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How to relax muscles after a stroke. Spasticity after stroke treatment. How muscles work

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Some positions of the body can increase muscle tone, some can decrease, and some can contribute to the development of spasticity.

That is why correct positioning is used to influence muscle tone and facilitate recovery.

Therefore, each position of the body must be thought out and must take into account the specific characteristics of a given patient.

For example, if it is necessary to increase muscle tone in a weakened leg when using the supine position, the patient's hand should be extremely careful if there is some tension in it.

How to approach a patient and influence his senses.

A stroke patient should always be approached from the affected side so that he tries to turn his head there. This rule should be followed by everyone who comes in contact with the patient - family members, visitors, medical and service personnel. All equipment of the room, furniture, inventory must also be placed in the correct way (for example, the bedside table must stand on the side of the lesion Fig. 2.1; 2.2).

Rice. 2.1-2.2. A stroke patient should always be approached from the affected side

The exception is patients who did not receive proper assistance at the previous stages and therefore found themselves in a neglected state by the time the rehabilitation began. If, in such cases, stimulating influences come from the diseased half of the body, this can cause the patient to have an increased feeling of inferiority and inferiority.

In these situations, at the beginning of rehabilitation treatment, it is advisable to approach the patient along the central axis of the body or from the healthy side. As his condition improves, you can gradually switch to the defeated side. Once the recovery is high enough, the original recommendations can be fully followed.

The patient should lie on a firm, but not too hard bed. An overly soft bed interferes with normal blood and lymph circulation, increases spasticity and can cause pressure ulcers. To reduce spasticity, one must try to eliminate all factors that increase muscle tone. The room should be warm and bright.

Sources of noise and any emotional stress should be minimized. When talking with the patient, you should be on the affected side so that your voice acts on their senses and stimulates hearing and vision.

The bedside table should be on the affected side. A patient who regains balance in a seated position should reach for objects on the table with a healthy hand, while turning the torso and leaning on the sore elbow.

Lying and sitting in bed

Lying on your back

This position is used very often. However, if used without proper attention, it can lead to the formation of pressure ulcers and exacerbate the typical variants of spasticity. Always use extreme caution when placing the patient in an antispastic position.

Here's what you should pay attention to when placing the patient on his back (Fig. 3.1):

Rice. 3.1. What to look for when placing the patient on his back

Rice. 3.2. There is a pillow under the affected shoulder that lifts it up

• the head is slightly turned to the affected side, but without excessive lifting with the help of supporting pillows;
• under the affected shoulder lies a pillow that lifts it up (Fig. 3.2);
• the hand is on the pillow; the elbow and hand are straightened;
• the palm is open (all fingers, including the thumb, are extended) and turned down;
• there is a pillow under the thigh to prevent the pelvis from moving back and turning the leg outward (the position of the leg is generally neutral);
• if the leg is completely paralyzed, a small pillow is placed under it to give the knee a position of slight bending; in this case, the rotation of the leg outward should be prevented;
• a soft pillow can be placed under the foot to prevent extension of the ankle and the development of stiffness. Placing the hand above shoulder level (palm turned up or down) facilitates circulation and prevents swelling of the hand. You can use a sandbag to hold your hand in this position.

Note
If the patient develops spasticity of the leg, especially the foot, a support splint should not be used.

It can create pressure on the forefoot that will increase muscle tone in the leg. However, from the very beginning of the treatment, a special arch should be used to eliminate the pressure of the blanket on the foot and prevent it from extending and fixing it in this position.

It should also be borne in mind that at the same time, different parts of the patient's body may be at different stages of recovery. For example, the muscles of the arm may be in a state of spasticity, and the muscles of the leg may be in a state of decreased tone. Therefore, giving the patient different positions, one must take into account his individual characteristics.

Position - supine position for patients with good shoulder mobility.

For people who have retained a sufficient amount of mobility in the shoulder girdle and do not have pain in the shoulder joint, the positions presented below can be used (Fig. 3.3, 3.4). Moreover, giving the hand the necessary positions, all movements should be performed carefully and smoothly, avoiding rapid muscle tension.

