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Publication date: 01.09.2022
DOI: 10.51871/2782-6570_2022_01_02_6
UDC 769.922, 612.062
PHYSICAL REHABILITATION OF MIDDLE-AGED MEN AFTER AN ISCHEMIC STROKE IN THE EARLY RECOVERY PERIOD
N.S. Lezova, N.V. Lunina
Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow, Russia
Annotation. The article presents the results of the effectiveness and content of the physical rehabilitation program for middle-aged men in the early recovery period after an ischemic stroke. The study included 50-59 years old men with a following diagnosis: an ischemic stroke of the left temporal lobe, moderate spastic hemiparesis on the right. The study was conducted in the early recovery period at the inpatient treatment stage. The duration of the physical rehabilitation program, which began in the early recovery period after and ischemic stroke, was 21 days and was divided into 3 periods: introductory (4 days), main (12 days) and final (5 days). According to the data obtained, the use of the developed program in the early recovery period for middle-aged men who suffered an ischemic stroke allowed to restore daily activity, alleviate depression and improve the psychoemotional state.
Keywords: physical rehabilitation, ischemic stroke, early recovery period.
Introduction. Brain diseases are an important problem of society, it is one of the main causes of fatal outcomes and long-term disability of the population. At the same time, strokes are increasingly occurring in people of working age, i.e. there is a tendency to "rejuvenation" of cerebral stroke: among patients with acute cerebral circulation disorders, up to 25% are people aged 41-50 years. Rehabilitation and social adjustment of patients who have suffered a brain stroke is becoming increasingly important in modern clinical neurology. The lack of timely and adequate restorative treatment leads to the emergence of irreversible anatomical and functional changes and the violation of the psychoemotional status of a person, leading to disability, the growth of which has been steadily increasing in recent years [1].
In Russia, the level of disability varies from 75% to 85% a year after a stroke, while in Western European countries this indicator is 20-30%. In our country, among patients who have suffered a stroke, 3-23% return to work, 85% require constant medical and social support, and 20-30% remain disabled throughout their lives [2]. Early rehabilitation reduces the percentage of disability, restores daily activity, reduces the risk of complications and alleviates depression in people who have suffered an ischemic stroke, which confirms the relevance of this work.
The aim of the study was to develop and evaluate the effectiveness of the physical rehabilitation program for middle-aged men after an ischemic stroke in the early recovery period.
Methods and organization. The assessment of the daily life activity of stroke patients was assessed on the Barthel scale [3]. The severity of neurological disorders and the level of personal adjustment were assessed on the Lindmark scale [4]. The assessment of depression was assessed on the Wakefield scale [5]. The obtained results were processed with mathematical statistics methods (mean value, standard deviation, validity of differences were evaluated using the Wilcoxon
T-test (p≤0.05)).
The study took place in the period from November 2021 to April 2022, was carried out in the Chekhov Regional Hospital (Chekhov, Moscow region). Men (n=6) aged 50-59 years with a diagnosis of an ischemic stroke of the left temporal lobe, moderate spastic hemiparesis on the right participated in the study with voluntary consent. The study was conducted in the early recovery period at the inpatient treatment stage.
The duration of the physical rehabilitation program, which began in the early recovery period after an ischemic stroke, was 21 days and was divided into 3 periods: introductory (4 days), main (12 days) and final (5 days).
During the introductory period, the following tasks of physical rehabilitation were set: prevention of orthostatic and stagnant phenomena; preservation of motor amplitude in the limbs; reduction of muscle spasticity; improvement of the functioning of the cardiovascular and respiratory systems; improvement of articulation and speech skills; improvement of the psychoemotional state.
The tasks in the main period of physical rehabilitation were: improvement of the functioning of the cardiovascular, respiratory systems; improvement of articulation and speech skills; reduction of muscle spasticity; formation of correct motor stereotypes; improvement of the psychoemotional state; expansion of motor activity; social and personal adjustment of patients.
During the final period of physical rehabilitation, the following tasks were solved: maintaining an improved state of the cardiovascular and respiratory systems; fixing the correct stereotypes of the movement of basic motor actions; consolidating the skills of voluntary muscle relaxation; maintaining the positive psychoemotional state; improving articulation and speech skills; improving the endurance of the body; social and personal adjustment.
To implement the tasks of physical rehabilitation in the early recovery period after an ischemic stroke, the means and methods included in the content of the rehabilitation treatment program were selected in the studied group (table 1).
