How to overcome spasticity of the arm using traditional methods. Spasticity of the arm after a stroke. Genetic defect in one of the contractile proteins

Relieving spasticity after a stroke turned out to be extremely difficult. The point is a contradiction that arises. We stubbornly restored strength and endurance. They did this with the help of special exercises with high loads and a lot of repetitions.

For the treatment of spasticity, this is a hindrance and harm. When relieving spasticity, you need a relaxing massage and light movements in the exercises. To continue recovery after a stroke, it is necessary to carry out mutually exclusive activities. But we came up with a simple solution. Make two groups of classes.

First: to restore strength and endurance. Second to treat spasticity, restore balance and coordination. The decision turned out to be very correct. True, we did not figure it out right away and for some time we did exercises to relieve spasticity along with exercises for strength and endurance. We noticed in time that active exercises made the spasticity worse.

What is spasticity?

Spasticity manifests itself in stiffness. It is impossible to make a fast or sudden movement. Constantly tense muscles block freedom. Feeling like you are a very rusty Terminator))).
Tension leads to rapid fatigue.

Recovery from a stroke can actually be blocked by spasticity. It is difficult to restore skills when the limbs seem to be tied with rubber bands and are always in a tense, unnatural position. To relieve spasticity after a stroke, we use basic exercises. The main thing is to do them easily, without stress.

Muscle spasticity is an involuntary contraction, cramp or spasm due to disruption of the conduction of nerve impulses after a spinal cord or brain injury.

Most often this condition manifests itself at night, but it can also significantly complicate life during the day.

Mechanism of spasticity formation

Experts call the main reason for the formation of seizures an imbalance of the inhibitory effect of the motor elements of the cerebral cortex on the cells in the structure spinal cord.

The natural result is the disinhibition of the tonic reflex - muscle spasticity is formed in the injured limbs of a person.

In a normal state, a person does not have to think about the order of the phenomena produced in the muscles: which of them first needs to be contracted, then relaxed - our brain has brought such activity to automatism.

After a stroke or injury, the death of cellular elements responsible for special inhibitory impulses in the motor neurons of the brain and spinal cord occurs. Reflex arc: limb – spinal cord – brain ceases to be unified system- there is a lack of coordination.

Spasms do not form immediately - for weeks, and even months. Leads to significant secondary changes in muscles and joints - enhances the negative impact of paresis on the motor system.

Degree of severity of limb spasticity

The first signs of the onset of muscle spasticity are observed on the very first day after the injury, and subsequently tend to intensify.

The degree of severity may change under the unfavorable influence of negative factors, for example:

when there is a change in emotional mood - a person has a tendency to depression;
when weather conditions change - fluctuations in temperature or light parameters;
with excessive physical overload caused by early physical activity the victim, contrary to the doctor’s recommendations.

When the intensity of the load on the muscle fibers in the limbs increases, their motor activity becomes difficult, and symptoms of pain in them of varying degrees of severity are observed.

Depending on the severity of spasticity, the following forms are distinguished:

Spasticity of the legs in a mild form is manifested by rapid fatigue of the muscles of the legs, a feeling of “muscle congestion”, from physical activity, walking becomes easier in heels, then it becomes difficult to pull your toes towards you and straighten it at the knee.

In severe form of spasm: one or two legs are fixed in a bent knee or hip joints, and the foot turns inward or outward. When walking without special shoes or shoes, deformities or contractures may occur.

Mild spasticity of the arms: extension is difficult
fingers and straightening the arm in elbow joint, a sign of a severe form is that the elbow and shoulder joints are bent, with the hand clenched into a fist.

If spasticity is present for a long time without treatment, contracture develops, that is, the joint is not fixed in a physiological state for the body.

In the future, the spasm will only have a negative impact on the implementation of recovery measures. In addition to the limbs, recovery will also worsen in the spine: increased muscle tone causes pain in the back - symptoms of vertebrogenic radiculitis.

Experts note: than before adequate treatment with modern drugs was started, and also, the less severe the spasticity, the better the prognosis for rehabilitation measures.

Even if the symptoms are significantly pronounced, and treatment of seizures for certain reasons began at a later time period - reduction in spasticity significantly improves general well-being.

How to treat spasticity using different methods

The most important requirement for treatment is that it be as painless as possible, since pain is greatly amplified by spasticity.

An important point is monitoring the activity of the pelvic organs - preventing inflammatory manifestations in them, as well as timely implementation of measures to prevent the occurrence of contractures and.

A complex of modern treatment to get rid of spasticity:

medicinal tactics (mydocalm, baclofen);
techniques;
orthotics;
surgical correction.

The treatment package is selected only individually, directly depending on the location of the lesion and the severity of spasticity. It is also necessary to take into account the technical capabilities of the medical institution.

Spasticity after a stroke or brain injury necessarily requires medication. Treatment should be carried out in stages - with a gradual increase in the therapeutic dose of medication, possibly replacing the drug.

Today, two subgroups are in demand:

Drugs with a central mechanism of action on the negative focus are reflex inhibition.
Peripheral drugs – significantly reduce the stretch reflex at the level of the spinal cord elements: muscle relaxants.

Like other subgroups of even the most modern drugs, the above have their own contraindications, so only a highly qualified neurologist should prescribe them.

Orthotics and plaster

Treatment of spasticity by long-term placement of a person’s limbs in a position where the muscles are optimally stretched and tonic reflex activity is reduced is called orthosis by specialists. It helps reduce hypertension in the extremities - pathological symptoms can be reduced many times over.

In case of severe spasticity, it is even recommended to apply a special plaster splint or splint to prevent the development of contracture. It is the splint that fixes the limb in the most acceptable position - in which the muscle fibers are located in a stretched position.

Orthosis treatment is carried out from one to two hours, directly depending on the person’s sensations - if pain increases, the procedure is completed.

Physiotherapy for muscle stiffness

local use of cold - helps to reduce excessive reflexes and maximize range of motion, improve muscle activity;
local use of heat is excellent for temporarily reducing tone. carried out using ozokerite or paraffin applications, the course is at least twenty procedures;
nerve endings is an excellent technique that allows you to achieve maximum response in the affected areas; the duration of the treatment course is prescribed by a specialist.

Exercise therapy development

Treatment with exercises aimed at optimal relaxation of muscle fibers is a long-proven rehabilitation method for treating spasticity that has proven itself to be excellent.

Dosed therapeutic stretching allows you to reduce their tone for a couple of hours, maximizing the range of movements in the affected limbs.

The kinesiotherapist knows that a decrease in tone will only be observed for a certain time and therefore it must be effectively used to carry out other complex exercises which were difficult due to spasticity.

Surgical intervention is determined by a specialist according to strictly individual indications, when conservative methods have already exhausted themselves, and no pronounced positive dynamics are observed.

Relieving spasticity is an important task. She greatly interferes with Everyday life, takes away strength and hinders movement. This makes it difficult to restore lost skills and stamina. To fully carry out recovery after a stroke, it is necessary to cure spasticity. We do this in parallel with other tasks.

