Methodological development “Massage as a method of rehabilitation for diseases of the cardiovascular system”

STATE AUTONOMOUS PROFESSIONAL EDUCATIONAL INSTITUTION

NOVOSIBIRSK REGION

"BARABINSKY MEDICAL COLLEGE"

METHODOLOGICAL DEVELOPMENT

THEORETICAL LESSON FOR TEACHER

Specialty 34.02.01 Nursing (with basic training)

Professional module 02. Participation in diagnostic, treatment and rehabilitation processes

MDK 02.02. Implementation of rehabilitation measures

Topic 6.20. Massage as a method of rehabilitation for diseases of the cardiovascular system.

Developer – teacher Yashunina A.S.

2020

METHODOLOGY SHEET

Type of lesson –

combined lesson

Type of activity

– obtaining and consolidating new knowledge

Duration
–
90 min.

OBJECTIVES OF THE LESSON

1. Learning objectives:

— to develop professional competence

:

— Carry out rehabilitation activities within the limits of their powers in primary health care and hospital settings (PC 2.7.)

2. Developmental goals:

— Understand the essence and social significance of your future profession, show sustained interest in it. (OK 1).

— Lead a healthy lifestyle, engage in physical education and sports to improve health, achieve life and professional goals. (OK 13)

3. Educational goals:

— create conditions for developing the ability to organize one’s own activities, choose standard methods and ways of performing professional tasks, evaluate their implementation and quality (OK 2).

Teaching methods

– explanatory and illustrative, reproductive; elements of information and communication technologies (use of multimedia presentation).

Location of the lesson

- college auditorium.

Classic massage for myocardial infarction

0

Marina Dmitrievna

2018.06.21

426

Heart attack

Massage for patients after myocardial infarction is recommended from the first days of recovery. The duration of the course corresponds to the duration of therapeutic exercises, therefore it is selected by the doctor individually, taking into account the severity of the lesion, complications and the dynamics of the course of the pathology.

Massage for myocardial infarction, purpose

Therapeutic massage for myocardial infarction

Massage is recommended for patients with myocardial infarction from the first days of treatment. The timing of massage appointments corresponds to the timing of therapeutic exercises and is decided individually depending on the severity of the disease, the presence of complications, and the nature of the course of the disease.

It is advisable in the first 1-2 days of the disease not to simultaneously prescribe several forms of exercise therapy: therapeutic exercises, massage and others, but to stagger them several times in time.

After making sure that the patient tolerates, for example, therapeutic exercises well, massage can be added after 1-2 days.

Massage is used to reduce congestion in the extremities and abdominal cavity, improve the motor function of the digestive tract, prevent hypostatic pneumonia and thromboembolic complications, normalize blood pressure levels, reduce headaches and vestibular disorders, pain in the heart, and eliminate shoulder-arm syndrome.

Depending on the tasks assigned, various areas are massaged: legs, arms, back, abdomen, shoulder-arm, collar and precordial areas.

The features of the massage technique are determined by the phase of the disease, the nature of the course, and the motor capabilities of the patient [7]. The number of massage procedures is 10-15, performed every other day or daily.

Patients are also taught individual self-massage techniques, which they carry out under the supervision of a physical therapy methodologist during therapeutic exercises, alternating with exercises, before and after classes [10].

It is advisable to teach patients self-massage of the arms, abdomen, head, and neck. The duration of self-massage is 1-2 minutes. Throughout the day they can be repeated up to 4-5 times.

Features of the massage technique are reflected in Table 2.7.

Table 2.7. Features of massage techniques in patients with myocardial infarction at the inpatient stage of rehabilitation, depending on the motor mode

Contraindications for exercise therapy

The importance of physical therapy for heart disease is difficult to overestimate. However, not everyone can use it during the rehabilitation period.

It is prohibited for patients who have the following health problems to engage in therapeutic physical activity:

• Severe stage of circulatory pathology;
• Increased heart rate (more than 110 beats per minute at complete rest);
• Labored breathing;
• Swelling of the lungs;
• Changes in heart rate uncontrolled by medications;
• Cardiogenic shock;
• Severe pain in the heart area;
• Elevated body temperature and blood pressure;
• Poor ECG results.

Any ailment should be regarded by the patient as a contraindication to training.

The need for massage after myocardial infarction

Massage is an important part of the rehabilitation program after myocardial infarction. It is used for certain indications, including:

• convalescence phase (the final stage of the disease);
• coronary insufficiency (I, II degree);
• post-infarction cardiosclerosis accompanied by hypertension;
• acute heart attack with a hypodynamic type of blood circulation;
• satisfactory general condition.

In addition to a specialized approach, it is useful for the patient to master self-massage. It is enough to perform it for two minutes and repeat several times a day. You can massage your neck, head, arms and stomach yourself.

After a heart attack, painful lumps affecting the connective tissue and subcutaneous tissue are often observed. During the massage, be sure to monitor the dynamics of the condition of these areas. Correctly chosen and implemented technique gradually reduces pain.

