After a stroke, a person can. Changing Behavior After Stroke: Psychological Therapy
According to medical statistics, stroke is one of the leading diseases in the world in terms of mortality. It occurs spontaneously and can be fatal within one day. This disease is caused by significant circulatory disorders in the cerebral cortex.
It is believed that the most common age for its development is 60 years. People who have suffered a stroke will no longer be able to be completely healthy, despite the restoration of most functions.
Rehabilitation is often a complex and lengthy process. After all, life after a stroke can be radically different than before the onset of the disease. A person sometimes has to re-learn how to move and talk.
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The maximum results in this can be achieved through constant efforts on oneself: regular exercise, healthy eating, as well as physical and psychological help from loved ones.
Types and causes of occurrence
Stroke can be of two types: hemorrhagic and ischemic. Each of them has its own distinctive features.
Causes of hemorrhagic stroke can be:
- intoxication;
- avitaminosis;
- defects or inflammation of the vessels of the brain.
In this situation, the vessels rupture and blood enters under the membrane and into the ventricles of the brain. Often this disease is called intracerebral hemorrhage.
The essence of ischemic stroke is reduced to blockage of blood vessels and the death of brain cells due to lack of oxygen. In the people, this disease is called a cerebral infarction.
It can be caused by the presence of a number of diseases:
- diabetes;
- violation of the heart rhythm;
- atherosclerosis.
Predisposition to both forms of the disease are people in old age, as well as those suffering from overweight and hypertension.
Re-impact prevention
During the first days after the onset of a stroke, special attention should be paid to preventing another attack. After all, each subsequent violation of blood circulation can lead to significant deviations in the functioning of the nervous system, up to the death of the patient.
It is immediately necessary to determine the causes of the disease and preventive procedures agreed with the doctor.
You should immediately abandon bad habits that contribute to the destruction of cerebral vessels - drinking alcohol and smoking.
In addition, there are a number of requirements, the implementation of which will minimize the risk of recurrence of a stroke:
- Change in diet.
- Slimming.
- Minor physical activity in the form of exercise, walking or playing sports.
The attending physician will tell each patient individually how to live after a stroke. They will be set a maximum blood pressure level that should be adhered to.
A list of medications to be taken as needed is also provided. Most often, drugs are prescribed to reduce blood clotting and the formation of blood clots.
It is necessary to take a blood test for the content of glucose in it. Achieving the required level can reduce the likelihood of relapse.
Rehabilitation
After a stroke, it is mandatory to carry out rehabilitation procedures, regardless of the complexity of the disorders in the body caused by the disease. The entire rehabilitation period can be divided into time stages from the first days of illness in the department of a medical institution to subsequent recovery in rehabilitation centers and at home.
| First month |
If the patient has endured physical and emotional stress well during the first 10–14 days, doctors proceed to the stage of speech restoration. |
| After discharge |
|
Diet
In case of excess weight in a patient or a high content of glucose in the blood, the attending physician will definitely prescribe a diet. The diet should limit the intake of salt, animal fats and sugar. Lowering cholesterol levels will allow for the cleaning of blood vessels from plaques and improve blood circulation.
The menu should contain foods rich in fiber, vitamins and minerals. Eating after a stroke is carried out at least four times a day in small portions.
Prohibited products include:
- pork;
- fatty fish;
- smoked meats and sausages;
- grilled meat;
- dairy products with high fat content;
- sweet pastries;
- grape;
- legumes;
- strong tea, coffee and carbonated drinks.
Vegetarian soups, boiled meats and vegetables, dried fruits, decoctions of herbs or rose hips, oatmeal porridge, brown rice or millet will be useful.
Such a diet will allow you to lose weight, normalize blood circulation and reduce the likelihood of a second stroke.
Adaptation in the social environment
In addition to restoring motor functions, due attention is paid to social and psychological adaptation. It is especially important for able-bodied people aged 40-50 with minor damage to brain cells. After all, they have every chance to return to the previous rhythm of life and work.
Relatives should not isolate a person from performing various tasks, explaining this by the loss of his physical abilities or forgetfulness. On the contrary, one should prompt those words that he cannot remember and regularly set him to perform any tasks around the house that correspond to the functional capabilities of the body.
A person should feel needed by society.
Social adaptation consists in the return of the patient to the previous work or, in case of impossibility, to another simpler work. If an elderly person or his deviations do not allow him to work, you need to provide assistance in finding a hobby, organize visits to exhibitions or a theater.
A person can be involved, receive additional communication and physiotherapy procedures in specialized sanatoriums or rehabilitation centers.
Moral support from loved ones is very effective for recovering a patient after a stroke. Recovery can be significantly accelerated by creating a favorable atmosphere in the family.
The main task of relatives and friends should be called helping a person to overcome the first period of his rehabilitation, when he is prone to passivity, is under the influence of psychological shock and does not believe in the success of his treatment. You need to constantly praise him for his successes, talk about the positive results of his recovery.
The most productive recovery after a stroke takes place in the first year of rehabilitation, and then the process slows down and adaptation (adaptation) to the existing functional impairment of the body begins. Therefore, the patient should be convinced that he should not give up and continue to work with him regularly until complete recovery.
A fulfilling life after a stroke
Having survived a stroke, the patient may have certain limitations on their previous capabilities. But this does not mean at all that he is not able to get joy and satisfaction from life.
A person is quite capable of adapting to any kind of leisure or hobbies:
- cooking lovers can be in the kitchen in a comfortable chair, clean and cut vegetables for salads, knead and roll out dough, decorate ready-made dishes, etc.;
- for gardeners and gardeners there is an opportunity to care for plants in pots and grow indoor crops;
- you can even knit and embroider with one hand, holding a knitting needle or hoop in a special tripod;
- even while in a wheelchair, you can take walks in the park, visit cinemas and restaurants.
For people who are socially active, doing simple household chores can significantly bring them closer to returning to a team or work.
