Stroke Recovery: Seven Months Later, What Can I Expect?

The recovery timeline after a stroke is complex and unique to every individual. While some people may recover in a matter of days or weeks, others may take months or years. The first three months after a stroke are considered the most crucial for recovery, with most improvements occurring during this period. However, it's important to note that recovery can continue for years, and setbacks or spontaneous recoveries may occur. At seven months post-stroke, improvements may be slower, but functional recovery is still possible with dedicated rehabilitation.

Rehabilitation and therapy can help with movement, speech, and vision problems

Rehabilitation and therapy are crucial aspects of stroke recovery, addressing movement, speech, and vision problems. While recovery varies for each person, rehabilitation can help mitigate the long-term effects of a stroke. Here is how rehabilitation and therapy can help with movement, speech, and vision issues:

Movement

Movement and physical therapy are vital components of stroke rehabilitation. Physiatrists, neurologists, physical therapists, and occupational therapists work together to help patients regain physical strength and mobility. Therapy sessions can be conducted individually or in groups, with patients encouraged to practice on their own as well. The focus is on restoring function to pre-stroke levels or developing compensation strategies for any remaining impairments. For example, a patient might learn to hold a toothpaste tube differently to accommodate a weaker hand.

Speech

Speech and language therapy are essential for addressing communication difficulties after a stroke. Speech-language pathologists work with patients to improve communication skills, restore language abilities, and teach compensation techniques. Therapy may involve one-on-one sessions or group settings, where patients can practice speaking in a low-stress environment. Speech-language pathologists also provide resources, such as computer programs and mobile apps, to aid in relearning words and sounds. Family members can support their loved ones by including them in conversations, giving them time to speak, and minimising distractions.

Vision

Vision rehabilitation is often necessary for stroke survivors, as about two-thirds experience visual impairment. This can include diminished central or peripheral vision, eye movement abnormalities, or visual perceptual defects. Comprehensive screening for visual disorders is recommended in the early days following a stroke, as early intervention is crucial. Neuro-Optometric Rehabilitation Optometrists work with other rehabilitation team members to help patients learn new ways of performing tasks and compensate for any residual visual disabilities. Treatments may include specialised prescription glasses or performance-tinted contact lenses to address balance issues and light sensitivity.

Recovery time varies from person to person, but the first three months are critical

The road to recovery after a stroke is complex and unique to each individual. While some may recover in a matter of days or weeks, for others, it can take months or years. The first three months are critical, with the most rapid recovery usually occurring during this period. This is when patients will see the most improvement, and the brain is still in a state of heightened plasticity, making rehabilitation particularly effective.

During the initial days after a stroke, the focus is on stabilising the patient and determining the type of stroke to administer the appropriate treatment. Once the stroke has been treated, rehabilitation begins immediately, with physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses all working together to support the patient's recovery. The typical length of a hospital stay after a stroke is five to seven days, during which the stroke care team will evaluate the effects of the stroke and develop a rehabilitation plan.

In the first three months, most patients will enter and complete an inpatient rehabilitation program or make significant progress in their outpatient therapy sessions. This period is crucial as it is when the brain is working hard to heal and rewire itself, and the heightened state of neuroplasticity means that healthy parts of the brain can take over the functions lost due to the stroke. Rehabilitation exercises during this time help to stimulate the brain and encourage it to form new connections.

While the first three months are pivotal, it is important to remember that recovery is an ongoing process, and improvements, albeit slower, are still possible beyond this timeframe. Some individuals may continue to make progress well into the first and second year after their stroke, and even years later, ongoing rehabilitation can lead to further gains. This highlights the importance of a dedicated and consistent rehabilitation program tailored to the individual's needs and goals.

The recovery journey is highly variable and depends on various factors, including the size and location of the stroke, age, overall health before the stroke, and the speed and intensity of treatment and rehabilitation. While the first three months are critical, each person's recovery timeline will be unique, and ongoing support and therapy can lead to continued improvements over time.

Depression is common after a stroke, and can hinder recovery

The first three months after a stroke are considered the most important for recovery, and patients tend to see the most improvement during this time. However, recovery can take months or years, and improvements are still possible after six months, albeit at a much slower pace. Most stroke patients reach a relatively steady state at the 6-month mark, with some achieving a full recovery, while others experience ongoing impairments, also known as chronic stroke disease.

