Stroke Recovery: a guide to stroke recovery

In recent years, national stroke education campaigns have helped to improve our recognition of the signs of symptoms of a stroke and the importance of seeking immediate treatment. However, the vast majority of the population still remains in the dark about what happens to a person after suffering a stroke.

Will I ever fully recover? Will I need to be on medication for the rest of my life? How long will my rehabilitation take? What is the best treatment plan for me? These are all common questions patients and family members have following a stroke.

How a person is affected by their stroke depends on where the stroke occurs in the brain and how much the brain is damaged. Equally, the type, intensity, duration and outcome of stroke rehabilitation will vary for each person. For example, some stroke survivors will have only minor problems such as temporary weakness of an arm or leg. Another may lose their ability to speak.

While we cannot predict the outcome, we can help patients and their families become more knowledgeable about their rehabilitation and empowered in the decisions they make.

What is stroke rehabilitation?

The goal of stroke rehabilitation is to help you relearn skills you lost when a stroke affected parts of your brain. Stroke rehabilitation can help you regain your independence and improve your quality of life. It requires a multidisciplinary approach and an individualized treatment plan that may include:

• physical activities such as range-of-motion and mobility training
• technology-assisted physical activities that utilize robotic, functional electronic stimulation or virtual reality technology
• cognitive activities that address speech, decision-making, memory or problem-solving deficits

When does stroke rehabilitation start?

Following hospitalization for a stroke, your care team will work to stabilize you, prevent further damage and limit any complications. They will identify the type of stroke, where it occurred, the type and amount of damage and the effects. Stroke rehabilitation may start in the hospital as early as 24 to 48 hours after your stroke.

Recent learning about neuroplasticity – the brain’s ability to reorganize itself by forming new neural connections – indicates that rehabilitation should begin as soon after a stroke as possible for the best outcomes. Simply put, the malleability of the brain in the days and months following a stroke offer rehabilitation specialists the opportunity to guide the brain as it rewires and reorganizes. For example, completing repetitive hand exercises under the guidance of an occupational therapist early in recovery can help a patient relearn correct grasping motions. This same process performed later in recovery may not yield the same positive results.

Where does stroke rehabilitation take place?

Once medically stable, you will be discharged from the hospital. Where and when you are discharged will depend on the type and severity of your stroke. Your rehabilitation may include care at one or more of the following locations:

• Inpatient Rehabilitation: this is the most intensive rehabilitation providing the most advanced technologies available. 24 hour medical care is provided as well as a multi-disciplinary treatment. The patient requires the ability to tolerate 3 hours of therapy a day.
• Transitional Rehabilitation Hospital: these facilities also provide 24 hour medical care with a multi-disciplinary approach to recovery. The intensity is at a moderate level.
• Skilled Nursing Center: these facilities provide 24 hour medical care with a less intensive therapeutic regimen suited to the patient’s abilities or condition.
• Outpatient Rehabilitation Center: these facilities offer specialized therapies to patients for an hour or two at a time. Patients may receive treatment multiple times a week.
• Home Health Programs: therapy and nursing staff provide care in the patient’s home.

How does stroke rehabilitation begin?

All stroke rehabilitation begins with an assessment of the patient’s abilities, usually performed by a physiatrist or a neurologist with rehabilitation experience. They will review your condition and place orders for therapy, taking into consideration any medical precautions such as medications.

Each therapist treating you will perform a separate assessment of your functional abilities. These assessments use a standard measuring tool to determine how well you are able to perform activities such as dressing, going to the toilet, walking, climbing stairs, communicating, problem solving etc. The results of these assessments provide a baseline for therapists to set goals and develop a treatment plan. For example, a speech therapist will set specific goals for communication, swallowing, memory and cognition based on your initial assessment. Giving patient’s small, incremental goals to strive for can help to keep them motivated and engaged in their recovery.

In inpatient rehabilitation, the goal is to help the patient be able to perform the tasks they need to be able to perform as independently as possible. The approach is twofold: working toward relearning a skill while also teaching compensatory methods. For example, physical therapists will work with a patient to restore the balance necessary to be able to walk. However, if their balance is so impaired as to make it unsafe to walk, they will also work on improving the patient’s upper body strength so that they can safely use a wheelchair.

Who is involved in stroke rehabilitation?

Stroke survivors receiving care as an inpatient benefit from a stroke team that includes physicians, physical therapists, occupational therapists, speech therapists, rehabilitation nurses, counselors, medical social workers, dietitians and rehab technologists. They work together with the patient and their family/ support system to meet the unique physical, cognitive, social and emotional needs of the patient. The team provides the necessary training to achieve those skills while focusing on the medical, social, emotional, spiritual and vocational needs of the patient and their family. As the patient achieves his/her goals, the team modifies the program to promote as much functional independence as able while ensuring the patient’s safety and wellbeing.

• Physicians: will guide your care, help prevent complications and implement healthy lifestyle behaviors to avoid another stroke.
• Physical therapists: help you relearn movements such as walking and maintaining your balance
• Occupational therapists: help you relearn hand and arm use for daily skills such as bathing, tying your shoes or buttoning your shirt. They can also help with swallowing and cognitive issues, and safety in your home.
• Speech and language pathologists: help with your communication, ability to swallow, and with memory and cognition problems.
• Rehabilitation nurses: specialize in caring for people with limitations and help to reinforce the skills learned in therapy and needed for your daily life.
• Counselor: will provide support for the psychological and emotional needs.

How long does stroke rehabilitation last?

Stroke recovery varies greatly from person to person, so a timeline of milestones isn’t helpful in showing patients what they can expect. The initial stages of stroke recovery can take 3 to 12 months, with your inpatient stay consisting of only a few weeks. Once you have the skills to return home, your recovery will move to the next stage as you work to regain more and more of your abilities. In some instances a discharge to home may require an interim stay in a skilled nursing facility prior to return home in order to allow more time to heal and regain the necessary functional abilities. The duration and intensity of your recovery will be affected by the type, the severity of your stroke, and any other complications. Stroke rehabilitation is lifelong and involves activities that restore, maintain and protect your abilities.

It is not uncommon for patients to experience plateaus in their recovery. While your recovery may not follow a straight trajectory, the good news is that patients can continue to see improvements in their condition and abilities years after a stroke. With ongoing work and with the support of assistive devices and advanced rehab technology, you can continue to see gains.

Learn more about stroke recovery at Allied Services. 

About the Author: Dr. Michael Wolk has been the Medical Director of Allied Services Rehab Hospital in Scranton since 2004 and the Medical Director of the Spinal Cord Injury Unit at Allied Services Rehab Hospital since 1994. Dr. Wolk is also the Medical Director of the Stroke Rehabilitation Unit and Out-Patient Services at Allied Services Institute of Rehabilitation located in Scranton, Pennsylvania. He is a partner at Northeastern Rehabilitation Associates and has been with the practice since 1992. He is certified by the American Board of Physical Medicine and Rehabilitation with a Sub-specialty in Spinal Cord Injury Medicine, and by the American Board of Independent Medical Examiners. Dr. Wolk's area of practice includes inpatient and outpatient rehabilitation, independent medical examinations, and utilization/peer reviews. He serves as a Clinical Associate Professor of Surgery for the Commonwealth Medical College. In 2004, Dr. Wolk received the special recognition award from the American Trauma Society, Pennsylvania division.