If the patient develops spasticity, then intermediate positions are preferable to prevent it:

• the head, with the help of supporting pillows, should not be raised too much (bending the neck forward increases the unwanted tone of the flexor muscles of the forearm);
• the shoulder is extended forward, the arm is turned outward and far to the side, the elbow is bent, the hand is located on the pillow and slightly unbent (if possible, the hand can be placed under the patient's head);
• a pillow can be placed under the foot to prevent it sagging (fig. 3.3);
• the hand is turned outward;
• the elbow is straight, the hand is turned up;
• the leg is slightly turned inward (Fig. 3.4).

Rice. 3.3. You can put a pillow under the foot

Rice. 3.4. The leg is slightly turned inward

Supine position for patients who develop spasticity in the leg and arm:

• the leg is bent at the hip and knee joints;
• the foot is slightly bent and supported by a soft pillow;
• the arm is turned outward and far away from the body;
• the arm is bent at the elbow, the palm is turned up;
• the hand rests on a small pillow, tilted back, fingers extended (to maintain this position, a sandbag can be used instead of a pillow). The hand can also be placed under the patient's head (Fig. 3.5);
• the shoulder is raised with the help of a small pillow placed under it (especially care must be taken so that the shoulder does not turn inward, leading to spastic internal rotation);
• the arm is bent at the elbow at an angle of 90 degrees, the forearm is located above the shoulder;
• the palm rests on the pillow;
• the leg is slightly bent at the hip and knee joints;
• the foot is raised (fig. 3.6.)

Rice. 3.5. The hand can also be placed under the patient's head

Rice. 3.6. The foot is raised

A.P. Grigorenko, J.Yu. Chefranova

Communication between muscles and the brain can be blocked, disrupting their coordinated work. This leads to the fact that muscles prone to lethargy stretch (extensors of the arm, flexors of the leg), and muscles prone to tension contract (flexors of the arm, extensors of the leg). This involuntary muscle tension is spasticity after a stroke. She limits your coordination, gait, normal movement. Such the stroke condition makes daily activities such as bathing, eating, and dressing more difficult.

Spasticity can cause long periods of strong contractions in major muscle groups, causing painful muscle spasms. This can manifest itself as:

Can spasticity be cured?

There are many strategies and treatments for spasticity that can help you recover, get back to work, and regain lost function. If you do not engage in competent treatment, contractures develop, which are very difficult to treat. To achieve the best results, it is necessary to use only an integrated approach, including drug and non-drug treatment of spasticity, giving preference to the latter.

Methods for treating spasticity:

• Medication methods;
• Stretching exercises to reduce spasticity
• Specialized differentiated massage;
• Electrostimulation of motor points;
• The use of orthoses and splints (together with physiotherapy exercises);
• Taping;
• Transcranial magnetic stimulation;
• Surgical methods.

Medicines to treat spasticity:

There are two groups of drugs that can reduce spasticity after a stroke. It is better to start drug therapy with muscle relaxants. If there is no effect, it is necessary to change the drug or add a centrally acting drug. It is imperative to remember that the dose must be increased gradually.

Peripheral drugs (muscle relaxants):

• Mydocalm (tolperazone) 100-450 mg / day
• Sirdalud (tizanidine) 6-36 mg / day
• Baclofen 10-100 mg / day

Centrally acting drugs:

• non-benzodiazepine tranquilizers (Diazepam, Clonazepam),
• anticonvulsants (Finlepsin, Gabapentin, Pregabalin),
• alpha-adrenergic agonists (Clonidine).

Botulinum toxin(muscle injections):

If a stroke patient has a muscle with increased tone without contracture, and also has pain, muscle cramps, decreased range of motion and impaired motor function associated with spasticity of this muscle, botulinum toxin type A or botulinum toxin can be used. The clinical effect after injection of botulinum toxin is noted after a few days and lasts for 2-6 months, after which a second injection may be required. The best results are observed when using botulinum toxin in the early stages (up to a year) from the moment of illness and mild paresis of the limb.