How to avoid depression
After a stroke, finding a patient in a state of depression is simply unacceptable. Indeed, in this case, a person becomes passive, constantly lies, turned away to the wall, does not want to communicate with anyone.
But that's not all. In such a state of mind, he absolutely does not show a desire for his own rehabilitation, daily activities, both physical and speech.
This situation can be resolved with the help of antidepressants. This is an effective way to make the patient look at the world positively. In addition, constant communication with loved ones is necessary. The patient should take on any responsibilities around the house.
Proper nutrition, walks in the fresh air, minor physical activity and water procedures can make a person more positive about life, as well as stimulate him to recover.
How long do they live after an attack
According to various statistics, after the development of a stroke during the first month, death can occur in 15–25% of patients. It should be noted that death occurs in half of these cases from repeated cerebral edema.
The rest is caused by complications in the form of kidney failure, pneumonia, and various heart diseases.
According to scientists, it can occur in 65% of patients. Of those people who managed to suffer a stroke, only 35% can live more than one year. With ischemic stroke, the statistics are less sad. Here the survival rate reaches 75%.
With, regardless of its type, the mortality rate is much higher than after the first pathology.
It should be noted that life expectancy after a stroke largely depends on the patient himself, his desire for recovery and return to normal life. One person can live only a month, and another for many years, reaching the age of 80 years or more.
Proper nutrition and taking the necessary medications, giving up bad habits, as well as constant efforts to improve the functioning of your body allow a person to recover as much as possible after a stroke and extend his life.
Stroke is a serious disease, often leading to death or disability. This is not surprising, because with a hemorrhage in the brain or an interruption in the supply of oxygen to it, part of the nerve cells irreversibly dies. Recovery after a stroke is possible due to brain plasticity - the ability to assign lost functions to previously unused cells and form new neural connections. The effectiveness of this process strongly depends on the time that has elapsed since the crisis, so promptness is important at each stage of treatment.
Initially, patients are admitted to the intensive care unit, then to the neurological hospital. After that, the longest stage, which directly depends on the patient and his relatives, passes - the rehabilitation period.
The effectiveness of rehabilitation after a stroke and its duration depend on many things: the timely detection of symptoms and the start of treatment, the type and severity of the stroke, the general health of the patient, the presence of concomitant diseases or senile dementia, the age of the patient. The mental state of the patient and his willingness to make efforts to recover after a stroke in order to return to a full life, support from relatives are also important.
The recovery period after a stroke can range from 1 month to 2 years. Some are able to rehabilitate almost immediately, others remain permanently bedridden invalids, and they are not even assigned rehabilitation measures. Therefore, the referral to rehabilitation should be assessed as luck. 85% of those who have suffered an ischemic stroke can be returned to full life in a year and a half, and two-thirds of these people recover in the first 3-4 months.
Is it possible to completely restore the brain after a stroke? Unfortunately no. Instead of damaged areas of the nervous tissue, voids filled with liquid are formed, which affects the loss of certain functions. A stroke leads to impaired memory and speech, coordination, especially fine motor skills, mental disorders, loss of control over one side of the body. From here we get the answer to the question of how to recover from a stroke - you need to return the lost abilities or compensate for them with new ones. You should not hesitate - neural connections are most easily formed if you start classes immediately after you get out of the crisis. It is important not to give up until the functions that require long-term exercises are restored, to continue taking the necessary drugs.
Complex of rehabilitation measures
Recovery after a stroke includes the return of psychological and physical usefulness, speech and memory functions, and the prevention of relapse by controlling blood pressure, eating healthy, giving up bad habits, and changing lifestyle for the better. How long the rehabilitation will last depends on the sequence of the patient regarding the instructions of the attending doctors.
Physical component
Physical rehabilitation for stroke includes active (physiotherapy exercises, or exercise therapy) and passive measures (massage, magnetotherapy, physiotherapy) to restore motor functions. The latter often seems preferable to patients, but is not able to replace physical exercise. If financially feasible, home stroke rehabilitation may include an exercise therapy specialist, but visiting a rehabilitation center and exercising with other patients will be the most beneficial.
Some of the exercises are available in bed. Often, stroke survivors experience excessive tone of the limbs, which can freeze in an awkward position. In such cases, you need to gradually increase the amplitude of movement and relieve muscle tension. Passive gymnastics is possible with a gradual connection of the patient's efforts. The following measures are available:
The hand after a stroke should be exercised by bending and unbending the fingers, the hand.
By moving the limbs in the joints, you can gradually regain control over the body.
The rotational movements available to a healthy person are helped by a caregiver to help a sick person.
Stretching of the limbs bent by spasm is a measure to combat paralysis, when the fingers, and then the entire hand, are fixed with bandages to a flat object for half an hour or more.
A patient who has succeeded in restoring his arm after a stroke can perform manipulations with a towel suspended over the bed, making all possible movements with it. After the towel rises, and the exercises are complicated by the weight of the patient.
The rubber ring can be stretched between the limbs in different combinations.
An increasingly larger roller, placed under the knee, serves to restore the functions of the leg.
The patient can help himself with his hands in flexion and extension of the legs, alternately grabbing the shins and leading the feet along the bed.
Reaching up to the back of the bed, the patient can sort of pull himself up while stretching his feet and toes.
Another set of exercises available to bedridden patients is eye gymnastics (movements from side to side, circular movements, focusing on near and distant objects, blinking, strong squinting).
A stroke survivor undergoes recovery gradually, then proceeding to gymnastics in a sitting position. It is aimed at the transition to purposeful movements and preparation for walking. Patients do:
- alternating leg raises;
- connection of the shoulder blades and tilting the head back on inspiration with relaxation on the exhale;
- arching the back back on inspiration with relaxation on exhalation.
Then comes the turn of standing exercises and a return to subtle movements. The complex includes:
- picking up small items from the floor or table;
- sipping with raising hands on inhalation and returning to the starting position on exhalation;
- torso inclinations;
- exercises for the hands, including with the help of an expander;
- exercise "scissors";
- squats.
