Features of massage after a stroke. How to massage a bedridden patient - techniques, features and contraindications Basic massage techniques for bedridden patients
Recovery after a stroke includes special massage and therapeutic exercises. Massage after a stroke is important for rehabilitation. Very often, after spending 2-3 weeks in the hospital, patients then lie at home for years without restorative therapy.
2 powerful vessels pass through the neck, which carry blood to the head. In a certain place, the vessels branch out like a bunch of grapes and supply blood to our brain. Suddenly, blood stops flowing to the brain, nerve cells stop receiving their portion of blood and die. This place of dead nerve cells in the head is called a stroke.
Hand massage
Hand massage after a stroke and for the forearm is performed for 15 minutes. Like any massage, you need to start with stroking from the fingertips to the beginning of the hand. Stroking the paralyzed hand should be done with the whole part of the palm.
How to do massage? With paralysis of the right hand, gentle squeezing movements are performed. Massage after a stroke at home relieves inflammatory conditions of the nervous system. Massaging movements of the masseur end with stroking, after which the second stage of hand massage begins: rubbing.
Rubbing with paralysis of the limbs is desirable to perform not only longitudinally, but also across the bone.
Foot massage
After a severe attack, some patients cannot even raise their heads, however, after several courses of massage and proper physical exercises, strength returns to the muscles, the legs begin to obey, including the leg on the affected side.
Patients may be aware of the severity of the situation: their legs do not obey, the body is completely paralyzed or on one side, the functions of the limbs have disappeared, it may seem to them that everything is over. However, the correct rehabilitation methods can put a person on his feet, make even the limbs of the affected side work as well as before the attack.
Professional massage therapists are able to influence the nerve endings of the feet in such a way that the former strength of the limbs returns. Patients can memorize all the masseur's techniques and then massage the feet on their own to get rid of all the consequences of a stroke, including on the affected side of the body.
gymnastics for the face
When restoring the face, the orbicular muscle of the mouth plays an important role, while the facial nerve is restored from top to bottom. Very often, speech functions are impaired after a stroke. The lower part of the face after a stroke recovers for a long period.
It is possible to engage in facial restoration after a hemorrhagic stroke no earlier than 3 weeks after the attack. Is it possible to do facial gymnastics if there are open skull injuries, fractures, wounds? Of course not.
Before starting a facial massage, the muscles of the face are kneaded with light rubbing. Next, you need to probe the lips with your fingers from the outside and inside. Warming up the lower part of the face helps to relax the orbicular muscle in the center and tighten the lowered corner of the mouth at the edge.
Cosmetic exercises for the face can be performed an unlimited amount of time.
General rules
If there is no specialist nearby, relatives can perform strokes at home: from the tips of the fingers to the beginning of the hand, from the tips of the toes to the beginning of the foot. Other types of massage are not recommended, so as not to harm the sick, it is better to call a specialist.
As soon as the relative was admitted to the hospital, it is necessary to observe the health workers, how to turn the patients correctly. You also need to look at how to change diapers correctly, this knowledge will be very useful when you arrive home and are left alone with the patient.
Being in the hospital from the first days it is necessary to try to prevent several formidable complications. The first complication is bedsores, they quickly form and heal for a long time, especially in patients with diabetes.
How to prevent bedsores:
- it is necessary to turn the patient every 2 hours;
- bags with millet are placed under problem areas. The first problematic place is the coccyx, then the shoulder blades, elbows, back of the lower leg, heels.
The second formidable complication is nosocomial pneumonia. When a person lies motionless, his lungs are poorly ventilated. What to do in this case? It is necessary to take a glass, pour water into it 2/3 of its volume. A tube from under the juice is inserted into the glass, and air must be blown out.
Several times a day of such exercises improve lung function. Also, turning over from side to side every 2 hours also ventilates the lungs. All innovations must be used only with the permission of the attending physician.
The third formidable complication is constipation. The chair must be achieved 1 time in 3 days necessarily. There are a lot of pills, herbs, drops, you also need to try to make the patient's diet as easy as possible.
