Physiotherapist helping an elderly man regain his ability to walk using a walking aid

A Complete Guide to Stroke Recovery & Rehabilitation

What can I expect post-stroke and how long does it take to recover? Here are some tips for stroke patients and their caregiver for a fuller recovery.

by Lorraine Bunag, R.N.

A stroke can endanger a person’s life. It happens when a part of the brain doesn’t receive adequate blood supply, usually because a blood clot is blocking an artery. Here’s what you need to know about stroke recovery.

What to Expect After Stroke?

When someone experiences a stroke, he or she may encounter challenges in many aspects of their life. However, the extent of those challenges depends on several factors, like their general health before the stroke incidence, the part of the brain affected, and how soon they received the necessary treatment.

Potential Concerns Based on Side of the Brain Affected

To better understand the effects you may experience post-stroke, you will have to understand which side of the brain was affected. Here are some of the symptoms you may experience depending on the side of brain affected: 

Left Side of the Brain

  • Weakness in the right side of the body
  • Speech and language issues
  • Slow behavior

Right Side of the Brain

  • Weakness in the left side of the body
  • Vision problems
  • Impulsive behaviour
  • Overconfidence in abilities

Please note that impulsivity and overconfidence may result in a reduced sense of danger, which is why people who recently had a stroke must be regularly monitored.

Communication Problems

One of the most challenging aspects of stroke recovery is having issues in speech and language. Because a person who recently had a stroke cannot communicate well, misunderstandings may occur, potentially causing frustration to both the care recipient and caregiver.

Aphasia

Aphasia is a type of language disorder. People who had a stroke may feel like they are learning their native language from scratch. Imagine how it feels like to be introduced to a foreign language for the first time–that’s how a person with aphasia feels like.

Some of the concerns you may encounter with this disorder are:

  • Inability to understand speech and written words
  • Difficulty stringing words into sentences
  • Inability to recall words they were familiar with prior to the stroke incidence

Please note that aphasia doesn’t affect a person’s intelligence or hearing; they are aware of what they want to say, but just cannot find the words or sentences for it.

Apraxia of Speech

Apraxia of speech is a neurological speech disorder. 

A person with apraxia of speech will not be able to speak as well as before, because the brain becomes incapable of providing normal motor and sensory control of the:

  • Vocal cords
  • Soft palate
  • Tongue
  • Lips
  • Jaw

Dysarthria

Another potential challenge during stroke recovery is dysarthria, a general term used to describe speech problems due to brain damage.

In this condition, a person develops one or several problems that affect their:

  • Muscle tone and strength
  • Coordination
  • Ability to make involuntary movements

Shoulder-Hand Syndrome

After a stroke, a person may experience a condition called Complex Regional Pain Syndrome (CPRS) of the upper limb, now commonly referred to as the shoulder-hand syndrome.

The exact cause is still unknown, but some reports say it happens when the shoulder joint is detached from its socket due to muscle loss. Symptoms of this condition include:

  • Changes in sensation
  • A varying sensation of hot and cold
  • Tingling sensation

Spasticity

During their recovery from stroke, a patient may experience spasticity, a phenomenon wherein the muscles become stiff or tight, making smooth, fluid movements unachievable.

The interesting thing about this condition is that it can also happen on the unaffected side. Experts highlight that due to the affected side’s weakness, the patient might use the unaffected side differently, resulting in increased tone (stiffening or tightening of muscles).

Spasticity is also a common cause of pain among patients under a stroke rehabilitation programme.

Emotional Changes

We cannot talk about the effects of stroke without discussing emotional changes. The physical challenges that bring limitations in activities of daily living, unexpected uncertainties, as well as discomfort and pain, can lead to:

  • Mood changes
  • Frustration
  • Anxiety
  • Hopelessness
  • Fatigue
  • Appetite loss
  • Sleep deprivation
  • Difficulty in remembering, focusing, thinking, and making decisions.

Unaddressed, these emotional changes may eventually lead to depression and even thoughts of death (suicidal ideation). For this reason, someone who has had a stroke should also receive support for their mental health.

A Note on What to Expect After Stroke

We have discussed what many individuals recovering from stroke experience on their road to recovery. However, do take note that this is not an exhaustive list. Besides the ones we already mentioned, someone can also experience other physical and emotional challenges and difficulties after a stroke.