Finally, the patient can proceed to exercise therapy itself. It is worth doing it diligently, since the length of stay in the rehabilitation center is short. You should not allow overwork: all exercises should correspond to the current capabilities and condition of the patient.
Before class, the muscles are warmed up with a warm-up, warm water treatments, a heating pad or massage. A positive effect will be the presence of relatives in the classroom, who can not only help the patient in the exercise, but also convince him of the benefits of hard work.
Exercise therapy is aimed at restoring movements in the previous volume, maintaining balance, walking, performing household tasks and switching to self-service. After all, the usual dressing or eating for stroke survivors suddenly become difficult operations.
In the early stages, passive measures can be used. They will not replace exercise therapy, but they will help prepare the patient for gymnastics. They include electrical stimulation, massage, magnetic and physiotherapy. Currently, an effective tool is the biofeedback method, when a patient performs tasks with the help of a computer program or game, receiving sound or visual signals about the functioning of the body together with the doctor.
Mental component
Not surprisingly, a stroke becomes a severe ordeal, often causing depression or apathy. Patients become irritable, quick-tempered and aggressive, having lost the former ability to control emotions. Often they themselves do not notice how difficult they have become in communication. The patience of relatives, their warmth and support are important, allowing them to overcome the crisis and undergo psychological rehabilitation after a stroke.
It is necessary to maintain good spirits and an optimistic attitude, and if you notice symptoms of depression, start treatment. Modern medicine will cope with it with the help of dietary supplements or psychotherapy. However, all drugs must be prescribed by a doctor, including antidepressants. A good option would be a specialized sanatorium that allows you to change the situation and conduct complex therapy.
Recovery of speech and memory
With the defeat of the corresponding centers of the brain, the return of functions will be gradual. A speech therapist should deal with a patient who has lost his speech, and relatives should constantly talk. Another obstacle on the way to full communication is the “freezing” of facial muscles, which is eliminated by the following exercises:
- grinning;
- curling lips into a tube;
- light biting of the lips;
- pushing the tongue forward;
- licking lips in different directions.
First, the pronunciation of sounds returns, then words. The singing heard by the patient and attempts to reproduce it will be an excellent help. You can say part of the word to the patient so that he completes it. A good effect is the repetition of rhymes and tongue twisters.
Restoration of memory is helped by taking certain medications. Otherwise, the process is reminiscent of working with children and includes memorizing and repeating numbers and phrases, playing games, board games that allow the patient to concentrate on one action. It is useful for a stroke survivor to remember and describe what happened to him over the last day, week, month, etc.
Return to normal life
Someone gets the opportunity to return to home conditions almost immediately, but many things will inevitably undergo changes. New restrictions will appear, and familiar things will require re-accustoming to them. It will be necessary to constantly measure blood pressure and follow all the recommendations of doctors. How to live after a stroke in order to maintain health and avoid relapse?
Diet
The patient's diet should be balanced. There are no significant restrictions, but it may be advisable to predominate in food products that do not linger in the intestines and do not cause constipation, that is, vegetables, fruits, cereals. The load on the urinary system will reduce the smaller amount of salty, sour and spicy foods. Excluding coffee and tea from the diet will have a beneficial effect on pressure, and avoiding fatty foods and fast carbohydrates will help keep blood sugar levels normal, which will also reduce the risk of a second stroke. Uncompromising should be the rejection of only one thing - alcohol.
Citrus fruits and tincture of pine cones are shown to those who have suffered a stroke - a folk remedy whose phytoncides maintain a good condition of nerve cells. It is also useful to drink an increased amount of liquid, 2-3 glasses per day.
dwelling
Taking the patient home, relatives must strictly follow the recommendations of specialists on how to care for the patient after a stroke. Changes in the apartment can take a lot of time. You will have to remove away all dangerous and capable of falling on the patient objects. Carpets, wires, etc. may lead to a fall. If the patient uses a walker or a wheelchair, it is necessary to provide him with free access to all rooms, consider overcoming steps or thresholds.
Greater independence will be provided by handrails in the bathroom, a bench in the shower, a special toilet seat. A shower, by the way, is preferable to a bath. The thermometer in it will save the patient with reduced heat sensitivity from burns. It is worth thinking about unbreakable dishes and small chairs on which the patient can lean. It will be useful to install handrails also by the bed and in general in any place where the stroke survivor will get up and sit down.
For independent walks outside the home, it is worth providing a person with a mobile phone with a one-button call function in case of a fall or a second stroke.
Work
Here we are dealing with a double-edged sword. On the one hand, returning to this part of life will be an important part of socialization. On the other hand, mental changes and physical limitations may require early retirement or a remote profession. It is important not to rush to return to the workplace, to make sure that the necessary opportunities have fully returned. If this is not the case, it is worth approaching with optimism the time freed up for your favorite hobby and communication with your family.
Personal life
Sex for stroke survivors is not only acceptable, but also beneficial in terms of rehabilitation. Violation of motor skills, apathy, troubles from the genitourinary system may appear (potency and sensitivity decrease). However, with a successful combination of circumstances, an active sex life will help to establish an emotional state and make the patient happy again.
Vascular dementia is one of the most unfavorable variants of the course of chronic ischemic brain disease. Our consultant: Nina Minuvalievna Khasanova, angioneurologist at the First City Hospital in Arkhangelsk.
It is noted that this disease occurs, as a rule, in old age. The cause of dementia after a stroke is associated with damage to the part of the brain that is responsible for memory or the performance of any skills.
Vascular dementia (dementia) is a combination of symptoms that are manifested by a deterioration in memory, thinking, a decrease in the ability to perform skills in everyday life, which either stops or significantly complicates the patient's independent life and his usual work.
Vascular dementia after a stroke is not necessarily an emerging symptom. This condition occurs when there is a pronounced lesion of the brain tissue or as a result of a repeated stroke against the background of uncontrolled arterial hypertension.