At integrated approach and the beginning of therapeutic measures at the earliest possible stage, drug treatment - normalization of muscle tone helps to maximize the acceleration of the patient’s recovery.

Methods such as myostimulation, Botox, of course, therapeutic exercises, medications (mydocalm, baclofen) and gentle surgery have shown themselves to work well in treatment.

What is it, causes of spasticity, prevention and treatment updated: November 21, 2017 by: author

A sedentary lifestyle and excessive exercise lead to stroke. The person feels little activity in the arms, hands, legs, and fine motor skills fingers.

Why this happens: due to lack of physical movement, blood circulates worse, preventing the brain from receiving the necessary energy. In the second case, there is a large release of adrenaline into the blood, which accelerates the work of the heart, enhances, and then disrupts blood circulation in the brain.

Restorative set of exercises for hands

Restoring the original movements will take a long time. Due to illness, a person may not feel his paralyzed parts of the body, and sometimes deny the presence of motor disorders, which can be encountered with low mental activity.

When performing exercises, you must:

Before starting the workout, you need to stretch the fingers of your paralyzed hand for about 15–20 seconds.
Place the affected hand on the patient’s chest and ask him to lift each finger one by one. First, the exercise should be performed with the palm facing down, and only then with the arm straightened.
In exactly the same positions as in previous classes, turn your fingers clockwise and counterclockwise. It is difficult to perform such gymnastics on your own, so a person who has suffered a stroke needs help.

Squeeze the patient’s hand after a stroke into a fist and then completely straighten the palm and spread the fingers.
Close your left hands and right hand to the castle. In this position of the hands, alternately raise and lower your fingers.
Alternately performing finger snaps on the paralyzed limb.
To warm up fine motor skills, use a bubble massage ball.

To start moving the phalanges better, develop them using a children's toy cube - a Rubik's cube. This way the victim will quickly learn to properly control the grip force.

Initial rehabilitation period

To make it easier for the patient to restore movement of the joints of the hand, he needs support. The warm-up at first should be aimed at restoring large extensor and flexor muscles, and then warm up fine motor skills of the hands with the help of ergotherapy.

In the exercises, it is important that the joints take part, starting from the lightest, with a gradual transition to more difficult exercises. If the exercises are difficult, suggest closing your eyes and mentally imagining that the paralyzed hand and forearm are working like a healthy limb.

If fine motor development is slow, praise the patient even for very little progress during recovery.

You shouldn’t do all the difficult exercises for the patient, let him also try to help himself at least for relief healthy hand. It is worth considering that after a stroke, recovery of arm movements always takes longer; it will be much easier to rehabilitate a paralyzed leg.

If in-patient rehabilitation after a stroke takes place under the supervision of experienced specialists, then upon discharge the patient is monitored by close people. It will depend only on them whether the victim will be able to independently stand on his paralyzed leg or make movements with his hand or arm.

Rehabilitation is also important for returning normal speech, memory and thinking. Blood pressure and cholesterol play an important role in recovery.

The main problem will come from the presence of spasticity in the arm and leg, which can be solved with the help of activities aimed at the following:

Reduced spasticity.
Reducing feelings of paralysis.
Increasing the mobility of the arm and leg joints after a stroke.
Improved nutrition in tissues.

It is the spasticity that appears that prevents any motor activity. This occurs as a result of prolonged immobility after a stroke.

To normalize tone and reduce spasticity during recovery, the attending physician may advise the victim’s relatives the following:

Constantly change the position of the injured arm and leg.
Place a soft ottoman under the leg on the spastic side at the level of the joint.
At first, it is better to practice under the supervision of others.
Before starting exercises, perform a warm-up aimed at stretching paralyzed muscles.
Monitor the temperature in the room with particular care. Cold can cause increased sensations of spasticity.
Warm up your hands during the massage, then begin the procedure. The movements of the massage therapist's hands should be soft and of low intensity.

Speed of rehabilitation

To restore basic movements after a stroke, each patient needs to follow an individual program.

How long this will take will depend on the following factors:

During which stroke the leg or arm was paralyzed.
How severely the brain tissue was damaged.
Did the patient receive medical treatment himself or with someone’s help and how quickly did this happen?
What methods and medications were used during the rehabilitation period of the victim.
Did the patient take part in a conversation with a psychologist? How productive were the sessions with the speech therapist and relatives? Did this help improve your emotional state?

If the brain is not seriously damaged, recovery may take from 7 to 20 days. Under the worst circumstances, from six months to several years. One week or 2-3 months is enough to develop speech abilities. To restore fine motor movements of the fingers, the hand must be trained for at least 4 weeks. From one month to learn to lean on a paralyzed leg.

When the main rehabilitation process is completed, but the patient after a stroke does not perform some movements quite correctly, you can help if you involve him in simple home hobbies. For example, get interested in beadwork, playing chess, checkers or cross-stitching.

If you have a computer at home, let him practice typing on the keyboard. But especially important for restoring fine motor skills will be children's games such as construction sets with details: mosaics, pyramids or puzzles.

Try asking the victim to lift small objects from the floor. A positive effect can be achieved by asking to collect scattered small buttons, beads or small coins from the table.

You should not limit the victim from playing sports, just monitor the intensity of the exercises performed. Crafts made from colored paper or figurines will provide positive effect to restore mobility of small joints of the hand. Useful sport considered for stroke patients nordic walking, light morning running no obstacles, bike ride.

Spasticity. Part 1.

Previously this word was unfamiliar to me. Spasticity resembles stiffness in very, very cold hands, when you want to move your fingers, but you can’t. Plus, it also brings them together and distorts them.

When my recovery from the stroke began, this condition was virtually throughout my entire body. Especially strong on the left side. I was almost completely paralyzed, but not big movements it still worked out. They turned out as if they were in condensed milk. Tight, clumsy and very slow. There was constant tension in my hands and fingers. It did not go away for a minute, even in a calm state, and did not allow normal movements. The hands involuntarily took an unnatural position. The left one was retracted away from the body. The right one bent at the elbow and pulled up to the chest. I was very tired physically and mentally because I couldn’t relax. Only in a lying position it was easier. But as soon as I sat down, the muscles of the body and limbs tensed like crazy. From excessive tension I quickly got tired again. It was possible to sit for one or two minutes and the strength ran out.

Spasticity did not make it possible to make subtle and precise movements. For example, if they handed me a cup of water, I couldn’t take it. If he didn’t “hit” it, he missed. When they put the cup in my hand, I could not hold it and wrap my fingers around it. They didn't shrink. At the same time, the tension in my hand was unreal. All this rigmarole was wildly exhausting. Relieving spasticity in all limbs at once is not a realistic task. It's too big. And we, as always, broke the difficult task into simple fragments that became feasible. We decided to divide the treatment of spasticity into pieces:

It has become easier. During the training, I noticed that the decrease in spasticity in my left hand was accompanied by little relief in my right hand and legs. The connection is not significant, but noticeable. We did exercises and massages evenly for both left and right limbs. Although the spasticity was much stronger on the left side of the body. Over time, everything became equal. This approach turned out to be correct.