Furthermore, the direct effects of stroke may result in secondary problems. Case in point, experiencing muscle weakness and then developing a sense of impulsivity may lead to fall accidents, which in turn can aggravate existing problems or produce new ones (e.g. head injury, fractures).

Can the Brain Heal Itself After Stroke?

Many of us grew up thinking that we were born with the number of brain cells we will have for life. But through extensive investigations, experts can now conclude that under certain conditions, the brain is capable of “healing” itself.

As it is, immediately after receiving stroke treatment, the following things contribute to brain healing:

  • Decreased swelling
  • Removal of toxins in the brain
  • Improved circulation

Moreover, brain cells which are damaged but are not beyond repair can heal and function just like before. Likewise, nerve stimulation and neurogenesis (the process of making new brain cells) can occur during stroke rehabilitation.

The bottom line is, when it comes to stroke recovery, the earlier the treatment commences, the better. Early intervention reduces the risk of irreversible damage to the affected brain cells.

Similarly, early rehabilitation prevents more significant disability. To put this into perspective, think about muscle weakness, which makes it hard for the patient to move. If rehabilitation does not start right away, nerve stimulation during physical therapy may no longer work.

Stroke Rehabilitation

Post-stroke rehabilitation is a holistic strategy that helps an individual recovering from stroke regain their strength and independence. While it may not be able to reverse all the effects of stroke, it will still increase the extent of recovery.

What Can Rehabilitation Help With?

Regarding stroke recovery, your first question might be: what can rehabilitation help with?

As it is, rehabilitation can help improve the following effects of stroke:

  • Visual problems
  • Paralysis, muscle weakness, issues in coordination
  • Neglect of the affected side of the body (one-sided inattention)
  • Pain and tingling sensation
  • Difficulty swallowing
  • Speech problems
  • Bowel or urinary incontinence
  • Fatigue
  • Cognitive problems, like short-term memory loss and lack of focus
  • Anxiety and depression

When Should Rehabilitation Begin?

As mentioned earlier, post-stroke rehabilitation must begin as early as possible.

There is no hard and fast rule here, but reports say it must commence as soon as the individual is in stable condition. This usually happens within 48 hours after the stroke incidence.

In most cases, the first goal of stroke recovery is to overcome paralysis or other motor problems. Generally, a physical therapist will help patients with fundamental movements like sitting up, moving between bed and chair, standing, and walking with aid.

Once they get stronger and gain better coordination, they can proceed with more complex activities.

What is Involved in Stroke Rehabilitation?

Another critical question that many people ask about stroke recovery is, what therapies should an individual recovering from stroke undergo?

The answer to this question depends on what the individual needs. In most cases, it is a collective effort between therapists and other medical disciplines, such as:

Doctors

Stroke recovery cannot start without physicians’ supervision because they take care of the individual’s overall health. However, please note that you may need to consult more than just one physician during stroke recovery.

In the course of an individual’s rehabilitation, you may need the help of the primary doctor who takes care of their medicines and rehabilitation, a geriatrician (a doctor who specializes in senior care), a neurologist, or an internist.

Medicine Delivery with Homage

With Homage’s medicine delivery service, you can now have stroke medications delivered to your home anywhere in Singapore. It only takes 3 simple steps:

  1. Consult a doctor: Download our app and consult a doctor in the comfort of your home via teleconsultation or by engaging a house call doctor.
  2. Get a prescription: After a thorough assessment and evaluation of your condition, the doctor will issue you a prescription if necessary.
  3. Receive medicine at home: With the prescription, you can get your medication at a nearby pharmacy or clinic, or have them directly delivered to your doorstep with Homage.

Physical Therapy

In case the client experiences difficulties due to sensory and motor impairments caused by the stroke, having a physical therapist on the team will be extremely beneficial. 

Under the physical therapist’s care, the individual’s limitations will be thoroughly evaluated so they can come up with an appropriate treatment plan. This treatment plan will be personalised based on the individual’s care needs. The strategies will more or less include exercises that improve strength, range of motion, balance, and coordination.

It is also highly likely that the therapist will advise constraint-induced therapy. In this method, they will intentionally immobilise the affected limb so that the individual will be forced to use their affected side.

If you or your loved one has recently experienced a stroke and are planning on physiotherapy, consider setting an appointment with our therapists. Here at Homage, our certified physical therapists can visit you at home to evaluate the client’s condition, develop a personalised treatment plan and provide appropriate interventions.