If a person after a stroke becomes apathetic, tearful, quickly emotionally exhausted, his mental abilities deteriorate, he ceases to be interested in family life, friends, this may be the first sign of oncoming dementia, which requires a doctor's examination for timely treatment.
The onset of post-stroke dementia, unlike, for example, Alzheimer's disease, is acute. For example, even on Wednesday, a person behaved normally, and on Thursday morning he became aggressive, uncontrollable, his memory deteriorated sharply. It is very important not to see a repeated stroke in a patient: it can be hidden behind such a sharp deterioration in well-being. Therefore, each such situation is an indication for a medical examination and an ambulance call.
Vascular dementia as a disease can also occur with light intervals. This disease, as it were, erases in layers those skills that have been acquired by a person throughout life.
Dementia after a stroke is necessarily combined with coronary heart disease, diabetes mellitus, arterial hypertension. In this case, there are always changes in the vessels of the brain, neck, fundus. Patients must be periodically examined by a cardiologist for assistance and selection of concomitant therapy.
The risk of developing post-stroke dementia depends on how carefully relatives or the patient himself monitors his blood pressure, cholesterol and low-density lipoprotein levels and their correct ratio, blood viscosity, how carefully all the recommendations of the attending physician are followed.
Unfortunately, modern medicine does not have the ability to effectively treat dementia and prevent its progression. Prescribed drugs can only remove or weaken individual unpleasant manifestations of the disease, partially slow down its development. Therefore, the leading role in helping patients with dementia belongs to the daily full care of them.
The most important:
1. try to prevent the development of infectious diseases and the worsening of the course of a somatic disease of your loved one, as this negatively affects the course of dementia;
2. create a comfortable and simple environment: familiar favorite items, their location. In a familiar environment, the patient feels most comfortable. The appearance of strangers in the house, moving dramatically worsen his condition. In the room where the patient is located, there must be a firmly established and habitual order for placing clothes, shoes, and other everyday items;
3. control the mode of taking prescribed drugs. Their irregular intake or overdose can dramatically worsen the patient's condition.
Patience needed!
When communicating with a loved one with dementia, never forget that you are communicating with a sick person who has a mental disorder, many character traits that attracted you before have been lost, and behavior has changed (alas, not for the better). Remember that against the background of rare temporary improvements, the disease, as a rule, will intensify, the patient's condition will worsen. Personality change progresses, emotional attachments to loved ones and the ability to empathize weaken, grouchiness, stubbornness and resentment increase.
In the future, orientation in time, space, and the environment is disturbed. Patients do not know the date, they can get lost in a familiar place, they do not always understand where they are, they do not recognize acquaintances and close people. And although such a person can serve himself, cope with personal hygiene, he already loses the skills to use everyday household appliances, such as a telephone, gas stove, TV remote control, etc. Then he can no longer be left alone unattended.
Vascular dementia rarely reaches the degree of deep total disintegration of the psyche, but over time, a sick person becomes a heavy burden for others and relatives. Here are some excerpts from the stories of relatives about their loved ones with dementia.
“After the stroke, my mother-in-law changed a lot, became unkind, suspicious, capricious. The person is simply unrecognizable! Her general health is now not bad, she even goes out to breathe on a bench at the entrance. She tells her neighbors all sorts of fables: either I was going to poison her, or we don’t let her sleep at night, or we lock her in the toilet. Her husband talks to her, shames her, but she either denies her stories, even yells at him or cries that we are slandering her. I once came home from work - it smells strongly of gas. The burner tap on the stove is open. Now we turn off the gas, leave the food in thermoses.
“I’ll put food for my mother, which we immediately eat ourselves, and she says that it’s not a pig to eat this, she throws the plate away. I take her by the hand to take her to the room or to the kitchen - she starts to twitch, scream that I beat her. After a stroke, my mother has been living with us for almost three years, but lately she wants to return home. When we leave, we have to lock it with a key, since she left once. We literally missed in 15 minutes, and she is gone! They searched all evening, night, morning. They called all the relatives, her friends, hospitals, morgues. Bypassed all neighboring yards. Almost went crazy! Well, an acquaintance works in the police, he helped us (and a missing person’s report is accepted only after three days). The next day at 12 o'clock she was found at the other end of the city.
“Mom started talking a lot. He talks to an imaginary woman, then he calls me mom, then he calls me sister. She stopped reading completely, often cries.
In such cases, do not try to convince patients, prove your case, appeal to their conscience, reason, logic. The person's personality has already been changed by the disease. This is not the same mother, mother-in-law, wife, not the same father, husband whom you have known all your life. You just need to remember: everything that your loved one does and says is not due to his malicious intent, deceit, harmfulness. This is a manifestation of the disease. Therefore, try to be patient with his “whims”, “antics”, be attentive, friendly and sensitive in dealing with him, because he still remains your dear person!
Do not forget that dementia is one of those
diseases that need to be treated before the first signs appear, therefore
medical supervision and implementation of recommendations for the treatment of chronic
diseases affecting the vascular system is the key to quality
and fulfilling life at any age.
Stroke Prevention Steps
Finishing the story about the consequences of a stroke, I would like to remind you once again: in many cases, a vascular catastrophe can be avoided; for this, the main attention should be paid to prevention. The most significant factors that can be corrected include arterial hypertension, coronary heart disease, diabetes mellitus, smoking, increased body weight, and elevated cholesterol levels.
- Physical activity is an effective factor in the prevention of obesity, type 2 diabetes, and arterial hypertension. During physical education, blood properties improve, and the risk of thrombosis decreases.
- Diet aimed at preventing atherosclerosis: limiting foods containing cholesterol and animal fats. Eat more fruits, vegetables and cereals, vegetable oil, sea fish.
- Smoking cessation: Nicotine causes vasoconstriction and stimulates the progression of atherosclerosis.
- Blood pressure control: arterial hypertension and atherosclerosis are closely related diseases, so their treatment and prevention must be carried out in parallel.
