home Audience 2 Massage for cerebrovascular disorders. Massage for acute cerebrovascular accident Indications and expected results

Massage for cerebrovascular disorders. Massage for acute cerebrovascular accident Indications and expected results

For spastic paralysis

First four procedures

Next four procedures

Starting from the eighth procedure

Anterior thigh.

Posterior surface of the leg.

Massage of the back of the foot.

Massage plantar surfaces.

Pressure.
Superficial planar stroking.
Continuous labile vibration.
Light superficial flat stroking.

Breast massage

Back massage,

Massage top limbs.

Anterior surface of the shoulder

Forearm

Brush

For flaccid paralysis

method of M. Ya. Leontyeva

Acupressure.

Shoulder extension

Shoulder abduction.

Lateral rotation of the shoulder.

Internal rotation of the shoulder.

Extension of the hand.

Bending the hand.

Abduction of the hand.

Extension of the fingers .

Opposition I finger

Supination of the forearm.

Pronation of the forearm.

Forearm extension.

Hip flexion.

Hip extension.

Hip abduction.

Hip adduction

Lateral rotation of the hip.

Internal hip rotation

Shin flexion.

Shin extension

Foot extension

Foot flexion ,

Foot abduction

Pronation of the foot.

Finger extension feet.

For dysarthria
For flaccid paralysis

apply on the upper limbs

On the lower extremities:

Due to significant fatigue of paretic muscles, the duration of the massage should increase gradually - first from 5 to 10 minutes and then from 15 to 20 minutes. The course of treatment is 25-30 procedures. Massage should be used for a long time with breaks between courses of at least 10-12 days.

Massage for the consequences of acute cerebrovascular accident

The cause of acute cerebrovascular accidents is most often ischemic (a consequence of vascular thrombosis or embolism) or hemorrhagic (hemorrhage) stroke. Residual effects of strokes are manifested by paresis (decreased muscle strength) or paralysis (complete lack of muscle strength). Paresis and paralysis are called central. They are caused by damage to motor centers and pathways. The tracts are called pyramidal (spastic). Paresis and paralysis are characterized by increased muscle tone, high tendon reflexes, and pathological signs. The first time after a stroke, muscle tone may be reduced, but then it increases.

With pyramidal paresis, the arm is brought to the body and bent at the elbow. The hand and fingers are bent. The leg is extended at the hip and knee joints. The foot is bent and the sole is turned inward.

In paretic (weakened) limbs, synkinesis (cooperative movements) occurs. They can be imitative and global. With imitative synkinesis, movement occurs on one limb while the other moves; when the healthy limb moves, the diseased one also moves. With global synkinesis, when trying to perform isolated movements, flexion contracture (muscle tension) in the arm and extension contracture in the leg intensify: when trying to straighten the arm, the arm bends even more, and in the leg it unbends. Because The attachment points of individual muscles are brought closer together for a long time; these muscles shorten over time. Prolonged rest leads to joint stiffness. Movement is worsened by cold, excitement, and fatigue.

Purpose of massage– reduce the reflex excitability of spastic muscles, weaken muscle contractures, activate stretched muscles, promote the restoration of movement, trophic disorders (cold skin, swelling, discoloration).

The massage area is paretic limbs, back with lower back and chest on the affected side.

Techniques– stroking, spiral rubbing. For the antagonist of spastic muscles - kneading, best of all gentle longitudinal, felting and pressure. Intermittent vibration is contraindicated. If tolerated, continuous vibration can be used.

Starting position: lying on your back, with a bolster under your knees. If synkinesis appears, the non-massaged limb is fixed with a bag of sand. The outer surface of the leg can be massaged on the healthy side, and the back surface on the stomach. A pillow is placed under the stomach and a bolster is placed under the ankle joint.

Massage sequence. First, massage the front surface of the leg, then the pectoralis major muscle on the affected side, the arm, the back surface of the leg, and the back. The limbs are massaged from the proximal parts.

Before the massage, it is necessary to relax the muscles by shaking, passive exercises at a slow pace (for example, rolling a rolling pin with your palm or sole), light shaking of the muscles of the thigh and chest, and warming the limb. To relax the foot muscles, use a light massage and shaking the Achilles tendon.

1. Massage of the lower limb.

a) First, continuous light superficial planar and grasping stroking, spiral rubbing of the thigh are performed, then selective massage of the muscles of the anterior, internal and posterior groups, because The muscle tone is high, then massage them gently.

b) Massage of the gluteal muscles.

c) Calf massage. General impact, stroking and rubbing, then selective muscle massage. The muscles of the front and outer surface of the lower leg are stroked, rubbed and kneaded. The back surface of the lower leg is massaged with gentle stroking and rubbing. The Achilles tendon should be massaged carefully.

d) Foot massage. On the back of the foot, stroking, rubbing, and kneading are used. The tone on the sole is high, comb-like kneading is used, preventing extension of the first toe (Babinsky's symptom).

2. Massage of the pectoralis major muscle. Carry out a gentle massage, superficial planar stroking, you can use light rubbing and shaking.

3. Massage of the upper limb.

a) Shoulder massage begins with the trapezius, latissimus, deltoid and pectoral muscles. When massaging the back, a special effect is applied to the trapezius and latissimus muscles.

A preparatory shoulder massage is carried out, stroking and rubbing, and then a selective muscle massage.

b) Forearm massage. A general effect is performed (stroking and rubbing), then a selective massage. First, the extensors are massaged (stroking, rubbing, kneading), then the flexors (stroking and rubbing).

c) Hand and fingers. First, massage the fingers, then the back and palmar surfaces of the hand. On the back side - stroking, rubbing and kneading, on the palmar surface - stroking and light rubbing.

4. Back massage. They use all known techniques, but gentle ones.

1. Each technique is repeated 3-4 times.

2. In the first three procedures in the early stages after a stroke, only massage of the proximal limbs is performed, without turning onto the stomach.

3. In the 4th – 5th procedure, massage of the chest, distal parts of the extremities (lower leg with foot and hand with forearm) is added with a turn to the side.

4. From the 6th to 8th procedure, add a massage of the back and lower back. At a later stage, the prone position is used.

5. After two months or more, during the first three procedures, massage of the limbs is carried out, after the third, massage of the back and lower back is added.

6. When massaging the hand, keep the 3rd – 5th fingers extended, and the first one abducted. When massaging the legs, lift the outer edge of the foot and place the foot at an angle of 90 degrees to the shin.

7. If you complain of heaviness in the head, headache. dizziness is added by massage of the head, neck and collar area. The technique depends on blood pressure.

8. On the day of an epileptic seizure, massage is not performed.

9. Massage is combined with exercise therapy and positional treatment.

Treatment by position carried out from the first days of the disease to counteract the formation of contractures or to reduce them.

ü The foot is fixed at an angle of 90 degrees, pronated, and a board, box, etc. is placed at the foot end of the bed to support the foot.

ü Extend your arm from your body to an angle of 90 degrees or as far as possible.

ü The shoulder is positioned outward, the forearm is supinated, the fingers are almost straightened. A bag of sand is placed on the palm, the first finger is retracted, and the hand is placed on a chair next to the bed.

