Just over one-third will experience complete recovery or have only minor stroke-related deficiencies, according to the National Institute of Neurological Disorders and Stroke. Strokes occur when blood stops flowing to part of the brain due to a bleed or a blood clot, causing physical and mental disability that takes time, and help, to heal.
What happens after you or a loved one have a stroke, and what can be done to improve chances of recovering?
As soon as possible after a stroke, a specialized team of healthcare providers steps in to help you regain strength, mobility, and the skills you need to live independently. The earlier rehab begins, the better your chance of regaining the highest possible level of independence and productivity.
Rehab doesn’t end when you check out of the hospital after a stroke. “The brain has the ability to rewire or rechannel bodily functions so that another part of the brain can take over and make the body work,” says Cheryl Miller-Scott, an occupational therapist and national director of therapy operations for HealthSouth Corporation, a network of rehab hospitals and home-care providers. “That sometimes can take six months to a year.”
Each member of the rehab team, whether in the hospital, doctor’s office, or at home, helps maximize recovery from a stroke. Here are nine essential people who should be on your recovery team or that of a loved one who has had a stroke:
A physician will orchestrate your rehab program and manage your medical needs. “There's a myriad of complications that can occur in the patient during the rehab phase,” says James C. Grotta, MD, director of stroke research at Memorial Harmon Hospital at the University of Texas Medical Center in Houston. Physical medicine and rehabilitation physicians are specially trained in rehab, but general practitioners, internists, neurologists, and others can also manage the recovery process and oversee the rehab team, he says.
Depending on the patient's overall condition, complications can include:
* Blood clots in the legs
* Urinary tract infections
* Skin breakdown
At the same time, a patient may have existing medical needs that must be addressed, such as high blood pressure, diabetes, or high cholesterol.
2. Physical Therapist
Depending on the part of the brain affected, you may have weakness or even paralysis of your arms and legs after a stroke. As soon as your condition has stabilized, often within 24 to 48 hours, a physical therapist will begin helping you to move and strengthen stroke-affected limbs. This initial rehab may include passive exercises, in which the therapist moves your limbs, and active exercises, in which you move on your own.
Post-stroke physical therapy is intense, requiring three hours of exercises daily. Because of this, some people are too weak or confused to be candidates for physical therapy immediately after stroke, says Dr. Grotta. “These patients often go to a skilled nursing facility for a period of time until they're qualified for rehab,” he explains.
The goal of physical therapy after a stroke is to get you up and moving on your own, as much as possible. “The physical therapists are going to do the gross motor things, the walking, the trunk control, the balance,” explains Lynda Shrager, an occupational therapist and Everyday Health contributor who offers tips for caregivers on her website, Otherwise Healthy.
3. Occupational Therapist (OT)
Taking up where the physical therapist leaves off, occupational therapists help stroke patients continue to rebuild their muscle strength and flexibility. Occupational therapists also work with stroke survivors to find ways to adapt to any lasting impairments. These therapists visit you soon after you return home, and may continue for several weeks or months.
“We look at their activities of daily living — how this stroke has affected their ability to take care of themselves and do the things that they normally did [before the stroke], from the minute they wake up to the minute they go to bed at night,” Shrager says. “The long-term goal is always to increase their independence to their maximum ability and get them as independent as they want to be for whatever they want to do with their life.”
Occupational therapists help stroke patients with activities of daily living, including:
* Going to the toilet
* Preparing meals
They identify any assistive devices that will help a person with these activities. An example is using a grab bar on bathroom walls to help you get in and out of the shower and use the toilet safely.
With an OT's help, a patient who has weakness in one hand can learn tricks to make dressing easier, like avoiding clothes with zippers and buttons. OTs also find helpful tools to assist stroke survivors, like specially-made cutting boards designed for one-handed chopping. Shrager calls these adaptations “hacks for health and home,” things that allow people to get back to doing the things they need and love to do.
4. Speech-Language Pathologists
Stroke can change your communication abilities in several ways. A stroke can damage parts of your brain responsible for producing and understanding words and sentences. Some people have difficulty reading and writing after a stroke. And many have weakness and poor coordination in the mouth and throat, which can cause swallowing problems, as well as difficulty with speech. Speech-language pathologists can help you with all of these issues.
After a stroke or other type of brain injury, people may have aphasia, which is difficulty understanding and speaking words. When you have difficulty controlling the muscles that produce speech, but no actual weakness or paralysis in these muscles, this is known as apraxia. Stroke survivors may have aphasia, apraxia, both at once, or no speech difficulties at all.
Speech-language pathologists will perform a swallowing evaluation and, if you have problems with drinking or eating, they will work with you over time to improve your ability to swallow a greater variety of foods and liquids.
One of the most important aspects of post-stroke care is taking steps to avoid a second stroke, and that may include consulting with a dietitian. Healthy eating combats three key stroke risk factors:
* High blood pressure
* Excess weight
* Unhealthy cholesterol levels
According to the American Stroke Association, eating five or more servings of fruits and vegetables every day may help prevent strokes.
Besides guiding you on the best way to eat in order to avoid future strokes, a dietitian can also provide suggestions to you and your caregivers on how to make food more appealing, because many people have a poor appetite after a stroke. Good nutrition is essential for optimal recovery.
If you have difficulty swallowing, a dietitian will work with a speech-language pathologist to adapt foods to make them safe for you to eat.
6. Rehabilitation Nurse
Rehab nurses work to educate you on the big picture of life after stroke, including:
* How to take your medications
* What you can expect during the recovery process
* How you can prevent another stroke
“It's kind of an extension of what we're able to provide in therapy,” explains Miller-Scott. “A patient might get three or four hours of therapy in a day, but there are 24 hours in a day. Nurses make sure those philosophies are carried out through the 24-hour day.”
After a stroke, it's not unusual to experience symptoms of depression, anxiety, post-traumatic stress disorder, or a combination of these. “Depression is common after a stroke, as is cognitive impairment,” says Grotta. “Sometimes it's hard to tell the difference between them, and a neuropsychologist can help with that.”
A neuropsychologist can assess you for mental health concerns, as well as issues with cognitive function, such as poor attention span and memory loss.
“A neuropsychologist is more concerned with cognition, memory, problem-solving ability, and the ability to perform all these tasks we're talking about,” Miller-Scott explains.
Once your mental health and cognitive function have been fully assessed, the neuropsychologist can work with your rehab team to develop an individualized care plan.
8. Support Groups
Attending support group meetings can be very important for stroke patients. “It helps to interact with people who have been through a similar experience,” says Miller-Scott. Many hospitals offer support groups for patients recovering from stroke, and the American Heart Association/American Stroke Association (AHA/ASA) runs support groups in many communities. You can find a stroke support group in your area by zip code through the American Stroke Association. The AHA/ASA also offers an online support network for family members of stroke patients.
Family and friends play a very important role in the stroke rehab process, says occupational therapist Glen Gillen, doctor of education and associate director of regenerative and rehabilitation medicine at the Columbia University Medical Center in New York City. They may be the most valuable player on your stroke rehab team.
“The optimal stroke rehabilitation includes the care partner as part of the team, which means training them if the person who has had a stroke needs any physical or cognitive assistance at home,” Dr. Gillen says. “That really facilitates the recovery process, when there's a caregiver involved as well.” The goal is to help you become independent after a stroke without the caregiver taking over for you.
Other members of the stroke rehab team will work closely with caregivers to make sure they’re well prepared and well educated for their role in supporting the patient, Miller-Scott says. “They are going to serve as the person's advocate, so caregivers need to make sure the person recovering from stroke gets all the resources they need to continue to be as independent as possible and to live a meaningful life.”