- Control of blood fats: a violation of the lipid composition of the blood leads to the development of atherosclerosis, which increases the risk of stroke.
- The fight against diabetes mellitus: this disease is associated with an increased risk of vascular damage and the intensive development of atherosclerosis.
Material: Irina Shaposhnikova
Cardiologist
Higher education:
Cardiologist
Kabardino-Balkarian State University named after A.I. HM. Berbekova, Faculty of Medicine (KBSU)
Level of education - Specialist
Additional education:
"Cardiology"
State Educational Institution "Institute for the Improvement of Doctors" of the Ministry of Health and Social Development of Chuvashia
The transferred brain lesions are often accompanied by the appearance of serious negative consequences for the health of the victim. And this is not accidental, because it is the brain that bears a significant share of the responsibility for the future life of a person, his physical and psycho-emotional capabilities. And behavior after a stroke, which has a negative impact on both brain tissue and the general condition of the patient, is largely dependent on the health of the victim, his ability to recover quickly. Dementia, which often occurs or worsens with a stroke, occurs in about 65-85% of patients. At the same time, gender practically does not matter, and the age subject to the greatest negative impact is people over 50-65 years old.
Dementia after a stroke is a common manifestation of the recovery period after a stroke condition. At the same time, the rate of development of dementia is several times higher in comparison with the existing insufficient blood circulation in the brain tissues. This is due to serious damage to the circulatory system, which is diagnosed with a stroke. The greatest danger is a stroke that has affected tissues in areas responsible for the intellectual and mental activity of the brain.
Factors affecting the development of dementia in stroke
The onset of dementia is often associated with reaching a certain age, when there is a deterioration in the overall functioning of the human body, due to chronic and acute diseases accumulated with age, resistance to infections and diseases decreases. The weakening of the brain is accompanied by significant changes, which are characterized by a weakening of memory, a decrease in concentration, complications when performing certain physical actions.
However, there are a number of factors that are more capable of provoking manifestations of dementia. To the greatest extent, they affect a person in the period after a stroke, when the weakening of the body occurs to a greater extent. These provoking factors include:
- diabetes;
- advanced stages of atherosclerosis;
- hormonal imbalance;
- arterial hypertension;
- heart failure.
In addition to the listed provoking factors, there are a number of reasons that can also cause a weakening of the body and cause an accelerated course of dementia against the background of a stroke that has occurred. These are bad habits (alcohol abuse, smoking), which negatively affect primarily the circulatory and cardiac systems, as well as a low educational level, several recurring periods of cerebrovascular accidents.
Old age should also be attributed to the probable causes of dementia, however, against the background of such a serious lesion as a stroke, this pathological condition is aggravated. Senile dementia can manifest itself with various symptoms, which largely depend on the individual characteristics of the organism and the degree of neglect of the condition.
Main symptoms
Behavior after a stroke can vary from person to person. For some, only a change in physical and practical skills is characteristic, others note a weakening of mental functions. And in some cases, a combination of both manifestations is possible, when the physical capabilities of the patient are also violated, and there is a gradual extinction of the main psycho-emotional factors on which the quality of everyday life largely depends - both for the victim after a stroke and his immediate environment.
Symptoms that characterize physical disorders in the event of dementia include:
- change in gait - the patient feels the uncertainty of his movements, as a result of which the gait loses confidence, it may seem to stagger, the direction of movement changes sharply;
- deterioration in the process of controlling one half of the body (which is most common);
- urinary incontinence (about 30% of cases after a stroke with the development of dementia).
With psycho-emotional problems in the process of aggravating dementia, the manifestation of such lesions as mood lability is likely, a tendency to depressive states appears, and a pronounced deterioration in speech, writing, and reading is possible. There may be changes in the perception of the surrounding world, reality. Disturbances in thinking, assessment of occurring phenomena are all manifestations of the consequences of the development of dementia after a stroke.
There is a certain relationship between the manifestations of dementia that occurs after a stroke and the intellectual level of the patient's development to the state of the disease. With a high level of intellectual development, manifestations are detected to a somewhat lesser extent; with a low level of intellectual development, manifestations of senile dementia are observed to a greater extent.
Dependence of manifestations on the location of brain damage
The zone of brain damage largely determines both the degree of manifestation of the consequences in the form of dementia and the direction of the lesions:
- If the focus of the stroke is located in the cerebral cortex, then deviations such as spatial orientation disorders, speech and motor activity disorders are especially often detected. Loss of practical skills, gradual fading of self-awareness can also be diagnosed.
- With the localization of the site of the focus of stroke in the subcortical structures, the disturbances are more pronounced in the psycho-emotional state of the patient. This is expressed in frequent mood swings, the predominance of depressive states, the patient gradually loses normal facial expressions (this is expressed in violent laughter and crying), the possibility for the usual manifestation of emotions for a healthy person decreases.
In some cases, there is a combination of the first and second signs of damage, while the intensity of the progression of the pathological condition is largely determined by the presence of parallel ongoing physiological diseases.
Dementia, which is a special type of disease that occurs as a result of damage to a certain part of the brain, also requires a therapeutic effect. This allows you to eliminate the aggravation of pathological processes noted in the brain tissues, correct the behavior and actions of the patient, and also carry out treatment in order to restore normal behavior and daily activities.
Features of the therapeutic effect
Since the brain suffers to a greater extent after a stroke, the therapeutic effect should be aimed primarily at restoring the normal functioning of its tissues. In this case, various methods can be used that provide the most comprehensive approach to obtain the most pronounced positive result.