Nutrition for the bedridden patient
It is necessary to adhere to diet number 10. Exclude spicy, salty, fatty, fried, smoked. It is often necessary to give the patient water, at the rate of 20-30 ml per kilogram of weight. If the patient weighs 75 kg, you need to multiply by at least 20 ml and you get 1.5 liters of pure non-carbonated water. This amount of water will help the intestines to function properly.
We must not forget about concomitant diseases, kidneys may be sick or there may be heart problems. In these cases, it is necessary to regulate the water content of the body, you need to consult a doctor.
Patients should not be given fresh white bread and other pastries. Bread should be given gray and yesterday, bread with bran has a positive effect on the work of the intestines.
Meat should be given only dietary: steam, boiled, baked in the oven. From meat they give chicken, turkey, beef. Doctors recommend using fish at least a couple of times a week. Recommended varieties of fish: salmon, trout, mackerel.
Potatoes and pasta are given minimally, they need to be replaced with cereals. You also need to cook soups with porridge, it is better to exclude borscht. Soups are cooked not only in broth, empty soups with a spoonful of olive or vegetable oil are also used.
Vegetables must be used familiar and seasonal. You should also not forget about kefir, doctors recommend drinking the whole pack at once, without leaving an open package of kefir for later, since beneficial bacteria begin to die during storage. Biobacteria in fresh kefir will contribute to the regulation of the intestines, 12 hours after storage of an open package of kefir, there will be 50% of biobacteria in the pack, and after 24 hours there will be no bacteria left at all and the effect will be the opposite of what was expected, that is, fixing.
You can not take dairy products in the market, as it is very fatty for stroke patients. They lie, do not move, they need little energy. Dairy products must be purchased at the store. The fat content of kefir is 1.5-2%, sour cream 10-15%, cottage cheese 5-9%. You also need to pay attention to children's sour-milk food and fruit and vegetable mixtures. You can cook vitamin-rich fruit compotes.
However, it must be remembered that all compotes, teas and kefirs are not included in those initial 1.5 liters of water that are intended for bedridden patients.
after an attack
We need to try to activate the cells that surround the dead brain tissue. Special physical therapy exercises for the arms, legs, tongue help to wake up the cells and teach them those movements that have completely disappeared or weakened.
Training new cells for limbs can be compared to the following everyday situation: often we turn on the light automatically, no matter where the switch is, but after repair, the switch will be in a new place and you need to develop an automatic habit again and get used to the new location of the switch. For some time, the person will go in and try to turn on the switch in the old place, but one day the person will consciously go in and turn it on in the new place. This suggests that a zone has formed in the head that already knows how to direct the muscles and turn on the light in a new place.
Exercise therapy of the arms and legs is the knowledge of the muscle what it needs to do, which appears with the help of special therapeutic exercises. During the time a person lies, his muscles weaken and massage during a stroke will help to add strength to these muscles.
This massage differs from general strengthening or general healing. After a massage, strength is added to the muscles, and after gymnastics, knowledge is added to the muscles, the combined techniques together will give movement, which then needs to be brought to automatism - this is how rehabilitation goes.
It is better to entrust gymnastics with massage to specialists - it is much more effective and safer. The massage technique consists of techniques that help reduce pressure.
Acupressure and acupuncture for stroke, acupuncture after stroke, acupuncture, acupuncture, and acupuncture have also proven themselves well. Acupressure can cause some pain, however, after its completion, patients feel a surge of energy in the muscles.
A few rules of rehabilitation
In each neurological hospital there is a rehabilitation methodologist who shows what exercise therapy exercises can be performed for the lower extremities and hands. After arriving home, they begin gymnastics with 15-20 minutes of classes, while proper breathing is needed.
After completing the exercise, you can wait a few seconds before doing the next exercise - this will allow you to observe proper breathing. During this period, you need to inhale and exhale so that the vessels and muscles rest.
Inhalation is done through the nose, it should be calm and deep. The exhalation is done through the mouth, the lips are folded into a tube and as you exhale, you can say: “Fuh”. All tension movements should be done on the exhale. In order not to think about how to breathe correctly, you can count aloud during exercises, since we talk on the exhale, and this is already a forced exhalation.
Movement is the key to life, even in the case when a person is not able (partially or completely) to move independently.