Treatment with positioning is carried out 3-4 times a day for 10-40 minutes, depending on the patient’s condition. In a state of sleep, position treatment is not carried out.

10. Passive movements are included in the early stages of the disease.

There should be only one exercised joint between the massage therapist’s hands. Before passive movements, active movements are performed on a healthy limb, the same as the subsequent passive ones. Subsequently, active movement on the healthy limb is performed simultaneously with passive movement of the diseased limb. Subsequently, these movements are performed alternately: during active movement, the healthy limb is flexed, and the diseased limb is passively extended.

11. It is better to start active movements with movement in the horizontal plane, when you do not need to overcome gravity. It is better to bend and straighten your leg on your side.

You should strive for flexion and external rotation of the shoulder, extension and supination of the forearm, extension of the hand and all five fingers, abduction and adduction of the bent hip, flexion of the hip at the hip joint during internal rotation, flexion of the shin, dorsiflexion of the foot when while simultaneously lifting its outer edge.

12. When it is allowed to sit, passive movements are carried out for the upper limbs - raising and lowering the scapula, adducting and abducting the scapula to the spine. The forearm and hand are extended.

13. When walking, pay attention to the position of your foot, do not move it to the side, and do not touch the floor with your toe. Place your feet correctly. It is enough to bend your leg at the hip and knee joint.

14. Duration of the procedure is from 5-10 to 15-20 minutes (according to Mashkov - up to 25 minutes). Course – 20-30 procedures. The break between courses is 14 days.

Acupressure for the consequences of acute cerebrovascular accident

Acupressure helps regulate the processes of excitation and inhibition in the cerebral cortex, as well as normalize the reciprocal relationships of antagonist muscles.

The starting position of the patient during acupressure is lying on his back.

Massage always begins with the upper limbs, preferably in combination with passive movements in the corresponding joints of the massaged limb.

Methodology, sequence of influence ( rice. 122, 123).

Rice. 122. Topography of “impact points” for acupressure during rehabilitation of post-stroke patients: a – on the chest, on the back; b – on the upper limbs

To relax or stimulate the muscles of the shoulder girdle, the following points are affected:

1. Jian-jing - on the line corresponding to the middle of the shoulder girdle, in the central part of the periosteal fossa.

2. Jian-yu - on the shoulder between the acromion and the greater tuberosity of the humerus (downward and anterior to the acromion).

3. Zhou-rong - in the second intercostal space, along the 3rd line of the chest, on the pectoralis major muscle.

4. Nao-shu - posterior to the fossa of the shoulder joint in a vertical line with the armpit (well defined when raising the arm).

5. Fu-fen - between the 2nd and 3rd thoracic vertebrae on the 2nd line of the back, at the inner upper edge of the shoulder blade

6. Gao-huang - at the level between the 4th and 5th thoracic bells on the 2nd line of the back, at the inner edge of the scapula D 4-3/2.

7. Bi-nao - on the outer side of the humerus at the posterior edge of the deltoid muscle and at the outer edge of the triceps brachii muscle.

8. Chi Quan – on the shoulder at the level of the axillary fold, directly at the lower edge of the pectoralis major muscle.

9. Jiang-zhen - down and behind the shoulder joint along the posterior axillary line, between the humerus and scapula.

To relax the flexors and pronators of the upper limb, the following points are affected:

1. Qu chi - in the area of the elbow joint at the end of the fold formed when bending the elbow joint on the side of the 1st finger.

2. Chi-tse - in the fold of the elbow at the outer edge of the biceps tendon.

3. Shao-hai - in front of the internal condyle of the ulna in the cavity, here the ulnar nerve is palpated with deep pressure.

4. Nei-guan – 2 cun above the middle of the wrist fold towards the elbow joint.

5. Da-lin - in the center between the wrist folds on the inner surface of the wrist joint.

6. Lao Gong - in the middle of the palm, when bending the fingers between the 3rd and 4th fingers (end phalanges).

7. Shih xuan – the tips of all 10 fingers (their distal phalanges).

8. Shou-san-li - on the back of the forearm 2 cun below the elbow fold, towards the 1st finger.

9. He-gu - at the top of the mound, formed by squeezing the 1st and 2nd fingers of the hand together, on the back of it.

To stimulate the abductors and other muscles, the hands act on the points:

1. Xiao-le - in the middle of the back surface of the triceps brachii muscle, 5 cun above the elbow joint, in the direction of the shoulder joint.

2. Yan-chi - on the dorsum of the wrist joint, in the center of the wrist fold.

3. Wai-guan - 2 cun above the yang-chi point, between the tendon of the common extensor of the fingers and the extensor of the 5th finger.

4. E-men - on the dorsum of the hand between the metacarpophalangeal joints of the 4th and 5th fingers, at their base.

5. Shih Xuan - on the tips of all 10 fingers.

6. Yan-xi - between the tendons of the long and short extensor of the 1st finger, in the anatomical snuff box.

7. Yang-gu - in the cavity between the styloid process of the ulna and the triquetral bone of the wrist.

8. Tian-ching - above the olecranon process, in the cavity of the olecranon fossa.

To relax the muscles that extend the thigh and lower leg, the following points are affected:

1. Bi-guan - on the front surface of the thigh, in the middle of the inguinal fold below it, 1 cun towards the knee joint.

2. Huan-tiao - in the depression in the middle of the gluteal muscle; when bending the leg at the knee joint, the heel is pressed against the point area.

3. Fu-tu - on the front surface of the thigh 6 cuns above the upper edge of the patella.

4. Du-bi - in the depression outward from the patella, at the level of its lower edge.

5. He-din - in the middle of the upper edge of the patella, where it is clearly visible when the leg is bent at the knee joint.

6. Cheng-jin – below the middle of the popliteal fossa, a fold of 5 cun between the bellies of the gastrocnemius muscle.

7. Cheng Shan - 3 cun below the Cheng Jin point or in the center of the back surface of the lower leg, in the depression at the junction of both bellies of the calf muscle.

8. Kunlun - behind and below between the outer ankle and the heel tendon.

To stimulate active contractions of the leg flexors, the following points are affected:

1. Cheng fu - in the center of the subgluteal fold.

2. Yin-men - in the middle of the back of the thigh between the biceps and semitendinosus muscles, 6 cun below the subgluteal fold.

For stimulation (and more often for relaxation, depending on the patient’s condition), the following points are applied on the inner thigh:

1. Yin-bao - in the middle of the lateral surface of the thigh, its inner side, 5 cun above the knee joint.

2. Ji-men - on the inner surface of the thigh, in the cavity at the inner edge of the quadriceps muscle, midway above the upper edge of the patella by 6 cun.

To stimulate the muscles that extend the foot and toes, the following points are affected:

1. Yin Ling Quan - on the inner surface of the lower leg, at the posterior edge of the inner condyle of the tibia.

2. Yang Ling Quan – at the anterior lower edge of the head of the fibula, in line with the Yin Ling Quan point, on the sides of the knee joint.

3. Zu-san-li (longevity point) 3 cun below the lower edge of the patella and 1 cun outward from the midline of the shin, under the joint of the fibula and tibia.

