Massage for a bedridden patient for the lungs. How to massage a bedridden patient

When caring for bedridden patients, regular massage deserves special attention, in the absence of contraindications from doctors. People confined to bed are faced with the problem of deteriorating tissue, skin and muscle quality. Such changes may cause pain. and influence the normal functioning of internal organs. Also, with a constant horizontal position, bedsores may begin to develop.

Indications for massage: a history of stroke or surgery, exacerbations in health conditions that require constant bed rest, cancer, some types of chronic diseases - heart failure, disturbances in the functioning of the stomach and other internal organs. Such patients are accepted in the Moscow region.

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Effect of massage

Regular massages for a bedridden patient not only improve the condition of the tissues in the massaged area, but also have a beneficial effect on the entire human body.

After the massage you can notice the following positive effects:

• Increases muscle tone;
• The functioning of the gastrointestinal tract, urinary system, heart, etc. improves.
• Swelling decreases significantly or disappears completely;
• Blood supply improves and internal organs receive more oxygen;
• The healing process is significantly shortened.

Massage is very necessary in cases where the patient has hope of returning to a normal lifestyle and getting back on his feet. The use of complex therapy in this case will help to significantly shorten the recovery process and quickly achieve the desired result.

Massage techniques

For each bedridden patient, depending on the cause of his illness, the necessary set of massage procedures is individually selected.

For example: a patient who has had a stroke, at first it is necessary to massage only in the area of ​​paralyzed limbs. Such actions improve lymph flow. The use of general massage is possible only at the stage of late recovery. Also, together with massages, a passive form of therapeutic exercises is used.

For patients after surgery, most often use light stroking and rubbing, without resorting to intense exposure. In the initial stages of recovery, massage is performed near the suture; over time, it is possible to include massage in other areas to normalize the functions of all body systems.

For the prevention of bedsores In bedridden patients, it is necessary to massage the spine and shoulder blades. Such sessions are recommended for almost all bedridden patients.

Caring for bedridden patients at the Eden boarding house in Moscow

Since a stroke often leads to loss of mental and physical capabilities, it is important to understand the specifics of the disease and its further consequences. This happens especially often with the limbs, and patients experience paralysis, numbness, loss of sensation.

Such consequences take a long time to pass, require professional rehabilitation and sometimes can only partially return.

And all because the areas of the right or left hemisphere are affected quite deeply, especially in old age.

A stroke involves blockage and thrombosis of blood vessels, their rupture and hemorrhage in the brain. Depending on the type of disease, the speed of progression and the age of the patient, the further consequences of a stroke differ. So, with a deep-seated lesion of the left or right hemisphere, a person suffers from a disorder or loss of physical capabilities, fully or partially. We are talking about paralysis, numbness, loss of sensitivity, paresis, convulsions and tremors in the limbs. If the foci of inflammation are located far from the right hemisphere, then the symptoms do not appear so clearly, and recovery will take a little less time - about three months.

Paralysis

Paralysis- this is a complete or partial loss of physical capabilities of the body, a separate area or limbs due to damage to the peripheral nerves and central nervous system. Paralysis develops when the right hemisphere is damaged, sometimes accompanied by central pain syndrome, paresis or numbness of the legs. Often it is the limbs that are affected, although in old age patients experience complete paralysis of the body, which can only be partially overcome.

Paresis

If we talk about a decrease in muscle tone, loss of strength and joint atrophy, then we can be sure that the patient is faced with paresis. This condition is often observed in bedridden patients or those who suffer from paralysis of the legs or arms. It also develops with repeated thrombosis of the extremities, the location of the stroke in the right hemisphere of the brain. Paresis goes away only after rehabilitation and prevention in the form of gymnastics, swimming or training on exercise machines. Sometimes accompanied by antispasmodic pain, numbness and loss of sensitivity.

Massage for stroke: goals and contraindications

Since it helps relax muscles, restore tone, eliminates the development of re-thrombosis, saturates the blood with oxygen and does not allow it to stagnate. Thus, the damaged hemisphere will recover faster.

If we talk about bedridden patients, then massage is for them will prevent tissue necrosis, bedsores and further deformation of the joints. In the initial stages of recovery, massage will help relieve pain syndrome And restore primary reflexes of the legs and arms.

But when carrying out procedures, you need to remember several precautions: the patient can be placed on his back only in the absence of heart and kidney disease, massage is performed only by the same specialist in a hospital setting, home procedures are possible only in the later stages of rehabilitation after the doctor’s permission.

Massage techniques

As mentioned earlier, leg massage after a stroke can only be performed by professionals or under his supervision, and from the first days of recovery. In this case, several techniques and techniques are used, which include stroking, rubbing, vibration, shaking, warming up, and shaking. All of them are aimed at returning reflexes and restoring blood circulation, so it is recommended to use all techniques in one session to achieve maximum effect in a short period of time.

Stroking

The massage begins with stroking, as this allows you to warm up the skin, improve blood circulation throughout the body and prepare the muscles for work. You can use oils, but the massage therapist's hands should be at room temperature. Hand pressure should be medium, while trying to rub, lightly press your hand into the body, leg or back. It is important that the skin turns pink, but does not become red, so spend no more than three to five minutes stroking.

Trituration

The rubbing technique is not particularly different from stroking, but the difference is the intensity and pressure on the legs. Here you can use additional tools, massagers and creams. The skin may become slightly red, warm, or hot. Rubbing is carried out for five minutes, especially intensely in the feet, fingers and legs.

Vibration

The essence of vibration is the transmission of oscillatory movements of a certain frequency to a separate part of the body. Starting from the place of massage, you can perform it with your fingers, the tip of one finger, palm or fist. During the process, it is important to ensure that muscles that are not involved in the process are not tensed, that is, the effect is only partial, but it is aimed mainly at the nervous system. Weak vibration will increase muscle tone, and strong vibration will reduce joint tone and regulate the excitability of the nervous system.

Shaking

Shaking is performed with two fingers - the index and thumb, which seem to grab the muscle. Next, the area of ​​skin needs to be pulled back and then shaken off, but this can be done easily and quickly. Manipulations with one area are carried out at least two or three times, and then the fingers need to be moved to the adjacent part. The movements can be made diagonally or arbitrarily; sometimes the left hand can help, which creates a burden. The easiest way to perform shaking is on the legs, but then the patient should stand upright, and the massage therapist should shake the muscles and skin with one hand.

Mild concussion

Concussion is also performed with the palm or several fingers on a certain area of ​​the body. To do this, you need to pat, create movement on the skin and muscle. It is better to repeat the procedure on one area twice, and then move on to the next part of the body. In this case, it is better for the patient to lie down or take a sitting position.

Kneading

Kneading is the main type of massage, which is spent almost half of the time of the entire session. But to achieve maximum effect, the patient’s muscles must be completely relaxed. Kneading allows you to get to the deepest muscle layers, this is achieved by capturing muscle tissue and pressing it to the bones. Knead using the thumb, tips or the entire palm, but make sure that the movements are fast and sliding. Perform the procedure slowly, painlessly, making about 50 movements per minute.

Preparing for a massage

Preparation for massage is necessary both for the patient and for the specialist himself. It all starts with washing your hands and washing your body with warm water, after which you need to dry your skin dry. Typically, the patient is undressed down to their underwear or completely, but the part of the body that is not exposed is covered with a towel or blanket. Keep an eye on the temperature in the room, as it should be at 23 degrees. Before starting the procedures, the massage therapist needs to warm up his hands to room temperature, the same applies to the patient’s legs. In the process you can use oils, creams and warming masks. The massage is performed in a lying, standing or sitting position on a special couch or on the floor, so as not to create inconvenience or additional stress on the body.

Combination with exercises

Light massage is often combined with exercises., gymnastics, swimming or exercise. In this case, massage will prepare the muscles for stress, disperse blood throughout the body and increase the overall tone of the joints. Then the procedure takes about 15 minutes and includes rubbing, shaking, vibration and kneading. Sometimes the procedure is carried out after exercise or gymnastics to relax the muscles.

Massage after hospitalization

After hospitalization, massage is performed at home or in massage rooms for preventive purposes. The procedure must be repeated at least three to four times a week for 30-40 minutes. In this case, the massage can be full, of the whole body, and not just the legs or arms. It is especially necessary for those who suffered from paralysis, numbness and paresis, since manifestations can accompany the patient for a long time after treatment, leading to a second attack. After this, it is recommended to visit a massage therapist at least once or twice every two weeks.

Rehabilitation: restoration of leg movement

Restoring physical activity of the limbs after a stroke, they are often carried out on the territory of sanatoriums or rehabilitation centers. In this case, the procedure may take up to eight months or a year, and an individual course is being developed. This may include medications, hydrotherapy and reflexology, motor exercises, diet, massages and rubbing, visits to a physiotherapist and exercise equipment, treatment of chronic diseases, mud wraps and acupuncture. In some cases, art therapy and bipolar effects on the nervous system or neurons cannot be avoided. It takes about six months, sometimes a year, for rehabilitation. With a second attack or in old age, the use of the legs may not be fully restored, and a second attack or thrombosis may develop after eight to twelve months. If you refuse to recover completely, then your physical capabilities will be lost forever, and the second stroke may be your last.