That is why it is so important to change the position of the body of a bedridden patient several times a day, if possible, go for a walk using special means of transportation, such as a wheelchair, and also apply the so-called passive gymnastics.
What is passive gymnastics?
Passive gymnastics are exercises that are performed with the help of extraneous force without the participation of the patient's muscular system.
A logical question may arise: why, in fact, do we need movements in which the human muscles still do not work?
The answer is simple: such manipulations provide vital processes in the patient's body, namely:
They have a beneficial effect on the functioning of the cardiovascular system, including by accelerating blood circulation;
Provide the necessary ventilation of the lungs and thereby prevent the occurrence of congestive pneumonia;
Activates the central nervous system due to irritating mechanical effects on peripheral nerve endings;
Improve bowel function and prevent constipation;
Actively help in the fight against bedsores.
Who can do passive gymnastics?
Passive gymnastics is related to massage. Of course, the manipulations performed by a professional will be as competent as possible from a medical point of view and therefore most useful for the patient.
However, it is not always possible to regularly resort to the services of medical personnel, and meanwhile, the patient needs passive gymnastics every day, and even more than once.
That is why it is important for relatives of the patient to master the basics of passive gymnastics in order to be able, first under the supervision of a doctor, and then independently help a bedridden patient.
Basic principles of passive gymnastics
Passive gymnastics, like massage, should be as delicate as possible. Follow a number of simple rules so as not to harm a sick person:
If the patient is able to speak or otherwise express his emotions and feelings, make sure that he does not experience discomfort, and even more so pain.
All passive gymnastics exercises should be carried out according to the “bottom-up” principle, that is, massaging the arms or legs, we start from the fingertips and gradually rise up.
Avoid sudden movements, as well as movements of large amplitude.
During passive gymnastics, as with massage, you can use creams and ointments, including warming ones, if there are no contraindications from the attending physician.
Do not do passive gymnastics immediately after eating. Wait at least 1-1.5 hours.
We draw your attention to the fact that all the above rules and exercises are advisory in nature! A set of exercises for passive gymnastics, as well as drug treatment, can only be prescribed by the attending physician.
Working on different parts of the body
As mentioned above, passive gymnastics is designed for all parts of the body, except for those that need immobilization (for example, injured limbs). So, let's get to the exercises.
Arms
Let's start with the gymnastics.
We knead each finger from the base up, then gently bend and unbend the fingers;
Let's work on the brush. To do this, we will enclose the hand of a sick person in a “lock” and make several circular movements in one direction and the other;
Let's move on to the elbow: carefully bend and unbend the arm at the elbow, and then make several rotational movements of small amplitude in both directions. Performing the exercise, we fix the elbow with one hand, and the hand with the other;
Forearm and shoulder. Raise the arm up several times and take it to the side at a slight angle, holding the elbow and hand.
Legs
Passive gymnastics of the legs is carried out by analogy with the hands: we work out the fingers, feet, knees and hip joints in turn. Separately, you can massage the foot, calf muscles and thigh.
Then, without taking your feet off the bed, bend the patient's leg at the knee by 90 ° or a little more, and then return it to the prone position in the same way. The scissors and bicycle exercises will also be useful.
Head
Carefully clasping the patient's head with your hands, turn it to the right and left, and then tilt your head to one shoulder and to the other;
Press your head to your chest, and then take it back;
Gently massage the trapezius muscle;
Run your fingers over your face and closed eyelids.
Muscles of the abdomen and chest
These parts of the body need to be worked out especially carefully. The main manipulations in this area will be:
planar, embracing (in the chest) and forceps (in the abdomen) stroking;
circular rubbing with palms and fingertips;
transverse and longitudinal stretching.
Begin and end the massage of the chest of the abdomen with stroking. This massage improves blood circulation and digestion, prevents the formation of constipation and congestion in the lungs.
Be close to those who need your support and help so much!
Since a stroke often leads to loss of mental and physical capabilities, it is important to understand the specifics of the development of the disease and the further consequences. This happens especially often with the limbs, and patients experience paralysis, numbness, loss of sensation.
Such effects take a long time, require professional rehabilitation and sometimes can only partially return.
And all due to the fact that the areas of the right or left hemisphere are affected quite deeply, especially in old age.