It was possible to relieve spasticity with a combination of gymnastics and massages.

Start with minimal movements.

Do not exert heavy loads during exercise.

Do the minimum number of repetitions.

Do not do active and strong massage. Light touches only.

Do not add or increase muscle tone.

Learn to relax your muscles and relieve tension in them.

Do not do gymnastics to relieve spasticity when you are tired.

Exercise only in the morning.

While recovering from a stroke, I got used to the fact that there are no simple tasks. But removing spasticity turned out to be extremely difficult work. The point is the contradiction of the tasks being performed. After the stroke, I needed to restore muscle strength throughout my body. That is, to work hard and hard. But at the same time, spasticity must be treated. And for this, loads and endurance training are a hindrance. It turns out that the first excludes the second. We solved this puzzle by alternating classes. One day: massage + gymnastics to relieve spasticity + exercises to restore balance and coordination. This does not require much strength, the load is not great. The next day: strength + endurance exercises. And so on in turn.

IN this moment The spasticity was removed. There are some leftovers, but they don't interfere. Freedom and lightness returned to my movements. The tension is gone. Muscle pain and fatigue are gone. I began to spend less energy on movements. This allowed us to gradually increase the load on morning exercises.

What would recovery after a stroke do? good results, you have to follow this regime. Gradually I am gaining strength and increasing my endurance. Now I can conduct classes in one day. I do exercises in the morning with strength exercises. In the afternoon, gymnastics and massages to relieve spasticity + exercises for balance and coordination. Half a day between classes is enough for rest.

Treatment of spasticity after stroke

Stroke is one of the most current problems modern medicine. High percentage of mortality and loss of performance, tendency to form

persistent residual effects, frequent damage to patients of working age are the main points that explain the need to develop effective preventive and treatment measures.

Movement disorders are the most common consequence observed in patients after a stroke. The greatest chances of recovery are observed during the first months. It is during this period that many patients after a stroke develop muscle hypertonicity, which significantly complicates rehabilitation.

Development mechanism

To better understand the mechanism of development of muscle hypertonicity, let's consider the main aspects of movement regulation.

The earlier classes to prevent spasticity begin, the better the result.

Fine muscle contractions regulated at three levels:

spinal cord;
stem nuclei of the brain;
cortex.

Any of these sections can stimulate muscle contraction. Thanks to the close cooperation of these departments, a person can perform the necessary movements, and muscle tone remains normal.

Impulses from motor neurons in the spinal cord provide automatic movements, such as sudden flexion when exposed to a painful stimulus. The overlying sections have a regulatory effect on the motor cells of the spinal cord, and it can be both inhibitory and stimulating.

The brainstem nuclei are responsible for maintaining posture and balance. The vestibular nucleus increases the tone of the muscles that extend the limbs. The red core, on the contrary, bends the limbs. In this case, spinal motor neurons of opposite muscle groups are inhibited. This relationship is called reciprocal.

The cerebral cortex regulates voluntary human movements. To date, scientists have compiled detailed maps of the localization of areas that are responsible for the movement of individual parts of the body.

The motor cortex of the brain has an inhibitory effect on spinal motor neurons, which ensures holistic movements rather than individual muscle twitches. In a patient after a stroke, damaged areas of the cerebral cortex lose their inhibitory effect on underlying structures. Externally, this is manifested by the development of muscle hypertonicity.

Treatment

Increased skeletal muscle tone often becomes a serious obstacle to the recovery of patients after a stroke.

It should be borne in mind that the optimal result can only be obtained with a combination of drug and non-drug treatment methods.

Non-drug treatment of hypertension includes:

correct positioning of the patient;
massotherapy;
gymnastics;
physiotherapeutic procedures.

An integrated approach will help overcome spasticity and restore motor functions of the limbs

Among the medications, muscle relaxants and botulinum toxin are actively used.

Patient position

One of the main points in the treatment of muscle hypertonicity in patients after a stroke is giving the paretic limb a physiological position.

An effective way to combat spasticity

The affected hand should be placed on a chair next to the patient's bed. Due to increased muscle tone, it will be drawn towards the body. To prevent this phenomenon, in armpit lay a cushion of soft fabric.

The arm is extended at the elbow joint and turned palm up. Sandbags or other devices are used to hold the limb in this position. It is advisable to bandage the fingers and hand to a splint.

The leg should be slightly bent at the knee, and the foot should be at right angles to the shin.

The duration of positioning treatment is about 2 hours. It can be repeated several times during the day. As soon as the attending physician allows, the patient is helped to sit down and taught to walk.

Massage

Massage relieves increased muscle tone well. It must be carried out from the first days of the disease. From massage techniques, you need to choose stroking and light rubbing. They help reduce muscle tone, improve blood circulation and lymph flow in the paretic limb. The duration of the first sessions should not exceed 10 minutes. Over time, it is increased to 20 minutes. The duration of the course depends on the individual characteristics of the patient and is determined by the attending physician. As a rule, after 20–30 sessions a break of 10–15 days is required. After this, the course is repeated. The decision to discontinue massage treatment depends on the results achieved.

Physiotherapy

The complex of therapeutic exercises consists of active and passive movements. Passive movements consist of flexion and extension of muscles, which is carried out by caring staff. If possible, the patient makes passive movements using a healthy limb. Due to increased tone, movements may initially be intermittent and abrupt. Over time, the tone decreases and they become smoother.

Exercise is very important for developing muscles and joints

As soon as a patient after a stroke can perform active movements, he should engage in therapeutic exercises on one's own. In addition to flexion and extension exercises, exercises aimed at stretching muscles are added. At correct execution they relieve hypertension well and help the patient recover faster.

If the patient has increased muscle tone after a stroke, exercises with expanders, elastic bands, and the like are strictly not recommended - they only intensify spastic phenomena and worsen the situation.

Muscle relaxants

Among the medications used to treat hypertension in patients after a stroke, centrally acting muscle relaxants are used, which effectively relieve muscle tone without affecting their strength. The mechanism of their action is to inhibit pathological impulses that come from spinal motor neurons.

Treatment with muscle relaxants begins with minimal doses. If necessary, they are increased to achieve effect. Expected effects:

decreased muscle tone;
improvement of motor functions;
pain relief;
prevention of contracture development;
increasing the effectiveness of therapeutic exercises;
facilitating patient care.

In our country, the most common muscle relaxants are baclofen, tizanidine, or sirdalud, tolperisone, or mydocalm, diazepam.

Doctors also prescribe muscle relaxants to restore and relax muscles.

The disadvantage of treatment with muscle relaxants is the possibility of developing side effects, of which the most common are:

drowsiness;
dizziness;
nausea;
constipation;
decrease in blood pressure.

Treatment with botulinum toxin

The use of botulinum toxin for the treatment of hypertonicity is indicated for post-stroke patients with local spasticity.