Massage after myocardial infarction provides a complex effect on the body, guaranteeing the following effects:

• the intensity of the pain syndrome decreases;
• the work of the heart muscle is facilitated;
• the lumen of the coronary vessels increases and the risk of stagnation in them decreases;
• blood circulation in peripheral tissues is stimulated.

Performing a massage reduces the load on the heart muscle due to stimulated blood circulation. Blood flows to the area being treated, causing the formation of new capillaries. At the same time, the volume of the vascular bed increases, against the background of which a decrease in blood pressure occurs.

The procedure involves relaxing the body. This is important for improving the patient’s mood and combating depression, which often occurs against the background of an illness. Massage after a heart attack is also necessary to prepare the cardiovascular system for upcoming physical activity.

General massage rules

Massage after myocardial infarction should be carried out exclusively by a specialist in this field with the appropriate qualifications.
It is permissible to begin such a rehabilitation measure only with the permission of the attending physician. After a heart attack, massage is performed according to certain rules. The following nuances must be observed:

• You can start massage only after the patient’s condition has stabilized.
• Gradually introduce different physiotherapeutic methods. Massage is just one of them. You should not start two or more procedures at once on the same day, since if you have a negative reaction to one of them, it will be more difficult to determine the cause.
• Start the massage gradually. They usually start with the lower extremities, performing only stroking. The remaining movements are added one by one, observing the patient’s reaction to them.
• At the initial stages, the massage is performed exclusively in a supine position. You can change it only when switching to free mode. When performing a massage in a lying position, the patient should be positioned so that the head of the massage is slightly raised.
• Monitoring the patient's condition. When adding new movements, it is necessary to monitor the patient's reaction to them. If it is negative, then the expansion of the technique should be delayed.
• Massage is recommended twice a day. The first session should only last a few minutes. The duration of sessions is increased gradually.
• A massage session always begins with checking the patient’s well-being. Monitoring of pulse, blood pressure, and respiratory rate is necessary. If any indicators change sharply in a negative direction, the procedure is stopped.
• When introduced into a rehabilitation program, therapeutic exercises are usually carried out 15 minutes after the massage session. At the same time, it is necessary to continue monitoring important indicators.

In addition to the general provisions, it is necessary to follow the individual recommendations of the attending physician. Each case is special, and therefore the approach to different patients may differ.

Dispensary and polyclinic stage

At this stage, patients are individuals suffering from chronic ischemic heart disease with post-infarction cardiosclerosis. Main tasks of exercise therapy

: prevention of further development of atherosclerosis, secondary prevention of ischemic heart disease, the possibility of complete or partial withdrawal of medications, return to work. Exercise therapy is carried out in the form of long-term physical training (LPT).

DFT is indicated when myocardial infarction is at least four months old in the gym using a group method or at home according to an individual program. Functional capabilities are determined using bicycle ergometry.

They use therapeutic exercises, dosed walking, skiing, cycling, etc. throughout the patient’s life.

Source: https://klinika-krovi.ru/bolezni-serdca/massazh-pri-infarkte-miokarda.html

MOTIVATION

Cardiovascular diseases remain the leading cause of death worldwide. According to WHO, in the Russian Federation they account for 56% of all deaths, with almost half of them due to ischemic heart disease. That is why one of the primary tasks of healthcare remains the search for more effective methods of prevention and treatment of patients with cardiovascular diseases.

At present, the previously prevailing opinion about the need for complete rest or restriction of the patient’s mobility during the period of treatment has been completely rejected. On the contrary, a sedentary lifestyle is one of the significant factors in the development of diseases such as atherosclerosis, hypertension, etc. It has become clear that physical activity in patients leads to a shorter recovery period and a reduced risk of complications such as pulmonary embolism or heart failure. Thus. Currently, there is a clear understanding that interventional interventions and pharmacological treatment of cardiovascular diseases alone are not enough. In this lesson we will look at the most common and effective types and methods of massage for diseases of the cardiovascular system.

Massage for myocardial infarction - indications, techniques and methods for the stages of recovery

Massage for patients after myocardial infarction is recommended from the first days of recovery. The duration of the course corresponds to the duration of therapeutic exercises, therefore it is selected by the doctor individually, taking into account the severity of the lesion, complications and the dynamics of the course of the pathology.

Indications for use

Massage is an integral method of comprehensive recovery after a heart attack. It is prescribed for specific indications:

• convalescence phase,
• insufficiency of coronary arteries 1 and 2 degrees,
• post-infarction cardiosclerosis, hypertension,
• acute infarction with hypodynamic blood circulation,
• general condition maintained at a satisfactory level.

In addition to therapeutic massage performed by a professional massage therapist, self-massage is also useful. It is enough to do it for a couple of minutes, repeating several times a day. It is permissible to massage the neck, head, stomach and arms on your own.

After a heart attack, painful lumps can form that affect the connective tissue, the fiber under the skin. In this regard, the dynamics of such compactions is monitored during the procedure. The correct technique helps to quickly eliminate pain.

Massage helps achieve the following results:

• reduce symptoms of pain,
• improve myocardial function,
• the diameter of the lumen in the coronary vessels increases, the risks of congestion formation decrease,
• stimulation of blood flow in peripheral tissues.