4. Jie-si - in the middle of the dorsum of the ankle joint, in the center of the fossa formed when the foot bends towards itself.

5. Shan Qiu - on the inner surface of the foot, in front and below the inner ankle.

6. Qiu-xu - on the back of the foot in front and below on the outside of the ankle.

7. Pu-shen – a series of points (5–6) along the outer edge of the foot, starting from the toes.

8. Yongquan - in the center of the plantar surface between the 2nd and 3rd toes, when the toes are compressed on the sole, a fold is formed, in the center of which there is a point.

Massage for acute cerebrovascular accident

Classical and TM massage for stroke.

Classical massage in the treatment of the consequences of acute cerebrovascular accident.

Position the patient lying on his back.

With this disease, special care should be taken to ensure that the patient’s head, torso, and limbs are in the most comfortable physiological position.

Begin the massage from the lower extremities, and it is customary to start it from the affected limb and carry it out from the proximal to the distal parts (thigh, lower leg, foot).

Then massage the back, shoulder girdle (area of the trapezius muscle), chest, paying mainly attention to the affected side.

When determining the set of techniques and their sequence, it is necessary to take into account that fatigue quickly occurs in paretic muscles under the influence of massage. That's why massage should not be long, and the techniques should be performed in a gentle manner. Otherwise, the course may result in persistent muscle weakness; cases of increased muscle atrophy have been described.

For spastic paralysis, where massage is carried out with the aim of reducing reflex excitability in the muscles and improving their trophism, it is recommended to start the session with exercises that restore the ability to relax the muscles, developing the ability to inhibit muscle spasms during movements. Therefore, in the first sessions you should not use kneading and impact techniques, as they increase reflex excitability. But it is not advisable to abandon them for a long time, because it is they who, to a greater extent, revive blood and lymph circulation in inactive muscles and prevent the occurrence of trophic disorders. The success of the course depends on how quickly the patient learns, at least partially, to inhibit involuntary muscle contractions at rest and during movement and can be massaged using all types of techniques and quite intensively. In any case, it is necessary to massage a patient during the recovery period of acute cerebrovascular accident with the utmost caution. The following sequence of restorative massage treatment is recommended:

First four procedures- massage only the proximal limbs, without changing the patient’s position.

Next four procedures- massage the entire limbs and chest. If the patient’s condition allows (this is decided not by the massage therapist, but by the attending physician), you can put him on his healthy side and massage his back and collar area.

Starting from the eighth procedure, you can change the position of the patient (lying on his back, on his stomach) and, along with the limbs and chest, completely massage the back and lower back.

Anterior thigh.

Light flat stroking from bottom to top.
Light grasping stroking in the same direction.
Continuous labile vibration.

Posterior thigh. Perform movements more energetically.

Posterior surface of the leg. The complex here is the same as on the front surface of the thigh - extremely gentle. Massage the heel tendon with extreme caution so as not to increase the tone of the foot muscles.

On the front surface of the leg a more energetic complex should be recommended.

Massage of the back of the foot.

Superficial planar stroking.
Embracing stroking.
Rubbing with the first fingers in a spiral manner along the intermetatarsal spaces.
Embracing stroking.
Rubbing in a spiral manner with the supporting part of the brush.
Pressure.
Superficial planar stroking.
Kneading is forceps-shaped.
Hatching.
Superficial planar stroking.
Continuous labile vibration.
Superficial planar stroking.

Massage plantar surfaces. Movements are performed gently, carefully with low intensity.

Light superficial flat stroking.
Rubbing with the first fingers in a spiral manner along the intermetatarsal spaces.
Pressure.
Superficial planar stroking.
Continuous labile vibration.
Light superficial flat stroking.

Breast massage is performed according to the traditional scheme in a gentle mode (here the muscle tone is quite high) - without kneading and impact techniques.

Back massage, including the latissimus dorsi muscle, shoulder girdle with transition to the deltoid muscle. In these areas, muscle tone is not so high, so massage can be performed much more energetically, and the range of techniques should be expanded by kneading.

Massage top limbs. You can apply the same complex that is recommended for the lower limb, in relation to the parts of the arm.

Massage from the back of the shoulder , where the movements are carried out energetically and in full range (as on the back of the thigh).

Anterior surface of the shoulder massaged in a gentle manner using a shortened complex (as for the front surface of the thigh).

Forearm massaged gently on the front surface, vigorously on the back.

Brush You can massage it quite vigorously on both sides, but it is better to use a gentle regime on the palmar surface.

Session duration is 15-20 minutes. A course of 12-15 procedures.
For flaccid paralysis massage effects are carried out using a stimulating method (vigorously, with a noticeable increase), while for spastic paralysis, sedative (inhibitory) techniques are used, in which the efforts of the massage therapist should be very moderate. This is some of the vulnerability of classical massage techniques in the treatment of spasticity, since even its most gentle techniques, under certain conditions or with minor mistakes by the massage therapist, can cause an increase in muscle tone. In this regard, acupressure and linear massage are highly recommended as an effective and harmless means of relaxing spastic muscles.

However, the method of using these types of massage for central (spastic) hemiparesis is not simple, since it involves combining physical therapy with an inhibitory effect on some points and stimulation of others in one session.

It seems the most effective method of M. Ya. Leontyeva(1974), which provides for each area of the body:

Acupressure.
Smooth, slow passive movements (3-5) together with acupressure.
Similar active movements of the same segments of the healthy limb.
Active (if possible) or passive movements with synchronous volitional impulses sent to the patient (idiomotor movements, in the absence of voluntary muscle contractions).

Active movements - 6-12 times, idiomotor movements - 3-5 times.

This part of the session is also accompanied by acupressure.

The session execution sequence is as follows:

Upper limb - movements in the shoulder joint, in the joints of the hand and fingers, in the elbow joint.

Lower limb: thigh - lower leg - foot. Session duration is 35-40 minutes.

During the session, 8-12 TA are massaged. Course 15-20 sessions.

Approximate session diagram (physical therapy and acupressure)

Flexion of the shoulder to horizontal. Before starting the movement, brake massage RP20 Zhou-rong (frontal area), then VB21 Jian-jing (shoulder girdle) or GI15 Jian-yu (acromion).

Shoulder extension . If it is difficult, stimulate GI14 Bi-nao.

Full extension is facilitated by braking at the moment of movement NW Shao-hai, R5 Chi-tse, RZ Tian-fu.

In the absence of contractions during idiomotor movement, stimulate RP20 Zhou-rong or

Shoulder abduction. Before moving, brake massage RP20 Zhou-rong, C1 Ji-quan, IG9 Jian-zhen.

Lateral rotation of the shoulder. Before movement, the muscles that internally rotate the shoulder are inhibited by massage

C1 Ji-quan, IG9 Jian-zhen, or stimulate IG10 Nao-shu, IG12 Bing-feng.

Internal rotation of the shoulder. Facilitated by stimulation of C1 Chiquan, IG9 Jianzhen

or inhibition of IG10 Nao-shu, IG12 Bing-feng.

Extension of the hand. Da-lin's MC7 and Yang-chi's TR4 are braked at the same time

or stimulate TR5 Wai-guan, TR6 Zhi-gou.

Bending the hand. As a rule, it turns out without any difficulties.

