stroke recovery

Stroke recovery process

In the previous article we talked about stroke after effects. Because stroke after effects can manifest as different types and forms of functional impairments, recovery process will also be different for every individual. Stroke recovery is a complex process with no two stroke survivors regaining function the same way. It starts with acute care, goes on to rehabilitation and home recovery process, may continue at a local clinic and in ways may last throughout life.

The process can be slow and uncertain, with some people recovering quicker, some later. However there are common patterns to what happens during different stages of stroke recovery.

Stroke recovery timeline

Recovery usually begins after doctors have stabilized your condition. This includes restoring blood flow to your brain and reducing any pressure in the area of the affected part. It also includes reducing any risk factors for a stroke. Because of this, rehabilitation may start during your initial hospital stay. Beginning the recovery process as early as possible can increase your chances of regaining impaired brain and body functions. Although recovery looks different for everyone, there are certain patterns during the different stages of stroke recovery timeline.

Initial treatment phase

If you experience a stroke, you will likely be admitted to an emergency department first. There, medical practitioners will stabilize your condition and determine the type of stroke you experienced. Depending on the stroke’s severity, you may need to spend time in intensive care or acute care.

Rehabilitation should begin as soon as possible. At some facilities it begins already 24 hours after experiencing a stroke. To read about acute care and rehabilitation options and process, read "What are the options for stroke rehabilitation?". The ultimate goal of rehabilitation is to improve and restore your speech, cognitive, motor, or other impaired functions so that you can be as independent as possible. Timely rehabilitation is key.

First few weeks after a stroke

The typical length of a hospital stay after a stroke is five to seven days. During this time, the medical practitioners will evaluate the effects of the stroke, which will determine the rehabilitation plan. The long-term effects of amstroke may impair cognitive, physical, psychological functions and more. To learn more about stroke after effects, read in our article "What are stroke after effects?". Physical and occupational therapists can help determine which areas of your brain were affected. During this time, therapy sessions should be conducted several times a day in order to properly evaluate the stroke patient's condition. This will help with determining the right approach for recovery procedures and allow to begin immediately.

Stroke rehabilitation will be very important in this phase of recovery. Rehabilitation will focus on performing activities of daily living such as bathing or getting dressed. You can also talk to your medical team about the activities that are most important to you and they will help you set recovery goals. Your doctors will evaluate what rehabilitation setting and option will be the most suitable. Even though you may attend rehabilitation sessions, it is also important to also practice on your own. For the after effects you are experiencing, a rehabilitation psychologist and neuropsychologist can help you create a plan to improve the affected functions and help you prepare for what could be permanent changes.

Afterwards you may be discharged from the hospital. In order to return living at home, you do not have to be completely recovered. If you can perform most of your daily activities and routines, or have loved ones that can assist you, it is possible to do so.

1-3 months after a stroke

This will be the most important phase for your recovery and the phase where you will see improve the most. During this time, it is recommended to enter and complete an inpatient rehabilitation program. Alternatively you may attend outpatient therapy sessions. The end goal for rehabilitation is to restore your lost functions or develop ways to work around a functional impairment with so called "compensation strategies". An example of a compensation strategy is learning to hold a toothpaste tube with your impaired hand so the strong hand can unscrew the cap.

During the first three months after a stroke, a patient might experience a so called spontaneous recovery. When a skill or ability that seemed lost suddenly returns as the brain finds new ways to perform tasks. This may happen when another part of your brain takes control over the lost function and performs it now instead. How brain recovers after a stroke is not yet fully understood, yet there are different explanations to how it happens. It may restore functions when the way tasks are normally performed is changed, if blood flow to the affected area of your brain is restored, and others.

During this time, some patients might experience additional health conditions resulting from stroke like pneumonia or a second stroke. This can be very difficult for the stroke patient since the rehabilitation process needs to be interrupted, recovery goals reevaluated and additional stroke after effects may arise.