The treatment significantly reduces the load on the myocardium by stimulating blood flow. Blood flows to the treated area, promoting the formation of new healthy capillaries. This increases the volume of the vascular bed, and blood pressure returns to normal.

The procedures help to relax the body, improving the patient’s mood, helping to overcome depression. Also, after a heart attack, massage allows you to prepare the blood vessels and heart for future physical activity.

Basics of the technique

There are several specialized techniques for patients after a heart attack. The choice of method is made by the attending physician. Sometimes procedures are prescribed immediately after vital functions begin to stabilize.

In the first days after an attack, the massage is done for only 5–7 minutes, affecting only the lower limbs. As health and well-being normalize, the duration of one session can increase; the right arm is massaged, then the muscles of the back and buttocks are gradually involved.

Breast massage is acceptable provided that you start carefully - this is light stroking in the area of ​​the chest muscles for 3 to 5 minutes. After the patient begins to sit down, the upper back and cervical-collar area are worked on. The duration of the session reaches 20 - 30 minutes.

Sessions are repeated twice a day, the full course lasts from 5 to 15 days. After each session, oxygen breathing is indicated for 15 minutes.

Basic techniques:

• stroking,
• easy kneading,
• trituration.

Execution technique

The technique will depend on the stage of recovery:

1. Maintain strict bed rest.

There is no massage. As the indicators normalize, stroking the limbs with light pressure is allowed. The massage therapist's movements are smooth and slow.

1. Light bed rest.

The patient's well-being continues to improve. You are allowed to take a semi-lying position, then sit in bed for several minutes without lowering your legs.

During sessions, light rubbing is added to the stroking; gradually, as positive dynamics develop, the force of pressure increases.

You are allowed to sit with your legs down from the bed and move to a chair. Gradually, it is acceptable to stand near the bed or walk around the room only under the supervision of a nurse.

The massage becomes deeper and more energetic. The technique of kneading and shaking is added. It is permissible to massage in the area of ​​the left shoulder blade, at first simply by stroking, gradually complicating the effect.

The patient is transferred to this mode in case of noticeable progress in recovery, returning to the ability to sit and walk freely.

The upper back and back of the neck are massaged. Techniques of stroking, rubbing, sawing, flat stroking, etc. are used.

Massage, which is implemented after a heart attack, helps a person begin rehabilitation and return to normal life. It is supplemented with other physiotherapy treatments according to the condition.

The specialist must follow the massage technique, taking into account the stage of rehabilitation and the recommendations of the attending physician.

During the organization of sessions and the inclusion of new techniques, the health and general well-being of the patient is necessarily monitored, and the body’s reaction is taken into account.

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Source: https://dlja-pohudenija.ru/serdcze/infarkt/tehnika-massazha-pri-infarkte-miocarda-pravila-organizaczii-metodiki

Appendix No. 2

Test questions to consolidate knowledge on topic 6.20. Massage as a method of rehabilitation for diseases of the cardiovascular system

Give oral answers to the questions - frontal survey:

1. Name the massage technique for ischemic heart disease.

Massage technique. First, massage the collar area in a sitting position, and then massage the lower extremities of the abdomen in a lying position. Techniques include: stroking, rubbing and kneading (especially when massaging the legs). The chest is only stroked. Techniques such as chopping, beating, and patting are excluded. The duration of the massage is 10-15 minutes. The course consists of 15-20 procedures, 3-4 courses are carried out per year.

1. List the objectives of massage for myocardial infarction.

Objectives of massage: relieve pain, psycho-emotional tension, accelerate muscle blood flow, relieve reflex mechanisms that increase spasm of coronary vessels, prevent thromboembolism, improve coronary circulation.

1. Name a massage technique for hypertension.

Massage technique. Patient's sitting position. Massage the back of the neck, starting from the scalp, then the shoulder area, upper back and spinal column. Continuous stroking, semicircular rubbing, transverse and longitudinal kneading are used. The mastoid processes are especially carefully massaged. Massage of the lower extremities is indicated; blood pressure can be normalized by massaging the abdomen. The duration of the massage is 10-15 minutes.

1. List the tasks of massage for hypertension.

The objectives of massage are: to normalize the functional state of the nervous system, improve blood circulation and metabolism, reduce the excitability of the neuromuscular apparatus of the vascular wall.

1. Massage technique for MI?

Massage technique. The first general massage procedure is carried out on the first day, and then repeated 1-2 times a day for 5-15 days. After the massage procedure, the patient breathes oxygen for 10-15 minutes. The technique and duration (10-20 minutes) of massage depend on the depth and extent of myocardial infarction according to ECG data, the general well-being of the patient and the functional state of the cardiovascular and respiratory systems. The following techniques are used: stroking, rubbing and shallow kneading. The back, lower limbs, stomach and upper limbs are massaged, the chest is stroked. Back massage is carried out with the patient on the right side, while the doctor or massage therapist supports the patient’s left hand with his left hand. hand, and with the right hand performs a back massage (rubbing, ordinary kneading, stroking).