Abduction of the hand. GI4 He-gu is braked together with GI5 Yan-xi.

Extension of the fingers . Movement is difficult. Both before and during movement it is necessary to brake GI4 He-gu, preferably together with IG3 Hou-si. For fingers I-II, combine with GI5 Yan-xi braking.

Opposition I finger facilitated by stimulating PI0 Yu Chi or inhibiting MC8 Lao Gong.

Supination of the forearm. In the case of high tone of the pronator teres, P5 Chi-tse, P6 Kun-ju, P7 Le-que, P9 Tai-yuan are inhibited.

Pronation of the forearm. As a rule, acupressure is not required, as is the case with forearm flexion.

Forearm extension. Before and during movement, the brakes are RZ Tian-fu, R5 Chi-tse, preferably in conjunction with NW Shao-hai, MSZ Qu-tse, GI10 Sho-san-li.

If the patient's condition allows it, it is better to conduct the session on the side.

Hip flexion. Before the movement begins, E35 Du-bi, E34 Liang-qiu, E32 Fu-tu are braked. During movement, E31 Bi-guan, E32 Fu-tu are stimulated.

Hip extension. Before moving, the E32 Futa is braked.

During movement, VB30 Huang-tiao, V36 Cheng-fu are stimulated.

Hip abduction. Movement is facilitated by braking RP10 Xue-hai, RP11 Ji-men, R10 Yin-gu.

Hip adduction facilitated by stimulating R10 Yin-gu, RP10 Xiu-hai.

Lateral rotation of the hip. Braking massage R10 Yin-gu, RP10 Xiu-hai, stimulating VB30 Huang-tiao, E31 Bi-guan.

Internal hip rotation facilitated by the opposite effect on the same points.

Shin flexion. Before movement, the increased tone of the quadriceps femoris muscle is neutralized by inhibition of E31 Bi-guan, E32 Fu-tu.

During movement, V40 Wei-chung and V56 Cheng-jin are carefully stimulated.

Shin extension facilitated before starting to move by braking V36 Cheng-fu,

during movement - by stimulating V32 Fu-tu, VB34 Yang-ling-quan.

Foot extension facilitated before moving by braking V56 Cheng-jin, V57 Cheng-shan,

and during movement - by stimulating E41 Jie-si, E44 Nei-ting.

With equinovarus foot placement , to eliminate the pathological posture, V56 Cheng-jin, V57 Cheng-shan, R3 Tai-si are inhibited,

and then during abduction and extension of the foot (passive or active with help) stimulate

V62 Shen-mai, V60 Kun-lun with VB40 Qiu-xu.

Foot flexion , usually does not require TA massage.

Foot abduction requires preliminary braking R8 Chiao-xin, P4 Zhong-feng.

During movement, V60 Kunlun, V62 Shen-mai, V63 Jin-men are stimulated.

Pronation of the foot. Before moving, they slow down RP2 Da-du, RP3 Tai-bai, RP5 Shang-qiu,

during movement they stimulate V60 Kunlun, V62 Shen-mai, VB40 Qiu-xu.

Finger extension feet. Before moving, they brake F3 Tai-chun, VB41 Tzu-lin-chi.

During movement, E41 Jie-hsi and E42 Chun-yang are stimulated.

For dysarthria, accompanying spastic paralysis, inhibition of VG26 Ren-chung, VG27 Dui-duan, VC24 Cheng-jian, EZ Ju-liao, E4 Di-tsang, E6 Jia-che, IG18 Quan-liao, IG19 He-liao has a good effect. In one session, 1-2 midpoints and two pairs of symmetrical ones are massaged.
For flaccid paralysis

apply on the upper limbs stimulating massage TA E12 Que-pen, TR14 Jian-liao, TR4 Yang-chi, IG5 Yang-gu, IG9 Jian-zhen, SZ Shao-hai, MS7 Da-lin, P5 Chi-tse, GI11 Qu-chi, GI4 He -gu.

On the lower extremities: RP12 Chung-men, RP10 Xue-hai, VB34 Yang-ling-quan, VB31 Feng-shi, VB3O Huang-tiao, VB29 Ju-liao, E36 Tzu-san-li, E41 Jie-si, V40 Wei-chung, V57 Cheng-shan, V60 Kun-lun, R3 Tai-si.

Massage for the consequences of cerebrovascular accident

Article: Massage for the consequences of cerebrovascular accident

The most common cause of circulatory disorders in the vessels of the brain is stroke: hemorrhagic (hemorrhage) or ischemic (thrombosis, embolism). Hemorrhagic stroke caused by rupture of blood vessels, diapedesis, occurs suddenly. In ischemic stroke caused by thrombosis and vasospasm, vascular catastrophe develops slowly. Stroke and its residual effects are manifested by paresis and paralysis.

Paralysis and paresis during stroke are caused by damage to motor centers and pathways. They are called central, or spastic, and are characterized by increased muscle tone, involuntary cooperative movements (syncinesia), high tendon reflexes and the presence of pathological reflexes. Lesions of the pyramidal fibers in the internal capsule or the pyramidal fasciculus in the brain stem cause central hemiplegia on the opposite side, while lesions of the cerebral cortex cause monoplegia. At first after a stroke, the tone of paralyzed muscles is often low, but after a few days or weeks the muscle tone increases.

Hypertension, or spasticity, of the muscles is the result of increased reflex tone, which leads to typical contractures. With pyramidal hemiplegia, the arm is usually brought to the body and bent at the elbow joint. The hand and fingers are also in a flexed position. The leg is extended at the hip and knee joints. The foot is flexed (dorsiflexion) and the sole is turned inward (supination).

Synkinesia occurs in paretic limbs as a reflex. Active contraction of the muscles of healthy limbs is accompanied by contraction of the muscles of paralyzed limbs. Synkinesia increases hemiplegic contractures. In the upper limb, flexion of the elbow joint, hand and fingers is noted, and in the lower limb, extension increases. Such synkinesis is called global, covering the entire limb. There is also imitation and coordination synkinesis.

Massage for central paralysis is carried out to reduce the reflex excitability of spastic muscles, weaken muscle contracture, activate stretched, atrophic muscles, which helps restore motor function and trophic disorders.

Indications. In the absence of a comatose state, massage and positioning treatment are possible already on the second day after a stroke (L. A. Guseva, 1962); G. R. Tkachev (1964) recommends massage during the first 10 days; A.F. Verbov (1966) - 15-20 days after a stroke, provided the condition is satisfactory. 3. S. Melnitskaya advises, taking into account the patient’s condition, to selectively prescribe massage, passive and active exercises in combination with positional treatment during the first week after a stroke (for thrombosis - on the 8th day, for hemorrhage - on the 6-7th day) . V.N. Moshkov recommends massage from the beginning or middle of the second week.

Contraindications: increasing hemiparesis, severe headache, pain in the heart, elevated body temperature.