Main indications for the use of botulinum toxin:

absence of contractures;
severe pain syndrome;
impaired motor function associated with increased muscle tone.

The mechanism of action is to block impulse transmission from nerve cell on muscle fiber. The clinical effect develops a few days after the injection and lasts for 2–6 months, depending on the individual characteristics of the patient. Due to the production of antibodies, repeated injections do not eliminate hypertension as effectively.

This method is not widely used in the fight against hypertension in patients after a stroke. This is primarily due to the high cost of the drug.

Finally

Treatment of increased muscle tone in patients after a stroke is one of the key points, which will not only significantly improve the patient’s condition, but also make it easier to care for him.

Therapeutic exercise and massage are the main treatment areas, while monotherapy with muscle relaxants will not bring the expected result.

Medicines only enhance the effect of gymnastic procedures. Relatives or guardians caring for the patient need to remember this.

Post-stroke spasticity

Until now, we have hardly discussed movement disorders in our loved ones, since there is no direct connection with cognitive disorders, and we did not want to dilute the main theme of our site. However, recent discussion of the problems that develop after a stroke - and in Russia stroke remains a very common cause of dementia - has shown that this topic is important.
I was asked to talk about it without much fuss, in simple words. I promised to try.

I read in a serious scientific journal that after a stroke, movement disorders manifest themselves in one way or another in more than 80% of patients. Due to the death of cells that previously regulated muscle function, they weaken (paresis) or turn off completely (paralysis). Disorders of body position and coordination of movements are also possible. This is fraught with falls and, at best, a developing fear of walking independently, and at worst, a fracture. The “head problems” that appear along with this only increase the risks.

Fortunately, even in old age, the plasticity of the brain allows it to restructure itself and gradually restore lost motor functions. And here the task of doctors (and, after overcoming an acute disorder, of those around them) is to create the necessary conditions for speedy rehabilitation: the main method is physical therapy in combination with physical and occupational therapy.

However, in approximately every third case, in the post-stroke period, so-called spasticity begins to develop - increased tone in the muscle, preventing it from stretching and forcibly returning the limb to a certain position, which limits overall mobility. The spasm is quite difficult to respond to physiotherapy and interferes with normal recovery. As it turned out, visitors to our site also encountered this phenomenon.

Due to constant tone, which does not decrease even at rest, changes begin to occur in muscles, tendons and joints (fibrosis, atrophy), painful deformations (contractures) and pathological postures develop, which aggravate the problem and seriously complicate the patient’s life.

Spasticity does not develop immediately, usually several months after a stroke. However, a specialist may notice the first signals after 2–3 weeks. Initially, flabby muscles come into tone, which increases and becomes more pronounced in response to external stimuli (for example, an attempt to bend or straighten a limb). After six months, maximum a year, spasticity turns into a problem that significantly affects the patient’s quality of life. It's getting painful.

In the upper body, the shoulder, elbow, wrist and fingers are often affected. In the lower body, spasticity may affect the hip, knee, ankle, or toes. The flexor muscles in the arm area are usually affected, and the extensors in the leg.
Look at the pictures from our newspaper “Memini”.

You've probably seen something similar in patients with cerebral palsy.
Needless to say, this problem has a negative impact on a person’s ability to dress independently, eat (he is simply unable to hold a spoon), write with a pen, hygiene suffers, etc.
If spasticity is not treated, then after 3-4 years contractures - joint deformities - form. Bones also become deformed. Forced painful postures arise.

I won’t write about who is to blame. I immediately turn to the question “What to do?”

The answer is simple: treat.

Treatments for spasticity may include:
prescription of medications (central and local action),
physiotherapy,
occupational therapy.
(In rare cases, surgery may be considered.)
The basis of therapy is the effect on the muscle, allowing it to decrease its tone. Below we will consider in more detail the role of each of these methods.

PRESCRIPTION OF MEDICINES

Oral (taken by mouth) medications most commonly used to reduce spasticity include:

centrally acting muscle relaxants– baclofen, tizanidine, etc.

anticonvulsants– clonazepam, diazepam.

Both groups of drugs help reduce muscle contraction and improve range of motion. Taking them relieves painful muscle spasms, enhances the effect of physical therapy and, as a result, prevents the development of contractures. Unfortunately, the peculiarity of these drugs is that they act not only on spastic muscles, but on the entire body as a whole. To treat spasticity, these drugs are prescribed in large dosages, which leads to side effects such as general weakness, dizziness, changes in mood and lethargy. This is especially unpleasant if the patient, after a stroke, begins to develop cognitive impairment without it.

For this reason, more and more specialists are inclined to replace the above-mentioned medications with injections of botulinum toxin type A. In terms of the strength of its effect on the muscle, botulinum toxin is significantly superior to all existing medications taken in tablet form and is comparable to surgical intervention. At the same time, muscle denervation using a toxin is an extremely simple and safe procedure that can be performed by a doctor who has undergone appropriate training. Botulinum toxin preparations are well tolerated, and the likelihood of drug-drug interactions when used is minimal. The American Academy of Neurology recommendation specifically states the need to offer botulinum neurotoxin to patients as a method of reducing muscle tone and improving passive function in adult patients with spasticity.

In our country, three botulinum toxin preparations are widely used to treat spasticity: Botox (USA), Dysport (England), Xeomin (Germany). The latter is positioned by the manufacturer as a new generation drug, free from complexing proteins. In addition, the Chinese drug Lantox is registered in Russia, but, as far as I know, it is used mainly in cosmetology.

Physical therapy has traditionally played an important role in the treatment of spasticity. The main components of the method include rehabilitation exercises, massage, acupuncture, thermal and electrical effects on spastic muscles, and the use of orthopedic devices.

Standard rehabilitation involves daily stretching to help restore strength to affected muscles, maintain joint range of motion, and prevent the development of contractures. Regular stretching can ease muscle contraction and reduce stiffness for a period of several hours.

Massage plays an important role in the process of restoring motor functions and preventing pathological conditions. It relieves pain, helps restore muscle performance, and improves their blood supply. However, you can only trust a specialist to perform a massage, since spastic and hypotonic muscles require different influences.

In Russia, acupuncture is often used in complex therapy, but controlled studies conducted abroad do not show significant effectiveness of this treatment method.

Electrical stimulation is widely used to restore balance between the tone of flexor and extensor muscles. The effect usually lasts about 10 minutes when stimulation is first applied, but after several months of similar treatments, the effect may be longer lasting. Alternatively, a spastic muscle can also be stimulated directly to fatigue it.

In the treatment of spasticity, limb fixing bandages, bandages, tourniquets, splints, and orthoses can be used. They allow you to support and straighten a spastic limb, as well as correct its deformity and improve function. Today, medical engineering has developed many orthopedic devices that provide not only immobilization and fixation in correct position, but also deep pressure and maintaining heat in the tissues. Modern devices include a setting mechanism that controls the required function: from fixation with a lock to providing the necessary movements with outside help.