Stroke means blockage and thrombosis of blood vessels, their rupture and hemorrhage in the brain area. Depending on the type of disease, the rate of progression and the age of the patient, the further consequences of a stroke also differ. So, with a deep lesion of the left or right hemisphere, a person suffers from a disorder or loss of physical capabilities in full, in part. We are talking about paralysis, numbness, loss of sensation, paresis, convulsions and trembling in the limbs. If the foci of inflammation are located at a distance from the right hemisphere, then the symptoms do not appear so brightly, and recovery will take a little less time - about three months.
paralysis
Paralysis- this is a complete or partial loss of the physical capabilities of the body, a separate area or limbs due to damage to the peripheral nerves, the central nervous system. Paralysis develops when the right hemisphere is affected, sometimes accompanied by central pain syndrome, paresis or numbness of the legs. Often it is the limbs that suffer, although in old age patients are faced with complete paralysis of the body, which can only be partially overcome.
Paresis
If we talk about a decrease in muscle tone, loss of strength and atrophy of the joints, then we can be sure that the patient is faced with paresis. This condition is often observed in bedridden patients or those who suffer from paralysis of the legs or arms. It also develops with repeated thrombosis of the limbs, the location of the stroke in the right hemisphere of the brain. Paresis passes only after rehabilitation and prevention in the form of gymnastics, swimming or training on simulators. Sometimes accompanied by spasmolytic pain, numbness and loss of sensation.
Stroke massage: goals and contraindications
Since it helps to relax muscles, restore tone, eliminate the development of re-thrombosis, saturate the blood with oxygen and prevent it from stagnation. Thus, the damaged hemisphere will recover faster.
If we talk about bedridden patients, then massage for them prevent tissue necrosis, bedsores and further deformation of the joints. In the initial stages of recovery, massage will allow relieve pain syndrome and restore the primary reflexes of the legs and arms.
But when carrying out the procedures, you need to remember a few precautions: you can put the patient on his back only if there are no heart and kidney diseases, only the same specialist performs massage in a hospital, home procedures are possible only in the later stages of rehabilitation after the permission of the doctor.
Massage Techniques
As mentioned earlier, foot massage after a stroke can only be done by professionals or under his supervision, and from the first days of recovery. In this case, several techniques and techniques are used, which include stroking, rubbing, vibration, shaking, warming up, shaking. All of them are aimed at returning reflexes, restoring blood circulation, so it is recommended to use all techniques in one session to achieve the maximum effect in a short period of time.
Stroking
It is with stroking that massage begins, as this allows you to warm up the skin, improve blood circulation throughout the body and prepare the muscles for work. Oils can be used, but the massage therapist's hands should be at room temperature. The pressure of the hands should be medium, while trying to rub, slightly press the hand into the body, leg or back. It is important that the skin turns pink, but does not turn red, so spend no more than three to five minutes stroking.
Trituration
The rubbing technique is not particularly different from stroking, but the difference is the intensity and pressure on the legs. Here you can use additional tools, massagers and creams. The skin may be slightly reddened, warm, or become hot. Rubbing is carried out for five minutes, especially intensively in the feet, fingers and lower leg.
Vibration
The essence of vibration is the transmission of oscillatory movements of a certain frequency to a separate part of the body. Starting from the place of massage, you can perform it with your fingers, the tip of one finger, the palm of your hand or your fist. In the process, it is important to ensure that the muscles that are not involved in the process do not tense up, that is, the action is only partial, but it was directed mainly to the nervous system. Weak vibration will increase muscle tone, and strong vibration will reduce joint tone and regulate the excitability of the nervous system.
shaking
Shaking is performed with two fingers - forefinger and thumb, which, as it were, capture the muscle. Next, the skin area needs to be pulled towards you, and then shaken off, but this is easy and quick to do. Manipulations with one area are carried out at least two or three times, and then the fingers need to be moved to the neighboring part. You can make movements diagonally or arbitrarily, sometimes the left hand can help, which creates burdens. It is easiest to perform shaking on the legs, but then the patient should stand upright, and the massage therapist should shake the muscles and skin with one hand.
