Theoretical Foundations of Psychological and Physical Rehabilitation of Patients with Ischemic Stroke

Abstract

The objectives of our article are: to study the characteristics of disorders of psychomotor function and psycho-emotional state of patients with ischemic stroke according to the initial examination; to develop a method of physical rehabilitation of patients with ischemic stroke at the inpatient stage of rehabilitation, depending on the severity of psychomotor functions and features of the psycho-emotional state; in a psychological and pedagogical experiment to evaluate the effectiveness of the proposed method of physical rehabilitation of patients with ischemic stroke at the inpatient stage of rehabilitation.

The following theoretical methods of the research were used to solve the tasks formulated in the article: a categorical method, structural and functional methods, the methods of the analysis, systematization, modeling, generalization. Also in our research we used empirical methods, such as the observation, the interview, the questionnaire, the method of psychological observation, psychological and medical experiment, testing (M. Lucher’s test is used).

The results of the research. It was developed a «Functional methodology for the restoration of motor function of patients with ischemic stroke, taking into account their psycho-physiological features», based on the psychological principles of stepwise, sequencing and complexity, as well as on the maximum and adequate psychological impact of the rehabilitation therapist on the patient.

Also we proposed the «Functional methodology of physical rehabilitation in the early period of ischemic stroke». The main provisions of this methodology are:

1. The stabilization of the psycho-emotional state of the patient: reducing the level of anxiety, increasing motivation to exercise in the course of physical rehabilitation.

2. The actualization of stable static and dynamic stereotypes of the patient in all initial positions – from horizontal to vertical ones, using the influence of simple, eye-motor, tonic (labyrinthine tonic reflexes, symmetrical cervical tonic reflex, cervical asymmetric tonic reflex, etc.). Restoration and maintenance of stress resistance of patients is provided by symmetrical maintenance of a projection of the general center of gravity on a basic surface in such initial positions in which normal proper afferentation of joints and muscles will be stimulated. These are the positions that the human body consistently takes in the process of verticalization: a supine position on the back; a lying position on the side (right and left); a supine position; a standing position on the knees; a standing position on the knees (with additional vertical support and without such a support); a standing position (with additional vertical support and without such a support).

It was proved that the starting position became a directly activated position with a torso extension, which had the aim to support all muscle groups of the patient, provided by the stimulation of a successive chain of muscle contractions directed from the center to the periphery of the body. The symmetry of maintaining the initial position of the patient during the lesson is constantly adjusted (passively or actively) in order to stimulate proper afferentation.

Conclusions. The main directions of psychotherapy and psycho-correction of patients who suffered from ischemic stroke are: the assistance in the process of understanding the patients, his / her basic needs, motives, instructions, relationships; his / her internal conflicts and mechanisms of psychological protection; features of his / her behavior and emotional response, their adequacy and realism; the correction of patients’ instructions; the assistance in formulating and securing adequate forms of patients’ behavior based on personal achievements in the cognitive, motivational, and emotional spheres; the promotion of positive motivation for recovery and increased activity in treatment at the behavioral level.

During the classes according to the proposed methodology, we have the aim to achieve the stabilization of a psycho-emotional state of the patient through the correction of his / her cognitive processes that motivate the patient to actions which generally affect the effectiveness of all rehabilitation measures.