Recovery after a stroke includes special massage and therapeutic exercises. Massage after a stroke is important for rehabilitation. Very often, after spending 2-3 weeks in the hospital, patients then lie at home for years without restorative therapy.

There are 2 powerful vessels passing through the neck that carry blood to the head. In a certain place, the vessels branch like a bunch of grapes and supply blood to our brain. Suddenly blood stops flowing to the brain, nerve cells stop receiving their portion of blood and die. This area of ​​dead nerve cells in the head is called a stroke.

Hand massage

Massage of the hand after a stroke and for the forearm is performed for 15 minutes. Like any massage, you need to start with stroking from the fingertips to the beginning of the hand. Stroking the paralyzed hand should occur with the entire part of the palm.

How to do a massage? When the right arm is paralyzed, gentle squeezing movements are performed. Massage after a stroke at home relieves inflammatory conditions of the nervous system. The massage therapist's massaging movements end with stroking, after which the second stage of hand massage begins: rubbing.

In cases of paralysis of the limbs, it is advisable to perform rubbing not only longitudinally, but also across the bone.

Foot massage

After a severe attack, some patients cannot even raise their heads, however, after several courses of massage and proper physical exercises, strength returns to the muscles, the legs begin to obey, including the leg on the affected side.

Patients may realize the severity of the situation: their legs do not obey, the body is paralyzed completely or on one side, the functions of the limbs have disappeared, it may seem to them that everything is over. However, the right rehabilitation techniques can put a person back on his feet, making even the limbs of the affected side work as well as before the attack.

Professional massage therapists are able to influence the nerve endings of the feet in such a way that the former strength of the limbs returns. Patients can remember all the massage therapist’s techniques and then massage their feet on their own to get rid of all the consequences of a stroke, including on the affected side of the body.

gymnastics for the face

When restoring the face, the orbicularis oris muscle plays an important role, while the facial nerve is restored from top to bottom. Very often, after a stroke, speech functions are impaired. The lower part of the face takes a long time to recover after a stroke.

You can begin to restore your face after a hemorrhagic stroke no earlier than 3 weeks after the attack. Is it possible to perform facial gymnastics if there are open skull injuries, fractures, wounds? Of course not.

Before starting a facial massage, the facial muscles are warmed up with light rubbing. Next, you need to feel your lips from the outside and inside with your fingers. Warming up the lower part of the face helps to relax the orbicularis muscle in the center and tighten the drooping corner of the mouth at the edge.

Cosmetic facial exercises can be performed for an unlimited amount of time.

General rules

If there is no specialist nearby, relatives can perform strokes at home: from the tips of the fingers to the beginning of the hand, from the tips of the toes to the beginning of the leg. Other types of massage are not recommended, so as not to harm patients, it is better to call a specialist.

As soon as a relative is admitted to the hospital, it is necessary to observe the health workers on how to properly turn the patients. You also need to look at how to change a diaper correctly; this knowledge will be very useful when you come home and are left alone with the patient.

While in the hospital from the first days, it is necessary to try to prevent several serious complications. The first complication is bedsores; they form quickly and take a long time to heal, especially in patients with diabetes.

How to prevent bedsores:

• it is necessary to turn the patient over every 2 hours;
• Bags of millet are placed under problem areas. The first problem area is the tailbone, then the shoulder blades, elbows, back of the shins, and heels.

The second dangerous complication is hospital-acquired pneumonia. When a person lies motionless, his lungs are poorly ventilated. What to do in this case? You need to take a glass and pour 2/3 of its volume of water into it. A juice straw is inserted into the glass and the air needs to be blown out.

Several times a day of such exercises improve lung function. Also, turning from side to side every 2 hours also ventilates the lungs. All innovations must be used only with the permission of the attending physician.

The third serious complication is constipation. It is necessary to achieve stool once every 3 days. There are a lot of tablets, herbs, drops, and you also need to try as much as possible to make the patient’s diet easier.

Nutrition for a bedridden patient

You must adhere to diet No. 10. Avoid spicy, salty, fatty, fried, smoked foods. It is necessary to give the patient water frequently, at the rate of 20-30 ml per kilogram of weight. If the patient weighs 75 kg, you need to multiply by at least 20 ml and get 1.5 liters of pure still water. This amount of water will help the intestines function properly.

We must not forget about concomitant diseases, there may be kidney disease or heart problems. In these cases, it is necessary to regulate the water content of the body and consult a doctor.

Patients should not be given fresh white bread or other baked goods. Bread should be given gray and yesterday's bread; bread with bran has a positive effect on intestinal function.

Only dietary meat should be given: steamed, boiled, baked in the oven. Meats include chicken, turkey, and beef. Doctors recommend using fish at least a couple of times a week. Recommended fish varieties: salmon, trout, mackerel.

Potatoes and pasta are given minimally; they need to be replaced with porridge. You also need to cook soups with porridge; it is better to exclude borscht. Soups are not only cooked in broth; empty soups with a spoon of olive or vegetable oil are also used.

Vegetables should be used that are familiar and seasonal. You also need to remember about kefir; doctors recommend drinking the whole pack at once, without leaving an open packet of kefir for later, since during storage the beneficial bacteria begin to die. Biobacteria in fresh kefir will help regulate the intestines; 12 hours after storing an open package of kefir, there will be 50% biobacteria in the pack, and after 24 hours there will be no bacteria left at all and the effect will be the opposite of what was expected, that is, fixing.

You cannot take dairy products from the market, as they are very fatty for stroke patients. They lie down, do not move, and need little energy. Dairy products must be purchased at the store. Fat content of kefir 1.5-2.%, sour cream 10-15%, cottage cheese 5-9%. You also need to pay attention to children's fermented milk foods and fruit and vegetable mixtures. You can cook vitamin-rich fruit compotes.

However, you need to remember that all compotes, teas and kefirs are not included in the initial 1.5 liters of water that are intended for bedridden patients.

after an attack

We need to try to activate the cells that surround the dead brain tissue. Special physical therapy exercises for the arms, legs, and tongue help to awaken the cells and teach them those movements that have completely disappeared or weakened.

Training new cells for the operation of limbs can be compared to the following everyday situation: often we turn on the light automatically, no matter where the switch is, but after repair, the switch will be in a new place and we need to develop an automatic habit again and get used to the new location of the switch. For some time a person will come in and try to turn on the switch in the old place, but one day the person will deliberately come in and turn it on in a new place. This suggests that a zone has formed in the head that already knows how to direct the muscles and turn on the light in a new place.

Physical therapy of the arms and legs is the knowledge of the muscle, what it needs to do, which appears with the help of special therapeutic exercises. While a person is lying down, his muscles weaken and massage will help to add strength to these muscles during a stroke.

This massage differs from restorative or general healing. After the massage, strength is added to the muscles, and after gymnastics, knowledge is added to the muscles, the combined techniques together will give movement, which then needs to be brought to automatism - this is how rehabilitation works.

It is better to entrust exercises with massage to specialists - it is much more effective and safer. The massage technique consists of techniques that help reduce blood pressure.

Acupressure and acupuncture for stroke, acupuncture after stroke, acupuncture, acupuncture, and acupuncture have also proven themselves well. Acupressure may cause some pain, however, after its completion, patients feel a surge of energy in the muscles.

Several rules of rehabilitation

Each neurological hospital has a rehabilitation methodologist who shows what physical exercises can be performed for the lower extremities and arms. After arriving home, they begin gymnastics with 15-20 minutes of exercise, while proper breathing is necessary.

After completing an exercise, you can wait a few seconds before performing the next exercise - this will allow you to maintain proper breathing. During this period, you need to inhale and exhale so that the blood vessels and muscles rest.

Inhalation is done through the nose, it should be calm and deep. Exhale through your mouth, form your lips into a tube, and as you exhale you can say: “Phew.” All tension movements should be done while exhaling. In order not to think about how to breathe correctly, you can count out loud during exercises, since we talk while exhaling, and this is a forced exhalation.

Has your patient been lying in bed too long? Is he passive, does he feel unwell, does he often lose his nerves? Instill in your dear ward faith in the success of treatment with the words that he so needs... And don’t forget to do restorative gymnastics with the patient every day. It works just as well as encouraging words! After all, gymnastics is the “way out of bed” into a normal life full of familiar movements. No medicine can compare with movement in its effectiveness. And you will see that even a tiny success in restoring motor functions can significantly improve the patient’s mood. And this is so important for speeding up recovery!

What are the consequences of immobility?

