PHYSICAL THERAPY AND NEUROREHABILITATION OF PATIENTS WITH CEREBROVASCULAR STROKE

Abstract

Cerebral stroke represents an acute disturbance of circulation in the brain, which occurs with local and general brain symptoms. Main etiological factors are: arteriosclerosis, increased blood pressure, arterial hypotension, heart diseases, malformations of brain blood vessels, etc. Stroke is the most common neurological disease and the leading cause of mortality in the world, right after cardiovascular and malignant diseases. Cerebrovascular stroke is a focal neurological deficit caused by intracerebral hemorrhage. It is a condition that occurs due to a change in blood circulation in the brain and a very low supply of oxygen and nutrients to parts of the brain, which results in their damage and disruption of the functions that depend on them. There are two types of cerebrovascular stroke: ischemic - thrombosis and thromboembolism (85%) and hemorrhagic – intracerebral and subarachnoid bleeding (15%). The clinical picture can develop gradually or, the patient can suddenly fall into a coma. Absence of movements of the affected limbs predominates, always opposite to the side of the impact with an outburst of the facial nerve of the central type. Hemiplegia is a loss of the voluntary movements of one half of the body, caused by damage to the opposite brain hemisphere. The musculature is atonic, tendon reflexes are reduced or lost. The aim of the research is to determine the effectiveness of physical therapy and neurorehabilitation in patients with cerebrovascular brain stroke. Treatment of stroke: In the acute stage, physical therapy is aimed at preventing complications of the loco-motor apparatus (contractures, muscle and tendon retraction, heterotropic ossifications), the respiratory system (hypostatic pneumonia) and the skin (decubitus). This is achieved through treatment with position (frequent change of the position of the body in bed), passive exercises performed according to strictly defined rules, breathing exercises, exercises for healthy limbs and great care of the skin. The trophic changes of the skin are treated with ultraviolet radiation in suberythemic doses or with D’Arsonval currents. The research was conducted at the University of Southeast Europe - (Stul University) at the Faculty of Health Sciences in the Department of Physical Therapy and Rehabilitation, over a period of 6 months, from the beginning of From the beginning of May - to the end of October 2023. The research included 27 stroke patients, of which 11 patients had a left-sided stroke, and the remaining 14 patients had a right-sided stroke. According to the gender structure, 12 patients are male and the remaining 15 patients are female. After completing the six-month treatment with physical therapy, kinesitherapy and the methods of Vojta and Carl and Bertha Bobat, the results show great progress in almost all parameters. A decrease in tonic primitive reflexes, neck and labyrinthine tonic reflexes, reduction of extensor hypertonia, improvement of motor-reflex activity, proprioceptive afference, coordination, reduction of neck tone, foot reflex, stimulation of the grip reflex and improvement of the position of the neck, limbs and body. The presented results shows significant improvement in both groups of participants. Physical therapy and rehabilitation combined with kinesitherapy have an exceptional positive effect in: prevention of pathological primitive reflexes;creation and automation of normal active movements;saving irregular positions of the limbs and the whole body;establishment of balance and correct pattern of movement; fight against spasticity, secondary contractures and deformities; improvement of coordination and awareness of the body in relation to the environment.