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Stroke recovery

Definition:

A stroke is an interruption of the blood supply to any part of the brain. Stroke is the leading cause of disability among adults in the United States. It is the country's third leading cause of death.

This article discusses recovery from stroke. How well a person does after a stroke depends on the severity of the stroke and how quickly treatment is received.

For addition information, see:



Alternative Names:

Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke



Information:

The treatment goals after a stroke are:

  • To help the patient re-learn as many skills as possible
  • Prevent future strokes
  • Prevent any complications from a stroke

The recovery time and need for long-term treatment differs from person to person. Problems related to moving, thinking, and talking often improve in the weeks to several months after a stroke. A number of people who have had a stroke will still continue to improve in the months or years after a stroke.

STROKE REHABILITATION

After having a stroke, many patients have stroke rehabilitation so they recover more fully. Participating in stroke rehabilitation helps the patient regain the ability to take care of his or her self. Most types of therapies can be provided wherever you or your loved one live, including in the home. Therapy may be done in a special part of a hospital or in a nursing home or rehabilitation facility. Those who have been released from the hospital might go to stroke rehabilitation therapy at a special clinic or have someone come to their home.

It can be difficult to decide whether the person who has the stroke will be able to return to their home after rehabilitation. Being able to stay in the home depends on how severe the stroke was and whether the person can take care of his or her self. It may also depend how much help there will be at home and whether the home is safe for them.

Sometimes, new living situations such as boarding homes or convalescent homes may be needed to provide a safe environment for a stroke patient.

For those being cared for at home:

  • Changes in the home may be needed to keep a loved one safe from falling or wandering, as well as making the home easier to use. This involves making sure the bed and bathroom are easy to get to and removing items (such as throw rugs) that may cause a fall.
  • A number of assistive devices are available to help with activities such as cooking or eating, bathing or showering, moving around the home or elsewhere, dressing and grooming, writing and using a computer, and many more activities.
  • Family counseling may help in coping with the changes required for home care. Visiting nurses or aides, volunteer services, homemakers, adult protective services, adult day care, and other community resources may be helpful.
  • Legal advice may be appropriate. Advance directives, power of attorney, and other legal actions may make it easier to make ethical decisions regarding the care of a person who has had a stroke.

UNDERSTANDING LANGUAGE AND SPEECH AFTER A STROKE

After a stroke, some people may have problems finding a word or being able to speak more than one word or phrase at a time. They can often still understand what is being said, but may become frustrated at not being able to communicate easily. Some people who have had a stroke may be able to put many words together, but it may not make any sense. These patients are generally unaware that what they are saying is not easy to understand. They may become frustrated when they realize others cannot understand.

A stroke can also damage the muscles that help a person speak. As a result, these muscles do not move the right way when the person tries to speak.

A speech and language therapist will work with the patient and family or caregivers. Depending on problems with speech and understanding, new ways for communicating with you or a loved one will be learned. New forms of communication such as pictures, verbal cues, and other methods may be needed in some cases. Caregivers may need to show the person pictures, demonstrate how to perform tasks more than once or in a different way, or use other communication strategies, depending on the type and extent of the language problems.

Family or caregivers must remain patient and help the one they are caring for stay calm.

MUSCLE AND NERVE PROBLEMS AFTER A STROKE

Moving around and doing some or all normal tasks such as dressing and feeding may be harder after a stroke.

Muscles on one side of the body may be weaker or may not move them at all. This may involve only part of the arm or leg, or the whole side of the body.

Muscles on the weak side of the body may be very tight (muscle spasticity). Different joints in the body may become hard to move (joint contractures)

Muscles on the side of the body not affected by the stroke may also become weak, causing fatigue.

A number of problems can cause pain after a stroke:

  • Muscle spasms or spasticity
  • Joint contractures
  • Subluxation or dislocation of a joint, most often the shoulder
  • Pain that results from changes in the brain itself
  • Reflex sympathetic dystrophy (complex regional pain syndrome)

Pain medicines may be used, but your health care provider should approve all medicines bought without a prescription. Braces, physical therapy, and medications that help with muscle spasms may be given to those who have pain due to spasticity.

