How to walk properly after a stroke. Learning to walk after a stroke: important rules

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Having taken 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 outside. Second half of February. The paths are slippery and not very smooth. Learning to walk on such a surface is not easy, but effective.

My ankle was weak and my legs often tucked up. Therefore, before we cut through 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 training. There was reason to get confused with the choice of boots.

Basic Rules

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

warm, waterproof, for going out in any weather, without the risk of freezing.

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

high to keep the ankle well from twisting. The legs were weak and often twisted.
with laces. A high boot with laces holds the foot firmly. Plus extra workout tying shoelaces several times a day, great for restoring mobility and coordination.

Tying my shoelaces was a hell of a routine for my non-working fingers. In the first exits, they put on shoes for me. Then I started learning how to put on my boots and tie my own laces. True, it was not a big ambush)) I sat down, leaned over to the boot to tie the lace and began to fall inexorably forward. Here I had to catch)). It was impossible for me to tie my shoelace and keep my balance at the same time.

with non-slip sole. With my unsteady walking, impaired coordination and dizziness, the slippery sole could become a fat point in my pedestrian “career”))).
upturned toe. To not stumble. I didn’t know how to raise my legs high, so I caught the toe of my boot on everything that was along the way.
easy. Every step in the beginning was a "feat". It turned out that I had Phenomenally heavy legs)) The extra weight did not please me.
loop on the back of the shoe. Putting on shoes was not easy for me. I could not press hard and insert my foot into the boot. With "pressure" was an ambush. The loop helped tremendously. I poked my finger into it and pulled the boot towards me. Thanks to her, I was able to put on my shoes without help.
easy to lace up and take off. When we returned from a walk, I almost fell off my feet. I was so tired that I could hardly take off my shoes. Sometimes it was not me who won in the fight with boots))
comfortable and fit well on the leg.

In order to learn to walk, I had to walk a lot. So many! In the first year we covered 1200 km. In the second year 900 km. The path is not close. Walking such a distance in bad and not comfortable shoes is not realistic. Insignificant callus and at least 5-7 days you do not walk.

Practice has shown that learning to walk again after a stroke is possible only in carefully selected shoes.

strong. The "run" for learning to walk turned out to be not small. I don't like changing shoes. The boot should last more than one hundred kilometers.

Conclusion

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

It took us a long time to learn to walk after a stroke. We are still learning today. In the beginning, I had to think about the movements before each step. Now walking happens subconsciously. True if slippery or not Smooth surface, you still have to think about how and where to attack. If at the same time you still worry 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

It will take a lot of strength and patience from the patient and from the one who helps him. Not everyone has the opportunity to visit a good rehabilitation center, where the patient will be provided with competent medical care, or to purchase complex and expensive simulators. But with the right attitude and persistent work, the patient will be able to return to the normal rhythm of life as much as possible at home. The simplest "simulators" will be the most ordinary household items, the handling of which has recently been the most common thing.

Rehabilitation measures should begin as early as possible, immediately after the completion of drug treatment and the restoration of normal cerebral circulation and blood pressure. In no case should the patient get used to a recumbent lifestyle. You must first learn to sit, even if just on the bed, then put your feet on the floor. At first, the patient may not be able to cope on their own with these actions, help will be needed. Gradually, it will become easier to cope with this task. Every day, you should complicate the task: put your feet out of bed yourself, try to “walk sitting”, that is, step your feet on the floor.

It is necessary to start getting up and walking under the supervision of a caregiver - it will be very difficult to take the first steps and even keep yourself in an upright position. Help will consist in supporting the patient from the affected side. The main difficulty, not only physical, but also psychological, is that the sensitivity in this side is very low, which creates discomfort and prevents the arm and leg from moving. You will have to come to terms with this, since such sensations can remain for a long time. The main thing is to learn how to move your leg and arm.

The main task at the beginning of movement is to learn how to bend the affected leg in all joints, hold it in correct position. In order to facilitate the coordination of movements, you can mark the setting of the feet on the floor, mark the prints on the floor on which the patient will put his foot - this will help control the length of the step. In order for the patient not to forget to fix the leg in the ankle joint and not to cling to the floor with the foot, small obstacles can be placed between the “footprints”, first pencils, then larger objects.