Medical massage

Massage after a stroke

A stroke is an acute disorder of cerebral circulation.
This disease is recognized as one of the most important health problems because it is the third leading cause of death. Unfortunately, in recent years this disease has become significantly younger.

One of the most common severe complications after a stroke are motor disorders, usually unilateral paralysis of the arms and legs. Timely initiation of treatment and rehabilitation procedures, their systematicity and duration, will help to quickly restore activity to nerve cells that are in a state of reduced activity or complete inhibition, which will speed up the patient’s rehabilitation. The emotional state of the patient and the person caring for him is no less important. A positive outlook on what is happening, determination, and the presence of various interests helps to overcome the disease.

The recovery period must begin a few days after the stroke. First of all, it is necessary to determine the amount of permissible physical and psycho-emotional stress.

Specialized centers and rehabilitation departments provide enormous assistance. The developed complexes for step-by-step rehabilitation of a person can be used at home. These complexes allow the patient to gradually return to normal and even active life. Upon returning home, the patient’s rehabilitation should initially be carried out under the supervision of a neurologist or rehabilitation specialist.

To perform massage manipulations and exercises at home, the massage therapist should:

• collect complete information about the presence of contraindications;
• find out which muscles in the patient are relaxed and which are tense;
• master the necessary massage techniques;
• learn how to properly position paralyzed limbs.

Performing massage and therapeutic exercises allows you to:

• improve lymph flow and blood flow in the body, which is especially important for paralyzed limbs;
• promote the restoration of motor functions in the affected limbs;
• prevent the occurrence of contractures (contractura, lat. - tightening, compression, narrowing) in physiology, prolonged, persistent, often irreversible contraction (rigor) of a muscle fiber or its section;
• reduce muscle tone of spastic muscles and the severity of conjugal movements;
• reduce the intensity of pain or get rid of it completely;
• influence the patient’s positive attitude;
• prevent congestive pneumonia in the elderly;
• prevent the formation of bedsores.

Recommendations for massage after a stroke

It is recommended to start massage as early as possible, if you feel well - literally on the second day. So, for ischemic stroke without complications and in the absence of contraindications, massage is prescribed for 2-4 days, and for hemorrhagic stroke, for 6-8 days. The duration of the first procedures varies from 5 to 10 minutes, gradually extending from 10 to 30 minutes. The increase in the intensity of exposure is strictly individual and depends on the patient’s condition. The course consists of 20-30 procedures, which are carried out daily. After a 1.5-2 month break, massage treatment is repeated.

Each massage technique is repeated 3-4 times. From the 1st to the 3rd session, the massage is performed only in the shoulder and thigh area, without turning the patient onto his stomach. From the 4th-5th procedure, taking into account the patient’s condition, the area of ​​the chest, forearm, hand, lower leg and foot is added. Cover the back and lumbar region 6-8 times, placing the patient on his healthy side.

Massage while lying on your stomach can be performed at a later date in the absence of contraindications associated with heart disease. During periods of strict bed rest, massage can only be performed by a highly qualified massage therapist, preferably under the supervision of a doctor. At home, a caregiver can perform a massage only during the period when the patient’s condition has significantly improved. In order to increase the effectiveness of the performed massage and therapeutic exercises, it is desirable to pre-warm the paralyzed limbs. For these purposes, you can use a salt heating pad, paraffin and ozokerite applications, and a warm blanket.

The massage begins from the front surface of the affected leg, because with hemiparesis (paralysis) the lower extremities are affected less than the upper ones. Next, massage the pectoralis major muscle. Then they move to the shoulder, forearm, hand, fingers.

Performing massage movements on the back of the leg - first massage the thigh, then the lower leg, foot. All movements on the back are carried out along the lymph flow.

Techniques used: various types of superficial stroking, light rubbing, continuous vibration (shaking, shaking). So, for a group of spastic muscles, light stroking and, somewhat later, rubbing techniques are used. For some muscles, light vibration is acceptable.

The following are susceptible to spastic conditions:

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

On non-spastic areas: the back of the arm, the front of the shin, the back of the foot, deep stroking techniques, intense rubbing, and even light kneading are used.
Any striking techniques (patting, tapping, chopping, etc.) are contraindicated.

Preparing the patient for massage

First of all, it should be remembered that anxiety, physical stress, fatigue, and cold impair the ability to move. In this regard, before starting a massage, you should achieve a maximum reduction in muscle tone, i.e. muscle relaxation. To do this, special relaxation exercises are performed. First - on a healthy area, then - on the affected one. To check whether the patient was able to relax the muscles, it is necessary to lift the patient’s healthy limb and, insuring it from a blow, release it - the limb should fall freely. If the patient lies on his back, then place a cushion under his knees and a pillow under his head. When synkinesis (friendly movements) occurs, the non-massaged limb is fixed with a bag of sand or salt weighing about 0.5 kg. Lying on your healthy side, you can massage the outer surface of your leg. With the patient lying on his stomach, the back surface of the leg is massaged, while a small pillow is placed under the stomach and head, and a bolster is placed under the ankle joints. If there are disturbances in the functioning of the heart, the patient is massaged on his side. To maintain warmth, the patient is covered with a blanket, exposing only the massaged area for massage.

