Providing effective rehabilitation at home is extremely difficult.
The Republican Hospital of Medical Rehabilitation uses advanced rehabilitation technologies and is equipped with state-of-the-art equipment, including kinesitherapy and ergotherapy systems for restoring lost limb functions and fine motor skills, as well as robotic complexes for relearning walking skills and early verticalization. Take advantage of this opportunity.
Proper care for a patient after a stroke is something you can do to ease the course of the disease and promote recovery of functions lost as a result of the stroke.
How to wash the patient, change bed linen, and other aspects of care
If the patient is unable to move independently in bed, it is necessary to:
- Regularly, 2–3 times a day, wash the face, clean the oral cavity in the morning and after each feeding, wipe the body with a damp cloth or towel, then gently pat dry (avoid rubbing the skin!).
- Use anti-decubitus mattresses and rubber rings. The sacrum, heels, and hip areas are the most common sites for skin maceration (inspect these areas daily). If redness appears (the first sign of a pressure sore), avoid placing pressure on the affected area.
- Turn the patient in bed every 2–3 hours. As the condition improves, encourage independent turning (using support on the unaffected arm).
- Use adult diapers, with special attention to perineal care. Air baths with the diaper removed are helpful to dry the skin.
Feeding
In cases of extensive stroke, swallowing may be impaired. Determine whether the patient can swallow independently. Check whether the patient can hold their head up, swallow saliva, and try offering a spoonful of water. If the patient can swallow independently, feed them 4–5 times a day with warm (not hot!) food in small portions in a semi-sitting position. Do not lay the patient down for at least 20 minutes after meals.
Cut food into small pieces to make it easier to grasp and bring to the mouth. Offer water through a straw or by spoon, with the head turned slightly to the side and downward (do not tilt the head backward).
Flour-based foods, sugar, salty, fried, spicy, and fatty foods should be avoided. Increase vegetable intake (beets, carrots), as intestinal atony may develop. The highest caloric intake should be in the first half of the day. With mild swallowing disorders, blended or pureed food is recommended. If choking occurs, thick liquids and purees are usually swallowed more easily; the use of thickeners may be helpful. In severe swallowing disorders, tube feeding is required (also performed in a semi-sitting position).
Monitor urination; in cases of urinary retention, seek medical attention urgently.
Monitor bowel movements, which should be daily. Use beets, prunes, kefir, a teaspoon of vegetable oil, and laxatives only after consultation with a physician.
Blood pressure and pulse monitoring
Both excessively high and low blood pressure are harmful to the recovery of brain cells; therefore, regular (several times a day) blood pressure monitoring is required. Maintain the level recommended individually by the physician.
Physical activity
Gradually, increased muscle tone develops in paralyzed limbs. To prevent future contractures, paralyzed limbs should be positioned in a specific way for 1–2 hours: the arm abducted at a 90° angle, extended at the elbow, with a roll placed in the axilla; the hand opened with fingers spread. The leg should be slightly bent at a 10° angle at the knee, with a roll under the knee, and the foot supported against the bed frame at an 80° angle.
Regular breathing exercises help prevent pneumonia, as hypokinesia and metabolic disturbances easily lead to pulmonary congestion. Exercises may include inflating a rubber balloon or blowing air through water.
Passive joint movements of the paralyzed limb: hold the limb with one hand above the joint being mobilized and the other below it. Perform movements smoothly and rhythmically at a slow pace, without causing pain, 2–4 movements per joint every hour.
Remember: inactivity weakens the patient, while early mobilization is the path to faster recovery.
Early sitting and verticalization (bringing the patient to an upright position). The timing of sitting the patient up after a stroke should be clarified with the physician, as it depends on many clinical factors. On average, for small strokes, sitting may begin from day 2, and verticalization from days 5–7.
Do not assume that prolonged bed rest after a stroke is safer for the patient. This is not the case. Prolonged immobilization leads to venous thrombosis in the legs, pulmonary embolism, congestive pneumonia, spastic contractures, and intestinal atony.
Helping the patient get out of bed is best done in two stages: first assist them to sit on the edge of the bed (supporting with the unaffected arm), and only then help them stand.
As the patient’s condition improves, encourage gradual independent performance of self-care skills and explain the necessary steps.
Remember: your task is to help the patient become independent from outside assistance and relearn lost daily living skills.
When the patient begins to stand and walk, the affected arm should be supported with a special sling or orthosis. Otherwise, downward dislocation of the humeral head may occur due to the weight of the paretic limb, which can later lead to pain and incomplete recovery of arm function. Footwear should be comfortable and stable for walking (not slippers; athletic shoes are preferable).
Protect the patient’s sense of dignity, remain calm, instill confidence and hope for recovery—this is the most important thing you can do for your loved one.
Work together with the patient to expand their mobility and activity levels.