Having mastered the movement with an assistant, you can try to move independently, but with reliable support. This can be a special cane with an armrest and preferably four supports. Comfortable shoes are also necessary - with a wide and low heel, holding tightly on the leg, preferably fixing ankle joint. Further restoration of motor functions depends to a greater extent on the patient, his perseverance and desire to start walking.

I'm sure you always pay attention to beautiful figure, nice walk. Have you ever wondered what exactly provides our beautiful gait?

Central nervous system: cerebral cortex, extrapyramidal and pyramidal systems, brain stem, spinal cord, peripheral nerves, cerebellum, eyes, vestibular apparatus of the inner ear and of course the structures that all this controls - the skeleton, bones, joints, muscles. Healthy listed structures, correct posture, smoothness and symmetry of movements provide a normal gait.

Gait is formed from childhood. Congenital dislocations of the hip joints or joint can subsequently lead to limb shortening and gait disturbance. Hereditary, degenerative, infectious diseases nervous system, manifested by muscle pathology, impaired tone (hypertonicity, hypotonicity, dystonia), paresis, hyperkinesis will also lead to impaired gait - cerebral palsy. myopathy. myotonia, Friedreich's disease, Strümpel's disease, Huntington's chorea, poliomyelitis.

Gait disorders in myopathies

Properly selected shoes will influence the formation of the correct gait. With tight shoes, the child will tighten his toes, the formation of the arch of the foot will be disturbed, the joints may be deformed, resulting in arthrosis of the joints and impaired gait. Flat feet, clubfoot impair gait. Improper prolonged sitting at the table will lead to curvature of the spine (scoliosis) and impaired gait.

At correct walking the body should lean back slightly. The back must be kept straight chest- straightened, buttocks tightened. With each step, the feet should be in line with the toes turned outward. Keep your head slightly elevated. Look straight ahead or slightly up.

Damage to the peripheral nerves - the peroneal and tibial - will lead to impaired gait. “Stepage” - when walking, the foot “slaps”, because dorsiflexion (flexion) is impossible and the foot hangs down. When walking, a patient with a lesion of the peroneal nerve tries to raise his leg higher (so as not to cling to the floor with his fingers), the foot hangs down, when lowering the leg resting on the heel, the foot slaps on the floor. Another such gait is called "cock". The peroneal nerve is affected in compression-ischemic, traumatic, toxic neuropathies. Compression - this means that you have compressed a nerve and / or blood vessels and ischemia has developed - circulatory failure. This is possible, for example, with prolonged sitting. "squatting" - repair, garden; in small buses on long journeys. Sports activities, very sound sleep in an awkward position, tight bandages, plaster splints can cause circulatory disorders in the nerves.

Hanging foot with damage to the peroneal nerve

Damage to the tibial nerve makes it impossible to plantar flex the foot and toes and turn the foot inwards. At the same time, the patient cannot stand on the heel, the arch of the foot deepens, a "horse" foot is formed.

"Horse" foot with damage to the tibial nerve

Atactic gait- the patient walks with legs wide apart, deviating to the sides (often towards the affected hemisphere), as if balancing on an unstable deck, the movements of the arms and legs are not coordinated. Turning the body is difficult. This is a "drunken walk". The appearance of an atactic gait may indicate a violation of the vestibular apparatus, a violation of blood circulation in the vertebro-basilar basin of the brain, and problems in the cerebellum. Vascular diseases, intoxication, brain tumors can be manifested by atactic gait and even frequent falls.

Antalgic gait- with radicular pain syndromes of osteochondrosis, the patient walks, curving the spine (scoliosis appears), reducing the load on the diseased spine and thereby the severity of pain. With pain in the joints, the patient spares them, adapting the gait to reduce the pain syndrome - lameness appears, and with coxarthrosis, a specific "duck" gait - the patient rolls from foot to foot like a duck.

With damage to the extrapyramidal systems. develops in Parkinsonism akinetic-rigid syndrome- movements are constrained, muscle tone is increased, concordance of movements is impaired, the patient walks, bending over, tilting his head forward, bending his arms at the elbow joints, taking small steps, slowly "shuffling" on the floor. It is difficult for the patient to start moving, "disperse" and stop. When stopped, it continues for some time an unstable movement forward or to the side.

