It takes place step by step, step by step, gradually strengthen the muscles of the legs, trunk, train balance and coordination of movements, along with this, the movements necessary for walking are mastered. Of course, when working with a post-stroke patient, you will strive to restore not only walking, but also all other lost movements, especially self-care skills. In this article we will talk about how to restore walking after a stroketo understand the gait recovery system. The body of a post-stroke patient remembers all the movements that he possessed before the stroke, but the connection between the brain and muscles is lost. Our task is to help restore this connection so that the brain "sees" its periphery and begins to control it. Exercise therapy after a stroke plays a huge role in this in complex therapy.

It is good that if your patient has been exercising regularly before the stroke, then recovery of walking and other skills will be easier and faster. It is likely that during physical therapy with a post-stroke patient, you will cope on your own without an assistant.

If the patient is over-trained, overweight, joint diseases, then it is not possible to cope alone, since it is very difficult to lift such a person, you will spend a lot of energy and, despite this, get low results. In addition, there is a danger of dropping it, since such a patient is almost "wooden". Even an experienced exercise therapy instructor cannot do it alone.

Preparation for walking begins from the first days after a stroke, when the prevention of sagging feet, muscle contractures and joint atrophy is carried out. We talked about this in the article.

To enhance the effect of physiotherapy exercises, I highly recommend using therapy before exercise.

How to restore walking after a stroke.

We are helped by passive gymnastics on all joints of the legs and arms with the gradual inclusion of active movements, depending on the patient's condition and his ability to understand you.

The combination of passive gymnastics with elements of massage has a beneficial effect on the nervous system and the appearance of neuromuscular impulses.

Don't forget about the need to prevent thromboembolism: during exercise therapy, wear elastic stockings or elastic bandages on the patient's legs. Leave the tips of the toes open to control blood circulation in the tissues of the feet and lower legs: the toes should be pink and warm.

Passive gymnastics on the legs begins with the feet (flexion, extension and rotation), then continues to the knee and hip joints. The knee joint bends and unbends. The hip joint requires volumetric movements: flexion and extension, abduction and adduction, rotation. It is convenient to rotate in the hip joint by bending the patient's leg at the knee joint and holding the foot with one hand and the knee with the other hand. Passive circular movements in the hip joint are performed in much the same way as in young children with hypoplasia of the hip joints.

During passive gymnastics, we strive to gradually "transform" passive movements into active ones.

Once you start using active movements, you should have a creative approach, taking into account the individual characteristics of the post-stroke patient and ingenuity.

The principle of the inclusion of active movements is based on the activation of volitional activity of a post-stroke patient.

1). Sending impulses. (Information on the site is sometimes repeated, but it is necessary). The patient mentally imagines any movement in the limbs. First, he makes a movement from the healthy side, memorizing the feeling of this movement. Then the same movement is mentally repeated on the affected side. The patient can send impulses independently during the day. Mental movements should be simple and short. For example, flexion and extension of the arm at the elbow joint, squeezing and unclenching of the wrist, raising the straightened arm, and so on. The sending of impulses can be strengthened with the help of a conscious (mental) weighting of the movement. For example, a patient imagines that there is a heavy dumbbell in his hand or a kettlebell is tied to his leg, and he needs to raise it.

2). During passive gymnastics, tell the patient: “Help me! I will set the amplitude of the movement, and you do the movement yourself. " You must learn to feel when your student can perform at least part of the movement on their own. At this time, without taking your hands off the limb, weaken your influence, let the student make maximum efforts. All movements are carried out at a slow pace.

3). The patient cannot perform a complete movement at once. Therefore, you must first master it in parts, then connect the parts of this movement.

Take the exercise "Bicycle" as an example, as it is indicative, it involves all muscle groups of the legs.
"Bike". Starting position - the patient lies on his back, legs are bent at the knee joints, feet are on the bed.
1 - tear off the foot from the bed, the thigh of the leg bent at the knee joint approaches the stomach.
2 - straighten the leg up - forward.
3 - lower the straightened leg to the bed.
4 - bend the leg, pulling the foot closer to the pelvis, return to the starting position.