Massage for the consequences of cerebrovascular accident - Methodology

You should approach the appointment of massage for spastic paralysis with caution and trust only experienced massage therapists to perform it. In the initial stage of hemiplegia, when muscle hypertension has not yet developed and their tone is reduced, the use of any intense massage effects is contraindicated. Before starting the massage, it is recommended to achieve the greatest possible relaxation of the muscles on the sore side through special exercises. First, exercises should be performed to relax the muscles of the healthy limb. Then, giving the patient a calm, comfortable position in a lying position, they teach him to relax the muscles, starting with the distal parts of the limb. This leads to decreased muscle tone and decreased synkinesis. In order not to cause hyperkinetic reflexes, it is recommended to massage with warm hands, and pre-warm paretic limbs.

In the first days after a stroke, some specialists use stroking and rubbing techniques to prevent or reduce trophic disorders and muscle contracture, trying to massage the arm extensors and leg flexors more. To prevent contracture, massage is combined with positional treatment. Using splints and sandbags, the limbs are given a certain position after the massage. The hand is fixed at maximum abduction in the shoulder joint, in the position of extension of the elbow and wrist joints, with a slightly supinated hand and maximally extended and spread fingers. To prevent extension contracture, the foot is fixed at an angle of 90°. The fixation time is set individually for each patient.

Experience in treating patients with post-stroke movement disorders has shown that massage in combination with positional treatment, passive movements and muscle relaxation exercises is a means of helping to restore impaired motor functions and prevent trophic disorders. At the same time, in the initial period of the disease, in order not to cause an increase in hemiparesis, you can use only the techniques of superficial stroking and gentle rubbing. In order to adapt the patient to extraproprioceptive stimulation, it is recommended to first massage the healthy limb, also using techniques that have a calming, inhibitory effect on the central nervous system. The massage begins with the lower limb, where reflex neuromuscular excitability is less pronounced than on the upper limb.

In the future, with an increase in muscle tone, the appearance of contracture and trophic disorders, massage in the complex treatment of patients with hemiplegia is becoming increasingly important. Properly performed massage helps to weaken excitation processes in the cerebral cortex and reduce the excitability of motor cells in the anterior horns of the spinal cord. During this period it should not be intense. This is also important for those patients who begin massage months and years after a stroke. Intense massage can aggravate the pathological condition of the muscles and negatively affect the normalization of the ratio of ago- and antagonist tone. The patient can react to even the slightest pain with increased muscle spasticity and synkinesis.

Massage is carried out differently. Muscles in which the tone is increased are massaged with soft, gentle stroking and rubbing techniques at a slow pace. Stretched, atrophic, weakened muscles are massaged using the same techniques, but more intensely, without, however, causing pain. During the first procedures, the techniques of grasping and pincer-like stroking, as well as rubbing, are used superficially. Massage is combined with muscle relaxation exercises and passive movements. If tolerated well, gentle kneading is used: without displacing the muscles, they resort to the techniques of felting, longitudinal kneading and pressing. First, kneading is used on stretched, hypotrophied muscles, and then on spastic muscles. Intermittent vibration techniques (patting, tapping, chopping, etc.) are contraindicated. At the same time, you can use gentle, continuous vibration using an electric vibrator if it does not cause increased muscle tone and synkinesis. If a patient develops trophic disorders of bones, ligaments, tendons, joint capsules, which is most often observed in the hand, shoulder, ankle joints, massage is carried out after warming the joints.

To reduce the excitability of the motor cells of the spinal cord and influence trophic processes, massage the paravertebral spinal segments (in the areas S5-S1, L5-L1, D12-D10 for the lower limbs and D2-D1, C7-C3 for the upper limbs) .

The duration of massage for spastic paralysis is set strictly individually and depends on the clinical form, course of the disease and the reactivity of the patient’s body. The first massage procedures should not exceed 5-10 minutes, later their duration is increased to 15-20 minutes.

At the stage of developed muscle spasticity, you can use the following technique proposed by L.L. Guseva. Massage of the paretic arm begins with the distal sections. Perform forceps-like stroking of the lateral, palmar and dorsal surfaces of the fingers, circular stroking and light rubbing of the interphalangeal and metacarpophalangeal joints. The finger massage is completed with passive movements in each joint. Then massage the back and palm surfaces of the hand, using only stroking. Massage of the extensors of the forearm and shoulder is carried out more energetically, using stroking, rubbing and, if the muscle layer is sufficiently developed, kneading. When massaging the extensors, special attention is paid to rubbing the tendons. The deltoid muscle, usually stretched and atrophic with central hemiplegia, is massaged using stroking techniques and vigorous rubbing. To combat adductor contracture of the shoulder joint, caused by increased tone of the pectoralis major muscle, latissimus dorsi muscle and subscapularis muscle, stroking and gentle rubbing in a circular direction are used. Foot massage also begins with the distal sections. Spastically contracted muscles are massaged using gentle stroking, rubbing and kneading techniques. Paretic antagonists are affected by the same, but more energetic techniques. In case of significant swelling of the limb, suction massage is used.

Consequences of acute cerebrovascular accident

Objectives of massage. Improve blood and lymph circulation, promote restoration of function, counteract the formation of contractures, help reduce increased muscle tone, reduce friendly movements, as well as trophic disorders in the limbs, promote general health, strengthen the body, reduce pain.

Methodology. A classic massage is performed. It is more rational to start the massage with the patient in the supine position (under the knee - a roller, if necessary, then a fixing bag of sand on the foot if synkinesis appears on the non-massaged limb). They start with stroking, light rubbing and continuous labile vibration on the front surface of the thigh (for relaxation), then the same relaxation techniques on the inner surface of the thigh. On the back of the thigh, techniques can be done more energetically, with kneading, pressing, and spiral rubbing.

Massage of the affected lower limb is carried out from the proximal part to the distal parts, i.e., having massaged the thigh, then massage the lower leg area, on the back surface all gentle techniques are used: stroking, rubbing, continuous labile vibrations, on the front surface all techniques can be carried out more energetically (comb-shaped stroking , spiral-shaped, comb-shaped rubbing, pincer-shaped kneading, pressing, vibration, shading, planing). When massaging the foot on the back of the foot, all techniques can be performed more energetically than on the sole, where light stroking, rubbing, pressing, and continuous labile vibration are required. Gently massage the heel tendon. Avoid causing Babinski's sign (sharp dorsal extension of the first toe).

After massage of the lower limb, they move on to massage the upper limb on the affected side. The procedure begins with the area of the pectoralis major muscle; most often its tone is increased, so all techniques are carried out using a gentle technique - light stroking, rubbing, relaxing vibration. Then they massage the area of the shoulder girdle, back, trapezius muscles, deltoid - here the tone is low, and manipulations can be carried out more energetically, using stroking, comb-shaped spiral rubbing, forceps kneading, pressure, vibration using shading, alternating them with other types of techniques. After this, they move on to a shoulder massage, on the front surface of which all techniques are used in a gentle way, and on the back surface you can resort to more energetic influences. Begin the massage from the back of the shoulder - stroking, rubbing, kneading, vibration. Specially affects the shoulder joint. Then a forearm massage is carried out, where the inner surface is gently affected, and on the outer side of the forearm and on the hand, all techniques can be carried out more energetically.

When massaging the hand, you should identify painful points (usually on the palmar surface), trying to have a relaxing effect on them. When the patient has the opportunity to lie on his side or stomach, the back, lumbar region, and pelvis are massaged. All techniques are carried out sparingly.