Tips on how to live with spasticity:

Assistive devices and household appliances can help reduce the risk of spastic falls. Here some changes to your home that will improve your safety:

• Ramps (ramps)
• Handrails
• Raising the toilet bowls
• Bathroom benches
• Rubber bath mats
• Suspenders, canes, walkers, and wheelchairs can help you move freely as you gain strength.

Parfenov V.A.
Moscow Medical Academy. THEM. Sechenov

The urgency of the problem

In Russia, 300-400 thousand strokes are recorded annually, which leads to the presence of more than one million stroke patients. More than half of them have motor impairments, as a result of which the quality of life is significantly reduced and persistent disability often develops (1).

Movement disorders after a stroke are most often manifested by hemiparesis or monoparesis of the limb with an increase in muscle tone by the type of spasticity (1,2,9). In stroke patients, spasticity usually increases in the paretic limbs over several weeks and months, relatively rarely (most often with the restoration of motor functions), a spontaneous decrease in spasticity is observed. In many cases, in stroke patients, spasticity worsens motor functions, contributes to the development of contracture and deformity of the limb, makes it difficult to care for an immobilized patient and is sometimes accompanied by painful muscle spasms (2,5,6,9,14).

The restoration of the lost motor functions is maximal within two to three months from the moment of the stroke; in the future, the rate of recovery decreases significantly. A year after the development of a stroke, a decrease in the degree of paresis is unlikely, however, it is possible to improve motor functions and reduce disability by training balance and walking, using special devices for movement and reducing spasticity in paretic limbs (1,2,6,9,14)

The main goal of post-stroke spasticity treatment is to improve the functionality of paretic limbs, walking, and self-care of patients. Unfortunately, in a significant part of cases, the possibilities of treating spasticity are limited only by reducing pain and discomfort associated with high muscle tone, facilitating the care of a paralyzed patient, or eliminating an existing cosmetic defect caused by spasticity (2,6,14).

One of the most important questions that have to be addressed in the management of a patient with post-stroke spasticity is reduced to the following: does the spasticity worsen the functional capabilities of the patient or not? In general, the functionality of a limb in a patient with post-stroke paresis of the limb is worse in the presence of severe spasticity than in its mild degree. At the same time, in some patients with a pronounced degree of paresis, spasticity in the leg muscles can facilitate standing and walking, and its decrease leads to a deterioration in motor function and even falls (2,6,14).

Before starting to treat post-stroke spasticity, it is necessary to determine the treatment options for a particular patient (improvement of motor functions, reduction of painful spasms, facilitation of patient care, etc.) and discuss them with the patient and (or) his relatives. Treatment options are largely determined by the timing of the disease and the degree of paresis, the presence of cognitive impairments (2,6,14). The shorter the time since the onset of the stroke that caused the spastic paresis, the more likely the improvement from the treatment of spasticity, because it can lead to a significant improvement in motor functions, preventing the formation of contractures and increasing the effectiveness of rehabilitation during the period of maximum plasticity of the central nervous system. With a long duration of the disease, a significant improvement in motor functions is less likely, but it is possible to significantly facilitate patient care and relieve the discomfort caused by spasticity. The lower the degree of paresis in the limb, the more likely it is that the treatment of spasticity will improve motor function (14).

Physiotherapy

Therapeutic gymnastics is the most effective direction for managing a patient with post-stroke spastic hemiparesis; it is aimed at training movements in paretic limbs and preventing contractures (2, 14).

As methods of physiotherapy, posture therapy, teaching patients to stand, sitting, walking (with the help of additional means and independently), bandaging of a limb, the use of orthopedic devices, thermal effects on spastic muscles, as well as electrical stimulation of certain muscle groups, for example, the extensors of the fingers of the hand or tibialis anterior muscle (4).