Gait of a patient with Parkinsonism

When chorea develops hyperkinetic-hypotonic syndrome with violent movements in the muscles of the trunk and limbs and periods of muscle weakness (hypotension). The patient walks, as if with a "dancing" gait (Huntington's Chorea, St. Vitus's dance).

When the pyramidal system is damaged in various diseases of the nervous system, paresis and paralysis of the limbs. So, after a stroke with hemiparesis, a characteristic Wernicke-Mann posture is formed: the paralyzed arm is brought to the body, bent in elbow joint and radiocarpal, the fingers are bent, the paralyzed leg is maximally extended in the hip, knee, and ankle joints. When walking, the impression of an "elongated" leg is created. The patient, in order not to touch the floor with his toe, describes a semicircle with his foot - such a gait is called "circumducting". In milder cases, the patient limps, in the affected limb muscle tone increased and therefore flexion in the joints when walking is performed in a smaller volume.

Gait with central hemiparesis

Some diseases of the nervous system can develop lower paraparesis- Weakness in both legs. For example, with multiple sclerosis. myelopathies, polyneuropathies (diabetic, alcoholic), Strümpel's disease. With these diseases, gait is also disturbed.

heavy gait- with swelling of the legs. varicose veins veins, circulatory disorders in the legs - a person stomps heavily, raising his burning legs with difficulty.

Gait disturbances are always a symptom of some disease. Even a common cold and asthenia changes gait. A lack of vitamin B12 can cause numbness in the legs and disturb the gait.

Which doctor to contact for gait disorders

For any violation of gait, you need to consult a doctor - a neurologist, traumatologist, therapist, otolaryngologist, ophthalmologist, angiosurgeon. It is necessary to be examined and treated for the underlying disease that caused the gait disturbance or to correct the lifestyle, the habit of sitting at the table “foot to foot”, to diversify a sedentary lifestyle with activities physical education, visiting the pool, fitness classes, water aerobics, walking. Useful courses of multivitamins of group B, massage.

Consultation of a doctor on the topic of gait disorders:

Question: how to sit at the computer correctly so that spinal scoliosis does not develop?

Transfer About the most important watch online channel Russia

Signs of a stroke

Stroke is a common cause of death worldwide. Many do not have time to understand what is happening to them, man fail to help. but we will show you how to determine are you at risk of a stroke a few hours, days or weeks before its onset.

Take this simple test help you save your life or life loved one. There were strokes in the family of our heroine, woman fears she is at risk of a stroke. The first sign of an impending stroke is sharp darkening in the eyes.

Then vision can be restored, the balance is lost. Arises This as a result of a short-term violation of cerebral circulation. Another symptom of a stroke is wobbly gait.

A person's gait is disturbed some time before the stroke. A person often grabs the walls. Take the balance test. For this you need walk straight along the line. Do you have noise in ears, like you put a sea shell to your ear. Some believe that the neighbors are constantly making noise.

Another symptom is this horse racing blood pressure . If the pressure is elevated, then the risk of stroke is high. Vessels are constantly expanding they can not withstand the pressure and burst. When such signs appear need to see a cardiologist. as well as a neurologist who will prescribe vascular drugs.

We remind you that the synopsis is only a brief summary of information on this topic from a specific program, the full video release can be viewed here About the most important issue 766 of May 23, 2013

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Types of walking disorders. Varieties of walking disorders.

Differential Diagnosis The most common walking disorders are schematically presented in the figure.

There are several types of such violations.

Walking in small steps with freezing» at the beginning of movement and when turning, it is characteristic of parkinsonism syndrome and lesions of the frontal cortex (with hydrocephalus, tumors of the frontal regions, frontal dementia, vascular encephalopathy). In parkinsonism syndrome, there is also a bent position of the body and bent arms, shuffling when walking. Lesions to the frontal lobe are characterized by "sticking" of the feet to the floor ("magnetic" gait) and/or apraxia of walking (as well as apraxia of the feet and legs in general when sitting).