Guidelines

In each procedure, repeat massage techniques 3-4 times.

During the 1st-2nd procedures, the area of influence is insignificant (only the proximal parts of the limbs, do not turn the patient on his back).

From the 4-5th procedure, if the patient has a good response to manipulation, expand the area of influence to the distal limbs, chest, turning to the healthy side - massage of the back, collar area.

From the 6th-8th procedure, the back and lumbar region are fully massaged (the patient lies on his stomach). Combine massage with other types of treatment

(treatment with positioning, balneotherapy, electrical procedures, aeroionization, etc.). Massage can be prescribed both before and after these procedures, in consultation with your doctor.

Timely treatment with the use of various therapeutic methods has a beneficial effect on the patient’s condition. There are 3 stages of treatment: early recovery (up to 3 months), late recovery (up to 1 year) and the stage of compensation for residual motor function disorders (over 1 year).

The most beneficial effect is exerted by therapeutic exercises in combination with acupressure.

Acupressure for the consequences of acute cerebrovascular accident. Acupressure helps regulate the processes of excitation and inhibition in the cerebral cortex, as well as normalize the reciprocal relationships of antagonist muscles.

The starting position of the patient during acupressure is lying on his back. Massage always begins with the upper limbs, preferably in combination with passive movements in the corresponding joints of the massaged limb.

Methodology, sequence of influence(Fig. 131, 132). To relax or stimulate the muscles of the shoulder girdle affect points:

Jian-ching - on the line corresponding to the middle of the shoulder girdle, in the center of the supraspinatus fossa;

Jian-yu - on the shoulder between the acromion and the greater tuberosity of the humerus (downward and anterior to the acromion);

Zhou-rong - in the second intercostal space, along the 3rd line of the chest, on the pectoralis major muscle;

Nao-shu - posterior to the fossa of the shoulder joint in a vertical line with the armpit (well defined when raising the arm);

Fu-fen - between the II and III thoracic vertebrae on the 2nd line of the back, at the inner upper edge of the scapula (Th 2 _ 3/2);

Gao-huang - at the level between the IV and V thoracic vertebrae on the 2nd line of the back, at the inner edge of the scapula (Th^^);

Bi-nao - on the outer side of the humerus at the posterior edge of the deltoid muscle and at the outer edge of the triceps brachii muscle;

Ji Quan - on the shoulder at the level of the axillary fold, directly at the lower edge of the pectoralis major muscle;

Jian-zhen - down and behind the shoulder joint along the posterior axillary line, between the humerus and scapula.

To relax the flexors and pronators of the upper limb affect points:

Qu-chi - in the area of the elbow joint at the end of the fold formed when bending the elbow joint, on the side of the first finger;

Chi-tse - in the fold of the elbow at the outer edge of the tendon of the biceps brachii muscle;

Rice. 131. Points of influence during the rehabilitation of post-stroke patients

Shao-hai - in front of the inner condyle of the ulna in the cavity; here, with deep pressure, the ulnar nerve is palpated;

Nei-guan - 2 cun above the middle of the wrist fold towards the elbow joint;

Da-lin - in the center between the wrist folds on the inner surface of the wrist joint;

Lao-gong - in the middle of the palm, when bending the fingers between the third and fourth fingers (end phalanges);

Shi-xuan – the tips of all 10 fingers (their distal phalanges);

Shou-san-li - on the back of the forearm 2 cun below the elbow fold, towards the first finger;

He-gu - at the top of the mound, formed by squeezing the first and second fingers of the hand together, on the back of it.

To stimulate the abductors and other muscles of the arm affect points:

Xiao-le - in the middle of the posterior surface of the triceps brachii muscle, 5 cun above the elbow joint, in the direction of the shoulder joint;

Yang-chin - on the dorsum of the wrist joint, in the center of the wrist fold;

Wai-guan - 2 cun above the yang-chi point, between the tendon of the common extensor of the fingers and the extensor of the fifth finger;

E-men - on the dorsum of the hand between the metacarpophalangeal joints of the fourth and fifth fingers, at their base;

Shih Xuan - at the tips of all 10 fingers of the hand;

Yan-si - between the tendons of the long and short extensor of the first finger, in the anatomical snuffbox;

Yang-gu - in the cavity between the styloid process of the ulna and the triquetral bone of the wrist;

Tian-ching - above the olecranon process, in the depression of the olecranon fossa.

To relax the muscles that extend the thigh and lower leg, affect points:

Bi-guan - on the front surface of the thigh, in the middle of the inguinal fold below it, 1 cun towards the knee joint;

Huan-tiao - in the cavity in the middle of the gluteal muscle; when bending the leg at the knee joint, the heel is pressed against the point area;

Fu-tu - on the front surface of the thigh 6 cuns above the upper edge of the patella;

Du-bi - in the depression outward from the patella, at the level of its lower edge;

He-din - in the middle of the upper edge of the patella, where it is clearly visible when the leg is bent at the knee joint;

Cheng-jin - below the middle of the popliteal fossa, fold 5 cun, between the bellies of the gastrocnemius muscle;

Cheng Shan - 3 cun below the Cheng Jin point, or in the center of the back surface of the lower leg, in the cavity, at the junction of both bellies of the calf muscle;

Rice. 132. Points of influence during the rehabilitation of post-stroke patients

Kunlun - behind and below between the outer ankle and the heel tendon.

To stimulate active contractions of the leg flexors affect points:

Cheng fu - in the center of the subgluteal fold;

Yin-men - in the middle of the back of the thigh between the biceps and semitendinosus muscles, 6 cun below the subgluteal fold.

For stimulation(and more often for relaxation, depending on the patient’s condition) on the inner thigh affect points:

Yin-bao - in the middle of the lateral surface of the thigh, its inner side, 5 cun above the knee joint;

Ji-men - on the inner surface of the thigh, in the cavity at the inner edge of the quadriceps muscle, in the middle of the distance, 6 cun above the upper edge of the patella.

To stimulate the muscles that extend the foot and toes, affect points:

Yin Ling Quan - on the inner surface of the lower leg, at the posterior edge of the inner condyle of the tibia;

Yang Ling Quan – at the anterior lower edge of the head of the fibula, in line with the Yin Ling Quan point, on the sides of the knee joint;

Tzu-san-li (longevity point) 3 cun below the lower edge of the patella and 1 cun outward from the midline of the shin, under the joint of the fibula and tibia;

Jie-si - in the middle of the dorsum of the ankle joint, in the center of the fossa formed when the foot bends towards itself;

Shan-xu - on the inner surface of the foot, in front and below the inner ankle;

Qiu-xu - on the dorsum of the foot in front and below on the outside of the ankle;

Pu-shen – a series of points (5–6) along the outer edge of the foot, starting from the toes;

Yongquan - in the center of the plantar surface between the II and III toes, when the toes are compressed on the sole, a fold is formed, in the center of which there is a point.

