Stroke Recovery: Aging Gracefully After A Setback

Stroke is a leading cause of death and disability worldwide. The road to recovery is long and challenging, but it is possible for seniors to recover from a stroke. The recovery process can be improved by acting fast at the first signs and symptoms of a stroke, which can be identified using the acronym FAST: face drooping, arm weakness, speech difficulty, time to call 911. Most strokes are caused by a blood clot that blocks blood flow and oxygen to the brain, and medication to dissolve the clot must be administered within three hours of having a stroke to be effective.

Stroke rehabilitation aims to help stroke survivors regain as much physical and cognitive function as possible. It can include speech, occupational, and physical therapy, and it may take six to twelve months of focused, intensive rehab for stroke survivors to recover. However, recovery is a long-term process, and improvements can continue to be made even years after starting rehabilitation.

The likelihood of survival and the level of recovery after a stroke depend on various factors, including age, sex, stroke type and event, motor impairment, and cognitive dysfunction. Age is a strong predictor of functional outcome and discharge destination, and older patients tend to have poorer functional outcomes. However, advanced medical testing and treatments have led to better recovery outcomes for seniors over 80 than ever before.

The importance of early intervention: The first three hours after a stroke are critical for recovery

Stroke recovery is a long-term process that requires hands-on medical intervention. The first three hours after a stroke are critical for recovery. Immediate intervention puts both stroke survivors and caregivers on the right path to recovery. Caretakers should act immediately if they observe any of the following symptoms:

• Face drooping
• Arm weakness
• Speech difficulty
• Body numbness on one side
• Dizziness or difficulty walking

Medications that dissolve the clot and improve blood flow must be administered within three hours of having a stroke to work effectively. In some cases, early intervention can reverse the effects of a stroke. Conversely, delayed treatment may result in the death of brain cells, causing serious problems with speech, cognitive ability, and basic motor skills.

The goal of rehabilitation after a stroke is to help the patient regain as much physical and cognitive function as possible. Recovery from stroke can take six to 12 months of focused, intensive rehab. However, stroke survivors can continue to improve mental, emotional, and physical function even years after starting rehab. The type and severity of the stroke will dictate how much rehab your loved one needs and whether they need inpatient or outpatient rehabilitation.

The importance of early intervention cannot be overstated. The brain is most likely to retain changes and new habits during the early period after a stroke. Consistent movement and repetition re-strengthen and "rewire" the lost connections caused by a stroke. Rehabilitation is not an easy process, but knowledge of what lies ahead calms anxieties and initial fears.

The role of rehabilitation: Physical, occupational and speech therapy can help regain physical and cognitive function

Rehabilitation plays a crucial role in helping stroke survivors regain physical and cognitive function. Physical therapy, occupational therapy, and speech therapy are key components of the rehabilitation process, and their combined efforts can significantly improve a person's ability to manage daily life tasks and enhance their overall quality of life.

Physical Therapy

Physical therapists are movement experts who work with stroke survivors to restore movement and walking ability, reduce disability, and improve overall function. They provide hands-on care, patient education, and prescribed movement exercises to help individuals regain their physical capabilities. Physical therapy typically begins soon after a stroke, often while the patient is still in the hospital, and continues throughout the recovery process.

Physical therapists conduct thorough assessments to understand the specific needs and challenges of each patient. They evaluate motor function, sensation, coordination, and balance, and develop treatment plans tailored to the individual. Treatments may include strength training, walking and balance training, constraint-induced movement therapy, functional electrical stimulation, and robotic or virtual reality exercises. Physical therapists also provide guidance on fall prevention, proper body positioning, and the use of assistive devices such as canes, walkers, or wheelchairs.

Occupational Therapy

Occupational therapists focus on improving a person's ability to perform daily tasks and participate in meaningful activities. They assess the impact of the stroke on motor function, sensation, coordination, visual perception, and cognition, and develop goal-oriented treatment plans. Occupational therapy interventions may include:

• Retraining motor, sensory, visual, and perceptual skills within functional activities
• Minimizing secondary complications
• Providing education and support to patients and caregivers
• Teaching compensatory strategies and task adaptations to improve independence
• Environmental modifications to enhance safety and accessibility at home or work

Occupational therapists also play a crucial role in preparing patients for discharge from the hospital, including assessing the need for home modifications, training caregivers, and facilitating the transition back to daily life.

Speech Therapy

Speech therapy is an essential component of stroke rehabilitation, addressing communication and swallowing difficulties that may arise after a stroke. Speech-language pathologists (SLPs) work with stroke survivors to improve their language, cognitive, and swallowing abilities. They conduct comprehensive assessments to identify specific deficits and develop individualized treatment plans.

SLPs use a variety of techniques and exercises to improve communication skills, such as aphasia and dysarthria, and enhance cognitive abilities, including memory, attention, and executive functioning. They also address swallowing difficulties, known as dysphagia, which can be a common complication after a stroke. SLPs may use exercises to strengthen the tongue and lips, improve articulation, and enhance oral motor skills. Additionally, they provide strategies to compensate for communication challenges and promote functional communication in everyday situations.