The most effective measures in the treatment of senile dementia after a stroke include the following measures:
- medicinal effect, which is expressed in the intake of nootropic drugs. They stimulate brain activity, provide improved nutrition of its tissues. With their help, the protective potential of the brain increases. These drugs include Piracetam and Nootropin;
- tranquilizers and antidepressants that stabilize the psychological state of the patient. However, their use should be carried out under the strict supervision of the attending physician and taking into account the receipt of a pronounced positive dynamics of the treatment process;
- vitamin complexes, which also help to quickly eliminate the consequences of brain disorders and stimulate the rapid recovery of lost brain functions;
- preparations to improve the blood supply to brain tissues are Tavegil, Cavinton;
- complex use of drugs to stabilize thought processes, improve memory - Memantine;
- conducting sessions of physiotherapy exercises and massage, which eliminate muscle stiffness, stimulate blood circulation processes, which allows you to gradually restore the normal physical state of the body;
- psychotherapy, providing psychological assistance to a patient who has had a stroke.
As a prevention of stroke recurrence and aggravation of the current manifestations of senile dementia (dementia), one should first of all eliminate bad habits, stabilize the patient's daily life, organize a healthy diet, give regular physical activity to his body, which should be normalized in accordance with his general condition.
Prognosis after stroke in the presence of dementia
The prognosis of survival after a stroke for patients who developed dementia is three times worse than for those patients who did not develop dementia after a stroke. However, with sufficient care, regular medical monitoring of the condition and taking the treatment regimen prescribed by the doctor, a more rapid recovery of a stable condition is possible.
There are two ways to describe them:
- Single time line.
- A "unique" timeline that reflects the recovery of individual stroke survivors.
Both approaches are useful.
Single timeline
A single time line is an average recovery process after a stroke. It gives a general idea of what stage of recovery the stroke survivor is in. If a person says, “I had a stroke seven months ago,” then doctors and therapists can make certain assumptions about what stage of recovery they are in. The unified timeline is also useful in research, in particular for determining the group of stroke survivors who are being treated. For example, a study might include “people 3-5 months after their stroke.”
The four stages of a stroke on a single timeline look like this:
- Hyperacute: 6 hours from the first symptoms.
- Acute: first 7 days.
- Subacute: after the first 7 days to 3 months.
- Chronic: after 3 months until the end of life.
"Unique" timeline
The "unique" timeline is based on studies using brain scans of people who have had a stroke. These scientific studies show that each stroke proceeds in its own way. Stroke survivors enter and exit phases of recovery at different times.
The choice of the best strategy depends in part on what stage of recovery the stroke survivor is in. Each strategy works at a certain stage.
Figuring out what phase a stroke survivor is in is often a matter of simple observation. The way the body moves makes it possible to understand what is going on in the brain. The survivor of a stroke and those around him can help determine the stage of recovery after an illness.
Hyperacute phase
In both forms of the timeline, the hyperacute stage is the same: from the first symptoms to 6 hours after the stroke.
As soon as the first symptom is discovered, the time has come! Some stroke survivors do not receive emergency care during the hyperacute period. This is unfortunate because this is the only period in which an aggressive clot-busting drug can be used. This drug, called TPA (tissue plasminogen activator), is a thrombolytic (“thrombo” - a blood clot, “litik” - destructive). (Caution: tPA is contraindicated in hemorrhagic strokes.) Stroke survivors who receive tPA generally recover better and faster. That is why it is vital to recognize a stroke and get emergency care. The sooner a stroke survivor can get to the hospital, the more likely they are to receive a tPA. Literally: time is the brain. Other medical interventions that can save the brain are also done during this phase. Providing emergency medical care is essential not only to save as much of the brain as possible, it is often of great importance to save the life of a stroke survivor.
What is the best recovery strategy during the hyperacute phase?
The most important thing a stroke survivor and their caregivers can do to help their recovery is seek emergency medical care as soon as possible. Call 911. Wasted time is wasted brain. During this period, no recovery occurs. If the patient is awake, health care providers may perform motion tests that will provide information about the extent of the damage caused by the stroke. However, at this stage, you should focus primarily on two tasks:
- Saving a patient's life.
- Saving as much of the brain as possible.
Acute phase
During the acute phase, two regions appear in the brain.
- killed by a stroke;
- all his neurons (nerve cells) are dead;
- has no chance of brain restructuring (neuroplasticity);
- forms a cavity in the brain that is filled with fluid.
Penumbra:
- much larger than the core;
- represents billions and billions of neurons;
- alive, but barely;
- eventually become a useful or useless region of the brain depending on what is done during rehabilitation.
A stroke causes the blood supply to the nucleus and penumbra to be cut off because the blood vessels are either clogged (in stroke with vascular blockage) or ruptured (in stroke with hemorrhage).
The interruption of the blood supply leads to the death of the nucleus. Penumbra remains alive, but barely. Because the main blood vessel is (at least temporarily) down, the penumbra uses the smaller blood vessels to continue life. The neurons in the penumbra receive enough blood to survive the acute phase, but not enough. Due to the reduced blood supply, the neurons in the penumbra are unable to do their job.
But for the billions of neurons in the penumbra, there is another problem.
Damage to any part of the body causes many body systems to come to the aid of the affected area. Think of the swelling caused by a twisted ankle or a bruised arm. The same thing happens with penumbra after a stroke. It receives calcium, catabolic enzymes, free radicals, nitric oxide and other chemicals. And this area is flooded with "metabolic soup" designed to promote recovery, which causes swelling. While this mixture of chemicals aids in recovery, it provides a meager environment for neurons to function.
Thus, the penumbra experiences two problems caused by a stroke:
- Insufficient blood supply.
- A mixture of chemicals that interfere with the functioning of neurons.
These two factors put a large area of the brain (the penumbra) inactive. The neurons in it are alive, but "stunned". The special term "cortical shock" is used to refer to this phenomenon. For many stroke survivors, this leads to paralysis. But paralysis during the acute phase will not necessarily be permanent. In some stroke survivors, penumbra neurons start working again. The restoration of the penumbra occurs at the next stage - in the subacute phase.
What is the recovery strategy during the acute phase?
Intensive care during the acute phase is a bad idea.
