Recovery and rehabilitation for stroke
Once an acute situation is under control and emergency treatment has begun taking effect, most stroke sufferers will be admitted to hospital for careful monitoring for at least a few days. Once out of immediate danger, a doctor will discuss procedures for effective recovery and also highlight the importance of preventative measures going forward.
A doctor is likely to discuss changes in diet and overall lifestyle to keep blood pressure and cholesterol at a healthy level, as well as ongoing care such as medications, or physical therapy. In some instances, the possibility of further surgery may be necessary (removing plaque from large carotid arteries or widen narrowed or clogged arteries in the brain).
If an ischemic stroke type occurred, one may be given aspirin or other blood-thinning medications as a means to prevent the occurrence of more strokes. If an existing heart condition is also determined as part of the underlying cause, long-term therapy and appropriate treatment will also be discussed. Cholesterol levels are usually problematic in this instance and medications will be prescribed to lower it.
A doctor will also discuss all necessary follow-up medical care, as well as rehabilitation therapy. This is crucial as the brain is likely to have sustained some damage during the stroke. As a result, the brain may begin to compensate for specific areas affected by the trauma and form new neurological pathways. Rehabilitation therapy is an intensive means to help the brain recover from the trauma and function in the way it is ‘wired to’. Programmes effectively assist with functions such as speech, physical therapy, occupational therapy and nutritional needs.
A trauma such as stroke can affect a person from a psychological perspective too. The body has been through an intense physical experience and recovery may be a slow and gradual process too. This can take a toll on a person’s emotions. A positive mindset may not always be easily achieved through the process. Thus, psychological care may be necessary as part of a rehabilitative therapy programme. Post-stroke depression can be treated with counselling, support groups and anti-depressants.
How will rehabilitation be approached?
A physical trauma such as stroke affects the body’s ability to function as well as overall levels of strength. Recovery is going to take time and in some instances, may be an ongoing process for the rest of the patients’ life. The primary goal is to ensure that a person is able to restore as much normal function as is possible and be able to return to their independent lifestyle
A programme that enables this will depend on the nature of the stroke and the impact it had on specific areas of the brain (the amount of damage to tissue caused).
- If the stroke affected the right side of the brain: Sensation and movement on the left side of the body is likely to be affected.
- If the stroke affected the left side of the brain: Sensation and movement on the right side of the body is likely to be affected. Speech and language may also be affected and require therapy.
Any damage to the brain can also result in difficulties with balance, vision, coordination, swallowing and breathing, as well as bowel and bladder control.
Rehabilitation will take into account the following factors as well:
- Overall health condition
- The degree of damage or disability
- A person’s normal lifestyle, interests, family or caregivers and other important priorities
The programme developed will be tailored in the most rigorous way and based on individual needs. An ‘aggressive’ and targeted action plan is necessary (the first few months following a stroke is the best period with the greatest chance of being able to regain most of a person’s ability to function normally and independently) and may begin even before being discharged from hospital and allowed to return home.
Depending on the nature of a person’s condition, he or she may be discharged and transferred to another rehabilitation facility where skilled medical teams can assist, to an outpatient unit or to their own home.
Who will the rehabilitation team consist of?
- Physiatrist (rehabilitation specialist)
- Dietician (assist with a healthy diet that prevents problems which can lead to further strokes)
- Physical therapist (assists with movement, coordination and balance)
- Occupational therapist (assists with normal tasks such as dressing, eating, bathing, and writing or drawing etc.)
- A social worker or case manager (assists a person and their caregivers or loved ones with necessary care equipment for maximum comfort at home)
- Recreational therapist (assists with returning to general activities a person may have enjoyed doing before the stroke)
- Speech therapist or speech-language pathologist (assist with re-learning of speech and basic language skills which may be lost, as well as problems with swallowing)
- Psychiatrist or psychologist (assist with mental and emotional coping methods)
- Vocational counsellor (assists with finding a job a person can cope with to earn an income if necessary)
All specialists involved will assist a stroke survivor in being able to:
- Live as independently as possible
- Adjust to physical changes to the body, which may have long-lasting effects
- Make necessary adjustments to the lifestyle a person was used to before the stroke, including their home environment, family life, work life and integration with the community.
