Regaining Abilities After A Stroke: Effective Strategies And Techniques

A stroke is a medical emergency that occurs when blood flow to any part of the brain stops, causing permanent, debilitating damage. While the effects of a stroke vary from person to person, they often include physical, cognitive, and emotional symptoms. Rehabilitation plays a crucial role in helping stroke patients regain their abilities and recover lost skills. This involves a team of specialists such as physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and psychologists. The rehabilitation process focuses on improving activities of daily living (ADLs) and addressing cognitive and emotional impacts. The brain's ability to rewire itself through neuroplasticity is key to recovery, allowing it to strengthen existing neural connections or create new pathways. Early and intensive rehabilitation is critical, with the first three months after a stroke being the most important for recovery.

The importance of early and intense rehabilitation

The first few weeks after a stroke are critical for recovery. Starting rehabilitation as soon as possible is vital to restore function and prevent long-term disability. While recovery looks different for everyone, the faster a patient receives treatment, the better their chances of regaining abilities.

Johns Hopkins stroke rehabilitation specialist Preeti Raghavan, M.D., says that "the first three months after a stroke are the most important for recovery and when patients will see the most improvement." During this time, most patients will enter and complete an inpatient rehabilitation program or make significant progress in their outpatient therapy sessions.

The goal of early and intense rehabilitation is to restore function as closely as possible to pre-stroke levels or develop compensation strategies to work around any functional impairments. For example, a patient may need to learn how to hold a toothpaste tube differently to be able to unscrew the cap with their weaker hand.

The rehabilitation team includes physiatrists, neurologists, physical and occupational therapists, speech-language pathologists, and nurses. They work together to address the patient's physical, cognitive, and emotional needs and help them regain independence.

Therapy sessions are conducted intensively, sometimes up to six times a day while the patient is in the hospital. This helps to evaluate the damage caused by the stroke and jump-start the recovery process. The more a patient stimulates their brain by practicing tasks, the easier they become as new neural connections are formed.

In addition to therapy, maintaining a healthy lifestyle can also aid in stroke recovery and prevent a second stroke. This includes maintaining healthy blood pressure and cholesterol levels, eating a healthy diet, and engaging in regular physical exercise.

Overall, the key to maximizing recovery after a stroke is to start rehabilitation early, be consistent with therapy, and make healthy lifestyle changes. By doing so, patients can improve their chances of regaining lost abilities and minimizing long-term disabilities.

The role of neuroplasticity in recovery

Neuroplasticity plays a key role in stroke recovery by allowing the brain to rewire itself and compensate for lost functions. This process involves creating new neural pathways and reorganizing existing ones, helping the brain to restore functions impaired or lost due to tissue damage caused by the stroke. The brain's ability to exhibit neuroplasticity gives hope to survivors that they can regain lost skills and increase their independence.

Neuroplasticity after a stroke works differently for everyone since each brain is unique and every stroke is distinct. The secondary effects experienced by a survivor depend on factors such as the area of the brain affected and the severity of the stroke. For example, a left hemisphere stroke may cause language difficulties as this is where the language centre of the brain typically resides. However, neuroplasticity can aid in recovery by strengthening existing neural connections or creating new connections in other parts of the brain.

To activate neuroplasticity, high repetition of tasks or movements, known as massed practice, is essential. This consistent repetition stimulates the brain to form new connections and rewire motor functions. The more a survivor engages in massed practice, the more improvements they are likely to see in their ability to perform daily tasks and achieve their recovery goals. Therapists, including physical, occupational, and speech therapists, incorporate massed practice into their treatment plans to help survivors improve strength, mobility, and language skills.

The first six months after a stroke are critical for recovery, as this is when neuroplasticity is most active, and survivors tend to experience the most significant improvements in function. This period offers the greatest potential for spontaneous recovery, where lost skills suddenly return as the brain finds new ways to perform tasks.

In addition to massed practice, enhancing neuroplasticity after a stroke can be supported by increasing brain-derived neurotrophic factor (BDNF), which promotes the growth of new neurons and synapses. This can be achieved through aerobic exercise, such as brisk walking or swimming, and by consuming a healthy diet rich in polyphenols and omega-3s, including berries, nuts, whole grains, and seafood.

