Stroke Recovery: Regaining Control Through Command Compliance

A stroke is a brain injury that occurs when the brain tissue cannot get enough nutrients and oxygen due to interrupted or reduced blood flow. It can lead to serious disabilities or even death. The road to recovery is complex and depends on various factors, including the area of the brain affected, the survivor's motivation, and the support they receive. Caregivers play a crucial role in this process, and it is essential that they educate themselves, seek support, and take care of their own well-being.

Understand the importance of follow-up care and work with neurologists and primary care doctors to reduce the risk of another stroke

After a stroke, the risk of a second stroke increases significantly, and the consequences can be more severe and even fatal. Therefore, follow-up care is crucial to reducing this risk and managing any long-term effects.

Understanding the Risk of Recurrent Strokes

The chance of having another stroke within the first year after the initial incident is 11%, rising to 26% within five years and 39% within ten years. This highlights the critical nature of follow-up care and prevention strategies.

Role of Neurologists and Primary Care Doctors

Neurologists play a vital role in stroke recovery. They can help identify the cause of the stroke and develop tailored treatments to reduce the likelihood of recurrence. Working closely with a neurologist is essential for managing risk factors and promoting recovery.

Primary care doctors are also key to stroke aftercare. They can monitor and manage overall health, including any health concerns unrelated to the stroke. Additionally, they play a crucial role in stroke prevention by helping to treat and modify risk factors such as high blood pressure, high cholesterol, smoking, and diabetes.

Importance of Follow-up Care

Follow-up care ensures that any ongoing issues are addressed and managed effectively. It also provides an opportunity to monitor progress and adjust rehabilitation goals as needed. This ongoing support is vital, as setbacks, such as pneumonia, heart attacks, or another stroke, can occur in the months following a stroke.

Reducing the Risk of Another Stroke

Several strategies can help reduce the risk of a second stroke:

• Adopting a healthy diet, such as the Mediterranean diet, can improve cardiovascular health and reduce the risk of stroke.
• Daily exercise is an excellent way to reduce cardiovascular risk and improve overall health.
• Managing risk factors with the help of a primary care doctor, such as treating high blood pressure and atherosclerosis, can also lower the chances of another stroke.

By understanding the importance of follow-up care and working closely with neurologists and primary care doctors, individuals can significantly reduce the risk of another stroke and improve their overall health and well-being.

Monitor changes in behaviour and emotions, and seek help from healthcare providers if needed

After a stroke, survivors can experience a wide range of secondary effects, depending on the type of stroke and the area of the brain affected. It is therefore important to monitor changes in behaviour and emotions and seek help from healthcare providers if needed. Here are some tips on how to do this:

Decide what to monitor

Focus on one behaviour at a time and keep it simple. For example, if you want to improve your financial situation, monitor your spending and earnings. If you want to lose weight, monitor what you eat and drink.

Create a monitoring record

Keep a record of the time of day, day of the week, what you are doing, the situation or context, and what you are feeling and thinking at the time. This could be done through a notebook, spreadsheet, or app. Do this for one week to establish a baseline, and then continue to monitor your behaviour to see if any changes are taking place.

Look for patterns

After a week, review your monitoring record and identify any patterns. When and where does the behaviour happen? Who are you with? What are you feeling and thinking at the time? This information will help you understand the context of the behaviour and make any necessary adjustments.

Seek help from healthcare providers

If you are having difficulty controlling your emotions or making the desired changes, consult a healthcare provider to develop a plan of action. They can provide support and guidance to help you manage any emotional or behavioural changes following a stroke.

Join a support group

Consider joining a support group for stroke survivors and caregivers. These groups can offer suggestions, resources, and social support. Sharing your experiences and connecting with others who understand what you are going through can be beneficial for your emotional well-being and provide additional guidance on how to manage any changes in behaviour and emotions.

Prioritise mental health and seek professional help for depression and anxiety

Depression and anxiety are common mental health issues after a stroke, with around one in two survivors experiencing depression and one in four experiencing anxiety. These conditions can be brought on by physical changes in the brain, such as a basal ganglia stroke, or by psychological factors such as changes in independence, financial strain, fear of another stroke, or post-stroke grief.

It is important to recognise and address these issues, as they can hinder the recovery process by reducing motivation and energy levels. Treating depression and anxiety can improve the survivor's mood and boost their physical, cognitive, and intellectual recovery.

If you or a loved one are experiencing symptoms of depression or anxiety, it is important to talk to a doctor. A doctor can refer you to a mental health professional, such as a psychologist or psychiatrist, who can provide effective treatment. Treatment may include psychotherapy, cognitive behavioural therapy (CBT), interpersonal therapy (IPT), or mindfulness-based cognitive therapy (MBCT). Antidepressant medication can also be prescribed to treat moderate to severe depression and some anxiety disorders.

In addition to seeking professional help, there are several self-care strategies that can be beneficial:

• Regular exercise
• Healthy eating
• Avoiding alcohol
• Engaging in enjoyable activities
• Spending time with supportive people
• Joining a support group for survivors and caregivers

It is also important for caregivers to prioritise their own mental health and well-being. Caregiving can be stressful and demanding, so it is crucial to take breaks, practise self-care, and seek support when needed.