In order for the patient to be able to independently perform the exercise "Bicycle", we will first apply the mastery of the first part of the exercise, teach to "walk" in the supine position, alternately lifting the feet of the bent legs from the bed; then we will separately practice raising and lowering straightened legs; and also separately - sliding the feet on the bed, straightening and bending the legs with full amplitude. We moderately help the “sore” leg to carry out all these movements, day by day weakening our help until the patient makes the movement completely on his own. We combine all parts of the movement into one whole and rejoice in success. If a student performs the exercise "clumsily", then we must set the required amplitude in order to achieve a full-fledged high-quality movement. (We take the limb in our hands, the student works himself, and we control and regulate the amount of movement).

We also master all other desired movements in parts, then we combine them into one whole with quality control of the movement.

We are interested in recovery of walking after a stroke... Therefore, the following exercises will be listed for teaching walking. These exercises should not be applied at once in one lesson. We gradually restore active movements and gradually complicate the tasks.

All standing exercises must be done with protection of the knee joint from over-extension back. I recommend purchasing a special orthosis for the knee joint with hinges, which allows you to freely bend and extend the leg in the knee joint, but excludes overextension of the joint backward, which occurs due to the weakness of the muscles of the paralyzed leg.

This orthosis will be useful for your patient while walking for a long time, because even with the appearance of movements in the leg and the restoration of walking skills, muscle weakness remains. If this is not possible, then at least make a bandage on the knee joint with an elastic bandage.

When the paralyzed arm hangs down, be sure to fix the arm with a bandage "Klondike" or use a special bandage for the arm before the patient takes an upright sitting or standing position.

Exercises to restore walking after a stroke.

It makes no sense to indicate the number of repetitions, since it depends on the patient's condition and the complication of the load (from 4 to 10 repetitions).

1). Sliding feet on the bed. Lying on your back, legs bent at the knee joints, feet on the bed. Alternately straighten and bend your legs back, starting with a healthy one.

2). Cross-legged. The starting position is the same (lying on your back, legs bent at the knee joints, feet on the bed). 1 - Throw a healthy leg over the "sick" (just leg to leg). 2 - Return to starting position. 3 - Put the “sick” leg on the healthy one. 4 - Initial position.

3). Heel to knee. The starting position is lying on your back, legs bent at the knee joints, feet on the bed. 1 - Put the heel of a healthy leg on the knee of the "sore" leg. 2 - Initial position. 3 - The same "sore" leg. 4 - Initial position.

4). Knee to the side. The starting position is lying on your back, legs bent at the knee joints, feet on the bed. 1 - Put a healthy leg on the "sore" leg on the leg. 2 - Take the same (healthy leg) to the side and lower it to the bed, so that there is a full range of motion. 3 - Again, put the healthy leg on the "sore" leg on the leg. 4 - Return to starting position. Repeat the same with "sore leg".

five). "Bicycle" with each leg, starting with the healthy one.

6). Feet inward - outward. Lying on your back with your legs straight and shoulder-width apart. Turn the feet with socks inward, then turn the feet toes to the sides.

7). Heel glide along the front of the lower leg. Lying on your back with your legs straight. 1 - Place the heel of a healthy leg on the shin of the "sore" leg closer to the knee joint. 2 - 3 - Slide the heel along the front surface of the lower leg to the foot of the "sore" leg and back. 4 - Return to starting position. Repeat the same with the “sore” leg.

8). Raising a straightened leg. Lying on your back, legs are bent at the knee joints, feet are on the bed. Straighten your healthy leg, sliding your foot along the bed. Raise and lower it several times, then return to its original position. Do the same with the “sore” leg.

9). Leaving the leg to the side. This exercise can be performed from a starting position lying on your back with both legs straight and bent at the knee joints. 1 - take your good leg to the side and put it down. 2 - Return to starting position. 3 - 4 - the same "sore" leg.

10). Complicating the previous exercise in the starting position lying on your back with your legs straight. 1 - Take your good leg to the side, put it down. 2 - Move the healthy leg to the "sore" leg to leg, as if crossing your legs. 3 - Move your good leg to the side again, put it down. 4 - Return to starting position. Do the same with the “sore” leg.

11). Raising the pelvis. Lying on your back, legs bent at the knee joints, feet on the bed. Raise and lower the pelvis, first to a small height, then day by day we increase the height of the pelvis.

12). Flexion of the legs. Lying on his stomach, legs are straightened, the foot of the “sick” leg lies on the ankle of the healthy one. Bend and unbend the legs at the knee joints, focusing the student's attention on the "sore" leg in order to strengthen the sending of impulses. For a "sore" leg, this is a passive exercise.