6 months and later

After six months, improvements are possible but will be much slower. Most stroke patients have reached a relatively stable state by now. Some patients may have fully recovered. Others may still experience impairments, also called chronic stroke disease. Whether a full recovery is possible depends on a variety of factors which you can read about later in the article.

Even though recovery process does slow down at this point, it is important to continue the rehabilitation process and to follow up with doctors. This may include checking in with your general practitioner about your health condition and prevention of future strokes, talking to your physiotherapist about ongoing rehabilitation plans, etc. You may also check in with your physical and occupational therapist about regaining lost functions or a psychologist who can help you after emotional and cognitive disturbances. All of this will help you regain confidence and help you return back to normal life.

Finding inspiration and stroke recovery tips

Finding inspiration from other stroke survivors. Learning about others' recovery process can be a great tool for inspiration, can help you with  feelings of isolation and finding hope. There are stroke survivors who surpass the recovery expectations through their dedication and efforts and return back to an independent normal life. You might find stories that you relate to, cases that might be similar to yours. This may give you the hope that you can recover, too.

Educating yourself about stroke and your situation. It is very important that you are involved and dedicated to your recovery wholly. This includes educating yourself about stroke, necessary therapies (occupational, physical and whichever therapy applies to you), reading information about stroke, etc. It is important to be proactive and engaged in your recovery on top of what the medical team prescribes. This too will speed up your recovery process and allow you to prepare and understand your condition and after effects better.

Neuroplasticity. One of the most confusing aspects in rehabilitation is neuroplasticity (retraining the brain to perform functions that may have been impaired by a stroke). It is a delicate phenomenon and hasn't yet been fully understood. However, neuroplasticity is one of the most important parts of rehabilitation. Nowadays it is made fun and interesting with the help of technology. Vigo, too, provides you the help for retraining the brain after a stroke.

Lifestyle changes. Even with all of the helpful rehabilitation therapies available, one's own lifestyle and habits are very important for recovery and preventing another stroke. Read more about lifestyle factors in our article "What can help prevent a stroke?"

Is stroke recovery always successful?

According to the American National Stroke Association, 10 percent of stroke survivors recover almost completely and 25 percent recover with minor impairments. Another 40 percent experience moderate to severe impairments that require special medical attention. This means that the likelihood of having some type of long-lasting functional impairment is quite high. Another 10% require long-term care at a healthcare facility. Successful stroke recovery depends on various factors, including:

  • the severity of stroke experienced
  • timing for how soon the recovery process was started
  • your own motivation and efforts to recover
  • Other potential medical conditions
  • Age when the stroke occurred

While recovery process changes over time, It is important to remember that recovering from a stroke is not a linear process. It is important to try and not get discouraged if recovery doesn't happen as fast as you would have liked or have expected. As you can see, your recovery depends a lot on your own motivation and efforts. A skilled and strong medical team can also affect how well you recover. The support you receive from your family and loved ones can also be a great help. Educating yourself, doing recovery work on top of what your medical team prescribes and possibly changing your lifestyle can greatly contribute too.

After experiencing a stroke, you might find it difficult to begin your life again. But staying motivated and proactive about getting well will be your best bet to recover.


stroke after effects

What are stroke after effects?

There are various effects and consequences that a stroke survivor experiences, both physically and emotionally. In this article, we will cover functional changes that a stroke survivor might experience. Stroke after effects can include physical changes, psychological changes, cognitive changes and more. Since no two stroke cases are the same, these can vary in type and severity.

Common physical stroke after effects

Weakness or paralysis on one side of the body

If the stroke occurs on the brain’s right side, the left side of the body and face (sparing the forehead) will be affected. It’s the opposite for a stroke that occurs on the left side of the brain. There are also differences in effects depending on which side of the brain the stroke occurred.