Massage technique

Leg massage Thigh While lying on your back, massage the front and inner surfaces of the thigh. Begin with light superficial stroking along the inner, middle (front) and outer surface of the thigh. The movements are directed from the knee joint to the groin area. Then they are joined by light, slow spiral and zigzag strokes. The correct execution of these movements is a slight relaxation of the spastic muscles. Then light rubbing with the pads of four fingers and the base of the palm is added to these techniques. Each technique is repeated 3-4 times. With the patient lying on his stomach or healthy side, a massage is performed on the back of the thigh. On the back of the thigh there are muscles involved in hip extension, to which, taking into account their spastic state, gentle techniques such as stroking and light rubbing should be applied. They are performed by moving from the popliteal fossa to the gluteal fold. The buttock is massaged with stroking movements, starting from the posterior surface of the sacrum towards the greater trochanter (protrudes on the upper outer surface of the thigh, can be easily felt during palpation).

Lower leg Moving on to the lower leg, take into account that on its front surface there are extensors of the foot, which are usually less spastic. Therefore, more intensive techniques are allowed. They start with superficial strokes, moving on to deeper ones. Next, more energetic rubbing techniques are used, as well as transverse and longitudinal kneading. The massage is carried out with all fingers and palms, from the ankle to the knee joint. The gastrocnemius and soleus muscles (responsible for flexion of the knee joint and foot), extending to the back of the lower leg, are very spastic. They are massaged using a gentle technique. Movements begin from the heel tubercle towards the popliteal fossa.

Foot On the back of the foot there are muscles (digit extensors) with mild spasticity. Therefore, the techniques of stroking, rubbing, and kneading are used. The masseur fixes the foot, placing the patient’s heel in his palm, with the toes pointing upward, and with the second, third and fourth fingers of his free hand he massages its back surface from the tips of the fingers to the shin. Finishes by stroking and rubbing the interosseous spaces with the first finger, which will clearly stand out in the form of indentations on the back of the foot if you spread your toes. On the plantar side of the foot there are muscles with increased tone, which are massaged using a gentle technique, moving from the toes to the heel.

Hand massage During bed rest, hand massage is carried out with the patient lying on his back, and at the end in a sitting position (in this case, the patient’s hand is placed on a nearby table). Massage of the pectoralis major muscle On the affected side, this muscle is in a state of hypertonicity, so the massage is performed using gentle techniques: superficial stroking, very light rubbing with the pads of four fingers and light vibration in the form of shaking or shaking. Shaking is carried out using the first and second fingers, as an option - you can put the hand on the chest and move it along the massaged area in the direction from the sternum to the armpit.

Shoulder The trapezius and deltoid muscles located here do not have increased tone, so deep stroking, intensive rubbing and light kneading can be used. It is necessary to move from the VI-VII cervical vertebrae (if you lower your head to the chest, the VII vertebra will protrude more than the others) to the end of the deltoid muscle, rubbing and kneading the latter well. Then they move on to massaging the triceps muscle, which is an extensor of the forearm. The tone of this muscle is not so strong, therefore, if the possibility of voluntary movements is completely lost, it is advisable to start the massage with this particular muscle. Here they use the techniques of superficial and deep stroking, vigorous rubbing and light kneading. The movements are directed from the elbow joint along the outer back surface of the shoulder to the shoulder joint. Next, they move on to massage the biceps muscle, which is a flexor of the forearm and shoulder. Due to the fact that she is very spastic, only light stroking and rubbing are used. The movements proceed from the ulnar fossa along the inner anterior surface of the shoulder, reaching the armpit. When performing these manipulations, you should be especially careful and careful, since the brachial artery, veins and nerves pass along the inner surface of the shoulder (on the internal groove), and under no circumstances should any pressure be applied to them.

Forearm It is advisable to start the massage with the muscles of the posterior (outer) surface of the forearm (extensors of the hand and forearm), since they are overstretched. Perform techniques of superficial and deep stroking, rubbing, kneading. The movements are directed from the wrist joint along the back surface of the forearm to the olecranon process. Then they move on to the muscles of the anterior (inner) surface of the forearm (flexors of the hand and forearm) - they are spastic, so they are only lightly stroked and rubbed in the direction from the wrist joint to the ulnar fossa.

Hand and fingers Due to overextension of the muscles of the back of the hand, massage begins precisely from the back of the fingers, moving to the back of the hand. Perform energetic techniques: deep stroking, rubbing, kneading. Due to the high tone of the muscles of the palmar surface of the hand, only superficial stroking is performed.

Back massage The patient is placed on his stomach or healthy side, with a pillow placed under his head. When performing a massage, all techniques are used, but in a soft and gentle manner, so as not to increase muscle tone, while improving tissue nutrition. Direction of movements along the lymph flow.