How long should rehabilitation therapy take?
There is no short road to recovery, and for most who have suffered a stroke, the journey becomes a life-long process. The process is one of gradual care and is likely to cause a few ups and downs as a survivor goes through the programme, both from a physical and mental or emotional perspective.
The important thing is to develop trust in the rehabilitation care team. Each member, with their specific set of skills, is there to help a survivor in the best way possible and should not contradict another specialist’s area of expertise. The stroke survivor is everyone’s primary concern and their well-being will come first. Each member of the team will guide, support and ensure that a survivor makes progress in every way possible. A survivor can help themselves too, by building a strong network of family, friends and colleagues to support and keep them motivated to get better.
The initial few weeks and months following a stroke are the most important when it comes to recovery. The process of getting better, however, can take years and a lot of hard work and effort, especially when it comes to improving cardiovascular health. This is where a network of people to support and uplift the spirit is important.
What else will rehabilitation therapy involve?
- Exercise and overall well-being: Gentle aerobic exercise, such as swimming, on a regular basis may be encouraged. Swimming is a good exercise activity (in a heated pool) as natural buoyancy in water can help restore any lost motor function and stimulate the body’s muscles. A survivor will be encouraged to quit smoking (if they do) or warned never to start. Women may be warned against taking oral contraceptive pills (birth control pills), especially if they frequently have or have had migraines with aura (visual disturbances). Migraines and the taking of oral contraceptives can increase a woman’s risk of experiencing a stroke. It may be beneficial to try relaxation techniques, such as yoga or meditation that assist with pain tolerance, or alleviate emotional frustrations and anger.
- Nutrition: A nutritious diet is a vital part of recovery and will need to be adjusted for the remainder of a survivor’s days. A proper diet not only contributes to preventing stroke in the future, but also to reverse a little of the damage caused by the one already had. A diet rich in minerals, vitamins and other nutrients which a person can get from lean protein sources, fresh fruits and vegetables, as well as low-fat dairy can help keep a person’s overall physical condition in tip-top shape. A dietician will advise that a survivor avoid processed foodstuffs, and especially those that are high in trans and saturated fats.
Can the brain completely recover after a stroke?
The simple answer is that it is not entirely understood how the brain recovers after a person experiences a stroke. One thing most will agree on is that a person is generally never quite the same again.
Some things that have been noted through experience include the following:
- The brain is capable of resuming some function: Therapy can help to create new habits by changing the way the brain processes ways for some tasks to be performed. It may take some time, but a person can re-learn how to do certain things after having a stroke. It can also happen that one area of the brain may begin functioning in a way it had not previously – i.e. taking control of certain functions it wouldn’t normally be responsible for prior to a stroke.
- Blood flow: There will often be a distinct difference in what cells and tissues have merely been damaged and what has been destroyed. Through the recovery process, a doctor will be able to see if blood flow has been restored to the affected areas of the brain or not. Damaged cells should be able to resume functioning over a period of time through the healing process. Destroyed cells and tissues may not.
What can be improved through rehabilitation?
What skills and functions can a person regain through recovery? Primary areas of concern are cognitive motor skills, speech and sensory functions. These are the main areas typically affected by damage following a stroke. The main goal is to work through an intensive programme that improves or restores these functions.
- Speech: One of the first notable things about a person recovering from stroke is the resulting language impairment due to the damage caused to the nerves that innervate (or supply) muscles that control speech. This is known as aphasia (the inability to speak at all). Dysarthria is the inability to articulate language. A person may have trouble speaking, finding the right words to explain something or find it very difficult to speak in full sentences. Therapy will involve re-learning how to speak coherently and how to articulate effectively. If impairment is quite severe, rehabilitation may also involve methods to assist with helping to communicate in ways other than just with speech.