The human body really does not like to live without movement. With immobility, literally all metabolic processes deteriorate, and numerous accompanying “stagnation” in systems and organs can cause great trouble. “Congestive” pneumonia can occur in the lungs, muscles lose their mass and atrophy, joints lose their mobility until they completely lose their ability to function, stones can form in the kidneys, the skin is affected by bedsores, etc. There is only one way out. Move! First, restorative gymnastics is used with the help of a caring person (nurse, instructor), and then the process is activated by the patient himself. Massage, self-massage, acupuncture, and home physiotherapy are also useful if there are no contraindications to them.

What are the features of rehabilitation exercises for a bedridden patient?

The nature and volume of gymnastics should be determined by a doctor or physical therapy specialist. Exercises during hospitalization should begin in a hospital setting and continue, if necessary, after discharge at home. At first, when a person is still physically weak, passive gymnastics and various isometric exercises are performed, then active gymnastics are gradually added to them.

Physical exercises are complemented by breathing exercises. All exercises are performed slowly, smoothly, and their intensity and duration, as a rule, increase gradually. Usually the complex lasts 10-20 minutes and each exercise is performed 3-4 times. Exercises should not cause severe pain.

What is the technique of passive gymnastics for a bedridden patient?

Basically, the objects of passive gymnastics are limbs of the patient.

The nurse grabs the limb in the joint area with one hand, and with the other hand grabs this limb at some distance from the joint. The first hand serves as a support, and the second makes the necessary movements with the limb. As a result, the patient’s limb “passively” moves.

Passive hand movement. For shoulder joint gymnastics, the nurse grabs the patient’s upper arm (“shoulder”) with her left hand, and with her right hand, grabs his arm by the elbow joint (“elbow”). She then moves the patient's arm up and down, back and forth, and rotationally clockwise and counterclockwise, imitating the basic natural movements of the arm. Exactly the same principle of natural movement is applied in gymnastics of other joints. When doing elbow joint gymnastics, the nurse grabs the shoulder part of the arm near the elbow with her left hand, and the forearm with her right hand.

During hand exercises, the nurse grabs the forearm at the wrist with her left hand, and the hand with her right hand. Gymnastics of the fingers includes passive movements of each finger individually and all together.

Passive gymnastics for the lower extremities covers the hips, knees, ankles and toes. The principle of gripping parts of the lower extremities is the same as for the upper extremities. An even simpler description of passive gymnastics is that all the joints of a sick person must be carefully “developed” without exerting pressure, turning and bending them in all directions. In this case, the joints must be supported with the palm of your hand.

What are isometric exercises for a bedridden patient?

The essence of isometric exercises is that the patient is asked to contract (tighten) a certain muscle, overcoming some kind of resistance, and hold the muscle in this state for several seconds. The joints are motionless.

An example would be stretching a resistance band or rubber band and holding it stretched. More examples. The patient brings his palms together, and then presses the pads of all the fingers of one hand onto the pads of the fingers of the other hand. Or he puts his hands together and tries to stretch his arms to the sides. Specific exercises have been developed for each muscle group, and the instructor must tell you about them.

What are the features of active gymnastics for a bedridden patient?

Neck exercises include pressing the head to the chest, moving it back, then bending the neck to both shoulders and also turning the neck left and right.

Hand exercises include flexion and extension of all fingers and hands, circular movements of the hand and circular movements in the elbows, raising the arms, raising the arms to the sides. Exercises with canvas or rubber balls, a hand expander, manual work with plasticine, and handling small objects are also useful.

Leg exercises include squeezing and unclenching of the toes, circular movements of the feet, stretching of the feet (one must mentally strive to stand on tiptoes), pulling the feet towards oneself, bending and straightening the legs at the knees in a position on the back and stomach, hip joints in different directions in position on the back and side, leg lifts.

Exercises to prevent thrombosis include frequent leg lifts and exercises known as cycling and scissoring.

Exercises to prevent osteoporosis are done with an expander and rubber bandages, that is, with weights.

Exercises for the lungs(for the prevention of pneumonia) include inflating balloons and taking slow breaths with short breath-holds and spreading and bringing your arms together on your chest after exhaling.

Exercise to prevent constipation include “inflating” the abdomen as you inhale and pulling the abdomen “into itself” as you exhale, pulling your legs bent at the knees towards you in positions on your back and side.

To cope with this, a specialist will help him. Massage is the first stage in the patient’s recovery. It is prescribed as soon as the patient’s body allows.

Restorative massage after a stroke: can it be done?

Massage plays a big role during stroke. Thanks to it, you can revive atrophied muscles, relax, and normalize their tone. Massage will help improve lymph and blood circulation, which, in turn, will prevent the formation of blood clots.

It is advisable to begin the procedure while the patient is still in the hospital, but therapeutic massage can also be effective at home.

Therapeutic massage for stroke is not only possible, but also necessary. The main thing is to follow all the doctor’s instructions

How to organize a massage at home

Rehabilitation after a stroke depends on the degree of damage to the body. Patients need to do therapeutic exercises and take walks in the fresh air.

When deciding to carry out procedures at home, you should consider the following factors:

• Invite a specialist to perform therapeutic massage;
• Master the technique of carrying out treatment and prophylactic procedures under the supervision of a rehabilitation physician.
• When you decide to do a massage yourself, you need to take into account your strengths and capabilities. After all, now the health of a loved one is in your hands.

Correct positioning of the patient during a stroke

Recovery after a stroke largely depends on how the patient lies. The correct position will help to avoid many complications, such as pneumonia, bedsores.

From the first hours of illness, it is necessary to adhere to several positioning principles:

• The patient must be placed on either side, most importantly not on his back - this will help avoid aspiration;
• To avoid the risk of bedsores, you should consider how support affects changes in muscle tone and the maintenance of their activity;
• The head of the bed should be raised 30 degrees;
• The patient's limbs lie naturally and do not rest against anything;
• Nothing should be placed on the limbs.

Position on the “healthy” side: pros and cons of positioning

• Blood circulation in the affected limbs is not impaired, which means there is no risk of bedsores;
• Bronchial drainage can be performed without difficulty;
• The cervical asymmetric reflex is absent.

• Feeling of helplessness - the “sick” side is crushed by its mass;
• Respiratory functions are performed worse than in the position on the paralyzed side.

Pros and cons of positioning on the “sick” side

• Respiratory functions are positive;
• The “healthy” side retained its activity;
• It is possible to stimulate the affected side.

Verticalization method

Modern medicine, in the case of stroke patients, uses the “verticalization” method. It is prescribed from the second day of illness.

This rehabilitation method consists of smoothly transferring the patient to a vertical position. It can be carried out using special beds or tables on which the head and the whole body are raised.

Why is early verticalization necessary:

• The swallowing process improves;
• Communication becomes full, the patient gets the opportunity to take part in the life around him;
• The blood is saturated with oxygen due to improved respiratory function;
• It becomes possible to wash, go to the toilet, and eat food on your own;
• The risk of pneumonia and bedsores is minimized.

To carry out a massage at home, the patient also needs the correct position. He should lie on his back, a bolster should be placed under his knees, and a flat pillow should be placed under his head. If the patient has cardiac problems, the procedure is performed in the “side lying” position.

To avoid hypothermia, the patient is covered with a blanket, leaving the area of ​​the body necessary for work exposed.

Therapeutic massage must be carried out in combination with drug therapy.

Goals of massage after a stroke

The main task of massage for stroke is:

• Restore joint mobility, return them to both simple movements and grasping reflexes;
• Improve the passage of blood and lymph in the affected limbs;
• Resist the occurrence of tendon tightening and contractions in muscle tissue;
• Prevent the development of synkenesis;
• Reduce pain;
• Relieve increased muscle tone;
• Avoid the possibility of developing pneumonia.

Massage techniques

In the first time after a stroke, it is allowed to do only local massage involving paretic and atrophied limbs. It is allowed to carry out the procedure in the lumbosacral area, in the chest area on the side of the injury.

In the early stages, when bed rest is still maintained, stroking techniques are used for tightened muscles. With reduced muscle tone, rubbing techniques are added to stroking.

During massage therapy, it is necessary to follow the correct sequence, namely:

• Massage starting from the front surface of the injured limb. This is due to the fact that with unilateral lesions or hemiparesis, the lower part of the body is less affected than the upper.
• Massaging the large chest muscle.
• Hand massage - from the forearm to the fingers.
• Work on the back of the leg begins with the thigh, then goes to the lower leg and foot.
• On the back, the massage is carried out along the passage of lymph flow.

In addition to stroking, massage therapy techniques include light, continuous vibration in the form of shaking. In places where the muscles are not compressed - the surface of the hand, the back of the foot, along the front of the shin, stronger rubbing, deep stroking, and kneading are carried out.

Because each area of ​​a stroke patient's body is massaged differently, they should be considered separately.

Foot massage method

Let's consider the technique of massage of the lower extremities.

Before starting the massage, the specialist places the patient in the correct position:

• To work with the outer part of the thigh and lower leg, the patient is placed on his healthy side. The neck and knees are placed on the bolster, the head lies on the pillow.
• When massaging the back of the leg, the patient lies with his stomach on a pillow. This prevents lower back spasm from happening. You need to place a cushion under your feet.