The speed and extent of recovery depend on several factors, including the severity of the stroke, how fast the initial treatment was provided, and the type and intensity of rehabilitation. It's important to continue following up with your care team, which may include a primary care physician, rehabilitation physician, physical and occupational therapists, a neurologist, and a rehabilitation psychologist. They can help manage health concerns, coordinate recovery aspects, and provide therapies to improve function in day-to-day activities.

Depression is a common experience for stroke survivors, with approximately one-third exhibiting symptoms of depression at some point following the event. It is often caused by biochemical changes in the brain, and when the brain is injured, survivors may not be able to feel positive emotions. Post-stroke depression is associated with a higher chance of poor functional recovery, recurrent strokes, diminishing quality of life, and increased risk of mortality.

Symptoms of depression may include:

• Persistent sad, anxious, or "empty" mood
• Restlessness and irritability
• Feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities, including sex
• Decreased energy and fatigue
• Difficulty concentrating, remembering, and making decisions
• Sleep disturbances, such as insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts

If these feelings persist for longer than two weeks and are accompanied by thoughts or expressions of self-harm, it is important to seek help from a healthcare professional immediately.

Depression can make the rehabilitation process more challenging as it may reduce the motivation to engage in the hard work required for recovery. However, treatments and strategies are available to improve these changes, including:

• Cognitive-behavioural therapy (CBT)
• Interpersonal therapy
• Psychotherapy
• Antidepressant medication
• Social support from family, friends, or support groups

Treating depression can improve the survivor's mood and boost physical, cognitive, and intellectual recovery. It is important to be aware of the signs of depression and seek help when needed, as this can facilitate a smoother path to recovery.

Survivors are at high risk of another stroke, so healthy habits are important

Even seven months after a stroke, survivors are at high risk of having another stroke. Therefore, it is important to take steps to reduce this risk. This includes eating a healthy diet, exercising, taking medications as prescribed, and visiting a healthcare provider regularly.

• Healthy diet: Survivors should aim to eat plenty of fruits, vegetables, whole grains, and lean proteins. A healthy diet can help lower the risk of another stroke by controlling illnesses such as diabetes and high blood pressure.
• Exercise: Regular physical activity can help improve overall health and reduce the risk of another stroke. This includes activities such as walking, swimming, and light strength training.
• Medication: Taking prescribed medications is crucial for managing health conditions and reducing the risk of another stroke. Be sure to follow the instructions provided by your healthcare provider.
• Regular check-ups: Visiting a healthcare provider regularly is important for monitoring your health and managing any ongoing conditions. They can also provide support and guidance on lifestyle changes.

By adopting these healthy habits, stroke survivors can actively work towards reducing their risk of another stroke and improving their overall health and well-being. Remember, it's important to consult with your healthcare provider to determine the best course of action for your specific needs.

Recovery can continue for years, with the right rehabilitation and mindset

The stroke recovery timeline is complex and unpredictable, and the rate of recovery is unique to everyone. However, recovery can continue for many years with the right rehabilitation and mindset. The most important factor that impacts your stroke recovery timeline is dedicated rehabilitation. The more you participate in your prescribed therapy exercises, the greater your recovery potential.

Rehabilitation after a stroke

Rehabilitation after a stroke generally consists of multiple therapy disciplines. Survivors will work with physical therapists, occupational therapists, and speech therapists, among other professionals. These experts will help pinpoint your exact needs and create a program that helps you reach your post-stroke goals.

The importance of mindset

Your mindset and motivation are also key factors in your recovery. The survivor's motivation is one of the many factors that influence recovery. It's important to stay active at home between outpatient therapy sessions. Massed practice or high repetition of home exercises will provide the brain with the consistent stimulation needed to rewire itself.

Recovery milestones

During the first three months of stroke recovery, you should see notable improvements in your progress. The brain is still in a state of heightened plasticity, which means that rehabilitation has a bigger effect during this time. After the first three months, results often slow down and many survivors experience a plateau in progress. However, recovery can continue for many years if you continue with dedicated rehabilitation.

Long-term recovery

There is documented proof of chronic stroke recovery as many as 23 years after the initial stroke. If you want to keep seeing results in the months and years after a stroke, you must continue with rehabilitation well after discharge from inpatient rehab. It's important to create healthy daily habits to optimize your overall wellness. Prioritizing sleep, getting daily exercise, and maintaining a healthy diet can boost your recovery and help reduce your risk of a second stroke.

Frequently asked questions