OCCUPATIONAL THERAPY OR OCCUPATIONAL THERAPY

Occupational therapy is practical activities specially selected by a doctor that allow the patient to restore self-care skills after a stroke. This can be considered a special version of physical therapy, in which the exercise performed has a practical meaning: fastening a button, using cutlery... With the help of occupational therapy - by regularly repeating the same movements - patients restore lost skills of daily life, whenever possible. Otherwise, when it is not possible to restore some important actions, occupational therapy allows you to choose devices that compensate for the loss of a useful skill, or to form new motor patterns, alternative to those used before the disease.

In other words, functional therapy aims to preserve all functions of the limb by restoring old motor patterns and/or creating new dynamic patterns based on a new muscle arrangement that allows normal movement. An important role here is played not only by the diligence of the patient, but also by the help of the person caring for him.

The two main categories of surgical interventions used for spasticity are performed at the level of the nervous system (neurosurgery) or bones, tendons and muscles (orthopedic surgery). The most significant indication for surgical treatment is the development of contracture. In this case, orthopedic surgery is often the only treatment for spasticity. With the help of surgery, muscles can be denervated, tendons and muscles can be released from contractures, lengthened or repositioned, thereby reducing spasticity. Muscles can be denervated by cutting off specific nerves where they exit the spinal cord (dorsal rhizotomy). This surgery is used primarily to treat severe spasticity in the leg muscles that interferes with the patient's mobility.

To briefly summarize, the ideal option is to relax with botulinum toxin (lasts about 3-4 months) and develop. That's just the prices.

Although I read two studies. In one, the authors argued that if you count the costs that can be avoided thanks to botulinum therapy (nurses, aids), then overall it turns out to be even beneficial. In another scientific language it is said approximately the following: it is better to spend money and get results than to take pills in large doses (in our country, by the way, they are also not free), without much success.
True, both studies were conducted abroad.

Hand spasticity after stroke

Mom has a stroke. Treatment and rehabilitation after stroke.

2556. Ilya | 30.11.2013, 18:40:34

Listen, please, everyone!

I myself am an instructor in restoring movements using wave techniques, and the author of the insult5.ru project.

2557. Ilya | 30.11.2013, 18:40:50

In addition, the muscles on the affected side are weak, atrophied, and it is basically impossible to strengthen them with pills, injections, or massagers.

We have a technique, a training video, and results for a 68-year-old man, after a terrible hemorrhagic stroke and paralysis, after 5 months. classes, the abs pump, and he walks with light support.

Our other student (54 years old, with craniotomy, movement coordination disorder, barely able to move, with severe spasticity of the arm and paralysis of the leg) after 3 weeks of classes began to stand up on his own without support and stand upright (classes continue)

Another client (72 years old, ischemic stroke 3 years ago, lack of any rehabilitation, contracture + paralysis of the left arm) during the 2nd lesson was able to move it to a bend, 10 cm, and lift it by 5 cm.

So, dear forum users! From my own experience, I want to say (I can no longer remain silent, reading some comments) MOVEMENT DISORDER IS TREATED MAINLY BY CORRECTLY ORGANIZED, GENTLE MOVEMENT, A COMBINATION OF DYNAMIC AND WAVE LOAD. (And the fact that they grumble and sometimes irritate them with their behavior - they are like children, they don’t need pity, and not punishment in the form of: “Oh, you are so! I won’t come!” THEY ONLY NEED HELP IN RESTORING MOTOR SKILLS, THE REST THEY WILL DO IT THEMSELVES: go to the toilet, shave, eat, etc.

I don't want to be unfounded. And I suggest that those who really need help here, and not “just complain,” take a course to restore movements at home. Go here: insult5.ru. I myself will guide you, advise you, and send you the necessary exercises. And you will post here on the forum about the results. This will help you and give hope to many other people. I can help those in Moscow personally.

Articles

Exercises to restore movement in the hand

There are many literary sources and publications that describe exercises aimed at restoring hand function. However, the bulk of the recommendations are suitable for people whose motor functions have not been completely lost.

We will try to describe recovery process. starting with a complete lack of movement in the affected arm.

Hand exercises need to start right away after paralysis. At the first stage, the main tasks of rehabilitation upper limb are:

1. Prevention of joint stiffness in the affected limb by performing passive movements in all joints of the paralyzed arm. Passive movements should be performed repeatedly throughout the day.

2. Slowing down the process of muscle atrophy: if there are no contraindications, then massage and electrical myostimulation are performed.

3. Prevention of injuries and sprains of the joint capsule of the shoulder joint: when the patient takes a vertical position, the sore arm should be placed in a shoulder scarf and fixed to the body.

1. Flexion - extension of the arm at the elbow.

2. The arm is bent at the elbow, straightening the arm upward.

3. The arm is bent at the elbow, the shoulder is moved to the side, the arm is straightened upward.

6. Flexion - extension in the wrist joint.

7. Squeezing - unclenching fingers.

8. Adduction - abduction and opposition of the thumb.

All exercises are performed passively (with outside help). The number of repetitions in each exercise is at least 50 times.

As active movements appear in the paralyzed arm, they begin to add to the set of exercises active-passive exercises. which are performed with outside help or with the help of a healthy limb.

When active movements occur in the affected limb, special attention should be paid correctness of the restored movements.

As a rule, people, not knowing the intricacies of the recovery process, are happy about any movements that appear and begin to actively develop them - this is main mistake. because in most cases, the first movements that appear are incorrect. Consolidation of incorrect movements leads to the appearance of spasticity and the formation of spastic contractures and stiffness of the joints.

Examples of active-passive exercises in a supine position:

1. Bend your arms at the elbows.

2. Arms bent at the elbows in front of the chest, straightening the arms upward.

3. Raising straight arms up.

Exercises can be performed by keeping your fingers in the “lock” position or fixing the affected limb (with an elastic bandage) to a gymnastic stick.

As the patient recovers, exercises begin to be performed from a sitting and standing position, which allows for more amplitude movements.

Restoring hand and finger movements

The most labor-intensive process is restoration of fine motor skills.

Many patients who have suffered a stroke, traumatic brain injury, or brain surgery develop spastic flexion contractures of the hand and fingers. Before you begin to restore movement, you must remove pathological tone and develop contractures. Spasticity is relieved with the help of muscle relaxants, massage and physiotherapeutic procedures.

Development of contractures- the process is painful and traumatic: not every person is ready to endure significant pain. When the patient experiences pain, the tone in the affected arm increases, which is why pain occurs when the joints develop.

This vicious circle can be overcome by correctly calculated scheme of rehabilitation measures. which includes:

Deep warming of spastic muscle groups and developed joints;

Electromyostimulation of antagonist muscles;

Passive development of movements in joints;

Staged fixation of the limb in extreme positions using individual splints.

Let's take a closer look at these procedures.

1. Massage can be performed with the addition of warming ointments. The main purpose of massage is to stimulate blood flow to the massaged area, to warm up and give elasticity to the ligaments that are planned to be developed.