13). Complicating the exercise "Calf flexion"... Lying on your stomach with your legs straight. Alternately bend and unbend the legs at the knee joints, starting from the healthy side. Moderately help the patient to raise the shin of the "sore" leg. We intensify the impulse message: we give instructions to imagine that a heavy weight is tied to the sore leg.

14). Bending the leg to the side. Lying on your stomach with your legs straight. 1 - Bend the good leg at the knee joint, sliding the knee along the bed to the side. 2 - Return to starting position. 3 - The same "sore" leg. 4 - Initial position.

15). Leg through leg. Lying on your stomach with your legs straight. 1 - Move the straightened healthy leg through the "sick", touch the foot of the bed. 2 - Return to starting position. 3 - 4 - The same "sore" leg.

16). We put the foot on the toes. Lying on your stomach with your legs straight. 1 - Raise the shins slightly and put the feet on the toes (foot extension). 2 - Put the feet back in the starting position.

17). Raise your leg while lying on your side. Lying on your side, healthy limbs on top, legs straightened. Raise and lower a straightened healthy leg. Then repeat on the other side, for this we turn the student onto a "healthy" side.

In the same starting position (lying on its side), bend and unbend the leg at the knee joint, bringing the knee to the stomach, take the straightened leg back, and transfer the leg over the leg.

18). "Push me with your foot." The patient lies on his back, the “sore” leg (foot) rests on the chest of the instructor, who, as it were, rests his chest on the student's leg. We give the command "And-and-and-time!". At this time, the patient pushes the instructor with his foot, straightening the leg.

19). Turn in bed. We teach how to independently turn in bed, not only to restore the skill of turning, but also to strengthen the muscles of the trunk. The patient lies on his back, legs are bent, feet are on the bed. 1 - Bend the knees to the "painful" side, the patient himself makes an effort to complete a full turn on the "painful" side. 2 - Return to starting position. 3 - The same with a turn to the healthy side. Remember not to pull on the paralyzed arm due to the weakening of the muscular corset of the shoulder joint.

20). Sitting on the edge of the bed. After we have mastered the turn in bed, we train the skill of sitting down on the edge of the bed. After the patient has turned on his side, we lower his legs down from the edge of the bed, the patient pushes off the bed with his hand and straightens up. He will not be able to do this without your help. Begin sitting down after turning onto a healthy side, as it is easier for the patient to push off the bed with his good hand. Sit the student on the edge of the bed so that his feet rest firmly on the floor, they need to be placed a short distance from each other for the structure to be stable. The patient's body is straightened and leans forward slightly to transfer the center of gravity to the feet so that there is no fall back. (Pause to adapt the patient to the upright position, ask if the head is spinning). Then you need to return in reverse order to the starting position lying on your back, but with your head to the other side. Now we sit down on the edge of the bed after turning to the paralyzed side. Here it will take more effort from you to support the student, since it is still difficult for him to sit down after turning on the "sick" side. Again, we create a stable structure so that the patient does not fall: the feet are spaced apart, firmly resting on the floor, the body is straightened and slightly tilted forward. We hold the patient, letting him get used to the vertical position a little. Then again slowly put to bed on your back.

21). Getting up. Getting up on the floor from a bed or chair is a difficult exercise. The patient should not be allowed to fall, as this can lead not only to injury, but also complicate further exercise therapy: he will be afraid to do certain exercises, refuse to walk. Therefore, we teach standing up gradually. Now our student can already turn on his side in bed, sit on the edge of the bed, sit on a chair without support.

We start to train getting up from the edge of the bed... The patient sits on the edge of the bed, feet firmly on the floor. We put our hands around the patient's chest, with our feet we create a solid obstacle for the patient's feet so that they do not move while standing up. We swing with the patient and help him to stand up a little, lifting the pelvis from the edge of the bed by about 10 cm, we do not linger in this position, we immediately sit back on the bed. We repeat several times, trusting the student more and more independence.

Complicating this exercise: practice standing up by moving around the edge of the bed. to one, then to the other side from one headboard to the other. First, we rearrange the patient's legs a little, then transplant him a little further than the point where the feet rest on the floor. Then we rearrange the student's feet a little again, and so on. We sat down to the back of the bed, sat down, rested, and again we change seats along the edge of the bed, now in the other direction. We strive for the patient to perform the movements himself as much as possible, we try to keep it intuitively less and less.