- Cognitive ability: The ability to think and reason is another main area affected by damage. A person may find that they have trouble with their memory and develop poor judgement skills. A common side-effect of this is adverse behavioural changes. Where a person was once outgoing and vivacious, they may become withdrawn and isolated. Sometimes, the opposite can happen. Others may even behave recklessly. The ability to anticipate consequences is often lost as a result of damage and therefore can lead to safety concerns for a person having experienced a stroke. Improving and restoring cognitive skills is thus very important during the recovery process. Therapists will make very specific recommendations with safety, particularly in the home, as part of the rehabilitation process, teaching someone to think and reason once more.
- Motor ability: Damage weakens muscles in the body, often on one side and as such hinders joint movement. Following a stroke, coordination is thus affected and impairs a person’s ability to move, walk and perform a variety of physical activities. Painful muscle spasms are another frustrating side-effect of this. Part of therapy if to re-learn how to work the body so as to strengthen muscles and restore balance. Exercises will be tailored to help a person learn how to gain control over their body and also gain the upper hand on dealing with muscle spasms. Walking aids are commonly used during the recovery process, until a person is able to move about without any assistance.
- Sensory skills: The ability to feel heat, cold or even pressure is often impaired following a stroke. Rehabilitation will assist a person with being able to adjust to the sensory changes now being experienced.
The road to recovery is going to be a slow and intensive one, but it can also be complex. Other issues which may arise will also form part of the recovery and rehabilitation process. Professionals and therapists will work with each and every single weakness, impairment and complication as carefully and with as much dignity as possible.
Some other physical and emotional problems which can occur may include:
- Bladder and bowel control: Following a stroke, a person may have difficulty recognising when they have the need to use a bathroom, making accidents a common occurrence. Alternatively, a person may realise they need to use a toilet too late and not get to one in time. It’s not uncommon for a person to experience problems with constipation, diarrhoea or a total loss of bowel control, as well as problems with urination (having a frequent need or trouble with urinating) or loss of bladder control. A specialist can help treat all of the aforementioned problems, often with medications. It may sometimes be necessary to be in close proximity to a commode chair throughout the day and night. A urinary catheter can also be inserted to remove urine from the body during extreme circumstances.
- Ability to swallow: A person can easily forget to swallow while they are eating. Nerve damage sustained during a stroke can cause difficulties with swallowing too. Choking is a common problem in this regard, as is hiccups. Learning how to eat normally again and swallow at appropriate times is part of the rehabilitation process. A nutritionist or dietician can also help a person with selecting healthy food options which may be easier to consume and reduce choking risk and problems swallowing.
What is the likelihood of a successful recovery?
A very small percentage of stroke sufferers ever recover completely. A slightly higher percentage typically can recover with a few minor impairments. Nearly half of all people who suffer a stroke ultimately learn to work through and live with moderate to severe impairments as a result of damage. Many require special care where a disability directly affects a person’s daily function in the home or in the workspace. A small percentage of the severely impaired require long-term care with nursing staff, either at home or in a care facility.
Thus, it can possibly be said that there are degrees of success which can be achieved when it comes to recovery and rehabilitation. Factors which contribute to the level of success depend on how much damage occurred during the stroke, a person’s age, if there are other health conditions, how soon a rehabilitation programme began, as well as how motivated a person is and whether they are committed to the intense requirements of their therapy. All of these things can influence the outcomes of a rehabilitation programme.
Recovery is a team effort and can also come down to the level of commitment and skilled experience of medical experts. The more skilled and experienced they are, the more a survivor stands to gain during the recovery process. A support network of family and friends also forms a critical part of a survivor’s success. Encouragement and support in healthy doses can really go a long way.
If everyone involved is committed to as successful a recovery as possible, there’s no doubt that the outlook can be positive. A survivor may never quite be the same again after having a stroke, but there’s little reason why a person can’t regain the pieces of their life and live in such a way that fulfils them. It just takes time, intense effort and an unfailing level of commitment from everyone involved.