The massage begins with kneading large muscles, moves to small ones and ends with the fingers.

Hip

• First, relax the muscles from the knee to the groin.
• Next, strokes are performed in the form of spirals and circles from top to bottom.
• After the muscles relax, a gentle massage with the base of the palm is added.

Buttocks

Massage is done from the sacral area towards the outer side of the hip joint.

Shin

• In this area, it is allowed to use a more rigid massage, but only if there is no muscle spasm.
• Longitudinal stroking is combined with stronger transverse stroking. The palm and all fingers are involved in the work.
• When massaging the calf, no force is used. Make smooth movements from the heel to the knee cavity.

Foot

• To work with the foot, it must be fixed. To do this, the heel rests against the palm of the massage therapist, the fingers are directed towards the ceiling.
• The specialist makes warm-up movements of all the tubercles and depressions of the back of the foot.
• Particular attention is paid to the hollows between the fingers.

All leg massage techniques are performed 3-4 times.

Hand massage

Massage of this damaged area is performed while lying on your back. Once completed, the patient should be lifted and seated. The paralyzed arm is fixed with a bandage or on a special stand.

Massage of the pectoralis major muscle is done primarily due to increased tone. The technique is gentle, the movements are superficial, circular. Light vibration is allowed.

Shoulders

• In the area of ​​the deltoid and trapezius muscles, deeper rubbing and kneading are allowed. Movements begin from the spinal column to the shoulders.
• First of all, stretch the triceps from the elbow to the shoulder joint.
• Next we move on to the biceps. In this area, due to the passage of a large artery of the shoulder and high spasticity, massage should be done with caution.

Forearms

• Massage is done from the wrist joint to the process of the elbow. From outside to back.
• The movements are smooth at first, then deep ones alternate.

Brush

• Tactile, tactile and motor functions need to be restored to the fingers. Therefore, hand massage is of great importance.
• Start from the inside of the fingers.
• Next they move to the inside of the hand, where the muscles are overstretched. More intense kneading and stretching are allowed.
• Due to the high tone of the palm muscles, massage in this area is carried out using a light technique.

Facial massage

A stroke causes paralysis of the facial muscles. To restore facial expressions and normal facial expression, special exercises should be done. Manual therapy is allowed.

It should only be carried out by a specialist who takes into account that exposure to certain points on the face may worsen your well-being.

With proper manual therapy:

• blood circulation is normalized;
• swallowing function improves;
• facial expressions are restored.

Therapeutic exercises

• To give the frontal part of the face the same mobility, you should put your hand on this area and try to raise your eyebrows.
• Gymnastics for the eyelids involves closing your eyes and bulging your eyes for a few seconds. Between exercises you should give your muscles rest.
• The cheek muscles are relaxed by inflating and retracting.
• Open your mouth as much as possible. At the same time, we move our lips, trying to stick them out and then hook them behind our teeth. It helps a lot to stretch your mouth into a smile.
• An exercise for the jaw consists of movements to the right, left, and imitation of chewing.

If it is difficult to perform the exercises on your own, then you should help with your hands, stretching the skin and muscles in the desired direction.

Precautions

A patient with a stroke should not undergo deep massage in the form of chopping with the edge of the palm or milk. This can trigger muscle spasms.

Muscle relaxation should be checked by raising and lowering the limbs. If they fall freely, it means the muscles are relaxed.

Rehabilitation after a stroke takes a long time. The main thing is to be patient, both for the patient and his loved ones. Due to astheno-depressive syndrome, the patient is more often in no mood, he is indifferent to everything. At such moments, the support of family and friends is needed.

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Classic massage for lying patients

Caring for bedridden patients is a very complex task, since it involves not only hygiene procedures and the prevention of bedsores, but also maintaining a satisfactory condition of the skin and muscles. The lack of movement for a bedridden patient means a gradual, and very rapid, deterioration of the soft tissues.

In the understanding of most people, a bedridden patient is a person who is completely immobilized as a result of a serious illness or injury, but there are plenty of situations in which the patient finds himself temporarily bedridden. A serious leg fracture, extensive surgery, serious illness, etc. require long-term and complete - but not lifelong - bed rest.

The most common situations in which a bedridden patient needs a special massage:

1. suffered a stroke with partial immobilization,

2. fractures of the spine and large bones, as well as multiple bone fractures,

3. after severe operations or acute conditions (myocardial infarction), when strict (stationary) bed rest is indicated for a long time,

4. for many chronic diseases of internal organs (pneumonia, bronchitis, coronary heart disease, heart failure, etc.),

5. cancer and neurological patients.

In each case, the need and scope of the massage course is assessed by the attending physician. For hospitalized patients, massage is performed by a medical massage therapist under strict control of the patient’s condition. Moreover, in each case, a certain set of massage movements is used, recommended for a specific disease.

Factors of the positive effect of massage on a bedridden patient

Thanks to the active effect on soft tissues, nerve endings, and the vascular network, blood circulation is effectively improved not only in the area of ​​massage, but throughout the body as a whole. Metabolism increases, organs and tissues receive sufficient amounts of oxygen and nutrients, toxins and metabolites are more actively eliminated (since venous outflow is activated).

Through massage manipulations, you can tone muscles whose ability to contract is reduced, and, conversely, reduce increased muscle tone (this situation is often observed after a stroke).

During a massage course, there is a significant improvement in the functioning of internal organs - the gastrointestinal tract, urinary system, lungs, heart, which allows the patient to improve their well-being and prevent the consequences of prolonged bed rest, which inevitably develop in most bedridden patients. These are constipation, congestion in the lungs, swelling of the extremities, etc.

Massage has a pronounced lymphatic drainage effect, as a result of which tissue swelling is significantly reduced. This is especially important for people who are significantly overweight and have underlying health conditions such as hypertension.

For bedridden patients with serious illnesses that do not allow them to hope for a full recovery and independent movement, massage is especially important. With the help of special massage techniques and passive therapeutic exercises, a certain muscle tone and blood supply to tissues are maintained, which is the prevention of bedsores and congestion in the lungs.

It is also important that the massage process itself, as a rule, gives a person pleasant sensations and positive emotions. Massage is not only a method of physical impact on the body for medical purposes, it has an important psychological component, it allows you to relax a little and take your mind off your illness. Often, for a bedridden patient, a massage session is not only a therapeutic manipulation, but also a pleasant pastime. Here, of course, a lot depends on the qualifications of the massage specialist and even on his personal qualities.

Note for relatives of bedridden patients

In the understanding of many people, massage is just an additional technique that allows the patient to recover from an illness. In fact, it is an effective rehabilitation technique, the early use of which in some clinical situations can significantly reduce the severity of the consequences of the disease (stroke, heart attack, consequences of extensive surgical interventions).

That is why it is very important that the massage is performed only by a qualified medical specialist, according to a strictly defined technique. Simple stroking and kneading of soft tissues will bring little benefit if they are performed by a person ignorant of medicine, especially since such an impromptu massage can be done in the wrong area of ​​the body where it is necessary. If a relative caring for a bedridden patient wants to do massage himself, he must definitely learn about the principles of massage for this disease and learn how to do it.

Rehabilitation after surgery using massage

Carrying out massage in the postoperative period has the following goals:

1. elimination of pain in the area of ​​the operation;

2. helps to normalize the functioning of the cardiovascular and respiratory systems, the depth of breathing increases and its frequency decreases compared to postoperative patients who do not undergo a massage course;

3. causes positive emotions and calms the nervous system;

4. increases the tone of the respiratory muscles, normalizes the act of breathing;

5. stimulates the regeneration process;

6. shortens recovery time and accelerates return to work.

Some experts advise performing the first massage session immediately after surgery on the operating table.

Massage after thoracic surgery

Contraindications: circulatory failure, pulmonary edema, surgery for lung cancer without complete removal of the tumor.

Starting position: the patient lies on his back and side, legs slightly bent.

Massage of the paravertebral zone in the area of ​​the cervical, thoracic, lumbar vertebrae: superficial stroking with fingertips and palm, ironing, rake-like rubbing, shading, pressing, continuous vibration with a small amplitude and at a slow pace. Rubbing the costal arches and iliac crests with your fingertips.

Abdominal massage: flat surface spiral stroking around the navel, stroking the abdominal muscles in the direction from the groin to the armpits and vice versa, pinching, longitudinal and transverse kneading, shifting, continuous vibration.

Massage of the liver and stomach area: pressure, continuous vibration, shaking. Next, a slight concussion of the abdomen is performed in the longitudinal and transverse directions.

Chest massage with fixation after the surgical suture through a bandage (in the early postoperative period): light stroking and rubbing around the site of the surgical suture, flat stroking towards the axillary, supra- and subclavian lymph nodes; stroking and rubbing the intercostal spaces, the area of ​​the sternum and shoulder joint, kneading the pectoralis major, trapezius and latissimus dorsi muscles, rubbing the area of ​​the shoulder blades and interscapular areas, rhythmic pressure with the palms along the ribs.