It is convenient to train standing up, either by moving the patient to the headboard so that he can hold on to it with his good hand, or by placing a chair with a high back that the patient can hold on to. We support him and control so that the feet do not move while standing up. The student is already ready physically and mentally to get up and stand, holding on to the support, because we strengthened the muscles that are involved in standing up. The muscles are still weak, but they can perform the movement. We show him the technique of standing up on ourselves: we sit on a chair sideways to the patient: we swayed a little back (for a "run-up"), then forward with a separation of the pelvis from the chair, transferred the weight of the body to the feet and straightened up carefully. We will do this decisively, since it is difficult to get up slowly. We sit down in the reverse order, but slowly: while lowering the pelvis on the chair seat, the body is slightly tilted forward. We sat down on a chair and straightened the body, not leaning back in the chair. Explain that you need to sit upright and hold your torso upright to train your trunk muscles.

The most reliable and comfortable support to hold with your hands is the wall bars. If there is such a possibility, the patient holds with both hands the bar of the Swedish wall at the level of the shoulder girdle, the “sore” hand can be bandaged to the bar with an elastic bandage. The patient can be rolled up to the wall bar on a wheelchair, or he sits on a chair facing the wall bar. The patient stands up and sits down as described above, holding the bar with his hands. The complication of this exercise is possible by reducing the height of the chair: the lower the chair, the greater the load on the muscles of the legs, the more the arms are straightened. To reduce possible muscle spasticity, we instruct you to exhale while sitting down.

22). Trampling on the spot. Starting position standing, hold on to the support, legs apart shoulder-width apart. To transfer the weight of the body to the healthy, then to the "sick" leg, as if swinging slightly to the sides to transfer the weight of the body from one leg to the other (without lifting the foot from the floor). Then we complicate this exercise due to the separation of the foot from the floor by a few cm. When the feet are lifted off the floor, swinging to the sides is replaced by raising the legs - walking in place.

Next, we teach to walk in placelifting your knees high.
Here we also include rolls from heel to toe in a standing position, legs together.
We will master the "bicycle" alternately with each leg in a standing position,
stepping with one foot forward and backward over a low block, stick.
Let's practice alternately taking the straightened legs back, putting the foot on the toe,
as well as an overlap of the shins back (that is, the patient takes the shin back so that the foot is directed upward and the knee joint is directed downward).

23). Exercises for the legs while sitting on a chair. In the initial position of the patient sitting on a chair, we train various leg movements:
rolls from heel to toe,
alternate rotation of the feet clockwise and counterclockwise,
sliding feet forward - backward in alternating oncoming movements,
leg-to-leg movement,
alternate abduction of the legs to the sides,
alternating lifting of straightened legs forward - up,
"Walking" while sitting on a chair.

As soon as the student can make the movement of the lower leg back, you can start learning to walk. Not immediately, but by warning him in advance that tomorrow (or the day after tomorrow) you will start walking training. This will help your student to mobilize strength for this difficult job. He will worry, worry, think about it, wait for you, imagine how he will walk. This is an additional send of impulses to the leg muscles.

Recovery of walking after a stroke.

Finally, the long-awaited moment has come when the patient will take the first steps.
First, do a few exercises for the arms and legs while lying on your back and sitting on a chair, practice standing up, trampling from foot to foot, and swing your shin back while standing and sitting. You already have experience with post-stroke patients and can choose any exercise to prepare the patient for walking. Don't overwork him. Walking takes a lot of energy.

So, the patient sits on the edge of the bed, the feet are slightly apart and firmly resting on the floor. You sit next to him from the healthy side in an embrace, the patient grabs your neck with his good hand. It is necessary to stand together on the command "And-and-once!". We got up, straightened up. Now you make, as it were, a jerking movement with both the body and the hugging arm, so that the patient's “sore” leg moves forward by inertia. At this time, when the "bad" leg moves forward, remind the student to try to make a stepping motion. Next, the patient steps on the "sore" leg, transfers the center of gravity to it, holding on to you with his good hand, and moves the healthy leg forward. You jerk again. The "painful" leg of the student moves forward. Etc.