2. Deep heating carried out using physiotherapeutic paraffin and ozokerite applications. Prolonged exposure to heat reduces spasticity and promotes muscle relaxation. Working out the joint after warming up is less painful.

3. Electromyostimulation of antagonist muscles- this is the stimulation of muscle groups opposite to the muscles in spasticity. Thus, a balance is gradually formed between these muscle groups.

4. Passive development of the joint- gradual stretching of the spasmed muscle, as well as contracted ligaments. With the help of repeatedly repeated passive movements, with a gradually increasing amplitude, the range of movements in the joint increases, the muscles and ligaments become more elastic.

5. After the development of the joint is completed, the hand and fingers must fix in extension position. to the maximum angle. Fixation can be achieved using orthoses for the wrist joint. as well as splints made from plaster or polymer bandage.

As the range of motion of the limb being developed increases, the splints must be changed.

This scheme for the development of spastic contractures allows quickly achieve stable results. while causing minimal pain to the patient.

Restoring hand and finger movements begins with active-passive exercises. After movements of all fingers and movements in the wrist joint have been restored, proceed to restoration of fine motor skills and individual finger movements: for example, learning to pick up and carry objects. The smaller the object, the more difficult it is to grasp and hold.

An approximate set of exercises aimed at restoration of basic movements in the elbow, hand and fingers(exercises are performed while sitting at a table):

1. Flexion - extension of the arm at the elbow along the table surface.

2. Bend the arm at the elbow towards the shoulder, without lifting the elbow from the table.

3. Sliding your hand back and forth across the table.

4. Circular movements of the hand along the surface of the table.

5. Turn the hand palm up.

6. The brush hangs from the table, lifting the brush.

7. Squeezing - unclenching the fingers, palm on the table surface.

8. Clenching and unclenching your fingers, palm up.

For quotation: Shirokov E.A. Stroke and muscle hypertonicity// RMJ. 2011. No. 15. P. 963

Acute cerebrovascular accidents (ACI) constitute one of the most pressing problems of modern medicine. The number of patients who have suffered a stroke in the Russian Federation is increasing and currently exceeds 1 million people. The most significant consequences of cerebrovascular accidents are associated with movement disorders. Paresis and paralysis, impaired coordination of movements require comprehensive rehabilitation measures aimed at restoring self-care skills and social adaptation. Restoration of lost motor functions occurs quite actively during the first months after a brain stroke, then the rate of recovery decreases. As a rule, the first weeks of the recovery period are characterized by a noticeable decrease in the degree of paresis, an increase in strength and range of movements. However, during this period, many patients experience another problem - muscle tone disorders. Spasticity (C) increases, which significantly limits the results of rehabilitation and often becomes an obstacle to the restoration of motor activity. The tone increases in different muscles to varying degrees. This leads to the fact that the hand acquires a stable position with flexion at the elbow joint and wrist joint. The leg with central paralysis, an important sign of which is hypertonicity, on the contrary, most often turns out to be straightened. Spasticity leads not only to the formation of stable pathological postures, but also contributes to pathological changes in the joints. As a rule, patients suffer from arthrosis and ankylosis, joint pain no less than from paresis.

