Психологічні засади фізичної реабілітації хворих на ішемічний інсульт у процесі їх перебування на стаціонарному етапі лікування

Abstract

The article deals with the problem of psychological principles of physical rehabilitation of patients with ischemic stroke in the process of their staying at the stationary stage of treatment. It was noted that the most frequent and severe consequence of cerebral ischemic stroke is the disorder of the motor functions of the personality. The characteristic feather is the polymorphism of motor disorders of patients with cerebral ischemic stroke. In this case, general for patients is only the loss or violation of arbitrary actions (in the cases of hemiparesis or hemiplegia). Other clinical symptoms are largely variable and depend on a certain extent of the size of affected area, also its localization. According to various authors, persistent disturbances of motor function are also observed in the first days afetr the disease (in 70–80% of cases of patients who had the ischemic stroke). In accordance with the purpose of the research and in order to solve the tasks, 50 patients with ischemic stroke participated in our experiment, they had disturbances in the area of the internal carotid artery in the acute and residual period, who were treated at the Ternopil Regional Communal Clinical Psycho-neurological Hospital during the period from January to December, 2018. Thus, most patients had a fairly low functional state, which required careful monitoring of the level of physical exercises which were being used. The latter also determined the method of further restoration measures (initial position for trainings, duration of trainings, the number of exercises performed by the symptom complexes, the frequency of repetition of exercises, the need for more frequent recording of changes in the frequency of heart rate and blood pressure in response to physical activity). The author of the article developed «Functional method of restoration of motor functions of patients with ischemic stroke, taking into account their psycho-physiological features». The main principles of this technique are: 1) stabilization of psycho-emotional state of the patient: reducing the level of anxiety, increasing the motivation to do physical exercises (to be included into the course of physical rehabilitation); 2) actualization of stable static and dynamic stereotypes of the patient in all initial positions of the body; 3) the restoration of a dynamic stereotype: considering the distal direction of muscles actions because it is prerequisite for providing motor actions; physical exercises must be carried out consistently, with gradual increasing of physical activity; 4) physical rehabilitation should be conducted to ensure the safety of rehabilitation measures, to avoid fatigue or over-stress of the cardiovascular system of the patient and to exceed the permissible level of increasing physical activity for the patient.It is noted that proposed functional method of physical rehabilitation of patients with ischemic stroke, based on mentioned principles, is differentiated, ontogenetically determined, which solves the problem of modeling the psycho-physiological hierarchical control of motor function from the nervous system, which takes into account the psycho-emotional state of the patient, which was actualized as a result of the disease.