Regaining Functionality After A Stroke: Is It Possible?

A stroke is a life-changing medical emergency that can affect a person's ability to talk, walk, and think clearly. The road to recovery for a stroke patient varies from person to person and depends on several factors, including the severity of the stroke, the speed of initial treatment, and the type and intensity of rehabilitation. While some may recover within days or weeks with little impact on their lives, others may face a long journey of months or years, requiring significant life adjustments and ongoing therapy. The first three months after a stroke are critical for recovery, with most improvements occurring during this period. However, it's not uncommon for stroke victims to continue making gains even into the first and second years.

The importance of immediate treatment

When a stroke occurs, blood flow to the brain is interrupted, resulting in brain cells dying and causing permanent damage. The longer the blood flow is cut off, the greater the damage, which is why time is of the essence in stroke treatment. Seeking immediate medical attention within three hours of the onset of symptoms is crucial.

Once a stroke patient arrives at the hospital, the initial focus is on stabilising their condition and determining the type of stroke. If the stroke is caused by a blood clot (ischemic stroke), clot-busting medication can be administered to reduce long-term effects, but this is time-dependent. The rehabilitation process should also start as soon as possible, ideally within 24 hours after the stroke, to address any physical, cognitive, or emotional impairments.

The first three months after a stroke are the most critical for recovery, with most patients making significant progress during this period. However, it's important to note that recovery can continue well into the first and second year, and in some cases, improvements may still be possible even after six months, albeit at a much slower pace.

To summarise, immediate treatment for stroke victims is of utmost importance as it can save lives, reduce disabilities, and increase the chances of a successful recovery. By seeking prompt medical attention and starting rehabilitation early, patients have a better opportunity to regain function and minimise the long-term impacts of the stroke.

Factors influencing recovery

Several factors influence the recovery of stroke victims. These factors can be categorized into socio-demographic, clinical, and genetic factors.

Socio-demographic factors

Older age is a significant prognostic factor for poorer outcomes after ischemic and hemorrhagic stroke. However, the impact of age on long-term recovery is less pronounced, and other age-associated factors, such as co-morbidities and social variables, should be considered. Females are less likely to achieve complete functional independence or are more likely to be disabled after a stroke than males. Racial disparities also exist, with Blacks having a higher stroke incidence, higher stroke mortality, and higher stroke recurrence. Socioeconomic status (SES) is another factor, with individuals of lower SES having higher stroke incidence and poorer short and long-term outcomes.

Clinical factors

The initial injury is a major determinant of chronic recovery, as it defines the residual neuronal capacity for functional recovery. Post-stroke depression (PSD) is common after a stroke and can impede the rehabilitation and recovery process. Co-morbidities, such as diabetes and severe peri-ventricular white matter disease, can also adversely affect outcomes.

Genetic factors

Genetic variations may influence chronic recovery and response to rehabilitation therapy. For example, the BDNF Val66Met polymorphism has been associated with poor outcomes and slower motor recovery. Apolipoprotein E (Apo-E) polymorphism has also been linked to variability in recovery after ischemic stroke.

Rehabilitation and therapy

The typical length of a hospital stay after a stroke is five to seven days. During this time, the stroke care team evaluates the effects of the stroke, which will determine the rehabilitation plan. The long-term effects of a stroke vary from person to person, depending on the severity of the stroke and the area of the brain affected. These effects may include cognitive symptoms such as memory problems and trouble speaking, physical symptoms such as weakness, paralysis and difficulty swallowing, and emotional symptoms such as depression and impulsivity.

Therapy sessions are conducted frequently while the patient is in the hospital, with up to six sessions per day. Physical and occupational therapy can help determine which areas of the brain have been affected by working with the patient to complete various tasks, such as walking or brushing their hair. Speech-language therapy is important for patients experiencing difficulty swallowing, which could be a result of the stroke itself or the aftereffects of having a breathing tube.

After leaving the hospital, stroke rehabilitation will often continue in an inpatient rehabilitation unit, an independent rehabilitation facility, a subacute rehabilitation facility, or at home with visits to an outpatient rehabilitation clinic. The decision about where to continue rehabilitation depends on the level of functional impairment and the amount of therapy the patient can tolerate. For example, inpatient rehabilitation units offer monitoring by a physician and up to three hours of therapy per day.