In the latter case, join as well as cognitive impairment. urination disorder and the so-called frontal motor disorders (revival of grasping, perioral reflexes, facilatory paratonia, etc.), which in Parkinson's disease appear only in the later stages of the disease.

spastic(with legs dragging, sometimes with clonuses) or spastic-atactic gait: damage to both legs (paraspastic) - primarily with pathological processes in the spinal cord (for example, with multiple sclerosis, Arnold-Chiari malformation); damage to half of the body (hemispastic) - primarily with supraspinal pathology (for example, a condition after a stroke).

Atactic. with lesions of the cerebellum (with legs wide apart, with lateropulsions, ipsilateral to the focus, in most cases also with ataxia of the trunk in a sitting position, and sometimes only with discrete ataxia in the extremities), with vestibulopathy (with lateropulsions, contralateral to the focus), with polyneuropathies (with violations of the vibration sense and the sense of position in space and a positive Romberg test).

Occasionally observed atactic gait in the absence of paraspastic disturbance and with lesions spinal cord(epidural metastases) (see above). Ataxia of the legs and atactic gait can also be observed when the frontal lobe is affected (sometimes it is a wide-legged gait, the so-called Brun's ataxia).

Paretic. with polyradiculopathy, polyneuropathy (sometimes steppage is observed) and myopathies (may be accompanied by Trendelenburg or Duchenne lameness). Depending on the severity of the lesion, paresis may be accompanied by ataxia of the affected limb and ataxia of walking.

Difficult classifiable walking disorder(atactic, pretentiously grotesque, "acrobatic", with sudden incomprehensible freezing in an unusual position, changeable, with bouncing, etc.): with choreic syndromes (primarily with Huntington's chorea; walking disorders are often regarded as psychogenic at first), dystonia (with Wilson's disease, with dopamine-sensitive dystonia (Segawa's disease) in children). Manganese poisoning is characterized by a gait on the tips of the fingers with an overbent torso (“cock walk”).

Only after exclusion these movement disorders psychogenic gait disorder may be suspected. The latter is characterized by improvement in distraction, dissociation between walking backwards and forwards (the latter is paradoxically worse).

non-specific. in the case of a predominance of uncertainty when standing over gait disturbance, orthostatic tremor can be assumed.

Most of these walking disorders discussed in more detail elsewhere in the book. Special mention should be made of multifactorial gait disorder common in older age:

For senile walking disorders characterized by small, uncertain steps, a bent posture and meager hand movements. It resembles the gait of a patient with parkinsonism, but there are no other manifestations of this disease (tremor, rigidity, hypokinesia). In older people, walking impairment is complex, it is based on a number of reasons, including non-neurological ones, which generally leads to unsteady gait and falls:

- the use of certain drugs (sdative, hypnotics, antiepileptic drugs, antidepressants, etc.);

- orthostatic hypotension (including due to side effect medicines);

- visual impairment;

- vestibulopathy;

- orthopedic and rheumatic diseases (coxarthrosis, gonarthrosis, foot deformities, etc.);

- mental factors, in particular, the fear of taking the first step.

Some of them factors can be corrected with treatment.

— Return to the table of contents of the section « Neurology. "

Smirnova Olga Leonidovna

Neurologist, education: First Moscow State medical University named after I.M. Sechenov. Work experience 20 years.

Articles written

Recovery of walking after a stroke occurs in stages. The muscles of the legs and torso are strengthened gradually, the ability to coordinate their movements and maintain balance returns. It takes a long time to eliminate movement disorders, but if you make an effort, you can achieve good results.

Implications for motor function

There is an acute violation of blood circulation in the brain. As a result, the body suffers from a lack of oxygen and nutrients, which leads to cell death. After an attack, the following disorders occur:

The ability to walk is impaired. The patient cannot get out of bed on his own.
There are sudden mood swings positive emotions are replaced by negative ones.
Cognitive functions become unstable.
There is no connected speech.
There is a violation of swallowing reflexes.

In the presence of these disorders, treatment should be started as soon as possible, otherwise complete paralysis will occur.

Not a single specialist can say exactly when a person will fully recover from an attack. the program is selected separately for each case. This also applies to the development of exercises to restore the ability to move.