Methodical instructions. The starting position of the patient is lying on his back. The massage therapist is always on the side of the paretic limbs. From the proposed points in this area, select the most effective for this procedure. Strive to achieve the desired effect (relaxation or stimulation) by using the appropriate acupressure technique: when stimulating - tonic, when relaxing - soothing, relaxing. Use combinations of certain points to increase the effectiveness of the impact: on the shoulder joint - Nao Shu and Zhou Zhong, on the elbow - Shao Hai and Qu Chi, on the wrist - He Gu and Lao Gong or Yang Chi and Da Lin , yang-xi and yang-gu, wai-guan and nei-guan, on the lower extremities - kun-lun and jie-si, yang-ling-quan and yin-ling-quan. In combination with passive movements, the effectiveness of acupressure is much higher; rehabilitation time is reduced.

In some conditions, it is more rational to start a massage not with classical techniques, but with acupressures and passive movements. The advantage of the acupressure technique is that this method in practice, when performed correctly, has no contraindications.

Acupressure can compete with acupuncture in terms of the speed of relaxation, which gives it an advantage during various gymnastic exercises.

It should be remembered that it is not always possible to achieve complete relaxation in the first procedure, especially in patients with a relatively long history of stroke, so you should not increase the intensity of the impact and especially frequently change selected points. One course consists of 20 procedures, 25–30 minutes each. The courses are repeated at intervals of 15–30 days or more.

From the book Neurology and Neurosurgery author Evgeniy Ivanovich Gusev

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Consequences of acute cerebrovascular accident. Objectives of massage: Improve lymph and blood circulation, promote restoration of function, counteract the formation of contractures, reduce increased muscle tone, reduce friendly movements, as well as

From the author's book

Consequences of acute cerebrovascular accident. Objectives of massage. Improve blood and lymph circulation, promote restoration of function, counteract the formation of contractures, help reduce increased muscle tone, reduce friendly

From the author's book

Acupressure for the consequences of acute cerebrovascular accident Acupressure helps regulate the processes of excitation and inhibition in the cerebral cortex, as well as normalize the reciprocal relationships of antagonist muscles. Starting position

Reason circulatory disorders in the vessels of the brain are hypertension, atherosclerosis, vasculitis caused by rheumatism, periarteritis nodosa, thromboangiitis obliterans; aneurysms, intoxication, trauma, brain tumors, blood diseases.

Clinically distinguished and dynamic (transient) circulatory disorders.

The acute period of dynamic circulatory disorder is manifested by symptoms of a cerebral crisis and signs of focal disorders in the area of the affected vessel. The most commonly affected branches are the vertebrobasilar region and the middle cerebral artery. In this case, transient paresis and paralysis of the limbs, paresthesia, aphasia, and disorders of the cranial nerves occur. These phenomena quickly disappear (after a few minutes, hours), less often they persist for several days.

The course of a stroke is long and is divided into several stages (phases) that transform into one another.

L.L. Guseva (1962), in accordance with the clinical and pathophysiological characteristics of these stages and periods (according to S.H. Davidenkov and N.V. Konovalov), developed indications and timing for the start of the use of massage, treatment with positioning and therapeutic exercises.

Evaluation of treatment effectiveness

V. Ya. Porokhova (1955) developed a five-point system for assessing motor disorders in spastic paresis, taking into account the presence of synkinesis and increased muscle tone.

The main principle of this system is to test integral motor acts and self-service skills. Our experience has confirmed the feasibility of using this scheme to evaluate the results of treatment for spastic hemiparesis.

Combination massage for cerebrovascular disorders with physiotherapy and balneotherapy: according to individual indications, physical factors are prescribed 1-1½ months or 3-10 months after a stroke (Z. S. Melnitskaya, 1971).

On the same day, you can combine electrophoresis of various medicinal substances, aeronization, hydrogen sulfide, iodine-bromine, and oxygen baths with massage. Massage can be prescribed both before and after these procedures: 30 minutes or more before physiotherapy and balneotherapy or 1-1½ hours or more after it.

Darsonvalization of paretic limbs and diadynamic currents on the shoulder joint (for pain in the joint) alternate with massage every day.

Contraindications for massage

Active rheumatic process.
Brain abscess.
The presence of a tumor of the central nervous system with progression of symptoms (after surgery, massage is indicated).

) there is no way to do without using such a physiotherapy procedure as therapeutic massage.

If at the beginning of the course it is carried out only in a rehabilitation center by specially trained specialists, then at home the massage course can also be carried out by relatives.

So it’s worth familiarizing yourself with the basic approaches and techniques of massage.

Purposes of massage

At its core, it is necrosis of brain cells, which develops due to impaired blood circulation in a certain area. Accordingly, where the death of neurons occurs, a metabolic disorder is observed - exactly the same and vice versa (in other words, a kind of vicious circle is formed).

Due to the disruption of the central nervous system, significant problems arise with peripheral organs and parts of the body - their sensitivity and functioning are impaired, and the ability to perform active movements is lost. However, a certain mechanical effect that massage provides during ischemic stroke contributes in the best possible way to the normalization of blood circulation and tissue trophism. In addition, if you massage for a certain period of time, you can achieve a greater effect - stimulation of the peripheral nerves will have a positive effect on the brain, since all parts of the nervous system are closely interconnected, not only in the anatomical, but also in functionally.

Indications for massage

If we consider exclusively massage for stroke (no matter - or ischemic), then in principle there can be no talk of any contraindications. This physiotherapy technique is indicated in any case at the rehabilitation stage, but in no case in the acute period.

The importance of including massage in the rehabilitation plan for a stroke patient cannot be overestimated in the following situations:

, face, entire lower or upper body, or simply impaired sensitivity (motor activity). In this case, the movements that the massage therapist will make will not only normalize metabolism in a specific area, but also promote the development of the surviving neurons of the brain, thanks to which they will be able to take on at least part of the functions of dead cells. Accordingly, this kind of approach will significantly improve the functioning of those organs whose innervation was damaged due to the cardiovascular accident.
Problems occur due to the fact that a person remains in one place for a long time. Not only tissue atrophy occurs, but also bedsores. To avoid all these complications, it makes sense not only to provide proper care for the patient, but also to periodically conduct massage sessions - as mentioned above, the mechanical action of the massage therapist’s hands can significantly activate local metabolism and prevent the development of necrotic processes that occur in soft tissues .
There are signs of damage to the peripheral nerves responsible for regulating the contractile activity of the facial muscles (in such cases, there is a smile from only one corner of the mouth, drooping of the eyelid, twitching of the cheek, and similar problems). Performing a facial massage is combined with Actovegin injections, which inject the affected nerve along the fibers. A very complex intervention, but it has its effect.

Rules

Like any other massage, this type of rehabilitation is carried out in several stages:

Stroking. This massage technique involves affecting only the skin. It is considered the most gentle, but its effectiveness should not be underestimated - due to the fact that the skin contains a large number of blood vessels and nerve endings, the mechanical effect on this structure contributes in the best possible way to the intensification of metabolic processes. Hand movements are performed in accordance with the principles of the lymphatic system. The flow of this biological fluid occurs from the distal to the proximal sections, which means that the movements of the massage therapist’s hands move in the direction from the periphery to the center. An important note - in order for stroking to be carried out correctly, it is necessary to ensure that the skin does not bunch up. There are several techniques for performing this technique: stroking with the back or ventral side of the palm, comb-shaped, rake-shaped, with fingertips, tenor and hypotenor. As a rule, during one massage session, the combined sequential use of several techniques is practiced.
Trituration. This massage technique allows you to effectively remove stagnation. More time should be spent on rubbing if a person exhibits manifestations of edema syndrome. This is a deeper impact, in which the massage therapist applies greater force to the patient. In other words, the subcutaneous tissue is being worked on. The hands should be moved with slightly more pressure than when stroking - this is done in such a way that the skin gathers into a fold.
Please note - now the effect is only on the skin and subcutaneous fat. The muscle layer is not yet affected.