Speech and language therapy

The most common type of stroke, an ischemic stroke, occurs when the blood supply to the brain is significantly reduced or cut off, leading to oxygen deprivation and brain cell death. This can cause a range of disabilities, including speech and language impairments, termed "aphasia". Aphasia encompasses various difficulties with speech and language, such as Broca's aphasia, where individuals struggle to produce sentences longer than four words and experience garbled speech, and Wernicke's aphasia, where individuals can produce words but struggle to comprehend their meanings.

Speech-language pathologists, or speech therapists, employ diverse techniques to enhance communication abilities. Rehabilitation may involve one-on-one sessions with the pathologist and group interactions with other aphasia patients. Group therapy can be particularly beneficial as it provides a low-stress environment for individuals to practice communication skills, such as initiating conversations, taking turns, and clarifying misunderstandings.

Additionally, speech-language pathologists can recommend resources outside of therapy sessions, including computer programs and mobile apps that aid in relearning words and sounds. Props and communication aids, such as pictures, notecards, and writing materials, are also encouraged to enhance the patient's ability to convey their thoughts.

Family members and friends can play a supportive role in the patient's journey by consistently including them in conversations, giving them ample time to speak, and minimising distractions during interactions. It is important to note that recovering language skills can be a slow process, requiring patience and persistence.

Furthermore, speech therapy can address issues beyond aphasia. For instance, it can help patients who experience dysarthria, which is when a stroke damages the muscles used for speaking, resulting in improper muscle movement during speech. Speech therapy can also assist patients with swallowing difficulties caused by a stroke or the aftereffects of having a breathing tube. Dietary changes, such as thickening liquids or consuming pureed foods, may be recommended, and in some cases, a permanent feeding tube may be necessary.

Physical therapy

Techniques

Physical therapists use a variety of techniques to help stroke patients regain movement, including:

• Task-oriented training
• Strength training
• Walking or balance training
• Constraint-induced movement therapy
• Electrical stimulation
• Virtual reality or video game tools
• Biofeedback
• Aquatic therapy

Timing

The rehabilitation process usually starts in the hospital within 24-48 hours of a stroke. The initial treatment may focus on simple tasks like trying to pick up an object, and will progress to more complex motor tasks over time.

The typical length of a hospital stay after a stroke is five to seven days. Once discharged, patients will likely continue their rehabilitation at home or at a clinic.

Duration

The duration of physical therapy depends on the severity of the stroke and the level of disability. It may be required for months or even years. Typically, patients will do several sessions per week.

The impact of diet and exercise on recovery

Diet

A healthy diet is crucial for stroke recovery. Eating well helps the body heal and reduces the risk of having another stroke. A dietitian can help stroke survivors ensure they are getting adequate nutrition, which may involve eating certain types of foods and drinks, eating more or less food, and taking nutritional supplements.

The Australian Dietary Guidelines recommend a diet rich in:

• Vegetables of different types and colours, legumes and beans
• Wholegrain and high-fibre grain (cereal) foods such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley
• Lean meats, poultry, fish, eggs, tofu, nuts, seeds, legumes and beans
• Milk, yoghurt, cheese and their alternatives, mostly reduced fat

It is also important to limit the consumption of foods containing:

• Saturated fat, such as biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips and other savoury snacks
• Added salt
• Added sugars, such as confectionery, sugar-sweetened soft drinks, cordials, fruit drinks, vitamin waters, energy drinks and sports drinks

In particular, stroke survivors should be mindful of their salt, sugar, and saturated fat intake. Too much salt and sugar can damage blood vessels and raise blood pressure, while saturated fat raises cholesterol, increasing the risk of stroke.

Exercise

Regular physical activity is one of the best things a stroke survivor can do to aid their recovery. Exercise helps improve overall stroke recovery, physical function (mobility, walking, balance), mental function (mood, depression), and reduces the risk of stroke recurrence, heart-related conditions, and falls.

There are various types of exercises that can be beneficial for stroke survivors, including:

• Rehabilitation exercises: These may include central nerve development, passive or active exercise, progressive resistance exercise, mat exercise, and balance, postural, mobility, and gait training.
• Aerobic exercise: This can help improve walking ability and cardiorespiratory capacity. Examples include walking, cycling, and swimming.
• Resistance exercise: This can help improve muscle strength and motor function. Examples include weight training and elastic band exercises.
• Functional exercise: This can help improve activities of daily living. Examples include task-oriented therapy and robotic rehabilitation.

It is important for stroke survivors to consult with their healthcare provider or physical therapist to determine the appropriate types and intensity of exercises for their specific needs and condition.

Frequently asked questions