slight concussion
Shaking is also performed with the palm of your hand or several fingers on a specific part of the body. To do this, you need to pat, create movement on the skin and muscle. It is better to repeat the procedure in one area twice, and then move on to the next part of the body. In this case, it is better for the patient to lie down or take a sitting position.
kneading
Kneading is the main type of massage, which is given almost half of the time of the entire session. But to achieve the maximum effect, it is necessary that the patient's muscles are completely relaxed. Kneading allows you to get to the deepest muscle layers, this is achieved by capturing muscle tissue and pressing it against the bones. Kneading is carried out with the thumb, tips or the entire palm, but make sure that the movements are quick and sliding. Perform the procedure slowly, painlessly, making about 50 movements per minute.
Preparing for a massage
Preparation for massage is necessary both for the patient and for the specialist himself. It all starts with washing hands and washing the body with warm water, after which it is necessary to dry the skin dry. Usually, the patient is undressed to underwear or completely, but the part of the body that is not exposed is covered with a towel or blanket. Keep track of the temperature in the room, as it should be at the level of 23 degrees. Before starting the procedures, the massage therapist needs to warm up the hands to room temperature, the same applies to the patient's legs. In the process, you can use oils, creams and warming masks. Massage is performed in a lying, standing or sitting position on a special couch or on the floor, so as not to create inconvenience or additional burden on the body.
Combination with exercise
Often light massage is combined with exercise., gymnastics, swimming or training on simulators. In this case, massage will prepare the muscles for stress, disperse the blood throughout the body and increase the overall tone of the joints. Then the procedure takes about 15 minutes and includes rubbing, shaking, vibration and kneading. Sometimes the procedure is carried out after exercises or gymnastics to relax the muscles.
Massage after the hospital
After the hospital massage is carried out at home or massage rooms for preventive purposes. The procedure should be repeated at least three to four times a week for 30-40 minutes. In this case, the massage can be complete, the whole body, and not just the legs or arms. It is especially necessary for those who suffered from paralysis, numbness and paresis, since manifestations can accompany the patient for a long time after treatment, leading to a second attack. After that, it is recommended to visit a massage therapist at least once or twice every two weeks.
Rehabilitation: restoring leg movement
Restoration of physical activity of the limbs after a stroke, they are often carried out on the territory of sanatoriums or rehabilitation centers. At the same time, the procedure can take up to eight months or a year and an individual course is developed. Medications, hydrotherapy and reflexology, motor exercises, diet, massages and rubbing, visits to a physiotherapist and exercise equipment, treatment of chronic diseases, mud wraps and acupuncture can be used. In some cases, one cannot do without art therapy, a bipolar effect on the nervous system or neurons. It takes about six months, sometimes a year, for rehabilitation. With a second attack or in old age, the legs may not be fully restored, and a second attack or thrombosis may develop as early as eight to twelve months. If you refuse to restore completely, then physical capabilities will be lost forever, and the second attack of a stroke may be the last.
A common procedure in nursing is massage. It favorably affects the muscle mass, skin and internal organs of the patient. With the help of massage, the work of the body systems and human organs as a whole returns to normal.
Massage, being a part of patient care, promotes excitation of motor cells of the cerebral cortex, stimulation of motor centers, and improvement of blood supply. Massage also has a beneficial effect on the skin. The work of the sebaceous and sweat glands improves, lymph circulation accelerates, and dead scales are cleansed. Thanks to a professional massage by a nurse-nurse, the skin will return to its former elasticity, and the muscles will contract better. After the course of massage, the patient's range of motion in the joints will increase, due to the improvement of blood circulation, the ligaments will become stronger. Professional nurses of our patronage service use massage to improve the functioning of the kidneys, increase the excretion of metabolic products from the body with urine. This is due to the fact that massage significantly accelerates the flow of blood, lymph, tissue fluid.
If the patient is at home, the massage can be performed by a member of your family. But still, it is desirable that it be carried out by a qualified worker. When caring for a patient, a nurse who has the skills to perform massage will successfully cope with these duties. An experienced specialist knows exactly which areas of the patient's body need to be affected and how to do it correctly. Relatives, if desired, will be able to adopt the skills of a professional worker and continue performing the massage on their own.