Modify your home to help prevent falls and increase independence

After a stroke, survivors often develop physical disabilities or limitations. Modifying your home environment can help to ease the transition back to everyday life and reduce the risk of falls. Here are some ways to adapt your home to increase independence and safety:

Flooring and walkways

• Opt for low-pile carpet, vinyl, or laminate flooring if you walk with or without a cane or walker, or use a wheelchair.
• Remove all throw rugs to prevent tripping.
• Secure large rugs with double-sided tape.
• Replace worn or torn surfaces.
• Keep walkways clear of clutter, furniture, toys, and cords.
• Tape down or use cable covers for loose cables and cords.

Doorways and passageways

• Ensure doors can swing open to at least 90 degrees, preferably to the adjacent wall.
• Consider reversing door hinges so that the door opens outwards into a hallway instead of a room.
• Install swing-clear hinges to gain more space.
• Widen doorways if necessary to accommodate wheelchairs or walkers.
• Clear paths to frequently used areas, such as the kitchen, bedroom, and bathroom.
• Remove clutter and keep phone and electric cords out of the way.

Stairs

• Install railings on both sides of the stairs, extending beyond the last step in either direction, to provide additional support when ascending and descending.
• Raise thresholds, steps, or stairs, and install a rail or handle for support.
• If using a walker, consider having one upstairs and one downstairs instead of carrying it up and down.

Lighting

• Use night lights, especially in red or orange hues, to illuminate paths to the bathroom or other areas. These colours are less likely to disrupt your internal clock compared to white or blue light.
• Ensure rooms are well-lit to prevent falls.

Bathroom

• Install grab bars in the tub, shower, and next to the toilet to provide stability and reduce fall risk.
• Use a shower chair and non-slip bath mats or tub decals to improve safety while bathing.
• Install a walk-in tub or shower to eliminate the need to climb in and out.
• Convert your existing tub into a tub transfer bench, allowing you to sit first and then swing your feet over the edge into the tub.
• Use a handheld showerhead for better control.
• Install a raised toilet seat or a bedside commode, especially if leg weakness is an issue.
• Use soap dispensers with pumps or electric sensors to conserve energy.

Bedroom

• Reorganize the layout to accommodate mobility aids such as wheelchairs or walkers.
• Modify the bed by raising it with bed risers or renting an adjustable hospital bed.
• Reorganize dressing areas, shelves, mirrors, and clothing storage to make them more accessible.
• Use easy-glide drawers and lower closet clothes bars if using a wheelchair.
• Add dressing aids such as shoe horns, zipper pullers, button hooks, grabbing tools, and slip-on shoes.

Kitchen

• Assess major appliances for ease of access and safety concerns.
• Store frequently used food items at waist level to avoid reaching too high or low.
• Use a microwave or a lowered electric cooktop instead of a stove to prevent burns.
• Add tables and seating to reduce the need for standing during meal preparation.
• Use adaptive utensils, rocking knives, contained vegetable choppers, and one-handed or lap cutting boards.
• Install a small, wheeled cart to help transport groceries and supplies.
• Use a large cutting board on an open kitchen drawer for seated food preparation.

Keep up with rehabilitation exercises to improve mobility and avoid regression

Rehabilitation exercises are a crucial part of stroke recovery. They can help stroke survivors relearn crucial motor skills and regain a high quality of life. Even permanent brain damage doesn't make disability inevitable, thanks to neuroplasticity—the brain's ability to reorganise and retrain itself.

However, it's important to start rehabilitation exercises as soon as possible. According to a study published in the Journal of the American Physical Therapy Association, spontaneous motor recovery only occurs during the first 6 months of recovery. After this initial period, rehabilitation is necessary to make further progress.

• Consistency is key: Consistency is crucial for effective rehabilitation. It's important to actively participate in physical, occupational, and speech therapy programs. The more you engage with these programs, the better your chances of regaining lost functions.
• Take advantage of the initial "recovery window": The first 3-6 months after a stroke are critical for rapid gains in function. This is when the brain is naturally healing itself through neuroplasticity. High repetition of rehab exercises during this period can lead to significant improvements.
• Inpatient rehabilitation: Inpatient therapy provides an intensive and effective environment for stroke survivors to regain function. It allows survivors to capitalise on the spontaneous recovery and heightened brain rewiring that occurs during the early stages of recovery.
• Tailored exercise regimen: A tailored and consistent exercise regimen is essential for proper post-stroke care. This means receiving support, tools, and specific instructions to stay active. This can include aerobic exercise and strength-training exercises.
• Address specific impairments: Stroke often results in motor and sensory impairments. Targeted rehabilitation exercises can help improve strength, range of motion, endurance, and balance. For example, arm-strengthening exercises can help improve muscle control and reduce spasticity, which is a constant contraction of muscles that can lead to pain.
• Modify your home environment: Making modifications to your home environment can help prevent falls and maximise your safety and independence. This may include installing grab bars and handrails, adding non-slip mats, and removing tripping hazards.
• Mental health support: Prioritising mental health is an important aspect of stroke recovery. Many stroke survivors struggle with depression and anxiety due to physical changes in the brain, changes in independence, financial strain, and fear of another stroke. Psychotherapy can help address these issues and improve your motivation for recovery.
• Join a support group: Support groups provide an opportunity to connect with other stroke survivors who understand what you're going through. They can offer suggestions, resources, social opportunities, and friendship.
• Healthy dietary choices: A healthy diet improves your body's ability to heal and provides energy for the recovery process. Consult with a dietitian to get personalised dietary advice and recommendations for foods that can aid in stroke recovery.

Frequently asked questions