Having no experience in restoring walking in post-stroke patients, invite an assistant just in case to eliminate possible difficulties. An assistant can help the patient's “sore” leg to move. Just do not need to move the "sore" leg too far, the step forward should be small.

It is necessary to train not only walking forward, but also backward. With each new step, you need to strive for the patient to make a stepping motion with the "sore" leg. Figure out how to attach a wide tape to his foot so that you can lift the leg by the tape so that it bends at the knee joint when lifting.

As soon as you understand that, despite the weakness of the muscles, the patient still walks, it is a great joy. Congratulations! Well done!

The following describes an idea for the rational recovery of post-stroke patients, as an option if you have the necessary conditions for such exercises. Your enthusiasm is required, the patient should not be overweight, it should be adequate, you need free space in the study room on the floor, a large carpet and, of course, a physically strong assistant.

The recovery of movements in a post-stroke patient will go rather quickly if you apply exercises lying on the floor (on a carpet), which are built in accordance with the stages of the physical development of an infant:
while lying on your stomach, raise your head,
turn from side to side,
roll on the floor from one edge of the carpet to the other,
get up in the knee-wrist position,
crawl backward in the knee-wrist position, then crawl forward,
crawl on bellies (lying on your stomach).
If everything works out well, then gradually you can include any exercises.

You only need to use this technique with an assistant, since this work is very difficult for your spine.

After a while, you will see that your student can do more than he did before the stroke.

Let me remind you that you learn to work out all the manipulations on a healthy person who imitates a paralyzed patient, and only then use them on a post-stroke patient.

Another tip: be prepared for the fact that your patient in the exercise therapy session activates the intestines, he may want to go to the toilet. If it is possible to walk to the toilet and sit on the toilet, then for your patient this is a real holiday, a reward for their efforts.

How to lift a post-stroke patient off the floor?

Move a stable chair closer, put the patient on his knees in front of the chair (put the chair as convenient), place his hands on the seat of the chair. Next, you need to put the patient's healthy leg forward on the foot. Now he himself stands on his good leg, resting his good hand on a chair, and straightens up with your support. All that remains is to put your student on a chair, wheelchair or bed. It is not as easy as written here. Be aware of the danger of falling backwards when straightening the chassis. Raise the patient from the floor with two people, do not pull the paralyzed arm.

Recovery of walking after a stroke - not an easy thing, but interesting and joyful. To succeed in restoring movements in post-stroke patients, you need enthusiasm, a sincere desire and interest in this matter, ingenuity and physical strength. Only by your mood can you "ignite" the patient and convince him to fight for his health. There are times when a person after a stroke refuses to do anything to recover, lies and waits for death. This is not difficult to fix. Bring joy and hope into his life, and he will both study and look forward to you every day.

Further, it remains to daily train balance, coordination of movements, strengthen the muscles of the trunk, legs and arms. Your student should be able to operate with both hands, so the next article will be and self-help skills.

As a result of the stroke, the following functions deteriorate:

• Impaired coordination, walking after a stroke, which makes it difficult to stand up on your own due to the presence of spasm in the limbs.
• A sharp change in mood from positive to negative emotions.
• Cognitive instability.
• Lack of coherent speech.

Physicians sometimes cannot determine the specific dates for the end of the recovery period. After all, for each person after a stroke, an individual program for the restoration of motor functions is needed.

Therefore, how soon the patient learns to walk depends on home treatment. Especially if relatives buy expensive exercise equipment. But not everyone can afford it. Therefore, home-made devices for training the motor functions of the legs and arms are becoming an alternative.

For proper walking, an early start of recovery is important, but only after a full medication course. First, teach the victim to sit in bed on their own, then get up from it. At first, such a task will seem difficult to the patient, so watch him to avoid accidentally falling to the floor.

Later, the victim will begin to maintain body balance more confidently, and while walking will be able to independently maintain the correct position of the body. The main role in walking is played by the ability to straighten and bend the legs, forearm and hand.

To improve the patient's gait after a stroke, purchase a special cane with four supports and orthopedic shoes with a small heel and wide soles. It is advisable that she has a clasp for fixing the ankle joint. Try to get the patient to develop independence to walk unsupported.

How to get the right gait

For the victim to learn to walk correctly, outside help is needed. You can start recovery by drawing a path with traces in front of the patient's bed. Usually, it is according to this technique that they learn to walk in specialized centers for the rehabilitation of motor functions after a stroke.

