It is extremely difficult to carry out rehabilitation at home.
Republican Hospital of Medical Rehabilitation uses latest rehabilitation technologies, it is equipped by the most modern equipment: kinesitherapy devices, ergotherapy for restoration of the lost functions and fine motor skills, robotics for restoration of walking skills, early verticatization. You can use this possibility.
A right medical care for patients with stoke is a something you can do to restore the lost function after stroke.
Aspects of care: how to wash a patient, how to make the bed and other aspects
If a patient can’t move in bed it is necessary to do the following:
- To wash his face regularly, 2-3 times a day, to clean mouth cavity in the morning and after each meal, to wipe the body by wet wipes, towel, then to wipe dry (avoid scrubbing!).
- to use pressure reducing support surface, air-pillows. Sacral bone, heels, areas of hip joints are the most common areas of formation of skin macerations (it is recommended to examine these areas daily) and in case of skin flushed (the first sign of decubitus) don’t put a patient on the effected site.
- to turn over the patient in bed every 2-3 hours. In case of improvement of patient’s state it is necessary to encourage him to turn over by himself (support on healthy hand).
- to use adult diapers, perineal region requires a special care. Air baths with open diaper are useful for skin drying.
Feeding
In case of massive strokes patient’s swallowing can be disturbed. It is necessary to determine if a patient can swallow by himself, if he is able to hold his head up, if he is able to gulp; give him a spoon of water. If a patient swallows by himself, feed him 4-5 times a day by warm (not hot!) food in small portions in a half-sitting position; don’t get a patient to bed for at least 20 minutes after the meal.
The food should be cut into small pieces to make it easier to take it and get it to mouth. It is recommended to drink water through a straw or with a spoon, turning the head to one side and down (without putting a patient’s head back).
It is prohibited to eat starchy foods, sugar, salty food, fried food, spicy and fatty food. It is recommended to eat more vegetables (beetroot, carrot), because intestinal atony can develop. A patient should consume a higher amount of calories until the afternoon. In case of some disorders of swallowing it is better to feed with mashed food; in case of choking it is better to feed with thick fluids, such as puree, sometimes it is reasonable to use thickeners. In case of significant disorders of swallowing tube feeding is recommended (feeding in a half-sitting position).
It is necessary to monitor urination, in case of urinary retention it is necessary to ask for medical care.
It is also necessary to monitor intestinal discharge, it should be daily. It is recommended to use beetroot, prunes, kefir, a spoon of vegetable oil, diarrheogenic drugs as agreed by a doctor.
Measurement of blood pressure and pulse
In restoration of brain cell function either high blood pressure or low blood pressure is harmful, so regular measurement of blood pressure (several times a day) is recommended. It is important to support the level of blood pressure which was recommended by a doctor.
Physical activity
Muscle tone will be increasing gradually in paralyzed limbs. To prevent from contracture formation, it is necessary to put paralyzed limbs in a particular position for 1-2 hours: the hand must be taken aside under 90°, straightened in elbow, a roller is under patient’s arms, hand is released, fingers are spread wide apart. The hand must be bent under 10° in the knee with a roller under it, the foot must be pressed against the bed board under 80 degrees angle.
Regular breathing exercises help to prevent pneumonia, because due to hypokinesia and systemic disturbance stagnant changes in lungs are easily developing. It is possible to use blowing through rubber balloon, air blow through water.
Passive movements in joints of a paralyzed limb: in this case it is necessary to embrace paralyzed limb with one hand above he joint, another one — lower, do the movements smoothly, rhythmically, at a leisurely pace, trying to avoid pain, 2-4 movements for each joint for an hour.
Remember: inactivity weakens a patient; early activation is the way to a speedy recovery.
Early sitting, verticalisation. A patient after a stroke is recommended to sit down only after the physician’s permission; it depends on many parameters of the patient’s condition, but on average in case of a minor stroke, sitting is recommended from the 2nd day, verticalisation – from the 5-7th day.
It’s not right to think that the more a patient stays in a lying position after a stroke the safer it is for him. It is not so! Staying in a lying position for a long time leads to the formation of thrombus in veins of legs, thrombembolia of lung artery, hypostatic pneumonia, spastic contractures, intestinal atony.
Getting out of bed is better to carry out in two stages: at first it is necessary to help a patient to sit at the edge of the bed, and then to get on his feet.
With the improvement of the condition it is necessary to encourage a patient to carry out self-care skills on his own; explain him what is necessary to do.
Remember: Your objective is to help a patient to become independent without any assistance, to teach him everyday skills.
When a patient starts staying or walking, a hand should be placed in a special supportive bandage — a dressing cloth or orthesis, otherwise there is a dislocation of head of humerus under the weight of paretic extremities, subsequently this may lead to pains and degraded recovery of hand. Shoes are also should be comfortable for walking and resistant (not slippers, but sneakers).
Keep self-esteem of a patient, his tranquility, give him confidence and hope for recovery – this is the most important that you can do for your dearest person.
Work with a patient and help him in expanding his movement regime!