Indirect lung massage: rhythmic pressure, light patting, continuous vibration over the lung fields. Stroking and rubbing the neck muscles.

Massage of the heart area: continuous light vibration, rhythmic light pressure with the palm. Compression, shaking, stretching of the chest (while exhaling, press from the sides on the chest, and quickly remove your hands at the moment of inhalation).

Massage of the upper and lower extremities: broad stroking, rubbing the joint area, kneading and shaking the limbs. Passive and active movements in the limbs.

The duration of the massage procedure is 20 minutes, the course consists of 8 procedures.

Massage after surgery on the abdominal cavity and pelvic organs

Contraindications: circulatory failure, pulmonary edema, surgery for kidney cancer, renal and liver failure, surgery with incomplete removal of a malignant tumor.

Massage of the paravertebral area in the area of ​​the cervical, thoracic and lumbar vertebrae: superficial stroking with fingertips and palm, ironing, light circular rubbing with fingertips and their back surface, sliding, continuous vibration with low amplitude at a slow pace.

Massage of the costal arches, iliac crests, sacral area: trituration.

Massage of the pectoralis major, trapezius and latissimus dorsi muscles: flat, rake-shaped stroking, rubbing with fingertips, palm in semicircular directions, longitudinal kneading, shifting, pressing, shaking, gentle patting.

Massage of intercostal spaces: rake-like stroking and rubbing in the direction from the sternum to the spinal column. Rubbing the collarbones, sternum, shoulder blades and interscapular areas with your fingertips. Stroking the back and side surfaces of the neck, pincer-like stroking, rubbing and kneading the sternocleidomastoid muscles.

Diaphragm massage: rhythmic pressure with palms along the ribs from the sternum to the spinal column, continuous vibration, Rhythmic pressure and continuous vibration over the pulmonary fields.

Massage of the heart area: gentle rhythmic pressure in the area of ​​the heart and lower third of the sternum. Compressing the chest with the palms along the axillary lines in the ribs. Concussion, compression and stretching of the chest.

Abdominal massage is performed through a bandage with fixation of the postoperative suture: gentle stroking with fingers around the suture, to the axillary and inguinal lymph nodes, stroking the oblique muscles of the abdomen, pressing, forceps-like kneading.

Massage of the colon area: stroking, stroking, continuous vibration, tapping and rhythmic pressure with fingertips. Abdominal shaking with small amplitude and at a slow pace.

Limb massage: stroking, rubbing joints, kneading, shaking.

Massage for children after heart surgery

When rehabilitating children after operations, it is necessary to limit the use of medications as much as possible, since they can irreparably disrupt the functioning of the young body.

With the help of therapeutic exercises and massage, the following problems are solved:

1. facilitating the work of the heart, its pumping function, which is provided by massage techniques that promote contraction of peripheral muscles and activation of blood circulation;

2. prevention of pulmonary complications (pneumonia, atelectasis, pleural, pleuropericardial adhesions);

3. preventing the development in patients of postoperative phlebitis, restrictions of movement in the limbs, especially in the shoulder joint, on the side of the operation;

4. prevention of complications from the gastrointestinal tract (intestinal and bladder atony).

Massage techniques recommended for children after surgery: stroking (weakly sliding your hand over the skin); rubbing (circular stroking with slight pressure on the tissue); kneading (impact on deeper tissues, tendons and joints); patting (light movement of the fingers of both hands, helping to improve blood circulation and activate the activity of internal organs).

Each massage movement must be repeated once. Their direction when massaging the limbs is from the periphery to the center. The legs are massaged in the direction from the feet and legs to the inguinal folds, the arms - from the fingers and hands to the shoulder and axillary region.

In case of moderate severity of the postoperative condition of patients, massage of the peripheral muscles of the limbs, chest, back, and abdomen is used in combination with an early change in body position.

In the case of a severe condition of patients after surgery under conditions of artificial circulation, when the child is on controlled breathing, a feature of the technique is the inclusion of percussion massage techniques (patting and effleurage of the back), stimulation of the respiratory muscles in a side lying position in order to improve the evacuation of sputum.

Additional articles with useful information

Massage

Basic requirements for proper massage

Currently, massage as an effective method of functional therapy is widely used in a variety of areas of clinical discipline. It is used at all stages of medical rehabilitation of patients. In this regard, caregivers need to become familiar with the basic requirements of massage at home, as well as its simplest techniques. More complex techniques can be mastered in massage courses and in specialized literature.

1. During the massage, the whole body, especially the muscles and joints being massaged, should be as relaxed as possible. The most complete relaxation of muscles and joints occurs in a position when the joints of the limbs are bent at a certain angle (average physiological position).

When massaging the back, the person being massaged lies on his stomach, his arms are located along the body and slightly bent at the elbow joints, his face is turned towards the massage therapist, a cushion is placed under his shins. All this allows you to further relax your torso muscles.

When massaging the front surface of the body, a small pillow is placed under the head of the person being massaged, and a cushion is placed under the knee joints.

2. The massage therapist’s hands should be warm, clean, without roughness. Long nails are not allowed.

3. The room for massage should be warm (not lower than +20 °C), pre-ventilated.

4. Massage is carried out before eating or 1.5-2 hours after eating.

5. Massage should not cause pain.

6. Massage at a late time (after hours) is unacceptable.

8. Massage movements are performed mainly along the lymph flow to the nearest lymph nodes. On the upper extremities, this is the direction from the hand to the elbow and axillary nodes; on the lower extremities - from the foot to the popliteal and inguinal nodes; on the chest - from the sternum in both directions to the axillary nodes; on the back - from the spine in both directions. When massaging the upper and middle parts of the body, the movements are directed to the axillary nodes, when massaging the lumbar and sacral areas - to the inguinal nodes; on the neck and head, movements lead from top to bottom to the subclavian nodes.

9. The first massage sessions should be short and not intense. The time and intensity of the massage is increased gradually. The duration of the massage also depends on the area being massaged (arm massage - 5 minutes, back - 20 minutes). The duration of the general massage increases from time to time.

In terms of intensity, the massage procedure should be structured as follows: min-max-min. First, stroking is performed, then light rubbing, kneading, vibration, and percussion techniques are performed. The massage procedure always ends with smoothing.

10. Massage is carried out based on knowledge of the main muscle groups.

11. The intensity and duration of the massage depends on the age, gender, physique, and condition of the patient.

12. Before the massage, the patient must take a shower or dry himself with a damp towel.

13. After the massage procedure, the patient needs rest for a period of minutes.

Contraindications to massage

Every caregiver should know the main contraindications to massage. They are divided into absolute (massage is completely contraindicated), temporary and local (i.e. massage is contraindicated in certain areas of the body).

Absolute contraindications to massage:

• malignant tumors (before their radical treatment);
• gangrene;
• thrombosis;
• active form of tuberculosis;
• acute venereal diseases;
• acute and chronic osteomyelitis;
• causal syndrome after peripheral nerve injury;
• circulatory failure and heart failure of the 3rd degree;
• angiitis (artery disease);
• diseases with pronounced mental changes;
• aneurysms of blood vessels, aorta;
• scurvy;
• HIV infection;
• blood diseases, tendency to bleeding;
• atherosclerosis of peripheral vessels, thromboangiitis in combination with atherosclerosis of cerebral vessels.

Temporary contraindications to massage:

• acute febrile conditions;
• acute inflammatory process;
• bleeding;
• purulent, infectious processes (furunculosis, etc.);
• lymphadenitis, lymphangitis;
• crises: hypertensive, hypotonic and cerebral;
• multiple allergic skin rashes, as well as hemorrhages and swelling;
• nausea, vomiting, abdominal pain;
• alcohol intoxication;
• acute pain requiring narcotic analgesics;
• acute cardiovascular, renal failure.

• massage of areas of the body affected by fungal, viral and other pathogens - warts, herpes, cracks, eczema, etc.;
• body massage in the area where the benign tumor is located, massage of other parts of the body is performed using a gentle technique (stroking only);
• body massage in areas adjacent to the site of excision of a malignant tumor;
• massage of the anterior surface of the chest for mastopathy;
• massage of the lumbar region, abdomen, thighs for ovarian cysts, fibroids, fibroids, adenomas (in men);
• massage near protruding moles;
• massage in areas of varicose veins;
• abdominal massage for hernia, pregnancy, menstruation, gallstones and kidney stones; massage of the lumbar region is performed using a gentle technique;
• massage of the mammary glands, groin area, nipples;
• massage of lymph nodes.

Basic massage techniques

Technique for performing the “stroking” technique

This technique is performed with the entire palmar surface of the hand if the muscle is large (on the back, chest, arm, leg), and with the fingers if the muscle is small (on the phalanges, toes).

When performing this technique, the massage therapist’s brush should be as relaxed as possible and easily glide over the skin without moving it into deep folds. Stroking can be superficial (the palm lightly touches the skin) and deep. With this technique we begin and end the massage and alternate other techniques.