If the left part of the brain was affected:

  • Paralysis on the right side of the body
  • Speech/language problems
  • Slow, cautious behavioral style
  • Memory loss
  • Vision problems

If the right part of the brain was affected:

  • Paralysis on the left side of the body
  • Vision problems
  • Quick, impulsive behavioral style
  • Memory loss

Fatigue After a stroke

Everyone feels tired sometimes, but post-stroke fatigue is not a typical tiredness. The extreme tiredness that a stroke survivor experiences is called post-stroke fatigue. Unlike usual tiredness, fatigue doesn’t always improve with rest and it isn’t related to how busy or active you’ve been. Post-stroke fatigue usually starts to lessen a few months after the stroke. But for some people, tiredness may continue for years. If you’re experiencing post-stroke fatigue, talk to your medical team about ways to reduce it.

Spasticity

After a stroke, muscles may become stiff and tighten up. This condition is called spasticity. It refers to muscle tone which is the natural tension or contraction in a muscle that resists stretching. Spasticity makes stretching a muscle much more difficult, also causing the tendons and soft tissue around the muscle to become tight or stiff. It is important to treat spasticity because it can lead to the muscle freezing into an abnormal, painful position. If you have spasticity, talk to your doctor about the best way to treat it.

Seizures

Some stroke survivors may experience seizures. Seizures occur when cells in the brain send electric signals to one another that pass along your nerves in your whole body. The electric disturbance happens due to the damage in the brain caused by a stroke. A seizure is most likely to happen within the first few days after a stroke, but can possibly occur much later. It is painless yet disorienting and upsetting, and can last few seconds or minutes. Some stroke patients may experience repeated seizures. Overall, your risk of having a seizure reduces over time after a stroke. Consult with your doctor if you think you might have had a seizure.

Psychological impact

Two of the most common psychological problems that can affect people after a stroke are anxiety and depression. To learn more about this, read in our article “Depression and anxiety after stroke”. Feelings of anger, frustration and confusion are also common as well as lack of motivation. If you haven’t received a psychological assessment from your healthcare team after experiencing a stroke, you might want to reach out to a psychological counselor to check whether you’re experiencing any emotional problems. CBT is a common type of therapy used after a stroke. It aims to change the way you approach things and helps you adopt a more positive state of mind.

Cognitive impact

“Cognitive” is a term that describes the many functions and processes that the brain uses to process information. One or more cognitive functions can be affected by a stroke. Examples are:

  • Communication
  • Spatial awareness (The natural awareness of where your body is in relation to your environment)
  • Memory
  • Concentration ability
  • Executive ability (planning, solving problems, reasoning in situations)
  • Praxis (The ability to perform skilled physical activities)

During treatment, these cognitive functions should be assessed and treatment and rehabilitation planned accordingly. You may need language and speech therapy to recover communication skills, use memory aids such as writing a diary, planning daily tasks to regain your memory, etc. You will find that most of your cognitive functions will return with time and treatment, but they may not be the same they were before.

One of the risks after a stroke is developing vascular dementia. This is a condition that describes problems with planning, judgment, memory and other thought processes due to brain damage from impaired blood flow to your brain.

Movement problems

When body muscles cannot properly perceive messages sent by the brain, this causes movement problems like paralysis and muscle weakness. Muscle weakness makes supporting the body difficult, causing movement and balance problems. A stroke can also cause weakness or paralysis on one side of the body, depending on which side of the brain was affected. This results in coordination and balance problems. To regain movement function, a stroke patient will usually need a rehabilitation program. To learn more about rehabilitation after stroke, read in our article “What are the options for stroke rehabilitation?”.

Communication problems

Communication problems are very common after a stroke. Around one-third of stroke survivors have problems with speaking, reading, writing and understanding what other people say to them. Most common communication problems are as follows:

  • Aphasia affects your ability to speak and understand what others say. It can also affect your ability to read and write. It happens when you’re no longer able to understand or use language. Aphasia is a common problem after stroke and around a third of stroke survivors have it.
  • Dysarthria happens when you’re not able to control the muscles in your face, mouth and throat too well. This creates difficulty to speak clearly. Your speech may become slurred or slow or your voice may sounds quiet.
  • Apraxia of speech is when you can’t move the muscles in your face, mouth or throat in the order you need to when you’re speaking. This can make it difficult for other people to understand you.