After an acute circulatory disorder in the brain, motor function disorders can be detected by the following signs:

Unsteadiness of gait appears, which is not observed in healthy people.
Unable to bend and straighten the leg and arm or fully straighten. The leg can always remain in a straightened position.
The gait becomes uncertain, and the steps are wrong. Unable to move quickly.
It is not possible to fully stand on the sole of the victim. Therefore, the patient begins to walk from the toe, and not from the heel, as ordinary people do.
Each next step can lead to an unexpected drop, as sensitivity decreases.
The movement of a sick person resembles a compass.

Some patients recover very quickly and learn to walk within 2-3 months after the attack, while others need much more time. It all depends not only on the degree of lesions, but also on the correctness and regularity of home treatment. The use of special ones speeds up the healing process, but not everyone can afford it. Therefore, many use homemade devices for training leg and arm movements.

If after a stroke the legs do not go well, what to do, you need to find out from the experts. The rehabilitation period should begin as early as possible, but only after the completion of drug treatment.

First, the patient must learn to sit, and only then can he try to get out of bed. At first, even sitting will be difficult, so relatives should make sure that the patient does not fall.

Gradually, the victim will begin to maintain balance, be able to keep the body in the correct position, which is necessary for walking.

You should also restore the ability to bend and unbend the leg and arm.

Recovery is facilitated by the use of:

special cane with four supports;
orthopedic shoes with a small heel and a wide sole. It is desirable that the fasteners fix the ankle joint of the affected limb well.

It is necessary to ensure that a person after a stroke develops independence in himself and is able to serve himself and walk without outside help.

How to develop a gait

In order for the patient to be able to learn to walk after a stroke, he needs help. In rehabilitation centers, the technique of drawing a path with traces in front of the bed is used. On them, patients begin to take their first steps. This method can also be used at home. It helps to restore motor functions faster.

It will be easier for the victim to start walking after a stroke if:

use holders to fix the foot;
wear knee braces so that the knee does not bend and the leg is held in a vertical position.

After the ability to rise to its feet without assistance has returned, you can connect treadmill designed specifically for stroke patients.

It is important that the classes are not carried out at a fast pace, as the ankle joint may not work correctly.

Recovery speed can be different:

If a stroke manifested itself in the form of a small ischemic circulatory disorder, then the ability to control the limbs to a person will return within a month.
The average degree of a stroke, which is always accompanied by a loss of consciousness, allows only half to save motor activity. Therefore, the patient must be gradually taught movements. First, it will be enough to warm up in a prone position. Gradually, you should move on to more complex exercises.
A stroke, accompanied by severe hemorrhage, leaves no chance for recovery. This condition is considered incompatible with life.

The order of training

Recovery of limbs after a stroke consists of:

passive in bed;
sitting in bed;
getting up and standing still without support;
walking with legs using technical means rehabilitation, and later without them.

Restoration of the vestibular apparatus after a stroke is very important, since with its help a person keeps balance. All training should be carried out, gradually increasing the load. It is impossible to start teaching the patient to walk if he still cannot sit up in bed on his own or make even the simplest movements.

Exercises for the legs after a stroke are developed individually. They should be as physical as possible.

You need to master the exercises in this order:

The first group consists of turning from side to side in bed, pushing the body with the legs from the headboard, trying to take a sitting position and lying down without falling.
The second group reinforces the ability to sit independently. During this period, you can do active gymnastics while sitting, lower your legs from the bed and get up on a healthy leg.
The third group can be started when the patient is stable on a healthy leg. In this case, you can already use a walker.
The fourth group - with the help of a walker, you can stand and carefully step from foot to foot.
Those who have passed to the fifth group can independently develop a stable gait using walkers. The legs can already withstand heavy loads, the patient can walk more distances than before, the intensity of the exercises can be increased.

In theory, this option is considered ideal. But in practice, everything is much longer and more difficult. Failures often occur, there are breaks in progress, there are bouts of depression and loss of faith in one's own strength. But gradually faith in victory returns, and the treatment continues.

How to learn to use a walker

As soon as the patient learns to stand confidently on his feet without support, he can begin to take his first steps. You cannot do without an assistant in this matter, since he must belay from the paralyzed side in order to prevent a fall.