Occupational Therapy

Should the client need to “relearn” specific everyday skills post-stroke, attending occupational therapy sessions is the best course of action. These skills may include ways to perform activities of daily living, or any specific movement that is required for work.

An occupational therapist guides the individual to find the best ways to perform self-directed skills (also referred to as occupations) such as taking a bath, preparing meals, and cleaning the house. Not only do occupational therapists help patients regain a greater level of independence in daily life, but also reduce the risk of accidents while they are performing their occupations.

Speech-Language Therapy

Many people who experience stroke develop speech or language problems; a speech-language pathologist will help them relearn their language or speaking skills. If the speech rehabilitation takes a long time, the client will also be taught to communicate using other ways.

Counseling

As we have mentioned before, stroke recovery often results in emotional changes like anxiety, frustration, or even depression. Since these feelings can interfere with post-stroke rehabilitation, the individual may be advised to attend counseling therapy sessions.

How Long Does Rehabilitation Last?

When it comes to post-stroke recovery, “how long” questions are usually difficult to answer, because it depends on how the client is doing.

To give you an estimation, experts say that rehabilitation usually lasts between 3 to 4 weeks, with the client having sessions for about 3 hours a day, 5 to 6 days a week. Of course, this rehabilitation program is a full-range strategy, which means that individuals usually stay in a facility to receive medical care and attend therapy sessions.

Now, if you’re wondering how long stroke recovery lasts, vast improvement usually occurs within 3 to 4 months after the incident, provided that they are in constant communication with doctors and therapists. Within a year or two, the client will have a semblance of normalcy or a level of independence in their daily activities.

However, please remember that each individual’s post-stroke recovery journey is unique: the recovery journey for mild stroke can happen faster while more severe cases can take longer, perhaps even with life-long effects.

Tips to Prevent Another Stroke

According to the American Heart Association, 1 in every 4 stroke and heart attack survivors experience another incidence. This is why doctors often prioritise stroke prevention along with stroke recovery strategies. 

The good news is, 80% of stroke and heart attack cases can be prevented with drug intervention and lifestyle modifications. Here are some tips to prevent a second stroke:

1. Follow The Doctor’s Advice

The first step in preventing a second stroke incidence is to follow the doctor’s advice. If they give specific prescriptions, ensure that you take them accordingly. For instance, many stroke survivors receive medicines like aspirin to prevent blood clots from forming, so as to reduce the risk of another stroke.

2. Control Blood Pressure

Did you know that hypertension is one of the most potent risk factors of stroke? Working closely with your doctor to get your blood pressure into the normal ranges will help to prevent another stroke.

3. Quit Smoking

Smoking is linked to an increased fat buildup in blood vessels. Moreover, it’s a habit known to increase high blood pressure risk. For this reason, stroke survivors are strongly advised to quit smoking.

4. Have a Healthy Diet

A healthy and balanced diet that includes plenty of fruits, vegetables, lean protein, and whole grains will not only help restore health, but also reduce the risk of another stroke incidence.

5. Perform Regular Physical Activity

Physical activity improves blood circulation. Along with a healthy and balanced diet, physical activity can help to keep obesity at bay – which is a risk factor of stroke. However, do consult your doctor before starting an exercise regimen.

6. Manage Diabetes

If you have diabetes, it is best to manage it with the doctor’s help. This is because high blood sugar, if left unchecked, often damages blood vessels, including those in the brain.

7. Treat Heart Conditions

Preventing another stroke requires an individual to manage any heart condition they may have. Heart disorders can produce blood clots, which can travel to the brain and cause another stroke.  

Tips for Caregivers

Are you taking care of someone who recently experienced a stroke? If so, please note that your loved one’s needs can change as they progress along with their rehabilitation.

To put things into perspective, a few days after the stroke incidence, your loved one may need you to do almost everything for them because the effects of stroke are still prominent. Months in, though, it’s not always a good idea to do things in their stead. This is because they need to train to relearn certain skills.

As it is, here are some general tips if you are caring for a loved one recovering from stroke:

1. Learn As Much As You Can About Stroke

The first crucial step for caregivers is to learn everything about stroke: how does it affect the patient? What are the common medications and their side-effects? How can you assist during their rehabilitation?

Knowing about these things helps you manage your expectations and prioritize your tasks. Learn more about the condition in our all-in-one guide on stroke here

2. Work Closely With the Healthcare Team

Don’t forget to continue communicating with the healthcare team after hospital discharge. They will keep you in loop about the patient’s needs, potential health concerns, and strategies in preventing another stroke incidence.

