Stroke Recovery: Programming Possibilities And Challenges

A stroke is a medical emergency that requires immediate attention to stabilise the patient and prevent further damage to brain cells. The recovery process is complex and varies from person to person, depending on the type of stroke and the area of the brain affected. It involves relearning old skills and can include physical, occupational, and speech therapy, as well as mental health support. So, can you program after a stroke? The answer is that it depends on the individual and the extent of their recovery. While some people may regain their ability to program, others may need to adapt and find new ways to code, leveraging the brain's ability to repair and rewire itself.

The importance of early treatment and rehabilitation

The treatment goals during this early period include stabilising the patient's vital functions, making a prompt diagnosis, and providing early treatment to prevent complications and reduce long-term effects. For ischemic strokes caused by blood clots, clot-busting medication can be administered to reopen blocked arteries, but this must be done as soon as possible, ideally within 4.5 hours of the onset of symptoms. Endovascular thrombectomy (EVT) is another procedure used to remove large clots and restore blood flow, recommended within six hours of stroke onset, or even up to 24 hours in select patients.

Rehabilitation should also start as soon as possible after the initial treatment. At Johns Hopkins, rehabilitation begins around 24 hours after a stroke. The rehabilitation team includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses, who work together to help the patient regain function and develop compensation strategies for any remaining impairments. The first three months after a stroke are considered the most crucial for recovery, with most patients making significant progress during this period.

Therefore, early treatment and rehabilitation are vital for optimising outcomes after a stroke, minimising long-term effects, and helping individuals regain their independence and resume their day-to-day lives.

The role of medication and physical therapy

Medication

If a stroke is caused by a blood clot (ischemic stroke), clot-busting medication can help reduce long-term effects if administered in time. This type of medication can prevent or treat blood clots and reduce the risk of another stroke.

Physical Therapy

Physical therapy plays a vital role in helping stroke survivors regain their physical functions and independence. Physical therapists are part of the stroke recovery team and work to improve movement, walking ability, and overall function while reducing disability.

Physical therapy for stroke typically begins early, often while the patient is still in the hospital. The primary goal of physical therapy after a stroke is to help the person return to their daily activities and improve their quality of life.

Physical therapists use a variety of techniques and treatments to help stroke survivors, including:

• Task-oriented and functional training: Practicing real-life tasks such as getting up from a chair or climbing stairs.
• Strength training: Using weights or functional approaches like rising from a chair to strengthen leg muscles.
• Walking and balance training: Challenging balance and improving walking patterns through various activities.
• Constraint-induced movement therapy (CIMT): Constraining the strong arm to encourage use of the arm/hand affected by the stroke.
• Functional electrical stimulation: Using electrical pulses to activate nerves and improve movement in weakened limbs.
• Motor imagery and mental practice: Rehearsing movements to stimulate the brain and improve function.
• Positioning: Proper positioning and support to reduce muscle pain and spasms and improve comfort.
• Robotic, virtual reality, and interactive video games: Mimicking real-life activities to "rewire" the brain and improve function.
• Body weight support (BWS): Supporting the patient's weight during walking, gradually reducing support as posture and balance improve.
• Biofeedback: Helping patients understand and control their muscle activity through visual feedback.

The specific treatments and techniques used by physical therapists depend on the individual's needs, the severity of the stroke, and the time since the stroke occurred. Physical therapy can continue even after the initial recovery phase to monitor progress, update exercises, and prevent further problems.

Speech and language therapy

Speech and language pathologists assess, diagnose, and treat speech and communication disorders. They examine language, vocal patterns, and swallowing to better understand a patient's condition and help them attain better communication skills.

Initial Assessment

An initial assessment of swallowing and communication difficulties is recommended within 24 hours of a stroke. Speech and language therapists assess all aspects of communication that can be impacted by a stroke, including:

• Difficulty understanding what has been said (receptive aphasia)
• Difficulty using words and sentences to express oneself (expressive aphasia)
• Difficulty thinking of the words one wants to use (word-finding difficulties)
• Reading difficulties (dyslexia) and writing difficulties (dysgraphia)
• Muscle weakness that may make speech slurred or difficult to understand (dysarthria)
• Difficulty with moving the muscles in the correct sequence to speak clearly (dyspraxia)

Treatment

Treatment plans are then created to help patients regain their communication skills and confidence. This may include breathing exercises, tongue strengthening exercises, and practising speech sounds and sentence formation.