The role of rehabilitation is crucial in helping stroke survivors, including those over 70, regain physical and cognitive function. Physical therapy, occupational therapy, and speech therapy work together to improve overall function, enhance quality of life, and support individuals in their journey toward recovery.

Preventing a second stroke: The risk of a second stroke is high, but can be reduced through medication, lifestyle changes and managing pre-existing conditions

The risk of a second stroke is high, but this can be reduced through medication, lifestyle changes, and managing pre-existing conditions.

Medication

It is important to take prescribed medications as instructed by a doctor. Not taking medication is a significant risk factor for repeat strokes. Patients who do not take their medication as directed have a four times higher risk of stroke than those who do.

Lifestyle Changes

Lifestyle changes that can help prevent a second stroke include:

• Moving more
• Healthy eating: A diet rich in fruit and vegetables can lower the risk of stroke.
• Getting healthy sleep
• Quitting smoking and vaping

Managing Pre-existing Conditions

Managing the following pre-existing conditions can help reduce the risk of a second stroke:

• High blood pressure
• High cholesterol
• High blood glucose

Dealing with communication difficulties: Aphasia, or loss of language, is common after a stroke, but intelligence remains intact

Aphasia, or loss of language, is a common occurrence after a stroke, affecting around one-third of survivors. It can manifest as difficulty in speaking, reading, writing, or understanding others' speech. However, it's important to note that intelligence remains intact, and the person's thinking, memory, and judgment may be unaffected. To deal with communication difficulties arising from aphasia, consider the following strategies:

• Seek professional help: Speech and language therapists can provide valuable support. They can help the person relearn skills like recognizing letters and offer guidance on communication tools such as charts or electronic devices.
• Start rehabilitation early: It is recommended to begin rehab as soon as possible after a stroke. Early intervention can improve outcomes and enhance the brain's ability to adapt and form new connections.
• Encourage practice: Relearning how to communicate takes time and effort. Encourage your loved one to practice their skills and exercises regularly. Be patient, positive, and provide emotional support throughout their journey.
• Create a conducive environment: When communicating with your loved one, ensure you have their undivided attention. Turn off distractions like the TV, and face them when speaking. Speak clearly and slowly, using simple sentences, and introduce the topic before starting a conversation.
• Explore alternative communication methods: Be open to different ways of communicating. Writing pads, cue cards, pictures, gestures, and computer programs can all facilitate connection and understanding.
• Join support groups: Connecting with others who have experienced similar challenges can be beneficial. Support groups provide a safe space to share experiences and learn from one another.
• Focus on overall well-being: Address any other health issues your loved one may have. Manage conditions like heart disease or pre-existing brain trauma, as these can impact their recovery.
• Advocate for adequate hospital stay: Ensure your loved one is not discharged from the hospital too soon. A longer hospital stay can provide access to necessary medical care and therapy, reducing the risk of further health issues.
• Prepare for the return home: The first few months at home are crucial for recovery. Set up a supportive environment and consider hiring a home caregiver to provide assistance and help your loved one with their therapy.

Coping with emotional effects: PTSD, depression and personality shifts are common, but can be managed through therapy and medication

Coping with Emotional Effects After a Stroke

Post-traumatic stress disorder (PTSD), depression, and personality shifts are common after a stroke, but they can be managed through therapy and medication.

PTSD

PTSD is a condition that can present itself following any traumatic experience, including medical emergencies like a stroke. According to a 2013 study, almost one-quarter of patients who survive a stroke will suffer from PTSD. The symptoms of PTSD can go unnoticed due to the focus on physical recovery, but they can lead to an increased risk of heart disease or another stroke.

Symptoms of PTSD can include:

• Reliving the traumatic event through nightmares or constant thoughts.
• General anxiety and avoidance of reminders of the event.
• Feelings of self-doubt, guilt, and hyperarousal or heightened alertness.

Treatment for PTSD typically involves medication, psychotherapy, or a combination of both. Antidepressants have been shown to be effective in relieving symptoms of anger, sadness, and overwhelming worry. Psychotherapy, or "talk therapy", can be conducted in a one-on-one or group setting with a mental health professional. Involving family and friends in the recovery process can also improve the speed and efficiency of mental recovery from a stroke.

Depression

Depression and anxiety are common emotional effects of a stroke. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can be prescribed to help manage these symptoms. Examples of SSRIs include citalopram (Celexa), fluoxetine (Prozac, Rapiflux), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), and sertraline (Zoloft).

Personality Shifts

Personality and mood changes can occur after a stroke due to the impact on the brain. Survivors may experience irritability, forgetfulness, carelessness, inattention, confusion, fear, frustration, anger, grief, sadness, and anxiety. These emotional and behavioral changes tend to improve over time, and seeking therapy or counselling can aid in managing and coping with these shifts.

Therapy and Support

Therapy and medication can play a crucial role in managing the emotional effects of a stroke. It is important to involve family and friends in the recovery process, as having a strong support system can improve mental recovery. Additionally, support groups and community-based organizations can provide valuable assistance and resources for individuals and their loved ones coping with the emotional aftermath of a stroke.

Frequently asked questions