Patient management in the recovery period of stroke
https://doi.org/10.14412/2074-2711-2014-4-101-105
Abstract
Stroke heads the list of all causes of disability in middle-aged and elderly people. In recent years, there have been about 30% of morbid events among able-bodied persons (less than 65 years of age). The major post-stroke incapacitating disorders are motor and speech defects, cognitive and psychoemotional disorders, and pelvic organ dysfunctions. The patients’ quality of life largely depends on the degree of recovery of lost functions. In turn, the degree of their recovery depends on the start, proportioning, and continuity of initiated rehabilitation measures and on whether the patient has cognitive, speech, and psychoemotional problems and pelvic organ dysfunctions. Unfortunately, after discharge from a specialized unit, only a small number of post-stroke patients are admitted to specialized rehabilitation centers. The responsibility of caring for
these patients rests with their relatives and outpatient physicians.
The main tasks in the early and late recovery periods following stroke are, in addition to the prevention of recurrent stroke, the implementation of rehabilitation programs to correct motor and speech disorders and cognitive impairments, the stabilization of emotions, and the provision of proper and qualitative general care for patients with severe motor defects and pelvic organ dysfunctions. The paper considers the main principles of patient management in the early and late post-stroke recovery periods. The authors give rehabilitation recommendations and main errors in routine practice (their relatives and junior medical staff have no speech contact with patients having speech disorders; psychoemotional disorders are underestimated and uncorrected; proper general care for patients with pelvic organ dysfunctions is absent).
About the Author
O. V. KosivtsovaRussian Federation
References
1. Скворцова ВИ, Иванова ГЕ. Реабилитация больных инсультом. Журнал Российской ассоциации по спортивной медицине и реабилитации больных и инвалидов. 2001;(2):12–8. [Skvortsova VI, Ivanova GE. Reabilitatsiya bol'nykh insul'tom. Zhurnal Rossiiskoi assotsiatsii po sportivnoi meditsine i reabilitatsii bol'nykh i invalidov. 2001;(2):12–8. (In Russ.)]
2. Гусев ЕИ, Скворцова ВИ, Стаховская ЛВ. Эпидемиология инсульта в России. Журнал неврологии и психиатрии им. С.С. Корсакова. 2003;103(9):114. [Gusev EI, Skvortsova VI, Stakhovskaya LV. Stroke epidemiology in Russia. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2003;103(9):114. (In Russ.)]
3. Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 c. [Parfenov VA, Khasanova DR. Ishemicheskii insul't [Ischemic stroke]. Moscow: MIA; 2012. 288 p.]
4. Hackam DG. Combining multiple approaches for the secondary prevention of vascular events after stroke. A quantitative modeling study. Stroke. 2007;38:1881–5. DOI: http://dx.doi.org/10.1161/STROKEAHA. 106.475525.
5. Парфенов ВА. Вторичная профилактика ишемического инсульта. Русский медицинский журнал. 2005;13(25):819–23. [Parfenov VA. Secondary prevention of an ischemic stroke. Russkii meditsinskii zhurnal. 2005;13(25):819–23. (In Russ.)]
6. Sacco RL, Adams R, Albers G, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke. 2006; 37:577–617. DOI: http://dx.doi.org/10.1161/01.STR. 0000199147.30016.74.
7. Парфенов ВА, Гурак СВ. Повторный ишемический инсульт и его профилактика у больных с артериальной гипертонией. Журнал неврологии и психиатрии им. С.С. Корсакова. Приложение Инсульт. 2005;105(14):3–7. [Parfenov VA, Gurak SV. Povtornyi ishemicheskii insul't i ego profilaktika u bol'nykh s arterial'noi gipertoniei. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. Suppl. Stroke. 2005;105(14):3–7. (In Russ.)]
8. Вахнина НВ, Никитина ЛЮ, Парфенов ВА, Яхно НН. Постинсультные когнитивные нарушения. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008;S22:16–21. [Vakhnina NV, Nikitina LYu, Parfenov VA, Yakhno NN. Post-stroke cognitive disturbances. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2008;S22:16–21. (In Russ.)]
9. Горбачева ФЕ, Зиновьева ОЕ, Абдулина ОВ. Таламический лакунарный инфаркт с грубыми мнестическими нарушениями. Неврологический журнал. 2004;9(3):15–8. [Gorbacheva FE, Zinov'eva OE, Abdulina OV. Thalamic lacunar infarction with severe mnestic disorders. Nevrologicheskii zhurnal. 2004;9(3):15–8. (In Russ.)]
10. Преображенская ИС, Яхно НН. Сосудистые когнитивные расстройства: клинические проявления, диагностика, лечение. Неврологический журнал. 2007;12(5):45–50. [Preobrazhenskaya IS, Yakhno NN. Vascular cognitive impairment – clinical manifestations, diagnostic approaches and treatment. Nevrologicheskii zhurnal. 2007;12(5):45–50. (In Russ.)]
11. Яхно НН. Когнитивные расстройства в неврологической практике. Неврологический журнал. 2006;(S1):4–12. [Yakhno NN. Cognitive impairment in neurological clinical practice. Nevrologicheskii zhurnal. 2006;(S1):4–12. (In Russ.)]
12. Вахнина НВ, Захаров ВВ. Опыт применения ривастигмина в лечении постинсультных когнитивных расстройств. Неврологический журнал. 2009;(4):42–6. [Vakhnina NV, Zakharov VV. The experience of rivastigmin (Exelon) administration for treatment of post-stroke cognitive disorders. Nevrologicheskii zhurnal. 2009;(4):42–6. (In Russ.)]
13. Парфенов ВА. Неврологические аспекты недержания мочи у пожилых людей. Неврология, нейропсихиатрия, психосоматика. 2013;(1):34–8. [Parfenov VA. Neurological aspects of urinary incontinence in the elderly. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2013;(1):34–8. (In Russ.)]. DOI: http://dx.doi.org/10.14412/2074-2711-2013-2395.
Review
For citations:
Kosivtsova OV. Patient management in the recovery period of stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2014;6(4):101-105. (In Russ.) https://doi.org/10.14412/2074-2711-2014-4-101-105