The Principle Of Modern Rehabilitation: The Goal Should Not Be Functions, But Activities

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The Principle Of Modern Rehabilitation: The Goal Should Not Be Functions, But Activities
The Principle Of Modern Rehabilitation: The Goal Should Not Be Functions, But Activities

Video: The Principle Of Modern Rehabilitation: The Goal Should Not Be Functions, But Activities

Отличия серверных жестких дисков от десктопных
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The principle of modern rehabilitation: the goal should not be functions, but activities

The most common and severe complication after a stroke is movement disorder. Someone recovers quickly enough, while others have complete or partial paralysis forever. Why this is happening, and how physical rehabilitation can help patients, Timur Ivanov, a neurologist and physical therapist at the April rehabilitation center, told Mednovosti.

The principle of modern rehabilitation: the goal should not be functions, but activities
The principle of modern rehabilitation: the goal should not be functions, but activities

Photo: CC0 /

The most common and severe complication after a stroke is movement disorder. Someone recovers quickly enough, while others have complete or partial paralysis forever. Why this is happening, and how physical rehabilitation can help patients, Timur Ivanov, a neurologist and physical therapist at the April rehabilitation center, told Mednovosti.

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Why can stroke cause paralysis?

- Stroke is an acute disorder of cerebral circulation (ACVA). In ischemic stroke, a vessel is blocked and blood stops flowing to the brain. In a hemorrhagic stroke, the vessel breaks and the blood spreads, a hematoma is formed - this is a much more severe form of OMNK. But in any case, the blood supply to the brain is disrupted, oxygen stops flowing and, ultimately, this leads to the death of nerve cells. And since the brain is the control center for our body, then when, as a result of OLSA, some parts of the brain stop functioning and send signals to the muscles, paralysis occurs.

Some people recover well after a stroke, others may have much less luck …

- Recovery occurs thanks to such a property of our brain as neuroplasticity. This is an amazing ability of the brain to learn - that is, if some neurons die, then other nerve cells can take over their function. In some cases, this mechanism is triggered by itself, in others, less favorable, we can start it with the help of physical rehabilitation.

At the same time, neuroplasticity is a double-edged sword. If you start teaching the brain incorrectly - non-physiological movements, wrong states, then it will “remember”, and then it will be difficult to retrain. Therefore, there are two important rules for rehabilitation: it should be started as early as possible, and it is advisable to work with a physical therapy specialist who is well versed in functional anatomy and understands what kind of load can be given depending on the specific person and the degree of damage.

A stroke often causes paralysis on one side of the body. In the first weeks and months, the goal of the physical therapist is to keep the muscles toned and stimulated, even before they regain voluntary movement. When function returns, patients re-learn daily skills and retrain healthy brain cells to control affected areas of the body. Here, in addition to a physical therapist, an occupational therapist and speech therapist should work with the patient.

How are physical therapists different from physical therapists?

- Physical therapy is a new medical specialty for our country. Such professionals should be well versed in functional anatomy, which, unlike conventional anatomy, combines knowledge of the connection of bones and joints, knowledge of muscles, neurology and the science of movement. And, thanks to this, it is good to understand how you can influence the musculoskeletal system. There is still no professional standard for a physical therapist in Russia, and we are looking forward to it when it appears and the systematic training of specialists begins. However, already now, many exercise therapy doctors study independently at various courses, where they teach, including foreign specialists. And gradually a circle of professionals is being formed, working in accordance with modern international practice.

As for physiotherapy, this is a completely different field that studies the effect on the human body of natural factors: heat, cold, light, water, electric and magnetic fields, mechanical stimulation and others.

What does the physical rehabilitation process look like?

–Rehabilitation often begins as early as 24 hours after a stroke. It aims to stimulate the affected muscles and nerves to maintain blood circulation in them and prevent muscle stiffness, which is a severe consequence of a stroke. After that, you need to retrain your muscles and brain using different motor techniques. Specialists know how to help patients retrain complex body movements and avoid complications that could hinder their progress later. Improving balance, coordination, and other basic movement skills is essential for the patient's overall quality of life after stroke. Of course, motor and sensory impairments are very common in these patients, but the chances of recovery increase if the person receives appropriate regular stimulation and support for the affected limbs.

The rehabilitation process begins with an assessment of how impaired the patient's functions are. The physical therapist makes this assessment using special tests and scales. In addition, the specialist finds out what household routines (brushing teeth, going to the toilet, eating, dressing) and life activities that are important specifically for this person, he cannot perform. After that, a rehabilitation plan is drawn up. In this case, the goals of rehabilitation are formed on the basis of activities, not functions. That is, the goal may sound, for example, like this: “In three months Ivan Petrovich will be able to brush his teeth and put on a Velcro jacket”. This is a very important, fundamental principle of modern rehabilitation: the goal should be activities, not functions.

Initially, it is about basic tasks and movements, such as moving safely from bed to chair, for example. They then gradually move on to exercises and tasks that improve balance, help re-master basic coordination skills, and retrain the brain to perform functional tasks such as walking. In addition, physical therapists use a variety of aids to help the person move around until function is restored, from a wheelchair to a walker and walking stick.

Where is it better to undergo rehabilitation - in a hospital or on an outpatient basis? Are there any intensive courses?

- Our brain is designed in such a way that it learns poorly under intense stress. An analogy with a foreign language is appropriate here, which is best to study every day for half an hour or an hour and at the same time take breaks. Neural connections are formed gradually and are fixed in the brain. This is a long process. And if the severity is high, it can take months or years. Therefore, a hospital is needed only in the very first days, and then a long routine recovery process will follow, which is more efficient to carry out on an outpatient basis. Unfortunately, so far we have very few centers that work on an outpatient basis, but they are gradually emerging.

Can I do it myself at home?

- It is possible and necessary. Especially if the violations are not severe. The main thing is not to overdo it, in my practice there were cases when people literally drove themselves. And, of course, it is advisable to do this under the supervision of a physical rehabilitation specialist. But if the violations are serious, then it is more effective to engage in an outpatient center with a specialist, and at home just do some exercises that the specialist showed to relatives.

What should be considered when choosing a physical therapist? How to understand that you are a professional?

- You need to pay attention to the following things. First, the specialist must necessarily assess the impairment of the patient's functions and use scales and tests to determine the quality of movement. Secondly, the result of the assessment should always be the goal of rehabilitation, which is formulated precisely in the form of activity (as in the above-mentioned Ivan Petrovich). The goal is to measure progress and create motivation. And both the assessment and the goal need to be repeated / changed from time to time. And thirdly, in my opinion, a good specialist always teaches the patient's family. Relatives can do a lot to make the recovery faster. With regard to professional competencies, find out what education the specialist received and what kind of experience he has with such patients.The most common techniques for stroke are PNF therapy (Proprioceptive neuromuscular facilitation) and Bobath therapy. It is desirable for the specialist to be proficient in at least one of these techniques and also have knowledge of functional anatomy.

Physical therapy is a new specialty. Is it possible to rehabilitate with her means if the stroke happened 15-20 years ago?

- Rehabilitation is always possible, just the goals will be different. The first six months after a stroke - the most important period - is a true active recovery. Further, there are less and less opportunities to return the lost function, but this does not mean that nothing needs to be done. In 5 and even in 25 years we can work, but this will no longer be the regeneration of brain cells, but an improvement in the quality of movement. Moreover, if you do not practice, then the condition will gradually worsen and regression will come. Therefore, rehabilitation is not only possible, it is mandatory.

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