function.
Positive attitude
A person after a stroke appears completely different to his loved ones - motionless, helpless, depressed. The usual rhythm of family life is inevitably disrupted; it is very difficult to realize that just recently a healthy, independent family member now, like a baby, needs constant attention, control and care. He has a lot to learn again - to walk, talk, think... And you must be there to help him return to normal life, and if this is not possible, adapt to the current conditions.
For rehabilitation to be successful, first of all, you need to be prepared for the fact that it will not be easy, but be as positive as possible in overcoming difficulties. It’s hard for you, but imagine how the patient himself feels, for whom life has suddenly stopped altogether, and he realizes that he cannot do anything on his own! Try to perceive the person as before, do not exclude him from family life, do not leave him alone for a long time. And inspire him and yourself that everything will work out, and together you can do everything.
Bedridden patient at home: how to get help?
If you cannot afford to hire a nurse or place a relative in a good boarding house, these recommendations will be useful to you. Thanks to them, you will be able to receive help from the state and reduce the cost of caring for the patient.
Contact your local clinic
Call a therapist home. The doctor will examine the patient, prescribe treatment and write out referrals to specialized specialists, who will also come to your home. All specialist doctors must come to the home of a bedridden patient. At home you can get tests, do an ECG, and carry out other procedures and treatment.
Submit an application to the social security department
Within 10 days, the applicant receives an individual program, which indicates the quantity, types of services and timing of their provision. Services can be guaranteed (partially paid or free) and additional (paid).
Apply for disability
To do this, you need to call a local therapist at home. If the doctor finds indications for disability, he will draw up documents for an examination. If opinions from specialized specialists are needed, relatives submit requests to visit them at the local clinic. After submitting the documentation, a commission goes to the patient’s home for observation for a month. The commission decides whether to assign a disability, send for further examination or refuse. If the commission assigns a disability, the person receives a pink certificate. For help you need to contact:
- to social security to obtain social services for disability;
- to the Pension Fund to arrange monthly benefits and payments;
- to the MFC to receive utility benefits;
- to your local clinic to receive medication benefits.
An assistant caring for a disabled person can register with the Pension Fund and then receive payments and increase his length of service.
Register with the hospice
If you have an incurable illness, you can go to a state hospice, where palliative care is provided. Hospices provide inpatient services and outreach services that help in the home. If appropriate symptoms are present, the patient will be admitted to a hospital.
To register, you will need a referral from a specialist. For example, in case of oncology, you need a referral from the district oncologist. You can visit a relative in the institution at any time.
There are many ways to provide help and care to a bedridden patient. Each of them has its own characteristics, advantages and disadvantages. Choose the ones that are most suitable for your situation.
What to do after a stroke
It is very important to follow these simple rules:
- be regularly examined by your doctor;
- give up all bad habits and unhealthy foods;
- under no circumstances stop performing therapeutic exercises;
- visit sanatoriums and resorts;
- walk more;
- Avoid stress and heavy physical activity.
A stroke is not a death sentence. Adequate treatment, correctly selected rehabilitation methods and compliance with all medical prescriptions can speed up the recovery process and return to a full life.
It is also necessary to once again recall the importance of the positive attitude of the victim himself and the provision of psychological assistance from loved ones.