Despite the simplicity of its implementation, it has a huge positive effect on the entire body, having an analgesic and calming effect. The pace of stroking is slow and rhythmic. The trajectory of hand movement can be different: rectangular, zigzag, spiral. This technique is performed with one or two hands.

If you perform deep stroking, it will have a tonic effect on the muscle and body. By stroking certain areas of the body, we also have a healing effect on the organ with which this area is connected. For example, stroking the interscapular area has a beneficial effect on the heart. Thanks to this technique, the patient, in addition, adapts to the hands of the massage therapist.

With the help of stroking, we exfoliate the upper dead layer of the epidermis on the skin, remove residual sweat and fat, and therefore improve breathing, blood and lymph circulation in the surface layers of the skin.

However, when performing even this simple technique, the dosage must be observed so as not to cause irritation to the patient. Even if you pet a cat, at first it purrs with pleasure, and when it gets tired, it may scratch.

Technique for performing the “rubbing” technique

This technique involves displacing and stretching the skin and underlying tissues. The massage therapist's hand does not slide, but shifts the skin, forming folds. Vigorously performing this technique helps warm up all tissues. At the same time, the skin turns slightly red, becomes more elastic and flexible. Rubbing helps increase blood flow to tissues and improves their nutrition. As a result, tissue mobility increases, scars, adhesions, and pathological deposits soften. The trajectory of the movement of the hands can be different, but in case of edema - along the lymph flow to the nearest lymph nodes.

This technique should be performed with the heel of the palm or the pads of the fingers, using one or two hands. You can also clench your hand into a fist and rub the skin with the backs of your fingers or the ridges of your fist, making movements reminiscent of planing, shading, and sawing. Directions of movement can be rectilinear (forward, zigzag), circular and spiral.

Rubbing with the pads of 4 fingers. The technique is performed with the pads of 4 closed, slightly bent fingers, resting on the thumb and the base of the hand. The fingers can be slightly spread, making movements in a spiral, in a circle or progressively - back and forth.

Rubbing with the pad of the thumb. This technique is performed with the pad of the thumb while resting on the 4 remaining fingers laid out to the side as much as possible. The movement of the thumb can be straight, spiral, or circular.

Rubbing with the base and edges of the palm. When performing this technique, the hand is slightly extended, 4 fingers are slightly bent and raised above the skin. The movements of the hand are translational: back and forth, spiral or circular.

Rubbing can also be done with the ulnar edge of the hand - in circular and spiral movements.

Sawing is performed with the elbow edge of the hands, located parallel to each other at a distance of 2 cm and moving in opposite directions. Soft fabrics should be wiped between the palms.

Intersection is used on rounded surfaces (neck, buttocks, side surfaces of the body). It is performed with the radial edges of the hands at maximum abduction of the first finger. The brushes are parallel and move in opposite directions.

Rubbing with the phalanges of 4 fingers. This technique is performed with the back of the middle phalanges of the 4 fingers, slightly clenched into a fist. With such a rather harsh effect on the muscle, it seems to be pressed against the bone. The thumb rests on the massaged area, helps fix the hand and move it forward. The movements of the brush can be progressive: up and down, spiral or circular.

Technique for performing the “kneading” technique

This technique promotes passive gymnastics of blood vessels and muscles. When performing kneading, the massaged muscle is grabbed, lifted and pulled, squeezed and, as it were, squeezed out. And if previous techniques affected the skin (stroking), subcutaneous fat layer and the superficial layer of muscles (rubbing), then kneading affects the condition of the deep layers of muscles. When kneading, muscle tone increases, they become strong and elastic, and blood supply not only to the massaged area, but also to nearby ones, significantly improves. This technique also enhances muscle contractility.

Kneading is carried out in different directions with one or two hands:

a) on small surfaces - with the palmar surface of the nail phalanges of the 1st and 2nd fingers (i.e., as if with the tips of the fingers);

b) on large muscles - with all fingers.

Single kneading is performed with one hand. Having tightly clasped the massaged muscle with your palm (the thumb is located on one side of the muscle, and all the others on the other), it is lifted, squeezing between the fingers and making translational movements forward or towards the little finger. When tearing and squeezing a muscle, there should be no gap between the palmar surface of the hand and the skin of the muscle. The first movement resembles squeezing out a sponge. In the second case, the muscle seems to be torn away from the bone bed, compressed, rotated towards the little finger and thus moves forward in a spiral. The movement is performed along the muscle, which is why it is also called longitudinal.

Kneading with two hands (“double ring” or transverse) is performed as follows. The massage therapist tightly clasps the massaged muscle with both hands so that they are in the same plane at an angle of 45° to the surface of the patient’s body. All fingers cover the massaged surface, but one hand pulls and squeezes the tissue away from itself, and the other pulls it towards itself. Then the direction of hand movement is reversed. Massage movements should be soft, without jerking and a little like kneading dough.

This technique is performed slowly, smoothly, there should be no muscle twisting or pain. Kneading always alternates with stroking and is performed along the lymph flow.

Tong-shaped kneading is performed on one side with the thumb, and on the other with the remaining fingers (they take the shape of tongs); the muscle is grabbed, pulled upward, and then kneaded between the fingers. 2-3 fingers work on small muscles (fingers, toes). The technique is the same as for longitudinal and transverse kneading.

Felting is used on the limbs, mainly to reduce muscle tone in case of hypertonicity. With parallel palms, they tightly cover the limb and make movements in opposite directions.

Pressure is used to increase muscle tone during hypotension. The massage therapist presses his palm tightly against the skin and gradually increases the pressure with a delay of up to 3-5 s at the end point. Then it also gradually reduces the force of pressure. Pressure can be applied more vigorously. The technique is performed with the pads of the fingers, the back of the hand or a fist placed flat.

The shift is performed with the thumbs on one side and all the fingers on the other. The underlying tissue is lifted and caught in a fold to form a muscle roll, which is then rolled in any direction.

Pinching is performed with the thumb and forefinger (or thumb and all the others) of one or both hands. The muscle tissue is captured and pulled upward. The movement is performed energetically and helps to increase muscle tone during hypotension.

Technique for performing the “vibration” technique

Vibration is the transmission of oscillatory movements to the massaged area of ​​the body, produced evenly, but with different speeds and amplitudes. It is performed on the palmar surface, the nail phalanges of one finger, thumb and forefinger or forefinger, middle and ring fingers, thumb and other fingers. Oscillatory movements performed with a large amplitude and oscillation frequency of up to 120 movements per minute will increase muscle tone, and with a frequency of more than 120 and with a small amplitude, they will reduce muscle tone. In other words, weak vibration increases muscle tone, and strong vibration decreases it. Vibration has a strong and varied effect on deep tissues. The movements of the massage therapist's hands should be gentle, soft, painless.

Labile vibration is performed with a brush. It makes oscillatory movements, moving in any direction over the massaged area. If the vibration continues for at least 10 seconds, it is called continuous. If the exposure time is less than 10 seconds, and the hands are periodically removed from the body, then it will be an intermittent vibration. Continuous vibration includes the techniques of shaking, shaking and shaking (to reduce muscle tone), intermittent - chopping, patting, quilting, puncturing (to increase muscle tone).

The direction of movements during oscillations is mainly from right to left and only on the stomach, when massaging certain organs - from top to bottom (pushing).

Stable vibration is performed on the spot with the pad of one or more slightly bent fingers (point vibration).

Shake. The masseur grabs the muscle by the abdomen (middle) with his fingers, pulls it slightly and shakes it with the brush at the required frequency. The technique is used to massage the limbs.

Shaking. This technique is also performed on the limbs and large muscles (such as the latissimus dorsi). The muscle is grabbed between the first and fifth fingers, the other three fingers are located above the skin. The hand performs oscillatory movements from side to side from one end of the muscle to the other (from the lower section to the upper).

Shaking. The massage therapist takes the patient’s hand or foot with both hands and performs oscillatory movements of the entire arm or leg from top to bottom or from right to left.

Chopping. It is performed with the ulnar edges of the hands placed parallel, at a distance of 2-3 cm from each other at an angle of 20-30°. The hands are relaxed. 4 fingers slightly spread and bent. Movements of the hands occur in opposite directions at a rate of beats per minute. Chopping is done along the muscle fibers.

Pat. If the technique is performed correctly, a dull sound should be heard. Patting is carried out with the palmar surface of the hand (the thumb is pressed) with the fingers slightly bent. The brush takes the shape of a box. The technique is performed with one or two hands alternately in opposite directions.

Effleurage. It is performed with a flat fist, and in small areas (on the hand, on the back of the foot) with the pads of the fingers.

Puncture (for elderly people). It is performed with the pads of half-bent fingers moving alternately, like the movements of a typist.

Quilting. It is performed with the palmar surface of the hands moving tangentially up and down.