Patients with severe spasticity in the flexors of the upper extremities should not be advised of intense exercises that can significantly increase muscle tone, for example, squeezing a rubber ring or ball, using an expander to develop flexion movements in the elbow joint.

Massage of the muscles of the paretic limbs, which have a high muscle tone, is possible only in the form of light stroking, on the contrary, in the muscles of antagonists, rubbing and shallow kneading at a faster pace can be used.

Acupuncture is relatively often used in our country in the complex therapy of patients with post-stroke spastic hemiparesis, however, controlled studies conducted abroad do not show significant effectiveness of this treatment method (10).

Muscle relaxants

Baclofen and tizanidine are mainly used in clinical practice as drugs taken orally for the treatment of post-stroke spasticity (5-7). Orally applied antispastic agents, reducing muscle tone, can improve motor functions, facilitate caring for an immobilized patient, relieve painful muscle spasms, enhance the effect of physiotherapy exercises and, as a result, prevent the development of contractures. With a mild degree of spasticity, the use of muscle relaxants can lead to a significant positive effect, however, with severe spasticity, large doses of muscle relaxants may be required, the use of which often causes undesirable side effects (2,5-7,14). Treatment with muscle relaxants begins with a minimum dose, then it is slowly increased to achieve an effect. Antispasmodics are usually not combined.

Baclofen (Baklosan) has an antispastic effect mainly at the spinal level.

The drug is an analogue of gamma-aminobutyric acid (GABA); it binds to presynaptic GABA receptors, leading to a decrease in the release of excitatory amino acids (glutamate, aspartate) and suppression of mono- and polysynaptic activity at the spinal level, which causes a decrease in spasticity.

Throughout its long history, it remains the drug of choice in the treatment of spasticity of spinal and cerebral origin.

Baclofen also has a central analgesic and anti-anxiety effect. It is well absorbed from the gastrointestinal tract, the maximum concentration in the blood is reached 2-3 hours after ingestion. Baclofen (baclosan) is used for spinal (spinal injury, multiple sclerosis) and cerebral spasticity; it is effective for painful muscle spasms of various origins. Baclofen (Baklosan) The initial dose is 5-15 mg per day (in one or three doses), then the dose is increased by 5 mg every day until the desired effect is obtained, the drug is taken with meals. The maximum dose of baclofen (baclosan) for adults is 60-75 mg per day. Side effects are manifested by drowsiness, dizziness at the beginning of treatment, although they are clearly dose-dependent and may subside in the future. Sometimes nausea, constipation, diarrhea, arterial hypotension occur.

Baclofen can be used intrathecally with a special pump for spasticity caused by a variety of neurological conditions, including the sequelae of stroke (8,11,13). The use of a baclofen pump in combination with therapeutic exercises, physiotherapy can improve the speed and quality of walking in patients with post-stroke spasticity, capable of independent movement (8). The existing 15-year clinical experience of using baclofen intrathecally in stroke patients indicates the high efficiency of this method in reducing not only the degree of spasticity, but also pain syndromes and dystonic disorders (13). The positive effect of the baclofen pump on the quality of life of stroke patients has been noted (11). Tizanidine is a centrally acting muscle relaxant, an alpha-2 adrenergic receptor agonist. The drug reduces spasticity due to suppression of polysynaptic reflexes at the level of the spinal cord, which can be caused by inhibition of the release of excitatory amino acids and activation of glycine, which reduces the excitability of spinal cord interneurons. The drug also has a moderate central analgesic effect, is effective in cerebral and spinal spasticity, as well as in painful muscle spasms. The initial dose of the drug is 2-6 mg per day in one or three doses, the average therapeutic dose is 12-24 mg per day, the maximum dose is 36 mg per day. Side effects may include severe drowsiness, dry mouth, dizziness, and a slight drop in blood pressure.