The patient should put his hand on the assistant's neck and rest his knee on his knee. Having fixed the joint, you can take the first step.

The task of the assistant is not only to support the patient, but also to control the correctness of his gait. When the patient moves with the help of a walker, it is necessary to ensure that the setting of the foot, turning the knee and hip joint were correct.

The whole process has several features:

The patient cannot fully grasp the assistant with his hand, as it is weakened.
To take a step, he needs to throw his leg forward, which leads to clinging to the helper's leg.
It is much more convenient to support the patient from a healthy part of the body, but the knee joint will not be fixed and the patient will not be able to hold on to the wall with a healthy hand.

The main purpose of using a walker is to gain the ability to bend the leg in all joints, otherwise the patient will constantly cling to the floor with the foot. The assistant should remind the person that the leg should be raised higher and bent at all joints.

High boots that fix the ankle joint will help facilitate movement. The sore arm should be fixed with a scarf so that during movement it does not sag, and the head of the shoulder does not come out of the articular cavity. During classes, you should control the work of the patient's heart and give him rest.

When the patient learns to move with the help of a walker without assistance, it is possible to start walking independently. This is done with a cane, holding on to the walls, moving a chair in front of you. But it is important to ensure that the load is evenly distributed. It is impossible to spare a sick leg, relying more on a healthy one.

Massage treatment

To speed up the healing process and in the brain can be used. Foot massage after a stroke (and the whole body) is performed using:

Stroking. With a relaxed palm, they glide over the surface of the skin, collecting it into large folds. At first, stroking should be superficial, but gradually their depth should be increased. They must capture adipose tissue and muscles. The hand of a specialist should move in zigzags, a spiral. With the help of this massage, you can bring the body into tone and, by removing the top layer of cells, improve blood circulation and tissue nutrition.
Rubbing. This increases the elasticity of tissues, reduces swelling due to the movement of fluid. You need to rub the skin with the help of fingertips, the base of the palm or a hand clenched into a fist.
Kneading. This is a kind of passive gymnastics. During the procedure, the muscle is captured, pulled and squeezed. There is also some effect on the vessels. Kneading helps to increase elasticity and tone muscle fibers. Therefore, in the presence of spastic changes, the procedure is prohibited.
Vibrations. The specialist performs oscillatory movements with a relaxed hand on the affected part of the patient's body. Massage with different speed and amplitude. Therefore, the result may be different. If the vibration is strong, then the muscle tone decreases, and if it is high, it increases. Movements are usually performed from right to left.

Similar treatment can be carried out at home. It is carried out independently by close people, hire a specialist or use massagers.

Relatives of the victim should perform massage from the side of the lesion, gradually moving to other areas. After a stroke, people remain in good shape only:

palmar surface, front of the shoulder and forearm;
chest muscle;
front surface of the thigh and back of the leg;
sole muscles.

These areas can only be massaged superficially by stroking or lightly rubbing. For other areas, heavy traffic is suitable.

When massaging the patient in a supine position, you need to put a pillow under the head, and a roller under the knee. To prevent a healthy limb from moving, it can be fixed with weights.

The recovery process after a stroke is difficult and lengthy, but if the victim himself and his relatives make every possible effort, the result will be positive.

Cardiologist

Higher education:

Cardiologist

Kuban State Medical University (KubGMU, KubGMA, KubGMI)

Level of education - Specialist

Additional education:

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

Research Institute of Cardiology. A.L. Myasnikov

"Course on functional diagnostics"

NTSSSH them. A. N. Bakuleva

"Clinical Pharmacology Course"

Russian Medical Academy of Postgraduate Education

"Emergency Cardiology"

Cantonal Hospital of Geneva, Geneva (Switzerland)

"Course in Therapy"

Russian State Medical Institute of 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 a stroke, as well as on how early rehabilitation treatment began. The most effective it will be the first six months after a stroke and the completion of intensive care.

Why is walking impaired?

During an ischemic stroke, areas of the brain 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 site 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. At the same time, all possible motor programs are stored in the "card file" of the lower motor system.

The task 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 ability of the brain to control them.

With it to start recovery?