During the acute phase, the brain remains in a very painful state. Penumbra neurons are especially vulnerable. Let's look at animal studies that have been induced to have a stroke. For those who were forced to do too many tasks in a short period of time after a stroke, brain damage increased. In human studies, the results of intensive rehabilitation (heavy exercise soon after a stroke) have been mixed at best. Scientists continue to look for an answer to the question: “What loads will be excessive during the acute phase?” And until it is found, the rules are simple:
- follow the recommendations of doctors;
- listen to the advice of therapists and nurses;
- don't stress.
Intense effort during the acute phase will impair recovery. But this does not mean that there should be no therapy. For many patients, doctors prescribe bed rest for the first 2-3 days after a stroke. However, even at this time, treatment begins. Doctors often make passive (without any patient effort) movements to the stroke survivor, that is, move his limbs along their range of motion. These actions will help maintain muscle length and joint health.
Once bed rest has been lifted by the doctor, therapists will use their own clinical judgment to carefully and safely restore the stroke survivor's movement. During the acute phase, most of the therapy is done "at the patient's bed" (in the patient's room). Therapists begin a gentle restoration of movement. Physicians who work with patients in the acute phase often describe their approach to treatment in a simple phrase: "We do what the patient can do safely."
Before conducting therapy in the acute phase, doctors will check:
- the ability to reason and understand safety rules;
- ability to follow commands;
- orientation in time and space (eg, "Where are you? Who am I? What time of day, season," etc.?) (Many patients may feel offended by such simple questions; however, they are important in determining the degree safety of therapy.);
- memory;
- ability to solve problems;
- vision;
- the ability to actively move the limbs (active range of motion, or AMA);
- strength;
- fine motor coordination;
- Feel.
After the evaluation, the treatment starts with very simple movements and actions. For example, if it is safe, then doctors will help stroke survivors:
- reach for objects, touch or take them with your hand / brush from the affected side;
- sit on the edge of the bed;
- change position from sitting to standing;
- walk.
During the acute phase, listen carefully to the recommendations of therapists. Therapists, as well as doctors and nurses, will advise you on which recovery strategies to use. Caregivers can also be helpful, acting on the advice of a therapist when the stroke survivor is most active. The caregiver's job can include anything from talking to the stroke survivor to encouraging them to perform basic movements (such as unclenching and clenching their hand).
In addition, caregivers are important for recovery during the acute phase, as they often spend many hours a day with the stroke survivor and can inform doctors of changes in their ability to move. For example, a person after a stroke is not able to bend his elbow at all on Monday. Then - without any exercise - on Wednesday he can flex his elbow a few degrees. This phenomenon is known as spontaneous recovery and is extremely important to recognize for two reasons:
- This is a sign of the subacute phase (which is discussed next).
- This indicates when you can start really difficult and effective work.
If you are caring for a stroke survivor and you see spontaneous recovery, let your doctor know! The most V8.ZHN8.I phase of recovery (subacute) has begun!
Subacute phase
| Begins | Ends |
|---|---|
| The first penumbra neurons begin to function again | All neurons in the penumbra function |
For many stroke survivors, the subacute phase is a time of great hope. At this stage, there is a huge influx of neurons, which allows the stroke survivor to recover at a rapid pace. A significant portion of recovery is considered spontaneous recovery (significant recovery with little effort). The reason for this rapid spontaneous recovery is that neurons that have been "turned off" are "turned on" again. Some stroke survivors experience an almost complete recovery during the subacute phase. Other stroke survivors are not so lucky. They take longer to “turn on” the neurons again, as they have one problem with the penumbra.
Problem with penumbra
The brain obeys the rule "what you do not use, you lose." If the penumbra neurons are not made to work again, they stop doing so. This process (the loss of function by unused neurons) is known as the "forgot how to use" phenomenon.
But why not use penumbra neurons? Of course, the stroke survivor will be encouraged to move. And the movements that a stroke survivor performs will set the neurons in motion and will not allow the “forgotten to use” phenomenon to develop, right? For a minority of people after a stroke, this is exactly the case. These “lucky stroke survivors” quickly recover functional (applicable, practical) movements and never develop the “forgot how to use” phenomenon.
But many stroke survivors "learn" not to use neurons. Much of the reason for the phenomenon is that the managed care system imposes a "meet it, greet it, treat it and put it on the street" approach on therapists. Doctors are guided by "rule number 1": ensure their safety, functionality and send them out the door. Functionality is indeed the end goal. But for stroke survivors who have not yet regained function, there is only one way to “get out the door”: compensation (using only the healthy side of the limb). Involving the healthy side in all movements means that the neurons in the penumbra will not have the load necessary to put them to work. When penumbra neurons become usable, no one asks for anything from them - this is how the “forgot how to use” phenomenon develops.
What is the best recovery strategy during the subacute phase?
The subacute phase is the most important stage in the recovery process. Its degree is determined by the intensity and quality of efforts at this particular time. Successful completion of the subacute phase provides the highest level of recovery.
During the subacute phase, billions of stroke-surviving neurons gain the ability to return to work. The point at which each neuron becomes ready for action is the beginning of the chronic period (which we will discuss next).
Much of the recovery during the subacute phase is due to the “turning on” of neurons that have been “turned off”. This is the essence of spontaneous recovery: neurons that are not available for work at the subacute stage become capable of it. During this phase, many stroke survivors have the opportunity to "ride the wave of spontaneous recovery." Everyone wants to take credit for healing. The stroke survivor might say something like, "I'm recovering well because I'm really working hard at it," and the therapist will assume that the stroke survivor is recovering because of intensive care. But much of the recovery during the subacute phase is due to the fact that billions and billions of neurons become usable again. As the swelling subsides after a muscle injury, so does the swelling after a stroke, as a result of which the neurons are able to return to work.
chronic phase
At some point, all the neurons in the penumbra regain functionality, so the "wave" to ride disappears. This is a sign of the onset of the chronic phase.
When the subacute phase ends and the chronic phase begins, the stroke survivor has two types of neurons. Let's call them "working neurons" and "lazy neurons".