Botulinum toxin

In patients who have had a stroke and have local spasticity in the paretic muscles, botulinum toxin type A or botulinum toxin (botox, dysport) can be used. The use of botulinum toxin is indicated if a patient who has suffered a stroke has a muscle with increased tone without contracture, as well as pain, muscle spasms, decreased range of motion and impaired motor function associated with spasticity of this muscle (2-4,12,14) ... The action of botulinum toxin when injected intramuscularly is caused by the blocking of neuromuscular transmission due to the suppression of the release of the neurotransmitter acetylcholine into the synaptic cleft.

The clinical effect after injection of botulinum toxin is noted after a few days and lasts for 2-6 months, after which a second injection may be required. The best results are observed when using botulinum toxin in the early stages (up to a year) from the moment of illness and mild paresis of the limb. The use of botulinum toxin can be especially effective in cases where there is an equino-varus deformity of the foot caused by spasticity of the posterior leg muscles, or a high tone of the flexor muscles of the wrist and fingers, which impairs the motor function of the paretic hand (14). Controlled studies have shown the effectiveness of dysport in the treatment of post-stroke spasticity in the arm (3).

Side effects from using botulinum toxin can include skin changes and pain at the injection site. They usually regress on their own within a few days after injection. Significant weakness of the muscle into which the botulinum toxin was injected is possible, as well as weakness in the muscles located close to the injection site, local autonomic dysfunction. However, muscle weakness is usually compensated by the activity of agonists and does not lead to a decrease in motor function. 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 limitation of the widespread use of botulinum toxin in clinical practice is largely due to its high cost.

Surgical treatments

Surgical operations to reduce spasticity are possible at four levels - on the brain, spinal cord, peripheral nerves, and muscles (2,14). They are rarely used in patients with post-stroke spasticity. These methods are more commonly used for infantile cerebral palsy and spasticity caused by spinal trauma.

Brain surgeries include electrocoagulation of the globus pallidus, ventrolateral nucleus of the thalamus, or cerebellum, and implantation of a stimulator onto the surface of the cerebellum. These operations are rarely used and carry a certain risk of complications.

A longitudinal cone dissection (longitudinal myelotomy) can be performed on the spinal cord to break 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 difficult and associated with a high risk of complications, therefore it is rarely used. A cervical posterior rhizotomy can lead to a decrease in spasticity not only in the upper limbs, but also in the lower limbs, but it is rarely performed because of the risk of complications. Selective posterior rhizotomy is the most common intervention for the spinal cord and its roots, it is usually used for spasticity in the lower extremities at the level from the second lumbar to the second sacral root.

Dissection of peripheral nerves can eliminate spasticity, but this operation is often complicated by the development of pain, dysesthesia and often requires additional orthopedic surgery, therefore it is rarely used.

A significant part of surgical operations in patients with spasticity of various origins is performed on muscles or their tendons. Elongation of the muscle tendon or movement of the muscle decreases the activity of the intrafusal muscle fibers, thereby reducing spasticity. The effect of the operation is difficult to predict, sometimes several operations are required. With the development of contracture, surgical intervention on the muscles or their tendons is often the only method of treating spasticity.

Conclusion

Treatment of post-stroke spasticity is an urgent problem of modern neurology. The leading role in the treatment of post-stroke spasticity is played by remedial gymnastics, which should begin from the very first days of the development of a stroke and be aimed at training lost movements, independent standing and walking, as well as preventing the development of contractures in paretic limbs.

In cases where a patient with post-stroke paresis of the limb has local spasticity, which causes deterioration of motor functions, local administration of botulinum toxin preparations can be used.

As medicinal antispastic agents used internally, it is recommended Baclofen (Baklosan) and tizanidine, which are able to reduce the increased tone, facilitate physical therapy, as well as caring for the paralyzed patient. One of the promising methods for the treatment of post-stroke spasticity is intrathecal administration of baclofen using a special pump, the effectiveness of which has been actively studied in recent years.