During training, when developing a correct gait, so that recovery is more productive, it is recommended to use holders that fix the foot. And so that the knee does not bend, wear knee pads specially designed to keep the leg upright after a stroke.

When a person has already more or less started to independently rise to his feet, offer classes on a treadmill to speed up the recovery period. It is desirable on those models that are intended for patients with stroke - diseases. Unlike conventional training ones, they have baffle-shaped handrails on the left and right sides of the simulator.

When exercising, it is important not to rush: there is a risk of developing addiction to the incorrect formation of the ankle joint. After a stroke, you can start Nordic walking.

Walking disorders

After a stroke in a patient, the doctor observes a mismatch of motor functions on one side of the body. Walking becomes less correct.

From the outside, this is noticeable by the following signs:

• Uncharacteristic for a healthy person, a wobbly gait.
• The patient cannot bend the fingers and fully straighten the leg. In some cases, the fully extended leg does not bend, and the patient makes a semicircle with the sore side, correctly resting only on the healthy leg.
• It becomes difficult for the victim to stand on the entire sole of the foot, so he begins to walk not from the heel, but from the toe of the affected limb.
• There is a risk of an unexpected fall of the victim due to the existing low sensitivity and paralysis.
• The gait resembles the movement of a compass.

Fast rehabilitation of motor activity of the legs

For stroke recovery to be successful, continue treatment in a hospital setting. If a person's condition is defined as mild ischemic disturbance of blood flow, then the victim will be able to walk after 3-4 weeks.

If the victim fainted, but it quickly returned, there is a chance of getting consequences during a moderate stroke. Then walking will be saved only by 50-60%.

When a spontaneous severe cerebral hemorrhage occurs during a stroke, it is hardly possible to help. The paralysis of the leg is more likely to remain for life. It is this form that is defined as very difficult, incompatible with the normal existence of a person. The patient's recovery is delayed for a long period.

Treadmill application

When a stroke occurs, a person is forced to constantly lie in bed, and he cannot stand up on his feet or perform elementary movements. Whether the patient will be able to walk will depend on the therapeutic techniques used.

At first, to increase sensitivity, it is recommended to do massage and gymnastics of a passive nature. Then the doctor may advise you to exercise on a treadmill.

It differs from the traditional one in the following characteristics:

• Work at very low speeds, as patients, due to an illness that has occurred, at first will not be able to walk even very slowly.
• The treadmill has long handrails.
• Multilevel setting of speed functions.
• Emergency stop button.
• The carrying capacity of at least 110 kg is based on the fact that a stroke occurs not only with high pressure, but also with obesity.
• Highlighting on the display of the treadmill values \u200b\u200bof weight, heart rate, burned calories and distance traveled.

If, after a few sessions on the treadmill, there is some improvement in the paralyzed leg, you should not increase the speed. Adjust the speed of the treadmill as recommended by your doctor, depending on the improvement.

Using leg warmers

It is possible to continue recovery on the simulators only after the person is confidently standing on the injured leg. You should not start moving without first receiving advice from your doctor.

If the patient does not know how to work with the simulator, tell me. It is desirable that a physician - rehabilitologist do this. After all, only he knows how to correctly start and how long to continue training.

Deterioration of leg work due to excessive overload can be provoked. Sometimes, for this reason, the victim may have a stroke right on the spot during intensive training of the muscles of the lower extremities.

Cardiologist

Higher education:

Cardiologist

Kuban State Medical University (KubSMU, KubGMA, KubGMI)

Education level - Specialist

Additional education:

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

Research Institute of Cardiology. A.L. Myasnikova

"Course in functional diagnostics"

NTSSSH them. A. N. Bakuleva

"Course in Clinical Pharmacology"

Russian Medical Academy of Postgraduate Education

"Emergency cardiology"

Cantonal Hospital of Geneva, Geneva (Switzerland)

"Course in therapy"

Russian State Medical Institute Roszdrav

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

Why is walking disturbed?

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

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

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

Start recovery with it?

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

Passive exercise

Recovering from a stroke begins with training individual muscles and joints. Stroke usually affects an area of \u200b\u200bone hemisphere of the brain. In this case, they speak of hemiparesis or hemiparalych - a unilateral impairment of motor functions. Restoring movement in a sore leg begins with passive exercises.