The development of C in cases of damage to the structures of the central nervous system is associated with a decrease in inhibitory effects on spinal motor neurons. The decrease in inhibitory effects on spinal structures is explained by combined damage to the pyramidal and extrapyramidal tracts of the brain, while an important role in the development of spasticity is attributed to damage to the cortico-reticulospinal tract. In conditions of weakening of corticospinal stimuli, dysfunction of the extrapyramidal system can usually be observed. One of the leading mechanisms of C formation should be considered the disinhibition of the tonic stretch reflex. Secondary changes in the muscles, tendons and joints that occur with muscle hypertension increase movement disorders; therefore, resistance to passive movement depends not only on disturbances in muscle tone, but also on muscle changes, in which signs of atrophy can often be found. An isolated lesion of the pyramidal tract, as a rule, does not cause hypertonicity, but only leads to paresis. However, with stroke, damage usually occurs not only to the pyramidal tract, but also to other structures, such as the cortico-reticular-spinal tract, which leads to inevitable disturbances in muscle tone. If post-stroke paresis persists for a long time (several months or more), then structural changes in the segmental apparatus of the spinal cord may occur (shortening of the dendrites of motor neurons and collateral sprouting of afferent fibers that are part of the dorsal roots), which contribute to a sustainable restructuring of the motor stereotype. This is facilitated by secondary changes in the muscles, tendons and joints, which increase the resistance that occurs in the muscle when it is stretched. Knowledge about the pathogenesis of tonic disorders arising in connection with stroke is necessary to understand the mechanisms of action of drugs, most of which have a so-called central mechanism of action.
It is possible to detect the first signs of increasing muscular-tonic disorders already in the first hours after a stroke. They are often characterized by a decrease in muscle tone. However, after a few days, spasticity becomes noticeable and increases along with the restoration of movements. The functional state of the muscles and muscle tone are assessed during a standard neurological examination of the patient, during the observation of active movements, and during passive changes in the position in space of body parts. Spasticity is characterized by increased muscle tone, which prevents the expansion of range of motion. Each time when performing the simplest movements, the patient has to overcome the resistance of tense muscles, which aggravates the picture of paresis or paralysis. Characteristic clinical sign C is its change during the study - the tone increases with passive stretching of the muscle, and the increase in muscle resistance directly depends on the speed of passive movement. A common sign that reveals dystonia is uneven muscle tone during flexion and extension of the limb - the “jackknife” phenomenon. The degree of muscle tone disorders can vary significantly during the day, under the influence of external and internal factors (weather, emotional state of the patient, ambient temperature). Patients who have suffered a stroke are characterized by changes in tone depending on the position of the limb, physical activity, its character and intensity. Hypertonicity can delay recovery after a stroke, since with severe muscular dystonia, the patient’s daily activity is limited to the confines of the bed: with any attempts to move to a vertical position, persistent muscle tension prevents movement and forces the patient to return to a horizontal position. Other complications of the post-stroke period also arise - limited mobility in the joints, arthrosis-arthritis and associated pain syndromes. Muscular dystonia has a significant impact on the statics of the spine, which in some cases becomes an independent problem (lumbodynia, thoracalgia, vertebrogenic radiculopathies). One of the most important questions that must be addressed when managing a patient with post-stroke spasticity comes down to the following: does high muscle tone worsen the patient’s functional capabilities? In general, limb functionality in patients with post-stroke limb paresis is worse in the presence of severe spasticity than in mild spasticity. However, in some patients with a severe degree of paresis, spasticity in the leg muscles can make standing and walking easier, and its decrease can lead to deterioration in motor function and even falls. Before you begin to correct hypertonicity, it is necessary to determine treatment options in this particular case (improving motor functions, reducing painful spasms, facilitating patient care, etc.) and discuss them with the patient and (or) his relatives. Treatment options are largely determined by the time since the disease and the degree of paresis, the presence of cognitive disorders. The shorter the time since the stroke that caused spastic paresis, the more likely it is to improve. With a long duration of the disease, a significant improvement in motor functions is less likely, however, it is possible to significantly facilitate patient care and relieve the discomfort caused by S. The lower the degree of paresis in the limb, the more likely it is that treatment will improve motor functions. For clinical assessment of muscle tone and monitoring the effectiveness of treatment, the modified Ashworth scale is used for practical purposes (Table 1).
The principles of spasticity correction in the post-stroke period are based on the following principles:
- pathologically increased muscle tone should be reduced in all cases to prevent irreversible changes in muscles and joints and speed up the rehabilitation process;
- treatment should be started as early as possible, when the first signs of C appear;
- the duration of treatment is determined by the restoration of the patient’s motor activity.
Drug therapy for muscle dystonia in patients who have suffered a stroke is based on the use of muscle relaxants. Before prescribing muscle relaxants, it is necessary to establish how much increased muscle tone makes movement difficult. In some cases (especially in the early recovery period), hypertonicity helps the patient maintain support on the paretic limb - then the prescription of muscle relaxants can be delayed. However, this feature usually requires attention for a short period of time - during the patient's first attempts to restore walking skills. In the future, a decrease in muscle tone plays a more important role in comprehensive rehabilitation programs, as it allows for an increase in range of motion.
Tolperisone is most often used to treat spastic syndromes. In its chemical structure, the drug is close to lidocaine. The action of the drug is based on the blockade of polysynaptic spinal reflexes. In addition, the drug has a central anticholinergic effect, has antispasmodic and moderate vasodilator activity. Tolperisone reduces increased muscle tone and muscle rigidity during spastic paresis, improves voluntary active movements, normalizes peripheral circulation, and has a membrane-stabilizing, local anesthetic effect. Its use in adequate doses leads to increased local blood circulation. The main contraindication for use is myasthenia gravis and lidocaine intolerance. Typically, the start of treatment occurs in the 2-3rd week of a stroke - the period of activation of the patient. When the first signs of spasticity appear, 50-100 mg of the drug per day is prescribed, which in most cases facilitates movement. In later periods of the disease, with the formation of persistent spastic paresis, higher doses of muscle relaxants are required. IN severe cases For increasing spasticity, intramuscular administration of the drug 100 mg 2 times a day is used. Tablets of 50 and 150 mg allow you to act in a wide range of therapeutic doses to achieve the desired effect. The vasodilating effect of tolperisone may be useful in cases of severe atherosclerotic changes in blood vessels lower limbs. The drug combines well with non-steroidal anti-inflammatory drugs. It is important to note that the drug does not cause general muscle weakness. Tolperisone does not have a sedative effect.
Other agents are used to correct spasticity of various origins: tizanidine, baclofen, dantrolene and benzodiazepines. The basis for the use of these antispastic drugs (or muscle relaxants) are the results of double-blind placebo-controlled randomized studies that have shown the safety and effectiveness of these drugs. Analysis of studies comparing the use of various antispastic agents for various neurological diseases, accompanied by spasticity, showed that tizanidine, baclofen and diazepam are approximately equally capable of reducing spasticity.
In stroke patients who have local spasticity in paretic muscles, botulinum toxin type A or botulinum toxin can be used. The effect of botulinum toxin when administered intramuscularly is caused by blocking neuromuscular transmission. The clinical effect after injection of botulinum toxin is observed after a few days and lasts for 2-6 months, after which a second injection may be required. top scores observed when using botulinum toxin in the early stages (up to a year) from the moment of illness and with mild paresis of the limb. The use of botulinum toxin may be especially effective in cases where there is a foot deformity caused by spasticity of the posterior calf muscles, or high tone of the flexor muscles of the wrist and fingers, which impairs the motor function of the paretic hand. Repeated injections of botulinum toxin in some patients give a less significant effect, which is associated with the formation of antibodies to botulinum toxin and blocking its action. The limited use of botulinum toxin in clinical practice is largely due to the high cost of the drug.
Treatment with muscle relaxants begins with a minimum dose, then it is slowly increased to achieve effect. Antispastic agents are usually not combined.
Surgical treatment for post-stroke spasticity is also possible. Surgical operations to reduce spasticity are possible at four levels - on the brain, spinal cord, peripheral nerves and muscles. Brain surgeries include electrocoagulation of the globus pallidus, ventrolateral nucleus of the thalamus, or cerebellum and implantation of a stimulator on the surface of the cerebellum. A longitudinal dissection of the conus (longitudinal myelotomy) can be performed on the spinal cord to sever the reflex arc between the anterior and posterior horns of the spinal cord. The operation is used for spasticity of the lower extremities; it is technically complex, associated with a high risk of complications, and therefore is rarely used. A significant part of surgical operations in patients with spasticity of various origins is performed on muscles or their tendons. With the development of contracture surgical intervention on muscles or their tendons is often the only method of treating spasticity.
So, drug correction of muscular dystonia is carried out mainly with muscle relaxants, but in necessary cases, to reduce muscle tone, it is possible to use representatives of other drug groups that act on different levels of the pathological process. In each specific case, the treatment regimen and dosage of medications are determined individually.
It should be noted that the correction of muscle-tonic disorders is achieved by complex treatment, which includes properly organized and systematic physical therapy, massage, reflexology. Several types of exercise are usually recommended for stroke patients. The so-called general tonic and breathing exercises(helping to improve the general condition of the body), exercises to improve coordination and balance, to restore the strength of paralyzed muscles, as well as techniques to reduce muscle tone. Along with therapeutic exercises they also use positioning or treatment in a position in which the patient is specially placed in bed so as to create best conditions to restore the functions of his arms and legs.

Literature
1. Gusev EI. The problem of stroke in Russia. Journal of Neurology and Psychiatry. S.S. Korsakova (STROKE supplement to the journal). 2003; 9:3-7.
2. Parfenov V.A. Spasticity in the book: The use of Botox (botulism toxin type A) in clinical practice: a guide for doctors. Ed. O.R. Orlova, N.N. Yakhno. - M.: Catalog, 2001 - p. 108-123.
3. Formisano R., Pantano P., Buzzi M.G. et al. Late motor recovery is influenced by muscle tone changes after stroke // Arch Phys Med Rehabil. - 2005; 86: 308-11.
4. Shirokov E.A. Sirdalud in the complex therapy of chronic pain syndromes//RMZh, 2006; 4:240-242.
5. Coward D.M. Tizanidine: Neuropharmacology and mechanism of action. //Neurology. 1994;11(9):S6-S11.
6. Hutchinson D.R. Tizadinine with modified release (review).//RMJ, 2007;12: 1-4.
7. Kadykov A.S. Rehabilitation after a stroke. M.: Miklos Publishing House. - 176 p.
8. Gelber D. A., Good D. C., Dromerick A. et al. Open-Label Dose-Titration Safety and Efficacy Study of Tizanidine Hydrochloride in the Treatment of Spasticity Associated With Chronic Stroke // Stroke. 2001; 32: 2127-31.
9. Kamchatnov P.R. Spasticity - modern approaches to therapy. http://www.medlinks.ru/article.php?sid=20428
10. Bakheit A.M., Thilmann A.F., Ward A.B. et al. A randomized, double-blind, placebo-controlled, dose-ranging study to compare the efficacy and safety of three doses of botulinum toxin type A (Dysport) with placebo in upper limb spasticity after stroke // Stroke. 2000; 31: 2402-06.
11. Francisco G.F., Boake C. Improvement in walking speed in poststroke spastic hemiplegia after intrathecal baclofen therapy: a preliminary study // Arch Phys Med Rehabil. 2003; 84:1194-9.
12. Ward A.B. A summary of spasticity management - a treatment algorithm // Eur. J. Neurol. 2002; 9(1): 48-52.