Consider the main massage techniques carried out by nurses in the process of caring for the patient:
Stroking. Stroking is the movement of the hand over the skin without moving. This technique is performed both with one and two hands, with the palm of your hand, or only with your fingertips. Stroking begins with superficial movements, and then they become a little deeper. This technique can be carried out both slowly and more rhythmically. Stroking effect: anesthetizes, has a resolving effect, improves lymph and blood circulation.
Trituration. This technique involves shifting and stretching the patient's skin in different directions. Rubbing can be done with one or two hands, as well as with a fist, palm or fingers. If rubbing is done correctly, then it is much slower than stroking. The effect of rubbing: resorption of adhesions and various scars, increased muscle contractility, resorption of pathological tissue deposits.
Kneading. The nurse performs kneading when she works directly with the muscles of the body. In this case, the tissues are captured, squeezed, stretched and compressed. The specialist conducts kneading with varying intensity at the beginning of the session and at the end. From the very beginning, the muscles should warm up only slightly, and at the end more intensively. With the help of kneading, the tone in the muscles increases, their contractility increases, painful foci resolve, and blood circulation improves.
Another massage technique is vibration. This is a very effective massage technique. With its help, even extinct reflexes are restored. In addition, it acts as an analgesic, stimulates tissue regeneration.
Here are some important conditions that must be observed when conducting massage while caring for the sick.
First, the guarantee of health is fresh air. Therefore, the patient's room should be well ventilated.
Always pay attention to the hands of the massage therapist. A professional nurse should have short-cut nails, clean dry hands and not decorate them with jewelry.
At the beginning of the massage session, the patient's skin should be lubricated with the necessary amount of a special cream or oil. In this way, the best glide is achieved.
Before proceeding with massage sessions to the patient, it is necessary to consult a doctor, since there are a number of diseases in which massage is contraindicated. These include, in particular: varicose veins, trophic ulcers, thrombophlebitis, various rashes on the patient's skin, and some other diseases.
HOW TO MASSAGE A LYING PATIENT
Imagine a stroke-stricken person with severe motor and sensory disorders, and at the same time he weighs well over a hundred kilograms. And he lies on a low sofa. Here's a challenge for the massage therapist. How do they cope with this task? Usually they don't work out. It is unfortunate, but the massage is usually limited to artistic stroking of the limbs on the affected side of the body. That is why I am writing this article.
Let's start with the fact that proper massage is the foundation of early rehabilitation. Without it, it is generally difficult to talk about rehabilitation. And we are talking about a massage of the WHOLE body (excluding the front surface of the torso).
The order of the massage is as follows:
1. We massage the arm, and then the leg from the side that is closer to the edge of the bed.
2. We turn the patient to God, with his back to himself, and massage the half of the back that is on top. We also massage the upper half of the neck and buttocks.
3. If the patient is able to do this, then shift his head to the other side, and repeat the process on the other side.
4. If not able, then just turn it on the other side, and massage the back like that.
Of course, in this position (on the side) you cannot massage the limbs, so you need to climb over the patient, sit on his sofa behind him and already in this position massage his arm and leg. If the situation does not allow this, then the person should be placed on the bed so that the non-massaged pair of limbs is on the healthy side.
If the patient is not able to stay on his side on his own, then you can keep him by using support on your leg, which must be placed on the bed close to the patient's lower back. Don't forget to take off your shoes.
When turning the patient to the affected side, be extremely attentive to his shoulder joint on the affected side - it is impossible for the patient to lie in a position in which he feels acute pain in the joint.
Under the sore arm, when the patient lies on a healthy side, it is necessary, as a rule, to put a roller.
Between the knees, as a rule, you also need to put a roller.
In the supine position, a roller should also be placed under the head - otherwise it will not work to massage the paravertebral muscles of the neck.
Do not forget that during the massage, those parts of the patient's body that are not being massaged directly at the moment should be covered with a sheet.
I am talking about the rehabilitation of specific patients in specific living conditions, and not about the rehabilitation of spherical patients in a vacuum. My recommendation is experience. And he suggests that not all families have the resources to purchase a functional bed (with the allocation of a separate room where you can easily get close to the patient from any side of the body). It's great when it's all there. But when this is not the case, you still need to work.