Working neurons
Some neurons feel quite normal and immediately return (during the subacute phase) to what they were doing before the stroke.
For example, neurons can return to...
- ...elbow flexion, then to...
- ...raising the leg while walking, then to...
- ... control over the movements of the mouth during speech, then to ...
- ...opening the hand...
- etc.
Working neurons take over their duties again. It is these neurons that, when activated during the subacute phase, provide spontaneous recovery.
"Lazy" neurons
These neurons are never asked to do anything after a stroke. As a result of a process known as the "forgot how to use" phenomenon, they are temporarily out of service. As is true for the rest of the brain, every neuron obeys the “what you don’t use, you lose” rule. "Lazy" neurons lose connections between themselves and other neurons, which are called "synaptic connections".
Usually, neurons use connections to communicate with other neurons. When this interaction occurs, they remain operational. If a neuron is not in contact with other neurons, connections are lost. This is the essence of the principle of the brain "what you do not use, you lose." Each of these non-working neurons loses dendrites - branches that provide connections between neurons. The word "branch" is aptly chosen here. In fact, there is a special term for shortening these branches - pruning (or pruning) - similar to pruning the branches of bushes or trees. Scientists use the expressions "dendritic pruning" or "dendritic pruning". This is exactly what happens to “lazy” neurons under the influence of the “forgot how to use” phenomenon. They lose touch.
The chronic period begins when all the neurons of the penumbra have become either working or “lazy”. At this point, the stroke survivor no longer spontaneously recovers. Doctors can recognize this stage of recovery - it's relatively easy to see. Stroke survivors never recover. Clinicians call this plateau. Due to the requirements of the managed care system (insurance companies), physicians are required to discharge (finish treatment) stroke survivors whose condition has reached a plateau. The idea is: “This patient is no longer getting better. Why should we pay for further treatment?”
For many stroke survivors, the plateau may not be permanent. Researchers have discovered two specific methods for coping with plateaus during the chronic phase.
- Inclusion in the work of "lazy" neurons.
- Connecting other brain neurons to perform functions lost during a stroke.
Inclusion in the work of "lazy" neurons
The reactivation of "lazy" neurons is known as "the elimination of the phenomenon of "forgot how to use"". The idea is to load "lazy" neurons so that they are forced to establish new connections with neighboring neurons (here the key word is "forced"). In fact, one way to force neurons to use unactivated connections is called "forced use". Forced use is a part of forced movement therapy in which the healthy limb is not allowed to perform any action. This encourages the diseased limb to perform difficult and uncomfortable work. But it is precisely this kind of work that forces the brain to rebuild itself. Changing the brain (also known as learning) is a difficult task, whether it's learning a foreign language or learning to play the violin. The key to learning, including transformation after a stroke, is task complexity. When we force "lazy" neurons to reach out to other neurons, this leads to the formation of new connections between them. Forcing "lazy" neurons to establish connections is one way to recover from a stroke during the chronic phase.
Connecting Other Brain Neurons to Perform Functions Lost During a Stroke
The brain is "plastic" and, like the plastic found in everything from auto parts to plastic bottles, it can physically change. In order for a plastic bottle to change shape, it must be heated. To change the brain, he needs an intense load. Here is an example of the manifestation of plasticity after a stroke.
Neurons from different parts of the brain are ready to perform tasks that they have never been asked to perform before. This is the capacity for plasticity, and stroke survivors may well use it in the chronic phase. Difficult tasks force other neurons in the brain to perform functions lost during a stroke.
What is the best recovery strategy during the chronic phase?
Below are the general rules for recovery during the chronic phase. Note that various strategies are described to help stroke survivors succeed during the chronic phase.
- Recovery requires independent efforts. Sooner or later there comes a moment after which there is no longer a therapist next to the person who has had a stroke. Therapists can help you periodically during the chronic phase (i.e. every 6 months, year, etc.). They look at what the stroke survivor is doing and give advice on how to rehabilitate. But in the chronic stage, there is no need for therapists. Once treatment is over, stroke survivors must take control of their own recovery. This stage of recovery is based on hard independent work. Patients who are willing to take charge of this process need the tools to start and follow the “upward spiral of recovery.” This is facilitated by the presence of a practical need for everything - from coordination of movements to endurance of the cardiovascular system. There are many recovery options during the chronic phase, from working on muscle strength to using mental training.
- Forget the plateau: it doesn't exist. The word "plateau" literally means "leveling off" and is used to describe the period when a stroke survivor stops recovering. Traditionally, the recovery curve was thought to have one plateau at the end of the subacute phase. Research in recent decades has shown that some stroke survivors can overcome plateaus. During the chronic phase, recovery consists of many plateaus that occur over a number of years.
- Stay fit. Everyone is getting old. As we age, staying fit is vital to everything from overall health to being able to continue doing what we love. But stroke survivors expend too much energy. After a stroke, basic activities of daily living (i.e. walking, dressing, etc.) require twice as much energy, and stroke survivors need even more as recovery takes effort.
- Do not allow soft tissues to contract. When tissue shortening occurs (i.e., muscle tension is noted), recovery of movement may be compromised and/or completely stopped. Even if you do a lot of hard work, but at the same time you do not have enough muscle length, you will not move further - it's simple. This is especially true of the tendency for soft tissue shortening in the elbow, wrist, and flexors of the fingers in the arm and hand. The main problem in the leg is the calf muscle. Muscle spasticity in the calf muscle keeps the foot tilted down. If she stays in that position long enough, the calf muscle will contract. But many other muscles are also at risk.
Recovery focused on phases
There are three ways in which recovery can take place.
Strength increases: You develop muscle strength and cardiovascular (heart and lung) endurance.
- Strength development should be encouraged during the subacute and chronic phases of a stroke.
- Strength development during the hyperacute and acute phases will impair recovery.
The penumbra is restored: during the subacute phase, the neurons of the penumbra restore their functions.
The brain is being rebuilt: during the chronic phase, brain plasticity allows another area of the brain to take over the lost function.