For assessment of your communication abilities, you should seek out a speech and language therapist. They will help you with regaining your lost communication abilities. Speech and language therapy might include:

  • Exercises to improve your control over your speech muscles
  • Use of communication aids – letter charts, electronic aids
  • Use of alternative communication methods, i.e, gestures or writing

Although it can be assumed that communication problems affect your intelligence, it is mistaken. If you experience communication problems, you simply have problems with the process of speaking and understanding language.

Swallowing problems

Damage to the area of your brain that controls eating and swallowing can cause you to have problems with the respiratory system. When the damage caused by a stroke interrupts your swallowing reflex, this is called dysphagia. If the muscles in your throat, tongue or mouth aren’t able to direct food correctly, food and liquid can get into the airway and settle in the lungs. This can cause serious complications, like infection and pneumonia. If you are experiencing issues with swallowing, you might need to be fed with a feeding tube during the first phase of your recovery. While dysphagia is a common symptom after a stroke, it usually improves with time.

Visual problems

After stroke, you might experience changes in your vision. Visual problems occur when the parts of the brain that receive, process and interpret information sent by the eyes is impaired. Some of the stroke after effects that affect vision include:

  • Problems with seeing clearly
  • Loss of ability to judge space and depth
  • Loss of half the field of vision (Only being able to see the left or right side of what's in front of you)
  • Double vision (When control of eye muscles is affected)

If you are experiencing vision problems after a stroke, you should be referred to an eye specialist called an orthoptist. An orthopist will assess your vision and suggest possible treatment options.

Bladder and bowel control

Some strokes may damage the part of the brain that controls the bladder and bowel. This can cause loss of control over these functions, resulting in incontinence. You might need to go to the bathroom more often, urinate during sleep, etc. Some stroke survivors may regain bladder and bowel control quite quickly. But if you still experience problems after leaving hospital, you should seek medical help from your hospital or general practitioner.

The aforementioned stroke after effects can certainly be a lot to deal with. Yet there is hope to regain your lost functions and abilities after a stroke with a proper treatment plan, self motivation and time. New routines will become second nature all of a sudden. Rehabilitation can build your strength and confidence, and seeing your own improvement will undoubtedly provide you with motivation. Having a strong support system and medical team will also be key to help you recover. It is important to remember that recovery from stroke is not a linear process, and staying encouraged can sometimes be hard. Yet your own motivation and active participation in recovery are the most important aspects to achieve progress.


Accessibility of rehabilitation for stroke during world wide isolation

It is well known that recovery from stroke takes a lot of time, discipline and effort from patients. It also requires a tremendous amount of human specialist involvement. Even before the COVID-19 virus had changed the world, the majority of stroke survivors worldwide were not able to receive stroke rehabilitation in sufficient amount. The reasons for that were multiple – there were simply never enough rehab facilities, beds in dedicated rehab centers, rehab specialists. Not to mention multiple social and functional barriers that kept patients away from stroke rehabilitation services. No surprise, results of stroke recovery are poor. 

And now this, when all non – essential travel has been restricted to the most of world’s population, where majority stroke survivors as high risk individuals are not able to access post stroke rehabilitation due to risk of catching Covid-19 virus, where they can’t even accept anyone coming to their own home without risking to be infected.

How can patients access rehabilitation? It’s time for Vigo

Vigo was born long before we knew what self isolation and quarantine is. Vigo was born when people were not afraid of meeting each other, before rehab facilities were closed. But now Vigo has become important. 

Vigo is your digital rehab assistant for stroke which is always by your side and will guide you through the rehabilitation process at the comfort of your home without putting you at risk.