The first thing done after a stroke to prevent loss of motion in the joints and tendons is treatment with position. 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

Recovery of walking after a stroke begins with training individual muscles and joints. A stroke usually affects one hemisphere of the brain. In this case, they speak of hemiparesis or hemiparalysis - a unilateral impairment of motor functions. Restoration of movements 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 at the hip joint.

If the patient understands well what is required of him, his consciousness must be involved in the process. He must learn to send an impulse to an immobile muscle. To do this, the exercise is done independently with a healthy leg, and then the movement is mentally transferred to the sore leg. The use of muscle memory is perhaps the most important component of the entire rehabilitation process.

Translation of movements into the active phase

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

As the muscle regains strength through passive exercise, the patient must 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:

Flexion and extension of the legs at the knees. At the same time, the feet slide on the bed. It is performed alternately with the diseased and healthy leg.
Switching legs. Legs bent at the knees, feet resting on the bed. A healthy leg should be thrown over a sick one, and then vice versa.
A similar exercise, only one leg should be put on the knee, moving it to the side, then repeat the exercise with the second leg.
Bicycle exercise.
Stop turns. Legs are bent at the knees, feet are on the bed. Turning the feet out and in.
Lying with straightened legs, alternately run the heel of one leg along the front of the lower leg of the other.
Raising and abducting the legs of the side.
Raise the pelvis, lying with bent knees.
Lying on your stomach, bend and unbend your knees.
Lying on your side, raise your leg.
Side Turns (restores the skill of turning over in bed). Lying on your back, lower your bent knees to the side, then complete the turn with your torso.

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

Transfer to a sitting position

A great achievement is the ability of the patient to sit on the bed independently, and most importantly, to maintain this position. Move it to a vertical position gradually and carefully to avoid dizziness and pressure buildup.

After mastering the skill of turning over the patient lying on his side, you need to slowly seat him - the legs are lowered from the bed, the healthy hand is repelled from it. His feet should be resting on the floor and slightly apart, the body is slightly tilted forward to maintain balance.

getting up

The next step is getting up. For training, several exercises are used:

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

After lengthy training, the muscles and consciousness of the patient are already ready to get 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 the next attempt for a long time. Getting up should take place with additional support and the help of an outsider. Trainings are accompanied by explanations of how certain movements are performed correctly. The patient will mentally remember them, stimulating the brain to send impulses.

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

Trampling is the transfer of the center of gravity from one foot to another, as if a person is shifting from foot to foot. First, the exercise is performed without lifting the feet off the floor, then they need to be slightly raised.
Rolling from toe to heel.
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 forward and backward.
Leading the legs back (the leg is placed on the toe).

Walking recovery

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

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

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

turning 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;
plastunsky crawling.

For these exercises, the instructor will also need an assistant.

Massage to restore walking

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 their condition of the patient and finds by experience an individual way of massage.

Not only a paralyzed leg or arm is subjected to massage. The entire damaged side of the body is massaged, starting from the scalp, ending with the toes. The procedure effectively restores blood circulation in numb skin and muscles, as well as the sensitivity of nerve endings. Massage courses begin 3-4 days after the stroke and should continue for the next year or even two years. Ordinary manual massage successfully complement the hydromassage and underwater shower.

How to ensure safety when restoring walking?

Falling after a stroke can lead to injury. Most often, such patients break the hip of the diseased leg. The reasons may lie not only in the lack of stability of the patient, but also in the imperfection of the environment. It can be slippery floors, too long pile carpets, poorly installed handrails in the bathroom and toilet, and simply insufficient supervision of a sick person.

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

Usually aids prescribed by the attending physician. He will also determine the deadlines for waiving them. Some fixtures are worth using all the time, for example, handrails in the bathroom.

How long will recovery take?

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

Significantly inhibits the recovery of cognitive impairment, decreased mental activity, loss of interest in life and depressive states. And vice versa, a well-timed and regularly carried out complex of rehabilitation measures significantly accelerates the restoration of lost functions. Specific terms of the recovery period are individual.

Why is walking important for overall recovery after a stroke?

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

Restoration of movement gives impetus to the restoration of other body functions. The successes that the patient makes and which must necessarily 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 strong-willed efforts, without which full-fledged rehabilitation is simply impossible.