LITERATURE
1. Damulin I.V., Parfenov V.A., Skoromets A.A., Yakhno N.N. Circulatory disorders in the brain and spinal cord. In the book: Diseases of the nervous system. A guide for doctors. Ed. N.N. Yahno. M .: Medicine, 2005, Vol. 1., S. 232-303.
2. Parfenov VA .. 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. Yahno. - M .: Catalog, 2001 - S. 91-122.
3. 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. - Vol. 31. - P. 2402-2406.
4. Bayram S., Sivrioglu K., Karli N. Et al. Low-dose botulinum toxin with short-term electrical stimulation in poststroke spastic drop foot: a preliminary study // Am J Phys Med Rehabil. - 2006. - Vol. 85. - P. 75-81.
5. Chou R., Peterson K., Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. // J Pain Symptom Manage. - 2004. - Vol. 28. - P. 140-175.
6. Gallichio J.E. Pharmacologic management of spasticity following stroke. // Phys Ther 2004. - Vol. 84. - P. 973–981.
7. 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. - Vol.32. - P. 1841-1846.
8. 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. - Vol. 84. - P. 1194-1199.
9. 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. - Vol. 86. - P.308-311.
10. Fink M., Rollnik J. D., Bijak M. Et al. Needle acupuncture in chronic poststroke leg spasticity // Arch Phys Med Rehabil. - 2004. - Vol. 85. - P.667-672.
11. Ivanhoe C.B., Francisco G.E., McGuire J.R. et al. Intrathecal baclofen management of poststroke spastic hypertonia: implications for function and quality of life // Arch Phys Med Rehabil. - 2006. - Vol. 87. - P. 1509-1515.
12. Ozcakir S., Sivrioglu K. Botulinum toxin in poststroke spasticity // Clin Med Res. - 2007. - Vol. 5. - P.132-138.
13. Taira T., Hori T. Intrathecal baclofen in the treatment of post-stroke central pain, dystonia, and persistent vegetative state // Acta Neurochir Suppl. - 2007. - Vol.97. - P. 227-229.
14. Ward A.B. A summary of spasticity management - a treatment algorithm // Eur. J. Neurol. - 2002. - Vol. 9. - Suppl. 1. - P. 48-52.

Undoubtedly, stroke affects the health of each person in different ways. Some may recover completely, while others may remain limited, but in any case, after a stroke, recovery is necessary. The correct approach to this situation is the key to a speedy recovery.

First, you need to prepare the person who has suffered a stroke to the fact that if the movements during the stroke have not recovered, then they will have to learn how to do everyday work and adapt to the loss of some opportunities. Moreover, patience, help and perseverance are the best helpers in this.... Over time, excellent results can be achieved, the patient can not only learn to control his movements again, but also achieve complete independence.

Now we turn directly to the development of movements. Of course, the patient can do something, but not everything is necessary. It should start with the fact that feasible movements should be done as often as possible.... For example, the patient may walk, even if little by little and slowly. It is necessary to make his movements as frequent as possible, first with support, then he must begin to rely less and less on his assistant, eventually he will begin to walk on his own. At first, pain will appear due to muscle stiffness, but this must be done! It is better to start with a feasible number of steps, for example, fifty, add one or two a day, if you can't walk, you can crawl around the apartment, increasing the distance every day. In both cases, of course, physical assistance and moral support are needed.

It is necessary that the patient be very determined and exercise regularly, as often as possible.

During training, the arms and legs must be considered together, since the restoration of the body must take place in a complex. A combination of different exercises for different limbs is important here. It is a mistake to believe that the leg is developed first, and the arm can be dealt with later.

It is always worth remembering that the loss of even a few days during rehabilitation may result in great losses in the future. If only the legs or arms develop, the result may be a curvature of the spine.

After an initial analysis of possible movements, specialists will give recommendations for mastering further techniques, after which the patient will be able to sit and stand. Next, you need support from the outside for movement. We must not forget about massage..

It plays a very important role in the recovery period. The duration of the course can vary from one to three months, and the sessions can be carried out at home, with the help of a nurse or one of the relatives. The massage technique can be learned from specialists, but in any case, it should be carried out every day.