Exercises for stroke

Passive movements can be performed 1-2 weeks after a stroke, if the patient’s condition allows. Such exercises stimulate the appearance of active movements, improve lymph and blood flow, precede the formation of contractures, and reduce muscle spasticity.

Sequence of development of arm joints: 1. shoulder; 2. elbow; 3. wrist; 4. finger joints.

Sequence of development of leg joints: 1. hip; 2. knee; 3. ankle; 4. finger joints.

That is, we first work with large joints, then move on to smaller ones. You need to start with healthy limbs, then work on the paralyzed ones. To begin with, perform from 1 to 5 movements, gradually increasing the number of times to 10. If the patient’s well-being allows, the exercises should be performed slowly, smoothly and in full, once in the morning in combination with a massage, the second time at the end of the afternoon rest.

It is necessary to ensure that each movement is performed in isolation. Therefore, the caregiver must fix the patient's limb above the joint with one hand, and with the other perform movements below the joint.

Be sure to teach the patient to slowly inhale and then exhale through slightly parted lips, while pronouncing the sound “w-w-w” and without holding his breath. This extended exhalation helps relax the muscles during passive and active movements. A simple rolling pin can serve as an assistant in relaxing the muscles of paralyzed limbs. It is necessary to roll the patient's palms and feet over its surface. The patient should also be told that when muscle relaxation occurs, a feeling of heaviness arises in the affected limb. It is advisable to show yourself the state of the muscles: at rest, during tension, during relaxation.

When the patient is able to perform the exercises himself, you can introduce exercises from the complex of active gymnastics, which are more conducive to the restoration of movements. Usually this opportunity appears in the third week after a stroke. Lying on his back or healthy side, the patient performs exercises with the affected arm and leg that he can do (flexion, extension, abduction, adduction, rotation) for 10 to 30 minutes twice a day. To make the task easier, the patient can hang his arm or leg on a towel pre-attached to something. You must not allow yourself to become overtired, so you need to take 2-4 breaks of 2-4 minutes each. Also, the volume of active movements increases significantly: exercises with cubes, pyramids, tops, modeling from plasticine, fastening and unfastening buttons, tying and untying ropes.

As the sick body recovers, it is recommended to perform exercises to restore and strengthen all the muscles of the body. A set of such exercises is similar to regular morning exercises.

Treatment by position

To prevent the development of contracture of paralyzed limbs, which will make it difficult to restore impaired movements, you should learn how to position them correctly. It is necessary to start doing this during the period of bed rest. Sequence of laying the limbs in a supine position. The extended paralyzed arm is placed on a pillow and turned palm up. At the same time, they take it to the side at an angle of 90º (in cases of severe pain, you can start with a smaller angle of abduction, gradually bringing it to 90º), making sure that starting from the shoulder joint and along the entire length, the arm is in a horizontal plane. In this case, a roller filled with cotton wool or padding polyester and wrapped in oilcloth is placed in the forearm cavity. The hand with the fingers spread to the side, on the palm side, is fixed with a splint cut from some light material and covered with material (bandage, gauze - for softness), repeating the shape of the arm and hand. They bandage it to the middle of the forearm. To fix the entire arm, a bag of salt or sand weighing 0.5 kg is placed on the forearm area. The affected leg is bent at the knee 15-20º, placing a cushion under it. The foot is bent at an angle of 90º, while fixing it in a special box, so that the foot rests with the sole against one of its walls. And the box itself is secured so that it is motionless. With this position of the limbs, the patient should remain for 1.5 to 2 hours.

The sequence of laying the limbs in a lying position on the healthy side

The patient's arm is bent at the shoulder and elbow joints and a pillow is placed under it, and the leg at the hip, knee and ankle joints is placed on another pillow. With this position of the limbs, the patient should remain for 30 to 50 minutes. The recommended positions of the limbs should be changed from a supine position to a lying position on the healthy side every 1.5 - 2 hours. With the exception of time: allocated for food, therapeutic exercises, massage, as well as afternoon rest and night sleep/

Appendix No. 3

Assignment for independent extracurricular work of students

Topic 6.20. Massage as a method of rehabilitation for diseases of the cardiovascular system

Discipline,

section, topic

Kind of activity

Literature

1.

Topic 6.20.

“Massage as a method of rehabilitation for diseases of the cardiovascular system.”

1. Study the lecture notes and the text of the textbook.

1. Dubrovsky V.I. “Therapeutic massage” [Text]: textbook for medical schools and colleges / V.I. Dubrovsky; Moscow Publishing house "GEOTAR-MED", 2004 - 93 p.
2. Epifanova V.A. “Fundamentals of Rehabilitation” [Text]: textbook for medical schools and colleges / V.A. Epifanova; Moscow Publishing house "GEOTAR-MED", 2015 - 163 p.
3. Lecture notes

Prices for rehabilitation services

Cost of stay from 1500 rub. day.