Physical therapists, occupational therapists, and doctors trained in rehabilitation will help the person who has had a stroke relearn how to:

  • Dress, groom, and eat
  • Bathe, shower, and use the toilet
  • Use canes, walkers, wheelchairs, and other assistive devices to stay as mobile as possible
  • Possibly return to work
  • Keep all of the muscles as strong as possible and stay as physically active as possible, even if the person can’t walk
  • Manage muscle spasms or spasticity with stretching exercises as well as a number of different braces to fit around the ankle, elbow, shoulder, and other joints

BLADDER AND BOWEL CARE

A stroke can lead to problems with bladder or bowel control. Some people who have had a stroke may have bladder spasms that make them feel like they need to empty their bladder often, even if it does not contain much urine. This is called urge incontinence.

Certain medicines your doctor may prescribe, called anticholinergics, may help with bladder control. A referral to a bladder or bowel specialist may be needed.

Sometimes, a schedule of reminding someone who has had a stroke about emptying the bladder or bowels will help. Placing a commode chair close to where the person sits most of the day may also make a difference. Some people need a permanent urinary catheter to drain urine from their body.

For those who soil themselves on a regular basis, cleaning up after incontinence is important in order to avoid skin sores.

Skin or pressure sores can also occur if a person spends most or all of their day in a bed, regular chair, or wheelchair. Changing position often and knowing how to move is important to prevent skin or pressure sores. Family or caregivers must learn how to watch out for skin sores. It’s also important to make sure a wheelchair fits correctly.

SWALLOWING AND EATING DIFFICULTIES AFTER A STROKE

Swallowing problems may be due to lack of proper attention when eating or damage to the nerves that help you swallow. Symptoms of swallowing problems are:

Symptoms of swallowing problems are:

  • Coughing or choking, either during or after eating
  • Gurgling sounds from the throat during or after eating
  • Throat clearing after drinking or swallowing
  • Slow chewing or eating
  • Coughing food back up after eating
  • Hiccups after swallowing
  • Chest discomfort during or after swallowing

A speech therapist can help with swallowing and eating difficulties after a stroke.

Diet changes will be recommended. This may include thickening liquids or eating puréed foods.

For some, a permanent feeding tube, called a gastrostomy, will be needed.

Sometimes, high calorie foods or food supplements which contain extra calories and certain vitamins or minerals are needed to avoid weight loss and keep you or your loved one healthy.

OTHER IMPORTANT ISSUES

Memory problems, changes in behavior, lack of judgment, and changes inability to think or reason may all be present after a stroke. Some people with stroke appear to have no awareness of their affected side. Presence of all of these problems increases the need for safety precautions.

Depression after stroke is common as you or your loved one learns to live with the changes due to the stroke. It may develop soon after a stroke, but symptoms may not be present for up to 2 years after the stroke. Some ways to treat depression are:

Depression after stroke is common as you or your loved one learns to live with the changes due to the stroke. It may develop soon after a stroke, but symptoms may not be present for up to 2 years after the stroke. Some ways to treat depression are:

  • Increased social activity provided by more visits in the home or attending activities or an adult day care center
  • Medicines for depression along with visits to a therapist or counselor

Both men and women may have problems with sexual function after a stroke. Medications called phosphodiesterase type 5 inhibitors (Viagra or Cialis) may be helpful. Ask your health care provider whether these drugs are right for you. Talking with a therapist or counselor may also help.

PREVENTING ANOTHER STROKE

Treatment and lifestyle changes to prevent another stroke are important. This includes healthy eating, controlling illnesses such as diabetes and high blood pressure, and sometimes taking medicine to help prevent stroke.



References:

Chung CS, Caplan LR. Stroke and other neurovascular disorders. In: Goetz, CG, eds. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 45.

Stein J. Stroke. In: Frontera, WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 149.




Review Date: 7/29/2009
Reviewed By: Reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Also reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine.

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