Furthermore, keeping in touch with the team helps you better report unexpected signs and symptoms that may arise.

3. Offer Support  and Inspire a Positive Attitude

As mentioned earlier, a lot of factors can affect a person’s recovery from stroke. But, while you cannot do anything about the side of the brain affected and the extent of the injury, you can certainly offer your support and find ways to inspire your loved one.

According to reports, support from the people around the affected individual plays a crucial role in stroke rehabilitation. Similarly, the individual’s positive attitude also helps them overcome difficult challenges.

If you notice signs of depression, don’t hesitate to contact the counselor. The earlier you intervene, the better: remember that depression can hinder recovery.

4. Measure Gains and Unexpected Losses

Caring for a stroke survivor includes monitoring their progress. Keeping track of their gains can help the doctor assess if the current programme is suitable for their condition. Likewise, reporting any setback gives the medical team significant clues if modifications in strategies are required.

To assess the individual’s progress, consider keeping a journal of the things they can and can’t do at the moment. If you notice that there seems to be no improvement despite rehabilitation efforts, alert the primary physician as soon as possible. It will also be helpful to record details of unexpected symptoms: when they happened, how long, and how frequent.

5. Avoid Caregiver Stress

Most importantly, take care of yourself. Attending to your loved one’s needs can be overwhelming, so take a break from time to time. Also, do not hesitate to ask for help and delegate some tasks. Keep in mind that caregiver stress can affect the quality of care you deliver to your loved one as well.

Do You Know Someone Who Has Recently Experienced A Stroke?

Do you know someone who has recently experienced a stroke? Our multidisciplinary team of doctors, therapists, nurses and caregivers can help with stroke care in the comfort of your home. 

References
  1. 15 things caregivers should know after a loved one has had a stroke. (n.d.). www.stroke.org. Retrieved February 8, 2021, from https://www.stroke.org/en/help-and-support/for-family-caregivers/15-things-caregivers-should-know-after-a-loved-one-has-had-a-stroke
  2. Can a brain heal itself after a stroke? – Lancaster general health | Penn medicine. (2015, May 11). Lancaster General Health – Lancaster General Health | Penn Medicine. Retrieved February 7, 2021, from https://www.lancastergeneralhealth.org/health-hub-home/2015/may/can-a-brain-heal-itself-after-a-stroke#:~:text=The%20initial%20recovery%20following%20stroke,heal%20and%20function%20more%20normally
  3. The Days and Months After a Stroke. (n.d.). UPMC: #1 Ranked Hospital in Pittsburgh. Retrieved February 6, 2021, from https://www.upmc.com/services/rehab/rehab-institute/conditions/stroke/after-stroke#:~:text=Problems%20that%20Occur%20After%20a%20Stroke&text=Weakness%2C%20paralysis%2C%20and%20problems%20with,of%20your%20arm%20or%20leg.%20https://www.stroke.org.uk/sites/default/files/f33_physical_effects_of_stroke_6pp_apr2016_web.pdf
  4. Post-stroke rehabilitation fact sheet. (2020, May 13). National Institute of Neurological Disorders and Stroke | National Institute of Neurological Disorders and Stroke. Retrieved February 7, 2021, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Stroke-Rehabilitation-Fact-Sheet#professionals
  5. Preventing another stroke. (n.d.). www.stroke.org. Retrieved February 8, 2021, from https://www.stroke.org/en/life-after-stroke/preventing-another-stroke
  6. Scientists identify main component of brain repair after stroke. (2015, October 28). National Institutes of Health (NIH). Retrieved February 7, 2021, from https://www.nih.gov/news-events/news-releases/scientists-identify-main-component-brain-repair-after-stroke
  7. Shoulder-hand syndrome after stroke. A complex regional pain syndrome. (December). PubMed. Retrieved February 6, 2021,
  8. Stroke rehabilitation & stroke recovery. (n.d.). Cleveland Clinic. Retrieved February 7, 2021, from https://my.clevelandclinic.org/health/articles/5600-stroke-rehabilitation-services

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About the Writer
Lorraine Bunag, R.N.
Lorraine is a registered nurse who spends most of her time writing informative articles on health and wellness. At the end of the day, she relaxes by reading a book or watching documentaries about unsolved mysteries.
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