Table 1
Physical rehabilitation (PR) program for middle-aged men after an ischemic stroke in the early recovery period
|
PR Period
|
Means and forms of rehabilitation |
Dosage |
Guidelines |
|
1. Introductory period (4 days) |
1. MHG: BE: - static – 70% - dynamic – 30% Calisthenics: for upper and lower limbs, trunk and neck (without and with the use of a myofascial roller) |
Daily, 1 time per day, 10-15 min. |
MHG starts from the first day with passive exercises, then – passive-active exercises. S. P. – lying, sitting. The pace is slow. Calisthenics:BE= 1:1
|
|
2. TG: Calisthenics: passive-active for upper and lower limbs BE: - static – 70% - dynamic – 30% SE: - passive – 70% -аctive-passive – 30% |
Daily, 1 time per day 15-20 min. |
TG begins from the first day with passive exercises, then – passive-active exercises. S.P. – lying, sitting. Pace – slow, medium. Rest pauses – every 2-3 exercises (muscle tone control). |
|
|
3. Therapeutic massage
|
Daily, 10-12 min. |
Perfomed according the method of A.A. Biryukov, paravertebral massage is performed (along the neck, thoracic and lumbar spine). After TG or 1.5-2 hours after eating. |
|
|
4. Ergotherapy:
|
Daily, 1 time per day, 10 min. |
Carried out individually. |
|
|
5. Mechanotherapy:
|
Daily, 10 min. |
Application scheme: lying – horizontally; lying – vertically; sitting – horizontally; sitting –vertically. The pace is slow. |
|
|
6. Dosed walking |
Daily, 2 times per day, 10-15 min. |
The pace is slow. First – with the help and supporting devices, and then – stimulation of independent movement with supporting devices. |
|
|
7. Physical therapy Electrophoresis |
Daily, 1 time per day, 7 min. |
Applied in the area of the neck-collar zone. Composition: 2% eufillin, 1-2% nicotinic acid, 1-2% no-spa, 5% novocaine. |
|
|
8. Art therapy: Origami |
Every second day, 30 min. |
Small group lessons with a therapist, making paper figures with oral instructions. |
|
|
2.Main period (12 days)
|
1. MHG BE: - static – 50% - dynamic – 50% Calisthenics: for upper extremities, body and neck ( without a use of a myofascial roller) |
Daily, 1 time per day, 10-15 min. |
MHG – active and active-passive exercises. S.P. – lying, sitting, standing. Pace is slow and medium. Calisthenics:BE=2:1
|
|
2. TG Calisthenics: active-passive, active for upper and lower limbs. BE: - static – 50%; - dynamic – 50%. SE: -active-passive – 50%;
|
Daily,1 time a day 20-25 min. |
LG exercises with objects, auxiliary aids. S.P. – lying, sitting, standing. Pace – slow, medium. Calisthenics:SE:BE =1:2:1. Rest pauses – every 2-3 exercises with an increase in muscle tone (control of muscle tone)
|
|
|
3.Therapeutic massage |
Daily, 15-20 min. |
Perfomed according the method of A.A. Biryukov, massage, after TG or 1.5-2 hours after eating |
|
|
4. Ergotherapy: a mobile simulator and manual for the development of manual skills
|
Daily, 1 time per day, 15-20 min. |
Carried out individually. |
|
|
5.Mechanotherapy: for lower limbs – a mobile transformer stepper (horizontal, vertical) |
Daily, 10 -20 min. |
Application scheme: lying – horizontally; lying – vertically (up and down); sitting – horizontally; sitting – vertically. The pace is slow, in the process of learning – is increased to medium |
|
|
6. Dosed walking |
Daily, 2-3 times per day, 15-20 min. |
The pace is slow and medium. Training, then – learning the ways of walking up the stairs.
|
|
|
7. Physical therapy: electrophoresis |
Daily, 1 time per day, 10 min. |
Applied to the area of the neck-collar zone. Composition: 2% eufillin, 1-2% nicotinic acid, 1-2% no-spa, 5% novocaine. |
|
|
8. Art therapy: Origami |
Every second day, 30 min. |
Small group lessons with a therapist, making paper figures with oral guideless. |
|
|
3. Final period (5 days) |
1. MHG: BE: - active – 50% - dynamic – 50% Calisthenics: for upper and lower limbs, body and a neck (without a use of a myofascial roller) |
Daily, 1 time per day, 10-15 min. |
MHG – active and active-passive exercises. S.P. – lying (when needed), sitting, standing, if possible – while walking (on a place, while moving). The pace is slow and medium. Calisthenics:BE=2:1 |
|
2. TG: Calisthenics: -active-passive, active for upper and lower extremities BE: - static – 50%; - dynamic – 50%. SE: -active – 50%; - active-passive – 30%; - with resistance and weights – 20%.