Training

Speech and language therapists also train other healthcare professionals to carry out screening and train family members, friends, carers, and other professionals to be 'communication partners' for people with communication difficulties.

Managing emotional and psychological impacts

A stroke is a life-altering event that can affect every area of your life, from your physical abilities to your emotional and psychological state. It is completely normal to experience a wide range of emotions after a stroke, and everyone's experience is unique. Here are some strategies to help you manage the emotional and psychological impacts of a stroke:

Understand Emotional Changes

After a stroke, it is common to experience emotional and behavioural changes due to the impact on the brain. You may feel irritable, forgetful, confused, fearful, frustrated, angry, grief-stricken, sad, anxious, or depressed. These emotions can be overwhelming and affect your motivation to participate in therapies and your overall recovery. It is important to acknowledge and accept these emotions without judgement.

Seek Professional Help

If you are experiencing emotional distress, depression, or anxiety after a stroke, seek help from a healthcare professional. Your doctor can refer you to a psychologist, counsellor, or psychiatrist who can provide talking therapies and, if needed, medication to support your mental health. Cognitive Behavioural Therapy (CBT) is a common and effective treatment for managing emotions and thoughts after a stroke.

Practice Self-Care

Engaging in self-care activities is crucial for managing your emotional and psychological state after a stroke. This includes getting enough rest, eating a healthy and nutritious diet, limiting caffeine and alcohol intake, and staying physically active. Physical activity releases chemicals in the brain that improve your mood and reduce anxiety. Even a short walk or some gardening can make a positive difference.

Identify and Avoid Triggers

Identify the triggers that cause strong emotional responses. Common triggers include fatigue, stress, anxiety, and noisy or crowded environments. Once identified, try to avoid or minimise exposure to these triggers. If you cannot avoid them, consider using coping strategies such as relaxation and breathing exercises to help you manage your emotional responses.

Connect with Others

The support of loved ones is essential during this time. Spend time with family and friends who can provide emotional support and encouragement. Consider joining support groups or stroke clubs to connect with others who have gone through similar experiences. Sharing your feelings and challenges with others can help you feel less alone and provide valuable insights and advice.

Set Small Goals

Focus on setting small, achievable goals to work towards, one step at a time. This will help you regain a sense of purpose and build your confidence. Breaking down larger goals into smaller steps can make them feel less overwhelming and help you track your progress. Remember that recovery takes time and everyone's journey is unique.

Practice Relaxation Techniques

Learn and practice relaxation techniques such as mindfulness, meditation, or deep breathing exercises. These techniques can help you manage anxiety, reduce stress, and improve your overall emotional well-being. They can also help you cope when your emotions feel overwhelming. There are many resources available, such as books, DVDs, websites, and apps, that can teach you these techniques.

Express Your Emotions

Find healthy outlets to express your emotions, such as journaling, art, music, photography, or poetry. If communication problems make it difficult to express yourself, consider working with a speech and language therapist to explore additional support options. It is important to find ways to express your feelings and seek emotional support.

The impact on caregivers

Caring for someone who has had a stroke is challenging. A caregiver's role is to provide the most important long-term support for the survivor's recovery and rehabilitation. Behaviour, memory, communication, and physical capabilities can all be impacted by a stroke. As a primary caregiver, you might be involved in choosing a rehabilitation facility, coordinating home care services, providing transportation, housekeeping, and cooking, and communicating with physicians and rehab staff.

It is essential to make time for yourself and seek support. More than 53 million Americans are caregivers, and it is crucial to balance caregiving with family, work, personal time, and other commitments. Caregivers need care too, and it is important to be an advocate for yourself.

• Be helpful, but encourage independence.
• Teach with patience.
• Break up tasks into simple and small steps.
• It's not only about skill development; it is about building confidence.
• Encourage people to come close and not be afraid of the survivor.
• Try to stay organized.
• Don't try to do it alone. Accept help.
• Set realistic goals. It is a prerequisite for hope.
• Do not ignore warning signs of hopelessness and despair.
• Keep your roles and routines alive as much as possible.
• Take care of yourself, too.

Rehabilitation psychologists and neuropsychologists can help caregivers by screening for cognitive and emotional challenges and creating a plan to improve cognitive function and develop resilience in the face of what could be permanent lifestyle changes.

Frequently asked questions