How to properly massage the legs of a bedridden patient. How to massage a bedridden patient - techniques, features and contraindications. Basic rules for performing massage on bedridden patients

A common procedure in caring for patients is massage. It has a beneficial effect on muscle mass, skin and internal organs sick. With the help of massage, the functioning of body systems and human organs as a whole returns to normal.

Massage, as part of patient care, promotes stimulation of motor cortex cells cerebral hemispheres, stimulation of motor centers, improvement of blood supply. Massage also has a beneficial effect on the skin. The functioning of the sebaceous and sweat glands improves, lymph circulation accelerates, and dead scales are cleansed. Thanks to a professional massage performed by a nurse, the skin will regain its former elasticity and the muscles will contract better. After a course of massage, the patient’s range of motion in the joints will increase, and due to improved blood circulation, the ligaments will become stronger. Professional nurses from our patronage service use massage to improve kidney function and increase the excretion of metabolic products from the body through urine. This happens due to the fact that massage significantly accelerates the flow of blood, lymph, and tissue fluid.

If the patient is at home, massage can be performed by one of your family members. But still, it is advisable that it be carried out by a qualified worker. When caring for a patient, a nurse who has the skills to perform massage can successfully cope with these responsibilities. An experienced specialist knows exactly which areas of the patient’s body need to be affected and how to do it correctly. Relatives, if desired, will be able to adopt the skills professional worker and continue performing the massage on your own.

Let's consider the basic massage techniques performed by nurses in the process of caring for a patient:

Stroking. Stroking is the movement of the hand over the skin without moving. This technique is performed with one or two hands, palm, or just the fingertips. Stroking begins with superficial movements, and then they become a little deeper. This technique can be carried out either slowly or more rhythmically. The effect of stroking: relieves pain, has a resolving effect, improves lymph and blood circulation.

Trituration. This technique involves shifting and stretching the patient's skin in different sides. Rubbing can be done with one or two hands, as well as with a fist, palm or fingers. If rubbing is done correctly, then it is done much slower than stroking. The effect of rubbing: resorption of adhesions and various scars, increased muscle contractility, resorption of pathological tissue deposits.

Kneading. The nurse performs kneading when she works directly with the muscles of the body. In this case, the tissues are captured, squeezed, stretched and compressed. The specialist carries out kneading with varying intensity at the beginning of the session and at the end. From the very beginning, the muscles should be warmed up only slightly, and at the end more intensely. With the help of kneading, muscle tone increases, their contractility increases, painful lesions resolve, and blood supply improves.

Another massage technique is vibration. This is very effective technique in massage. With its help, even faded reflexes are restored. In addition, it has an analgesic effect and stimulates tissue regeneration.

Here are a few important conditions which must be observed when performing massage when caring for patients.

Firstly, the key to health is Fresh air. Therefore, the patient's room should be well ventilated.

Always pay attention to the hands of the specialist performing massage sessions. A professional caregiver should have short-cut nails, clean, dry hands and no jewelry.

At the beginning of the massage session, the patient's skin should be lubricated with the required amount of special cream or oil. This way the best glide is achieved.

Before starting massage sessions for a patient, it is necessary to consult a doctor, since there are a number of diseases for which massage is contraindicated. These, in particular, include: varicose veins, trophic ulcers, thrombophlebitis, various types of rashes on the patient’s skin, and some other diseases.

Has your patient been lying in bed too long? He is passive, he has bad feeling, often lose your nerves? Instill in your dear patient 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” 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 recovery 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 may occur in the lungs, muscles lose their mass and atrophy, joints lose their mobility up to total loss ability to act, 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 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 hip joints, knees, ankle joints 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, handmade with plasticine and sorting through small objects.

Leg exercises include squeezing and unclenching of the toes, circular movements of the feet, stretching of the feet (one must mentally try 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 a supine and side position, 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 yourself” as you exhale, pulling your legs bent at the knees towards you in positions on your back and side.

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 out 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 is the place of the dead nerve cells in the head and 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 massage? When the right arm is paralyzed, gentle squeezing movements are performed. Massage after a stroke at home relieves inflammatory conditions 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 of the bone, but also across it.

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 a face important role the orbicularis oris muscle plays, while facial nerve 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 do facial gymnastics, if any? open injuries skulls, fractures, wounds? Of course not.

Before starting a facial massage, the facial muscles are warmed up lung help rubbing. Next, you need to feel your lips with your fingers from the outer and inside. Warming up the lower part of the face helps to relax orbicularis muscle in the center and tighten the downturned 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, in order 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 serious 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 and 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 with 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 beneficial bacteria are starting 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 painful sensations However, after its completion, patients feel a surge of energy in the muscles.