List of sources used

1. Dubrovsky V.I. “Therapeutic massage” [Text]: textbook for medical schools and colleges / V.I. Dubrovsky; Moscow Publishing house "GEOTAR-MED", 2004 - 93 p.
2. Epifanova V.A. “Fundamentals of Rehabilitation” [Text]: textbook for medical schools and colleges / V.A. Epifanova; Moscow Publishing house "GEOTAR-MED", 2015 - 163 p.
3. Massage for coronary heart disease. [Electronic resource]/Cardio.ru// Access mode: https://heal-cardio.ru/2016/01/25/massazh-pri-ishemicheskoj-bolezni-serdca/
4. Massage for hypertension. [Electronic resource]/Medrich.ru// Access mode: https://medrich.ru/publication_p_1.html?id=133

Massage technique

Indications for massage for coronary heart disease and myocardial infarction: In the convalescence phase after myocardial infarction, coronary insufficiency of the first or second degree (according to L. I. Fogelson), post-infarction cardiosclerosis with concomitant hypertension without circulatory failure and with circulatory failure of the first and second degree massage of the collar zone and heart area is indicated. In the post-convalescence phase after myocardial infarction, coronary insufficiency of the first or second degree (according to L.I. Fogelson), post-infarction cardiosclerosis with concomitant osteochondrosis of the cervicothoracic spine without circulatory failure and with circulatory failure of the first and second degree, massage of the back and heart area is indicated. In case of acute myocardial infarction, a light suction massage of the legs is indicated, starting from the second to sixth day, but only with a hypodynamic type of blood circulation. Strict monitoring of the state of hemodynamics is necessary, without which massage cannot be prescribed in the early stages; with a hyperdynamic type of blood circulation, massage in the early stages is contraindicated. At the end of the acute period, on the sixteenth to twenty-sixth day from the onset of the disease, that is, at the end of bed rest and when prescribing semi-bed rest, it is indicated for a hypodynamic type of blood circulation to add a back massage to the leg massage. With the hyperdynamic type, you can start massaging the legs and back. During this period, massage is used for stability of hemodynamic parameters, improvement of clinical data, normalization of clinical and biochemical blood tests.

We have not found any indications in the literature about the use of massage after surgical treatment of patients with coronary artery disease, including those who have suffered a myocardial infarction. Academician B. A. Korolev emphasizes the need to develop methods for the rehabilitation of patients with coronary artery disease after surgery, as the number of those operated on is increasing. Along with this, B. A. Korolev notes that the number of works devoted to rehabilitation both in our country and abroad is very small. L.F. Nikolaeva also emphasizes the importance of developing this problem. Patients with coronary heart disease are referred for surgical intervention if there is no effect of drug therapy. The first coronary artery bypass surgery was performed in the USA (1967). In our country, these operations began in nineteen seventy by B.V. Petrovsky, M.D. Knyazev, and their effectiveness was shown based on observational data on long-term results. However, such patients require further conservative restorative treatment. At the Institute of Balneology and Physiotherapy, together with the surgery center, work was carried out to study the possibility and feasibility of using physical factors after surgery in patients with coronary artery disease. Chest massage after surgical interventions on the organs of the chest cavity due to suppurative processes in the lungs was used by M. M. Kuzin. Other authors recommend foot massage to prevent thromboembolism. There is a point of view that foot massage is not necessary. Along with this, Yu. N. Shanin uses general massage, early getting up, and therapeutic physical training in such patients in the early stages after surgery. M. Valrenberg offers massage and physical therapy 3-5 weeks after surgery. N. Kohlrausch and N. Teirich-Leube prescribe passive exercises and massage in the first 3-5 days after surgery; a number of authors recommend massage and therapeutic physical training in the pre- and postoperative periods. From the data presented, it is clear that there is no consensus on the timing of massage appointments or the choice of area of ​​influence.

The methodology and technique of massage are not presented in these works. V.I. Dubrovsky proposed, scientifically substantiated and described in detail the use of general massage and oxygen inhalation after surgical interventions on the thoracic (thoracotomy, resection of the lungs) and abdominal cavities in the early postoperative period directly on the operating table and in the next 3-5 days (6 -12 procedures). The author compared the results of treatment of patients who received massage after surgery and those who did not receive it. It has been statistically reliably confirmed that general massage promotes a more rapid restoration of the functions of external respiration, the cardiovascular and muscular systems, in combination with subsequent inhalation of oxygen, and significantly reduces the incidence of postoperative complications. To prevent complications from the lungs, chest massage and therapeutic exercises during mitral commissurotomy were used by E. I. Yankelevich and others. Essentially, there are no differentiated massage techniques in cardiac surgery. The work of scientists from the surgery center and other institutions in the country is devoted to the surgical treatment and clinical characteristics of patients with coronary artery disease after surgery. The authors note that after the operation, some patients still have manifestations of coronary artery disease and disorders of the cardiovascular, respiratory and central nervous systems, however, in the majority, the manifestations of severe angina decrease, and some patients return to work. L. F. Nikolaeva emphasizes that after coronary artery bypass surgery, the study of adaptation mechanisms in patients is of particular interest, since these mechanisms have features associated with coronary artery disease and the surgery.

Exercise therapy and massage for myocardial infarction

Myocardial infarction is necrosis of a section of the heart muscle that develops as a result of impaired blood supply due to narrowing of the coronary arteries or closure of the lumen by a thrombus or atherosclerotic plaque.

Stationary stage

Features of exercise therapy in a hospital:

1. early activation and possibly early discharge from the hospital;
2. application of individualized rehabilitation programs.

The entire period of this stage of treatment is divided into four steps, which are divided into sub-steps (a, b, c) for a more detailed definition of physical activity. The transfer of a patient from one stage to another is carried out by the attending physician.

On the second or third day of illness, after the elimination of pain and severe complications (arrhythmias, cardiogenic shock, pulmonary edema), a class according to the severity of the disease is determined for the patient, a rehabilitation program is prescribed, and physical therapy is prescribed.

Stationary stage

Sanatorium stage

Objectives of exercise therapy: restore the physical performance of patients, psychological rehabilitation and preparation for independence and productive activities.

For three to four days, the patient performs the IV stage activity regimen, and subsequently he is transferred to V, VI and VII stages. Classes are conducted in a group method and include work of all muscle groups and auto-training.

The best way to adapt the cardiovascular system to moderate exercise is measured walking.

Complex No. 1

IP lying down.

1. Flexion and extension of the fingers 6-8 times. Breathing is voluntary.
2. Flexion and extension of the feet 6-8 times. Breathing is voluntary.
3. Bending your forearms, elbows to the sides - inhale, straighten your arms and lower them along your body - exhale (2-3 times).
4. Hands along the body, turn your palms up - inhale. Raising your arms forward up, palms down, stretch them to your knees, raising your head, tensing the muscles of your torso and legs - exhale. (2-3 times). During the first lesson, you don’t have to raise your head.
5. Calm breathing for 20-15 seconds. Relax.
6. Alternately bending the legs without lifting them from the bed – 4-6 times. Breathing is voluntary, from the second or third lesson, bend and straighten your legs simultaneously - one leg bends, the other unbends.
7. Arms along the body, legs straightened and slightly apart. At the same time, rotate the arms and legs outward - inhale, inward - exhale. Return to IP – inhale. Do the same with your left hand to your right knee (4-5 times).
8. Lower your legs, bent at the knee joints, onto the bed to the right and then to the left. Breathing is arbitrary (4-6 times).
9. The legs are bent at the knee joints. Raise your right hand up - inhale, stretch it to your left knee - exhale. Return to IP – inhale. Do the same with your left hand to your right knee. (4-5 times).
10. Legs straightened. Take your right arm and left leg away from the bed at the same time, turn your head to the right - inhale. Return to IP – exhale. The same with the left hand and. with your right foot, turn your head to the left (3-5 times).
11. Calm breathing for 30-40 seconds. Relax.
12. Bend your arms at the elbow joints, clench your hands into fists, and straighten your legs. Simultaneous rotation of the hands and feet 8-10 times. Breathing is voluntary.
13. Legs are bent at the knees. Straighten your right leg up, return to IP. The same with the left leg (4-6 times). Breathing is voluntary. This exercise is included from the third or fourth lesson.
14. Legs are straightened and slightly spread, arms along the body. Place your right hand on your head - inhale, touch your right foot to the opposite edge of the bed - exhale. The same with the left hand (3-4 times).
15. Hands along the body. Alternate moderate static tension and relaxation of the gluteal muscles, muscles of the lower extremities and pelvic floor for 2-2.5 seconds. When relaxing, inhale; when tense, exhale. Repeat 4-5 times. This exercise should be started from the second or third lesson.
16. Hands along the body. Raise your hands up - inhale, return to IP - exhale. Repeat 2-3 times.

Complex No. 2

IP sitting on a chair.

1. Lean against the back of a chair, hands on your knees, do not strain. Hands to your shoulders, spread your elbows to the sides - inhale. Return to IP – exhale (4-5 times).
2. IP - the same. Roll from heels to toes with legs apart, simultaneously clench and unclench your hands into fists. Breathing is arbitrary (10-15 times).
3. Hands forward up - inhale. Return to IP – exhale (2-3 times).
4. Sliding the feet forward and backward on the floor. Breathing is arbitrary (6-8 times).
5. Spread your arms to the sides - inhale. Return to IP – exhale (3-5 times).
6. Sitting on the edge of a chair, move your right arm and left leg to the side - inhale. Return to IP – exhale. The same with the left hand and right leg (6-8 times).
7. Sitting on the entire seat of the chair, lower your arms along your body, raising your right shoulder up, at the same time lower your left shoulder, then change the position of your shoulders. Breathing is arbitrary (3-5 times).
8. Spread your arms to the sides - inhale. Using your hands, pull your right knee to your chest – exhale. The same with the left knee (4-6 times).
9. Hands on the belt. Circular rotations of the head first to the right, then to the left 3-5 times in each direction. Breathing is voluntary.
10. IP - the same. Place your right leg on the knee of your left leg - exhale, return to IP - inhale. The same with the left foot (3-5 times).
11. Calm breathing for 20-30 seconds.

Tags: heart attack, cardiovascular diseases, myocardial infarction

Source: https://nmedik.org/massaj-posle-im.html