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

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

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

Transfer of movements to the active phase

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

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

Walking after a stroke is restored with the following exercises:

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

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

Transfer to a sitting position

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

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

Getting up

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

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

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

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

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

Walk recovery

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

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

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

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

The instructor will also need an assistant for these exercises.

Walk recovery massage

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

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

How to ensure safety while walking recovery?

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

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

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

How long will it take to recover?

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

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

Why is walking important for overall stroke recovery?

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

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

Article from our reader

Having made the first steps around the house, I wanted to go outside. I sat at home "I don't want to". There was a lot of snow on the street. Second half of February. The paths are slippery and not very level. Learning to walk on such a surface is not easy, but effective.

My ankle was weak and my legs often twisted. Therefore, before cutting along the street, we were puzzled by the choice of shoes. Learning to walk is not an easy task. We were well aware that any freebie in the selection of shoes can greatly complicate the training. There was a reason to be very confused with the choice of boots.

Basic Rules

To make it easier and safer to learn to walk after a stroke, we decided that the boot for cold weather should be:

• warm, not wet, for going outside in any weather, without the risk of freezing.

They noticed that if I froze, my movements became completely "oak". Getting sick was also not part of our plans. A cold in parallel with a stroke, this is some kind of perversion)).

• tall, that would be good to keep the ankle from twisting. The legs were weak and twisted frequently.
• with laces... High boot with laces to keep the foot firmly in place. Plus additional training in tying shoelaces several times a day, great for restoring mobility and coordination of movements.

Tying my shoelaces was a hell of a routine for my non-working fingers. On the first outings, they put on my boots. Then I started learning how to put on my shoes and tie my shoelaces. The truth was not a big ambush)) I sat down, bent over to my boot to tie a lace and began to fall inexorably forward. Here I had to catch)). Tying a lace and maintaining balance at the same time was not feasible for me.

• with non-slip sole... With my unsteady walking, poor coordination and dizziness, the slippery sole could become a fat point in my "career" as a pedestrian))).
• with raised toe... So as not to stumble. I did not know how to raise my legs high, so I caught the toe of my boot for everything that was along the way.
• light... Each step in the beginning was a “feat”. It turned out that I had phenomenally heavy legs)) The extra weight was not pleasing.
• eyelet on the back of the boot... It was not easy for me to put on a boot. I could not push hard and insert my foot into the boot. There was an ambush with "push". The loop was great help. I slipped my finger into it and pulled the boot towards me. Thanks to her, I was able to put on my boots without help.
• easy to unlace and remove... When we returned from a walk, I almost collapsed. I was so tired that it was difficult to take off my shoes. In the fight with boots, sometimes it was not me who won))
  comfortable and fits well on the leg.

In order to learn to walk, I had to walk a lot. Lots of! In the first year, we covered 1200 km. In the second year, 900 km. The path is not close))). Walking such a distance in shitty and uncomfortable shoes is not realistic. An insignificant callus and at least 5-7 days you do not walk.

Practice has shown that you can only learn to walk again after a stroke in carefully selected shoes.

• strong... The "run" for learning to walk was not small. I don't like changing shoes. The boot must hold out for more than one hundred kilometers.

Output

For the warm season, we selected lightweight and well-ventilated sneakers. The main selection criteria are the same as for winter shoes. Only ventilation and lightness are needed instead of heat.

It took us a long time to learn to walk after a stroke. We are learning to this day. In the beginning, I had to think about the movements before each step. Now walking happens subconsciously. True, if the surface is slippery or not even, you still have to think about how and where to step. If you still bother about shoes, it will be difficult to walk. Shoes should be such that you put on and forget.

Shoe selection updated: September 21, 2017 by: author

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

Impaired motor function

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

How violations can manifest:

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

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

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

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

Occupational safety

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

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

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

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

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

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

Passive gymnastics

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

Workouts can include:

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

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

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

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

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

Active gymnastics

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sports Techniques

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

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

1. Increase speed gradually, taking into account your capabilities. Start only with a slow walk.
2. Hold on to the handrails while exercising. This will prevent you from falling in the event of an unforeseen violation of the movement of one of the legs.
3. Monitor your pulse. To do this, you can use a special sports bracelet or get readings from a sensor built into the simulator.

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

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

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

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

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

Is it difficult to achieve the result

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