Several rules of rehabilitation

Every neurological hospital has a methodologist-rehabilitation specialist who shows what physical exercise Exercise therapy 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.

Rehabilitation at home in Moscow includes:

Consultation with a specialist doctor on this disease.
Consultations with doctors (cardiologist, orthopedist, neurologist, surgeon, etc.).
Psychological consultations.
Physiotherapeutic procedures.
Classes with a speech therapist on speech restoration. If swallowing functions are impaired as a result of the disease, the doctor will help with the selection of a special diet and organization of the diet.
Medical Physical Culture. Exercise therapy classes are conducted by a qualified instructor who will select an individual set of exercises. If the patient is recommended to exercise on simulators or with technical means, the trainer will teach correct use and adjust them.
Massage. A massage therapist will help you cope with pain in the joints and back, the consequences of diseases, and excess weight.
Carrying out doctor's orders by a qualified nurse (injections, healing procedures, droppers).
Drug therapy.
Medical nutrition.

What you need to organize recovery at home

Nowadays massage is like effective method functional therapy finds wide application in the most various areas clinical discipline. It is used at all stages medical rehabilitation sick. 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 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 18-19 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 15-20 to 40-50 minutes.

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 to rest for 15-30 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 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:

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

Local contraindications:

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

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 glide easily 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 impact positive influence throughout the 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. Vigorous performance of this technique helps to 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 using the pads of 4 closed, slightly bent fingers while resting on thumb and the base of the brush. 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 performed with the ulnar 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.

Crossing used on rounded surfaces (neck, buttocks, side surfaces torso). 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 had an effect on the skin (stroking), subcutaneous fat layer and superficial layer of muscles (rubbing), then kneading affects the condition deep layers 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 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 annular” 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 kneading performed on one side with the thumb and on the other with the remaining fingers (they take the shape of forceps); 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.

Wallow 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 used to increase muscle tone in case of 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.

shift performed thumbs on the one hand and everyone else 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.

Tingling performed large and index fingers(or the big one and all the others) of one or both hands. Muscle at the same time it 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 done 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 performed on the spot with the pad of one or several 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 lower section to the top).

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 speed of 80-120 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.

Puncturing(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 earlier stroke was the lot of older people, now last years he suddenly became 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 goal, diverse interests, an active attitude towards life help to overcome 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 who specialize 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 define specific goals, e.g. tasks 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 hours 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 6th-8th procedure the back is covered and lumbar region with the patient lying on healthy side. The prone position is used in more late dates 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 additional method treatment, while the main ones include positional treatment (special styling) and therapeutic exercises.

Treatment by position

Principles of treatment consist in giving paralyzed limbs correct position during the time the patient is in bed. It is currently believed that the development of hemiplegic contracture with the formation of the Wernicke-Mann posture (arm pressed to the body, fingers clenched into a fist, leg turned outward, straightened, foot hanging and turned inward) may be associated with long stay paralyzed limbs in the same position in early period diseases. Exist various options styling of 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 entire 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 is fixed with a bag of sand or salt weighing about 0.5 kg (any kind of splint can be used as a splint). lightweight 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.

Laying the patient in 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 - 30-50 min.

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 upper limb- shoulder, forearm, hand, fingers. The direction of movement is along the lymph flow.

Massage techniques include different kinds 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 (cooperative movements) the non-massaged limb is fixed with sandbags. Massage outer surface The legs can be carried out with the patient 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 amazed lower limb repeats the movement of the upper one, for example, bending the arm causes bending the leg. We must also remember that anxiety, physical stress, fatigue, and cold impair the ability to move.

Therefore, before starting to perform massage techniques, it is necessary to achieve the maximum reduction in muscle tone, i.e. muscle relaxation. For this purpose they use special exercises to relax, 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 circular movements outward in the shoulder joint while simultaneously pressing on the head 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 calf muscle on the back of the lower leg. 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 diseased 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 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 of 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 massage them 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. 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. Movements come from wrist joint along the back surface of the forearm to the olecranon process.

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. Muscles back side the brushes 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. Even twenty years ago, the motto of older people was the words: “We can grow to a hundred years 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 3 - 4 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 exercises 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.

Physiotherapy

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

age;
accompanying illnesses;
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 2-3 times 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;
headache;
dyspnea;
pain and discomfort in the heart area or other places;
appetite;
pulse;
arterial 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, for 5 - 10 minutes. did exercises, performed daily homework. 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. Can be ironed and easily rubbed on hands, starting from fingers up to 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 inhale; 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 position.

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. Except 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 hand, 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 the i.p.

8. In i.p. while sitting, lower your arms along your body. On the count of “one - two”, slowly tilt your torso to the right, left hand slides along the body up to the armpit, and the right one reaches towards the floor. On the count of “three - four”, return to IP. 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 3-4 times. 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.