Massage for stroke

From a medical point of view, a stroke is a severe and dangerous vascular lesion of the central nervous system. And if previously stroke was the lot of older people, in recent years it has become sharply “younger”. In the first month after a stroke, rehabilitation measures begin. The earlier treatment is started, the more favorable the outcome of the disease! The success of recovery is largely determined by the mood of the patient himself, as well as his loved ones. Optimism, the desire to achieve a set goal, diverse interests, and an active attitude towards life help defeat the disease even to a greater extent than medications. It is clear that treating stroke in a specialized stroke unit improves clinical outcome. In such departments, specially developed programs of restorative procedures are used and specialists of various profiles work, including experienced massage therapists and exercise therapy instructors specializing specifically in this disease. But after the patient is discharged from the hospital, it is necessary to continue doing therapeutic exercises and massage for many months, and sometimes years.

Unfortunately, in our time, due to the difficult financial situation of most people, not every close relative can allow the patient to use the services of such specialists. In this regard, there was a need to acquaint those caring for this category of patients with the basics of rehabilitation gymnastics and massage.

Before you begin performing these procedures, you should find out from the attending physician whether the patient has any contraindications to them, and also clarify (ask to show) which muscles in your patient are relaxed and which are tense. It is also necessary to determine specific goals, i.e., the objectives of massage and therapeutic exercises:

• increase blood and lymph circulation in paralyzed limbs and throughout the body;
• improve nutrition of all tissues;
• contribute to the restoration of movement function in the affected limbs;
• counteract the formation of contractures;
• reduce muscle tone in spastic muscles and reduce the severity of conjugal movements;
• reduce or relieve pain;
• increase the emotional tone (mood) of the patient;
• prevent congestive pneumonia in the elderly;
• prevent the formation of bedsores.

In the first months after a stroke, only local massage is allowed, involving paralyzed or paretic limbs, the back and lumbar region, and the chest (on the affected side). General massage is allowed only in the late rehabilitation period, since prolonged exposure can cause overwork of the patient, which is unacceptable.

During the massage, each technique is repeated 3-4 times. During the first procedures in the early stages after a stroke, the area of ​​influence is small; only the shoulder and thigh are massaged, without turning the patient onto his stomach. In the 4th-5th procedure, depending on the patient’s condition, massage of the chest, forearm, hand, lower leg, and foot is added. From the 6-8th procedure, the back and lumbar region are covered with the patient lying on the healthy side. The prone position is used at a later date and only in the absence of contraindications due to heart disease.

In the early stages of bed rest, only stroking techniques are used for spastic muscles, and stroking and rubbing for muscles with reduced tone.

To increase the effectiveness of massage and therapeutic exercises, it is advisable to pre-warm paralyzed limbs. For this purpose, you can use a reusable saline heating pad.

It is necessary to emphasize once again that the increase in the intensity of exposure is strictly individual and depends on the patient’s condition. After a stroke, in the absence of contraindications, massage is prescribed for uncomplicated ischemic variants - on the 2nd - 4th days, and for hemorrhagic ones - on the 6th - 8th days. The duration of the massage is gradually increased from 10 to 20 minutes. During strict bed rest, massage should only be performed by a highly qualified massage therapist and under the supervision of a physician. A caregiver for such a patient can perform massage only in the late recovery and rehabilitation period, when the patient’s condition has significantly improved and he is discharged from the hospital. But there are also unforeseen circumstances, and the help of a caregiver may be needed in the early stages. It should be noted that massage is an additional method of treatment, while the main ones include positional treatment (special styling) and therapeutic exercises.

Treatment by position

The principles of treatment are to give the paralyzed limbs the correct position while the patient is in bed. It is currently believed that the development of hemiplegic contracture with the formation of the Wernicke-Mann posture (the hand is pressed to the body, the fingers are clenched into a fist, the leg is turned outward, straightened, the foot hangs and is turned inward) may be associated with a long stay of paralyzed limbs in one and the same place. the same position in the early period of the disease. There are various options for styling paretic limbs.

Laying in a supine position. The paralyzed arm is placed on a pillow so that it is at the same level throughout the horizontal plane. Then the arm is abducted to the side at an angle of 90° (for pain, start with a smaller abduction angle, gradually increasing it to 90°), straightened and turned outward. The hand with extended and spread fingers is fixed with a splint, and the forearm with a bag of sand or salt weighing about 0.5 kg (as a splint you can use some light material - plywood, light metal, covered with gauze). A cotton roll covered with oilcloth is placed in the forearm cavity, and the fingers, hand and forearm are bandaged to the splint.

The paralyzed leg is bent at the knee joint by 15-20° and a cushion is placed under it. The foot is bent at a right angle and held in this functionally advantageous position using a wooden box (“foot case”). The sole of the sore leg should rest against one of its walls. For a more reliable fixation, the case is tied to the headboard. The patient should remain in this position for 1.5-2 hours. During the day, a similar procedure can be repeated 2-3 times.

Place the patient in a position on the healthy side. With this placement, the paralyzed limbs are placed in a bent position. The arm is bent at the shoulder and elbow joints and placed on a pillow, the leg is bent at the hip, knee and ankle joints, placed on another pillow. If muscle tone has not increased, the position on the back and healthy side is changed every 1.5-2 hours. In cases of early and pronounced increase in tone, treatment on the back lasts 1.5-2 hours, and on the healthy side.

Sequence of massage

The procedure begins with a massage of the front surface of the affected leg, since with hemiparesis the lower limbs are less affected than the upper ones. Then the pectoralis major muscle, arm, back of the leg, and back are sequentially massaged. Leg massage is performed according to a certain pattern - first the thigh is massaged, then the lower leg and foot. On the upper limb - shoulder, forearm, hand, fingers. The direction of movement is along the lymph flow.

Massage techniques include various types of superficial stroking, light rubbing and light continuous vibration (shaking, shaking) for spastic muscles. The spastic state is distinguished by:

• muscles of the inner (front) surface of the shoulder, forearm and palmar surface of the hand;
• pectoral muscle on the affected side;
• muscles that extend the knee (quadriceps) and externally rotate the thigh;
• muscles of the posterior surface of the lower leg (gastrocnemius, posterior tibial, long flexor and 1st fingers);
• muscles located on the sole.

During the massage of these muscle groups, light stroking and, somewhat later, rubbing techniques are used. Light vibration is suitable for some muscles.

In other areas - the back (outer) surface of the arm, the front surface of the shin, on the back of the foot - the muscles are not spastic. Therefore, here you can perform deep stroking, more intense rubbing, as well as light kneading.

Impact techniques are contraindicated: patting, chopping, beating, etc.

Position of the patient during massage

The patient lies on his back, a bolster is placed under his knees, and a pillow is placed under his head. In cases of synkinesis (friendly movements), the non-massaged limb is fixed with sandbags. Massage of the outer surface of the leg can be performed with the patient positioned on the healthy side. The back surface of the leg is massaged with the patient lying on his stomach, a small pillow is placed under the stomach, and a bolster is placed under the ankle joints; under the head - a small pillow. In case of cardiac problems, the patient is massaged on his side. To preserve heat, it is covered with a blanket and during massage only the massaged area is exposed.

With spastic paralysis, the patient has no voluntary movements, muscle tone increases, all tendon reflexes intensify, and involuntary friendly movements occur. So, when a healthy limb moves, exactly the same movement is reproduced by a paretic one and vice versa. Sometimes the affected lower limb repeats the movement of the upper limb, for example, bending the arm causes the leg to bend. We must also remember that anxiety, physical stress, fatigue, and cold impair the ability to move.

Therefore, before starting massage techniques, it is necessary to achieve a maximum reduction in muscle tone, i.e. muscle relaxation. To do this, use special relaxation exercises, first on the healthy hand and then on the affected one. To test the ability to relax muscles, the massage therapist lifts the patient’s healthy limb and releases it - the limb should fall freely. The massage therapist protects his hand from injury.

Hand exercises

1. The caregiver supports the patient’s elbow with one hand and the hand with the other. Raises and lowers the hand with shaking movements. Rubs the area around the elbow.

2. The caregiver makes outward circular movements in the shoulder joint while simultaneously pressing on the head of the humerus. The range of movement should be small. The exercises are performed very slowly, gently and carefully. The patient should not be overfatigued, so the number of exercises should be minimal at first (1-2 times). If, nevertheless, friendly movements arise during the exercises, then the other limb should be pressed to the body.

After the described exercises for the arms, they begin to perform techniques of stroking and shaking the pectoralis major muscle on the side of the paresis. Then the hand massage begins.

Leg exercises

1. The caregiver, supporting the foot, slowly lifts the leg with shaking movements and gently swings it to the sides. Before the exercise, the patient inhales, and during the movements exhales.

2. Then a slight concussion of the thigh muscles is performed.

3. The caregiver, supporting the leg under the knee joint with one hand, bends and unbends it with the other, without bringing it to maximum extension.

4. To relax the muscles of the foot, gently shake the calf muscle on the back of the shin. The leg should be bent at the knee joint.

5. The essence of muscle relaxation is explained to the patient, signs indicating its onset are named (feelings of heaviness of the sore limb). Next, the caregiver shows himself what the state of the muscles is at rest, during tension and relaxation.