Rehabilitation goals are centred around activities of daily living (ADL), which include tasks like bathing or preparing food. Rehabilitation psychologists and neuropsychologists can help patients and caregivers cope with the cognitive and emotional impacts of a stroke, which can be serious and lead to permanent lifestyle changes.

The first three months after a stroke are the most important for recovery, and patients will see the most improvement during this time. This period may also include a phenomenon called spontaneous recovery, where a skill or ability that seemed lost returns suddenly as the brain finds new ways to perform tasks.

Even after the first three months, improvements are still possible, but they will be much slower. It is still crucial to continue following up with members of the care team, including the primary care physician, a rehabilitation physician, physical, occupational and speech therapists, a neurologist, and a rehabilitation psychologist.

Post-stroke depression

The risk factors for post-stroke depression include increasing stroke severity, functional dependence, the presence of cognitive impairment, and a history of depression. The development of post-stroke depression may also be influenced by biochemical changes in the brain, such as increased levels of inflammatory markers and decreased levels of neurotransmitters and neurotrophic factors.

The treatment of post-stroke depression typically involves a combination of psychotherapy and antidepressant medication. Psychotherapy may include cognitive-behavioural therapy or interpersonal therapy, while antidepressant medication may include selective serotonin reuptake inhibitors or tricyclic antidepressants. Social support is also crucial in the treatment of post-stroke depression.

Long-term care

The road to recovery after a stroke is often long and challenging, and for some, it may even be a lifelong journey. The first three months are the most crucial for recovery, with most patients making the most progress during this time. However, it's not uncommon for survivors to continue to recover well into the first and second year after their stroke.

The long-term effects of a stroke vary from person to person, depending on the severity of the stroke, the area of the brain affected, and the individual's health before the stroke. These effects can be physical, such as weakness, paralysis, and difficulty with movement and daily tasks; cognitive, such as memory problems and difficulty speaking; and emotional, such as depression and impulsivity.

• Therapies: Physical, occupational, and speech therapies are key components of long-term stroke rehabilitation. These therapies help individuals regain function and independence in their daily lives. Physiotherapy and exercises, for instance, can improve movement and address issues like numbness on one side of the body. Speech therapy can aid those with aphasia (difficulty speaking or finding words) and dysarthria (damage to the muscles used for speech).
• Medical support: A team of medical professionals will continue to support the individual's recovery. This team may include a primary care physician, rehabilitation physician (physiatrist), neurologist, and rehabilitation psychologist. These specialists work together to address the individual's physical, cognitive, and emotional needs.
• Medication management: Medications play a crucial role in preventing another stroke and managing any ongoing impairments. It's important for caregivers to be aware of the medications and their side effects.
• Home modifications: Depending on the individual's needs, modifications may need to be made to their home environment to ensure safety and facilitate independence. This could include removing fall hazards, making the bed and bathroom easily accessible, and introducing assistive devices for cooking, eating, bathing, and moving around.
• Support services: Community resources, such as support groups for stroke survivors and caregivers, can provide valuable assistance and connection during the long-term recovery process. Additionally, legal advice may be necessary to make decisions about care and future planning.
• Prevention of subsequent strokes: Stroke prevention is of utmost importance for survivors. This includes lifestyle changes such as a healthy diet, regular exercise, and managing underlying health conditions like diabetes and high blood pressure.
• Cognitive and behavioural therapy: Addressing the psychological impacts of a stroke is essential. Cognitive behavioural therapy (CBT) can help individuals manage anxiety, depression, and tiredness. Additionally, activities to improve memory, concentration, thinking, and mood (cognitive rehabilitation) can be beneficial.
• Bladder and bowel care: Strokes can lead to issues with bladder and bowel control. A healthcare provider may prescribe medications or refer individuals to a specialist. Creating a schedule and making environmental adjustments, such as placing a commode chair close by, can also help.
• Swallowing and eating: Speech therapists can assist with swallowing and eating problems that may arise after a stroke. Dietary changes, such as thickening liquids or pureeing foods, may be recommended. In some cases, a permanent feeding tube may be necessary.
• Sexual function: Problems with sexual function after a stroke can be addressed with medications and counselling.

Frequently asked questions