When my recovery from the stroke began, this condition was virtually throughout my entire body. Especially strong on the left side. I was almost completely paralyzed, but I still could not make much movement. They turned out as if they were in condensed milk. Tight, clumsy and very slow. There was constant tension in my hands and fingers. It did not go away for a minute, even in a calm state, and did not allow normal movements. The hands involuntarily took an unnatural position. The left one was retracted away from the body. The right one bent at the elbow and pulled up to the chest. I was very tired physically and mentally because I couldn’t relax. Only in a lying position it was easier. But as soon as I sat down, the muscles of the body and limbs tensed like crazy. From excessive tension I quickly got tired again. It was possible to sit for one or two minutes and the strength ran out.

HAND SPASTICITY.

LEG SPASTICITY.

It was possible to relieve spasticity with a combination of gymnastics and massages.

EXTREMELY IMPORTANT!

Start with minimal movements.

Do not exert heavy loads during exercise.

Do the minimum number of repetitions.

Do not do active and strong massage. Light touches only.

Do not add or increase muscle tone.

Learn to relax your muscles and relieve tension in them.

Do not do gymnastics to relieve spasticity when you are tired.

Exercise only in the morning.

At this point, the spasticity was removed. There are some leftovers, but they don't interfere. Freedom and lightness returned to my movements. The tension is gone. Muscle pain and fatigue are gone. I began to spend less energy on movements. This allowed us to gradually increase the load on morning exercises.

In order for recovery after a stroke to give good results, you have to follow this regimen. Gradually I am gaining strength and increasing my endurance. Now I can conduct classes in one day. In the morning I do exercises with strength exercises. In the afternoon, gymnastics and massages to relieve spasticity + exercises for balance and coordination. Half a day between classes is enough for rest.

Exercises to relieve spasticity in:

HAND SPASTICITY.

Stroke represents one of the most important modern medical problems. Strokes are the main cause of long-term disability. According to statistics, 85% of people who have suffered a stroke require an intensive course of restoration of functional changes. Simply put, a third of patients who do not receive proper medical care after a stroke become disabled. To avoid this, you must immediately seek medical help and undergo a course of treatment and rehabilitation.

The first three months after the onset of a stroke, muscle tone increases in paretic (paralyzed) limbs, and mild muscle spasticity appears.

At this stage it is not a pathology. However, an increase in muscle tone leads to pronounced attacks of muscle spasms and the development of their contractures. To fully restore the patient, it is necessary to relieve muscle spasticity, otherwise he will not only lose his ability to work, but also will not be able to independently care for himself in everyday life.

Treatment of spasticity after stroke

Recovery after a stroke is impossible without stopping muscle spasticity. At the first stage of rehabilitation, a number of exercises are used to reduce it: the patient is placed in various positions, thanks to which the spasms go away. These exercises can only be performed by qualified medical personnel and in conjunction with physiotherapy, which includes paraffin heat therapy, application and similar manipulations. Great importance Manual therapy, gymnastics and medical massage help reduce muscle spasticity.

In some cases it is prescribed surgery muscle spasticity, this treatment method is practically not used during rehabilitation after a stroke.

Three months after a stroke, muscle spasticity is unacceptable. It is at this time that muscle relaxants play a vital role in restoring the normal functioning of the limbs. With their help, you can reduce the tone of the striated muscles, reducing the motor activity of the muscles, up to the complete elimination of their contractions. Muscle relaxants are injected into the areas of problematic limbs. Only the supervising neurologist determines the need for drug treatment, and only after three months have passed since the onset of the stroke.

Treatment with Dysport

One of the effective muscle relaxants used in our country is Dysport. Dysport is a botulinum toxin type A used to relieve muscle spasticity in patients who, after a stroke, suffer from increased muscle tone without contracture. Such patients, as a rule, experience muscle spasms accompanied by pain, as well as impaired motor function of the limbs.

The drug Dysport is administered intramuscularly in several injections.

The clinical effect occurs only after some time: from several days to 2 weeks. The improvement lasts up to six months. In this case, the timing of injections is of great importance. Treatment with Dysport one year after a stroke will not lead to the same effect as treatment for early stages. In this case, mild paresis may persist. Practical studies of Dysport have proven its high effectiveness in the treatment of spasticity of the arm muscles after a stroke.

The components of Dysport may cause allergies. Side effects also include pain at the injection site and minor skin rashes. When Dysport is administered for the first time, you may experience general weakness, with a repeated course of treatment, as a rule, these effects are not observed.

Dysport injections at the Three Sisters center

Only qualified doctors who have experience in diagnosing and treating the drug, as well as those who have undergone appropriate training, can prescribe and carry out treatment with Dysport. Under no circumstances should injections be given by an inexperienced doctor or without prior examination. It is important to know that side effects can be avoided by administering the minimum effective dose of the drug.

At the Three Sisters rehabilitation center, the drug Dysport is used in the treatment of patients undergoing recovery from a stroke. Before prescribing Dysport, patients at the Three Sisters rehabilitation center undergo a full examination using the latest equipment. The center’s specialists have extensive experience in treating with this drug, regularly take specialized training courses in Russia and abroad and know all the nuances of its use.

How to sign up for treatment

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How to overcome spasticity of the arm using traditional methods. Spasticity of the arm after a stroke. Genetic defect in one of the contractile proteins

What is spasticity?

Mechanism of spasticity formation

Degree of severity of limb spasticity

How to treat spasticity using different methods

Orthotics and plaster

Physiotherapy for muscle stiffness

Exercise therapy development

Restorative set of exercises for hands

Initial rehabilitation period

Speed ​​of rehabilitation

Spasticity. Part 1.

Treatment of spasticity after stroke

Development mechanism

Treatment

Patient position

Massage

Physiotherapy

Muscle relaxants

Treatment with botulinum toxin

Finally

Post-stroke spasticity

Hand spasticity after stroke

Mom has a stroke. Treatment and rehabilitation after stroke.

Articles

Exercises to restore movement in the hand

Treatment of spasticity after stroke

Treatment with Dysport

Dysport injections at the Three Sisters center

How to sign up for treatment

Speed of rehabilitation