Depending on how the rubbing is carried out, it is customary to distinguish several varieties of this procedure: comb-shaped, rake-shaped, with the edge of the palm or with its base.
Kneading. This technique requires the most effort from the massage therapist, as significant pressure will be required. It is necessary to affect not only the skin and subcutaneous fatty tissue, but also muscle tissue. Kneading is especially difficult for stroke patients. This is explained by the fact that after a cardiovascular accident, muscle soreness very often occurs, and it is almost impossible to knead them during a massage in a constantly compressed state. But massage, in this case, is the only procedure that can adequately eliminate the manifestations of the consequences of acute cerebral circulatory failure. Taking into account the fact that the effect is on the muscles, you should work the limb with the maximum possible force in the direction from the fingers to the body. Please note that in this case, a possible negative reaction on the part of the patient does not matter - the elimination of muscle soreness is always accompanied by severe pain. There are many types of kneading: rake and comb-shaped, with the base of the palm or its edge, rolling, pressing and many others. The choice of technique is determined mainly by the anatomical features of the muscle being worked on at the moment.
Vibration. A massage technique that is quite rightly considered the most difficult to perform. Here the massage therapist performs small vibration movements that affect the internal organs (structures located deeper than the muscles). During a stroke, vibrations are not given the main place, since in such patients, as a rule, massage of the limbs is carried out.

The rules discussed above are relevant in almost all cases, regardless of whether a person has only the lower part of the body affected, paralysis of the upper limbs, or simply impaired facial expressions; all the same, the massage will be carried out using all the techniques listed above (the affected side is also not the point here). important). The difference will only be in the ratio of the duration of each of them. In some situations, the emphasis is on kneading, in others on rubbing (depending on the location of the foci of neurological symptoms).

Very often, patients who have suffered acute cerebrovascular insufficiency are recommended to perform a light course of massage. This is usually observed when facial expression is affected, since recovery from skeletal muscle soreness will require mechanical action of increased efficiency.

Contraindications

It is immediately necessary to stipulate that massage for patients with acute cerebrovascular insufficiency is performed only during the rehabilitation period. In the acute period, any physiotherapeutic procedures are strictly contraindicated. Almost all patients with a history of a recent or hemorrhagic stroke are indicated for massage, although very rarely, there are situations when this procedure is not recommended for use, much less at home. As a rule, these limitations are associated with concomitant therapeutic or surgical pathology:

Aneurysm of the thoracic or abdominal aorta. Mechanical impact on this pathological structure can lead to its rupture, which will cause massive bleeding and death of the patient.
Unstable blood pressure numbers. In this case, there is a high probability of a recurrence of a cardiovascular accident, therefore there can be no talk of any physical procedures.
The patient's serious condition associated with loss of consciousness. In this case, there is no point in performing a massage, since it is impossible to track its effectiveness. First, you will need to take care of restoring the functioning of higher nervous activity.
If the left part of the temporal gyrus is affected, then you should also not perform mechanical effects on the human body, since there is a high probability of relapse of the disease and progression of the necrosis focus. In this case, there are anatomical and physiological features that currently do not yet have a full explanation.

Aids

Massage can be carried out using only brushes, or you can use other devices - auxiliary means. Some neurologists recommend that patients who have suffered a cerebral infarction perform vacuum massage - they motivate this by the fact that in order to eliminate soreness, a strong impact on the area with impaired innervation is necessary.

In the event that a loss of tactile and temperature sensitivity is diagnosed as a consequence of a hemorrhagic or ischemic stroke, then in the recovery period, in parallel with massage, it is recommended to use warming with an ultrasonic device.

There is no data in the literature regarding the advisability of using various oils and creams with aromas, but it is worth assuming that aromatherapy will have some significance when performing massages on a stroke patient.

Massage at home

After the patient is discharged from the rehabilitation center, he will face a long period of recovery. In fact, it will last until the end of life, for the simple reason that it will be almost impossible to completely restore the functional activity of the brain.

So, a patient who has suffered acute circulatory failure will need to undergo a course of massages two or three times a year. In combination with drug therapy, these measures will give a decent result. Patients who were rehabilitated in this way generally regained the ability to self-care within a short time.

However, not every family has the financial opportunity to hire a massage therapist for each session, so you have to do everything yourself.

In principle, there is nothing difficult in providing massage to a post-stroke patient who is in a stable condition. It’s enough to watch a few training videos, note the features of the basic techniques and put them into practice. Ideally, invite a massage therapist to one course in order to observe his actions, and only then do everything yourself.

To prevent ischemia from further affecting the brain, it is necessary to do everything possible to speed up blood circulation. Please note that even if you perform a massage while lying down, your patient’s head should be slightly elevated - this will allow the blood circulation of the central nervous system organs to be normalized in the shortest possible time.

One of the complications of stroke, which manifests itself in the residual period, is a violation of coordination movements and fine motor skills. In order to quickly eliminate these disorders, you should massage your hands in the direction from the distal phalanges of the fingers up to the shoulder joint.

Foot massage after a stroke

Here the main emphasis is on kneading, and on physiotherapy procedures associated with the use of ultraviolet light, since, most likely, it will be necessary to eliminate the formed soreness. The technique is the same as always - first we work with the upper layers (skin and subcutaneous fat), and then we tackle the muscles. Movements - from bottom to top, along the flow of lymph.

Course duration

Correctly, a step-by-step course of rehabilitation after a right-sided (or) stroke involves performing both acupressure and classical massage techniques.

If the lesion is insignificant, then all symptoms will be limited to impaired facial expressions. Massage carried out for 7 days will significantly reduce the severity of pathological manifestations.

If it is necessary to restore hand motor skills, you should perform exercises that involve precise movements (for example, lifting a matchbox from the floor or threading a thread into the eye of a needle). Accordingly, the duration of such a course of physiotherapy will be about 14-15 days, and maybe more, depending on the severity of the patient’s condition and the presence of concomitant pathology.

Regarding the frequency of sessions, repeating massage courses 3-4 times a year is quite enough.

The book will be of interest both to those learning types of massage for the first time, and to massage therapists who want to improve their skills. The author sought to convey in an accessible form the basics of performing various manipulations used in classical, segmental, periosteal, and acupressure massage. All types of massage, the mechanisms of its action on the body are described, recommendations are given for the use of massage and self-massage for the most common diseases. The etiology and pathogenesis of many diseases that occur in the practice of a massage specialist are outlined in a brief, informative form.

The publication is intended for massage specialists, physical therapy methodologists, nurses in medical, health and preventive institutions, as well as for everyone interested in the use of massage and self-massage.

Book: