Living with the sequelae of cerebrovascular accident

This article is expertly consulted by Master, Doctor Bui Ngoc Phuong Hoa - General Internal Medicine - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.

Cerebrovascular accident, which is very common today, not only occurs in the elderly but also occurs in young people. The disease can leave very severe sequelae that affect their lives, making it impossible for them to return to their previous work, they may not be able to speak, cannot understand, cannot move their hands or feet. let's go...

Having a stroke can sometimes cause temporary or permanent disability, depending on how long the brain is deprived of blood and what part is affected. Sequelae may include:
Paralysis or loss of muscle movement or hemiplegia. You may experience paralysis on one side of your body, or loss of control over certain muscles, such as on one side of your face or an arm. Physical therapy can help you return to activities affected by paralysis, such as walking, eating, and dressing. Difficulty speaking or swallowing. A stroke can affect the control of the muscles in your mouth and throat, making it difficult for you to speak clearly (dysphagia), swallow (dysphagia) or eat. You may also have difficulty with language (aphasia), including speaking or understanding speech, reading, or writing. Therapy with a speech-language pathologist can help. Memory loss or difficulty thinking. Many people who have a stroke experience some memory loss. Others may have difficulty thinking, making judgments, reasoning, and understanding concepts. Emotional problems. People who have had a stroke may have more difficulty controlling their emotions, or they may become depressed. Pain. Pain, numbness, or other strange sensations may occur in the parts of the body affected by the stroke. For example, if a stroke caused you to lose sensation in your left arm, you may experience an uncomfortable tingling sensation in that arm. May be sensitive to temperature changes, especially extreme cold, after a stroke. This sequelae is called central stroke pain or central pain syndrome. This condition usually appears several weeks after a stroke, and it can improve over time. But because the pain is caused by a problem in your brain, rather than a physical injury, there are few treatments. Behavioral change and self-care. People who have had a stroke may become more withdrawn and less communicative or impulsive. They may need help with grooming and daily chores. Hemiplegia should not be able to move or have limited movement, which can easily lead to many complications such as: ulcers caused by lying down for a long time, pneumonia, shoulder dislocation, muscle atrophy, osteoporosis due to inactivity, muscle contractures. to stiffness, commonly in elbows, knees, wrists, ankles, fingers, knee overextension, loss or decreased sensation, prolonged facial paralysis affecting eating and drinking function, disturbances language...

In order to prevent the sequelae as mentioned above, the patient's family and relatives need to have preventive measures:
Make the patient room with a large enough room, cool, enough light, avoid placing the patient inside paralysis facing the wall, objects placed on one side of the paralysis; Anti-ulcer. Turn the patient at least every 2 hours, possibly using an anti-ulcer ring, if the patient is comatose; Prevent stagnation of phlegm. Place the patient in a supine position with the head tilted to one side, regularly aspirate sputum, and pat the patient's back and shoulders; Wear arm-leg-hand support belt when allowing patient to sit, stand, walk; Exercise movement of the paralyzed and non-paralytic limbs; regularly check the joints of the ankles, knees, elbows, hands and fingers to prevent stiffness; When letting the patient stand, pay attention to the knee joint, try to keep the knee straight and parallel to the healthy leg; use the patient's skin stimulation such as: stroking, patting... facial exercises, massage and keeping the face warm; Practice pronunciation for the patient such as: a, o, e..., practice speaking. In addition to regular exercise for the patient, the correct posture of the patient is also extremely important. Specifically as follows: Set the correct posture:
Lying on your back: Arms: Shoulders slightly extended (90 0 internal or external rotation), elbows slightly flexed, forearms pronated, wrists slightly extended (20 degrees), fingers in functional position (fingers slightly flexed, thumb opposite). Legs: hips slightly apart, knees slightly bent (5 -10 degrees), feet in neutral position (90 degrees). Lying on side: Side of paralysis: The body is slightly tilted back, the shoulder of the paralyzed side is pulled forward, the elbow is extended, the forearm turned upside down, creating an angle of about 90 degrees to the body, the paralyzed leg is placed straight. Strong hands are placed on the abdomen, strong legs have support in the position of hip flexed, knees bent. Strong side tilt: The body is slightly tilted with a pillow to support the back. The paralyzed arm is bent at the shoulder, the elbow is bent on the knee, the paralyzed leg is on the knee with the hip and knee bent. Strong legs stretch hips, bend knees. Sit: Shoulders level, back straight. Both feet are placed perpendicular to the floor. Standing: shoulders level, back straight. Legs parallel, knees straight, not too stretched. Walking: Right leg hip flexed, knee bent. For hands: practice holding objects from large to small objects, practice writing... When the patient gets better, it is necessary to encourage the patient to do personal hygiene such as shoveling food, combing hair, brushing teeth, etc. put on clothes... When the patient goes away, the patient is encouraged to go home to continue exercising and at the same time encourage family members to take care of the patient so that they do not feel guilty because of their illness. Cerebrovascular accident patient After discharge from the hospital, it is necessary to strictly follow the treatment instructions of the doctor. In addition to medication and exercise, a reasonable diet will help patients recover quickly and reduce the progression of the disease.
Food must be balanced and meet all necessary substances such as protein (meat, fish, eggs, tofu...), carbohydrates (rice, noodles, bread...), fat (oil) , fat) vitamins and fiber (vegetables and fruits).

Food should be prepared in accordance with the patient's chewing ability. It can be chopped, minced, and simmered for easy eating and absorption by patients. Should be divided equally 3-4 meals/day. The energy in the diet should be reduced, the patient should not eat too full to avoid weight gain, slightly reduce the activity of the digestive and circulatory apparatus, especially the patient lying in bed or having limited mobility. energy will be lower than the average person. The diet should reduce salt and water, because the patient cannot excrete much salt and water because of venous hematoma causing edema, poor kidney function. Avoid using hot and spicy spices, wine, tea, coffee... and processed foods with a lot of salt such as melons, coffee, salted onions, bread, smoked meat, bate, sausages... For patients who cannot eat on their own due to paralysis of the pharynx and must be fed through a tube, the diet must absolutely follow the doctor's specific instructions to avoid possible unfortunate complications. . For patients with complicated medical conditions such as hypertension, cardiovascular disease, diabetes, it is necessary to consult a specialist on an appropriate diet. Recovery of sequelae of cerebrovascular accident according to traditional medicine.
Acupuncture: Follow the acupressure formula: Acupressure points in the hands, feet, head, face, neck.

Electro-acupuncture: The doctor places the patient in a supine or side-lying position. Electrostimulation once a day, needle retention time: 25 - 30 minutes. The course of treatment is from 30 to 45 times of acupuncture, depending on the severity of the disease, then it is possible to repeat a number of subsequent courses. Shui acupuncture: Often used acupressure points such as Giap Tich corresponding to chi paralysis, Kien Ngung, Thu Tam Ly, Phong Thi, Tuc Tam Ly, Thua Son, Duong Lang Tuyen, and Giai Khe. Acupressure massage and exercise: An indispensable measure when treating sequelae of leprosy, especially for hemiparesis during the recovery period. The patient needs to be massaged on the head, face, back and limbs, focusing on the paralyzed side. Exercise is a very important content in rehabilitation. Conduct early exercise for patients from passive to active depending on the condition of each patient. In order to prevent recurrence of cerebrovascular accident, patients need to adhere to treatment, periodically monitor their health, control risk factors, have a regular lifestyle, work and exercise regime. Besides, it is also necessary to avoid adverse factors such as letting the body get cold, working hard, stress...
In short, to bring good results to the patient, there must be a close cooperation of the team. recovery, the patient's family and the patient's good cooperation from the first time when the patient is admitted to the hospital until the patient adapts to his remaining capacity.
Master. Doctor Bui Ngoc Phuong Hoa has more than 24 years of experience in the field of neuropsychology. Doctor Hoa was formerly Deputy Head of the Department of Neurology - Quang Ngai Provincial General Hospital and participated in many continuous training courses on Epilepsy, Cerebrovascular Accident, Alzheimer's, Movement Disorders, Geriatrics. Endocrine Pathology.