Massage technique

Foot massage

Thigh massage. The anterior and inner surfaces of the thigh are massaged with the patient lying on his back. First, light superficial stroking is performed on the inner, middle (front) and outer surface of the thigh. The movements go from the knee joint to the groin area. Then add light, slow spiral and zigzag strokes. The criterion for correct execution is a slight relaxation of the spastic muscles. In the future, light rubbing with the pads of the 4 fingers and the base of the palm is added to these techniques. All these techniques are combined with stroking. Each technique is performed 3-4 times.

Massage of the back of the thigh is carried out with the patient lying on his stomach or side. On the back of the thigh are the gluteus maximus, biceps, semitendinosus and semimembranosus muscles. All these muscles are involved in hip extension, and, given their spastic state, gentle techniques should be used: stroking and light rubbing. Movements are performed from the popliteal fossa to the gluteal fold. The buttock is stroked from the posterior surface, the sacrum to the greater trochanter (it protrudes on the upper outer surface of the thigh and can be easily felt during palpation).

Shin massage. On the front surface of the lower leg there are extensors of the foot - they are usually less spastic. Therefore, more intensive techniques are permissible here: first superficial and then deep stroking, more energetic rubbing techniques, as well as transverse and longitudinal kneading. Massage is carried out with all fingers and palm. The movements go from the ankle up to the knee joint.

The gastrocnemius and soleus muscles extend onto the back surface of the lower leg, which flex the lower leg at the knee joint and the foot. They are very spastic, and therefore they must be massaged using a gentle method. The movements go from the heel tubercle to the popliteal fossa.

Foot massage. On the back of the foot there are muscles - extensors of the fingers with mild spasticity. Therefore, the techniques of stroking, rubbing and kneading are used here. The caregiver fixes the foot with one hand (places the patient’s heel in his palm, so that the toes point upward), and with fingers II-IV with the other, massages its dorsal surface from the tips of the toes to the shin. Then I use my finger to stroke and rub the interosseous spaces. If you spread your toes, the interosseous spaces will clearly stand out in the form of indentations on the dorsum of the foot.

On the plantar side of the foot there are muscles with increased tone, and they are massaged using a gentle technique. The direction of movement is from toes to heel.

Massage of the pectoralis major muscle on the affected side

With hemiparesis, this muscle has a very high tone, so the massage here should be very gentle. Apply superficial stroking, very light rubbing with the pads of 4 fingers and light vibration in the form of shaking or light shaking. Shaking can be done with fingers I-II, or by placing the entire hand on the chest and moving it along the massaged area in the direction from the sternum to the armpit.

Hand massage

Hand massage is carried out with the patient lying on his back, and at the end of bed rest - in a sitting position (the patient's hand is on a nearby table, and the caregiver is sitting opposite him).

Shoulder massage. The massage begins with the trapezius and deltoid muscles. Their tone is not increased, so they use the techniques of deep stroking, intense rubbing and light kneading. The direction of movement is from the VI-VII cervical vertebrae (if you bend your head, the VII vertebra will protrude more than the others) to the end of the deltoid muscle. The deltoid muscle should be rubbed and stretched well.

Next, the triceps muscle, which is an extensor of the forearm, is massaged. The tone of this muscle is not so high, so in case of hemiplegia it is advisable to start the massage with this muscle. Apply the techniques of superficial and deep stroking, vigorous rubbing and light kneading. The movements go from the elbow joint along the outer back surface of the shoulder to the shoulder joint.

Then they move on to massage the biceps muscle, which is a flexor of the forearm and shoulder. She is very spastic, so only light stroking and rubbing are used here. Movements are performed from the ulnar fossa along the inner anterior surface of the shoulder to the armpit. The brachial artery, veins and nerves pass along the inner surface of the shoulder (on the internal groove). Therefore, when performing a massage, you must be especially careful and under no circumstances apply any pressure to this surface.

Forearm massage. The muscles of the posterior (outer) surface of the forearm - the extensors of the hand and forearm - are overstretched, so it is advisable to start massaging the forearm with them. Perform deep and superficial stroking, rubbing, and kneading techniques. The movements go from the wrist joint along the back of the forearm to the olecranon.

The muscles of the anterior (inner) surface of the forearm - the flexors of the hand and forearm - are spastic during hemiparesis, so they are easily stroked and rubbed in the direction from the wrist joint to the ulnar fossa.

Massage of the hand and fingers. The muscles on the back of the hand are overstretched. Therefore, the massage begins with the back of the fingers, then moves to the back of the hand. Here they perform energetic techniques: deep stroking, rubbing, kneading.

The muscle tone of the palmar surface of the hand is very high, so the massage is performed using a gentle technique - only superficial stroking.

Back massage

The patient lies on his stomach or on his healthy side, with a pillow under his head. When massaging the back, all techniques are used, but they must be soft and gentle so that muscle tone does not increase and tissue nutrition improves. The direction of movement was described in previous sections.

Therapeutic exercises and massage for the elderly

Numerous examples of the beneficial effects of therapeutic exercises and light massage on the body of older people put beyond any doubt the feasibility of their use. Twenty years ago, the motto of older people was: “We can grow to be a hundred years old without getting old.” On the running tracks of our stadiums, every day one could see numerous groups of people who were over 60, 70, and even 80 years old. Today we see a completely different picture. In medical and physical education clinics and specialized centers you can meet only small groups of people who have suffered strokes, heart attacks and other diseases or injuries. This suggests that in our troubled times, elderly people have neither attention nor funds, and they sometimes feel useless and are in dire need of the care and help of loved ones.

We can provide such assistance by doing short-term gymnastics with them, performing simple massage manipulations on limited areas of the body. The technique of massage and therapeutic exercises, as with diseases, is different in each specific case.

Therapeutic gymnastics

When drawing up a therapeutic gymnastics lesson plan, you need to consider:

• age;
• concomitant diseases;
• human condition: blood pressure, pulse, muscle tone, general well-being;
• contraindications (see earlier).

Therapeutic exercises for older people should be done every other day or once a week. The load should be minimal, the training time should be from 10 to 30 minutes, the exercises should be performed in light starting positions: sitting, lying down. To make sure that you are doing everything correctly, you can keep a journal in which you need to note the following indicators:

• mood;
• fatigue;
• feeling of cheerfulness;
• performance;
• headaches;
• dyspnea;
• pain and discomfort in the heart area or other places;
• appetite;
• pulse;
• blood pressure;
• activity of the gastrointestinal tract.

One should try to make such observations unobtrusively, without particularly focusing the attention of older people, since among them there is a category that likes to delve into their feelings and aggravate their condition.

Gradually, you need to ensure that your wards independently every day, every day. did exercises and did daily housework. Then they will have an incentive in life and many “sores” will go away on their own.

Massage

Massage for older people is done mainly in a sitting position. Perform light stroking of the collar area, i.e. from the scalp down the neck to the shoulders. You can stroke and easily rub your hands, starting from the fingers up to the shoulder joints. Light shaking is acceptable. Kneading and striking techniques are excluded. You can massage your toes, feet and lightly your legs to your knees, and then your thighs from bottom to top. Massage of the arms and legs is best performed while lying on your back, half-sitting.

An approximate complex of therapeutic exercises

1. Arms extended in front of the chest. On the count of “one - two,” spread your arms to the sides and inhale. On the count of “three - four”, return to the starting position (i.p.).

3. Place your hands on your knees, raise your shoulders on the count of “one”, and lower your shoulders on the count of “two”. (You can raise your shoulders at the same time, or you can alternately).

4. Perform body turns in one direction or the other.

5. On the count of “one”, spread your arms to the sides and take a breath; on the count of “two”, wrap your arms around yourself and exhale.

6. On the count of “one”, bend your torso forward and stretch your chest towards your knees; on the count of “two”, take the I.P.

7. At the count of “one” straighten one leg, at the count of “two” - the second, at the count of “three” return one leg to the I.P., at the count of “four” - the other. This exercise can be combined with arm movements. In addition to physical activity, exercises will develop attention and coordination of movements. The arms can be straightened in the same way as the legs, or they can be opposite. On the count of “one,” straighten your right leg and left arm, on the count of “two,” straighten your left leg and right arm, on the count of “three,” bend your right leg and place it on your knee, on the count of “four,” return your left leg and right arm to .p.

8. In i.p. while sitting, lower your arms along your body. On the count of “one - two”, slowly tilt the body to the right, the left hand slides along the body up to the armpit, and the right hand reaches towards the floor. On the count of “three - four”, return to i.p. Then repeat everything in the other direction.

9. On the count of “one,” pull one knee to your chest and clasp it with your arms. On the count of “two” take the i.p. On the count of “three - four”, pull up the other knee and return to the I.P.

10. On the count of “one - two”, raise your arms up through your sides and inhale; on the count of “three - four”, lower your arms down through your sides and exhale.

Perform each exercise promptly. You can also include exercises with massagers. Periodically roll the rolling pin with your hands and feet, and also rub your fingers and hands, you can lightly rub your ears.

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