|
Daily, 1 time per day, 20-25 min. |
LG exercises with objects, auxiliary aids. S. P. – lying, sitting, standing. Pace – slow, medium. Calisthenics:SE:BE =1:2:1 Rest pauses – with an increase in muscle tone (control of muscle tone).
|
|
|
3.Therapeutic massage |
Daily, 15-20 min. |
Perfomed according the method of A.A. Biryukov, massage, after TG class or 1.5-2 hours after eating. |
|
|
4. Ergotherapy: a mobile simulator and manual for the development of manual skills
|
Daily, 1 time per day, 15-20 min |
Carried out individually. |
|
|
5.Mechanotherapy: |
Daily, 10-20 min. |
Exercises: free, in case of correctly formed stereotype of movement – with weights, with resistance. The pace – slow, while learning – increased to medium. |
|
|
6. Dosed walking |
Daily, 2-3 times per day, 15-20 min. |
The pace is slow and medium. Walking up the stairs, different types of walking.
|
|
|
|
7. Physiotherapy Wax bath therapy |
Daily, 1 time per day, 7-10 min. |
Applied as an application in the neck-collar area. It is prescribed after the LG procedure. |
|
|
8. Art therapy: Origami |
Every second day, 30 min. |
Small group lessons with a therapist, making paper figures with oral instructions. |
Note: MHG – morning hygienic gymnastics; TG – therapeutic gymnastics; BE – breathing exercises; SE – special exercises; S.P. – starting position
The effectiveness of the developed program of physical rehabilitation of patients after an ischemic stroke in the early recovery period was assessed by the dynamics of the studied indicators (table 2).
There was a significant increase in the assessment of the daily activity of patients after an ischemic stroke, assessed on the Barthel scale from 78.3±0.3 points to 83.3±0.4 (p≤0.05), which indicates an improvement in their condition, with a good adjustment of the body to the constantly increasing physical, personal and social loads.
Table 2
Dynamics of the studied indicators in the process of physical rehabilitation of the studied group after an ischemic stroke in the early recovery period
|
Indicator (in points) |
X±σ before PR |
X±σ after PR |
∆ (difference) % |
Wilcoxon T-test (p)
|
|
Assessment of daily life activity (Barthel scale) |
78.3±0.3 |
83.3±0.4 |
5 |
≤0.05 |
|
An indicator of the degree of severity of neurological disorders and the level of personal adjustment (Lindmark scale) |
310±2.03 |
367.67±2.05 |
13 |
≤0.05 |
|
Depression indicator (Wakefield scale) |
18.67±0.14 |
16.33±0.03 |
6.5 |
≤0.05 |
The indicator of the Lindmark scale, reflecting the severity of neurological disorders and the assessment of the personal adjustment level after physical rehabilitation of the studied contingent in the early recovery period increased by 13%, reaching values from 310±2.03 points to 367.67±2.05 points (p≤0.05). There was a decrease in the depression index of, determined by the Wakefield scale by 6.5% from 18.67±0.14 points to 16.33±0.03 points (p≤0.05).
Conclusion. The use of physical rehabilitation in the early recovery period in middle-aged men who suffered an ischemic stroke allowed to restore daily activity, alleviate depression, and improve the psychoemotional state.
REFERENCES
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INFORMATION ABOUT THE AUTHORS:
Natal’ya Sergeevna Lezova – 4th year student, Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow.
Natal’ya Vladimirovna Lunina – Candidate of Biological Sciences, Associate Professor, Associate Professor of the Department of Physical Rehabilitation, Massage and Health-Improving Physical Culture named after I.M. Sarkizov-Serazini, Russian State University of Physical Culture, Sports, Youth and Tourism, Moscow, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it..
For citation: Lezova N.S., Lunina N.V. Physical rehabilitation of middle-age men after ischemic stroke in the early recovery period. Russian Journal of Sports Science: Medicine, Physiology, Training, 2022, vol. 1, no. 2. DOI: 10.51871/2782-6570_2022_01_02_6