In addition to massage, paralyzed limbs need to be constantly stretched and trained with various exercises, all this is done with an assistant. Often, during warm-ups, pain appears, but you still need to stretch the muscles, overcoming it. After a while, the pains will disappear, which means that the recovery process is going in the right way. If the pain is not overcome, the limbs may never heal.

It should also be borne in mind that the patient's joints are very weak, so it is easy to get a sprain. While working out the arms and legs, everything should be done smoothly, gradually and carefully to avoid stretching.

The restoration of activity should always begin with activating the work of the fingers, since they are closely related to the work of the brain, they activate it. Finger training is the key to restoring the functioning of nerve cells in the brain.

In addition to the above, you need to spend herbal treatment, which should also be recommended by the attending physician. Moreover, complex treatment with warm-ups, massage and herbs will give a much better result than choosing one of the methods.

Muscle spasticity after a stroke is an increase in muscle tone that significantly reduces the quality of life.

Muscle contraction as a stretching impulse occurs against the background of mono- or hemiparesis (unilateral and bilateral paralysis, respectively).

The reason for such processes is damage to the cells of the motor pathways of the brain. The following areas are susceptible to post-stroke spasticity:

• arms;
• legs;
• shoulders;
• hip.

With a long stay in the supine position, the symptoms gradually increase.

A positive trend is observed in the restoration of motor functions, which is achieved by different methods.

Spasticity after a stroke: drug treatment
The success of therapy directly depends on the time that has passed since the moment of the disease.

The earlier treatment is started, the more positive the prognosis for recovery. The best results can be achieved when recovery begins in the first months after the impact, but no later than a year later.

To immobilize a muscle group by blocking neural transmission, botulinum toxins are injected (Dysport, Xeomin, Botox). The effect lasts an average of six months, after which it may be necessary to re-administer botulinum toxic drugs.

• Baclofen
• Midocal;
• Sirdalud.

Baclofen for Stroke from Spasticity

The baclofen pump is used intrarectally. Acts on the spinal level by reducing the production of a number of amino acids (aspartate, glutamate).

In addition to relieving spasticity, a centrally acting muscle relaxant helps to achieve significant success in reducing dystonic disorders, as well as minimizing pain.

Side effects:

• stool disorders (diarrhea, constipation);
• drowsiness;
• lowering blood pressure.

The regimen assumes a systematic increase in dosage from 15 to 60 mg per day.

Spasticity after a stroke: treatment with folk remedies

Popular methods:

1. Exposure to heat on the spasmodic area (applying warm compresses, bags of salt or cereals).
2. Bandaging the upper and / or lower extremities.
3. Light massage (in the form of stroking and rubbing).
4. Taking warm baths (not hot!).
5. Kinesio taping.
6. Taking herbs.

Teas and tinctures are made from the following components:

• calendula;
• horse chestnut flowers or fruits;
• raspberries;
• mountain ash bark;
• Melissa;
• oats;
• blackthorn.

Hand spasticity after a stroke is eliminated by creating a bath effect.

The limb is placed in a bag of birch leaves, which is fixed and left overnight. They work similarly with spasticity in the legs, provided that the dimensions of the container correspond to the length of the limb to the lumbar.

Treatment of spasticity after a stroke with acupuncture
Acupuncture is a popular treatment method in post-Soviet countries, but clinical studies conducted abroad do not confirm the effectiveness of this technique.
Exercises for spasticity after a stroke

This is the most effective way to deal with such an unpleasant consequence. The loads should not be too exhausting, since excessive intensity only worsens the patient's condition (tone increases).

Examples of exercises:

1. Exercise with an expander (squeezing / unclenching a special rubber ring).
2. Patients are taught to stand again, to walk - for this they use stilts and other auxiliary items.
3. Classes on orthopedic devices.
4. Physical activity (independent execution, with an assistant).

Types of gymnastics:

• alternate bending of the legs while lying on the bed, when the ankles are pulled up to the buttocks (performed 10 times) - assistance may be required;
• gradual stretching of atrophied areas with vibrational movements.