How to recover from a stroke?Many people begin to recover from a stroke almost immediately after it has occurred. Spontaneous recovery accounts for most improvements in the first month after a stroke. Successful recovery after a stroke depends on the extent of brain damage, the person's attitude, the skill of the medical team, and the cooperation of family and friends. Not all people recover on their own. For them, rehabilitation therapy can be invaluable. Rehabilitation can teach new skills to replace old skills that may have been lost. It involves teaching other areas of the brain to take over the work of the damaged portions.One of the
first rules of successful rehabilitation is that it must begin as soon after a stroke as possible. Therefore, it usually starts in the hospital and is continued as long as necessary after the person goes home. The goal of therapy is to improve function so that the person who has had a stroke can become as independent as possible.
Types of Rehabilitation ProgramsHospital programs - These programs can be provided by special rehabilitation hospitals or units within an acute care hospital. Complete rehabilitation services are available. The patient stays in the hospital during rehabilitation and a team of professionals provides therapy. These programs are usually more intense than other programs and require more effort from the patient.
Nursing home programs - The person stays at the facility during rehabilitation. These programs are very different from each other, so it is important to get specific information about each one. They vary from providing a complete range to only limited services.
Outpatient programs - Outpatient programs allow a patient who lives at home to get a full range of services by visiting an outpatient department, outpatient rehabilitation facility, or day hospital program.
Home-based programs - The patient can live at home and receive rehabilitation services from visiting professionals. An important advantage of home programs is that the person learns skills in the place where they will use them.
In all, 90% of stroke survivors experience varying degrees of improvement after rehabilitation. With current cost cutting, there is pressure to send elderly stroke victims directly to a nursing home rather than try rehabilitation first, although one study found that patients were three times more likely to return home from rehab units than from nursing homes. Not all patients, however, need or benefit from formal rehabilitation, if the stroke is severe, intensive training would not be very helpful, if the stroke is mild, patients often improve on their own.
Physical therapy should be started as soon as the patient is stable, as early as two days after the stroke. Some patients will experience the fastest recovery in the first few days, but many will continue to improve for about six months or longer. Because stroke affects different parts of the brain, specific approaches to managing rehabilitation vary widely among individual patients:
Retraining muscles. One approach is based on training different muscles to replace those that have been impaired by damaged brain cells. In one small but important 2000 study, 13 stroke victims who had right-side paralysis had their non-paralyzed arm immobilized so that they were forced to use their paralyzed arm. Eleven of the patients experienced improvement in their impaired arms. The affected side of their brains also appeared to become more active. More studies are necessary. Physical exercise relating to the disability caused by the stroke is, in any case, important and may actually help repair the brain.
Speech therapy and sign language. While professional speech therapy progresses, the patient's caregivers should use and encourage the patient in nonverbal communications, such as pantomime, facial expressions, and pen and paper. Learning and using the sign-language alphabet may be helpful both in communicating and improving small-motor dexterity.
Biofeedback techniques combined with physical therapy. This combination has been beneficial in certain cases. Electrical stimulation of the throat, for example, may help patients with dysphagia recover their ability to swallow faster. Stimulation of the wrist and finger is also showing promise for improving motor capabilities.
Attention training. Problems in attention are very common after strokes. Direct retraining teaches patients to perform specific tasks using repetitive drills in response to certain stimuli. (For example, they are told to press a buzzer each time they hear a specific number.) A variant of this approach trains patients to relearn real-life skills, such as carrying on a conversation. For example, in one study, small electric cars were used in a lab to teach driving.
The Emotional state of the patients. Strong motivation with the goal of independence after rehabilitation is important for recovery. Unfortunately, depression is very common after a stroke, both as a direct and indirect result of the stroke. Strokes that affect the right hemisphere in the brain particularly increase the risk for depression. Patients can certainly become depressed by the great changes in their ability to function.
A peculiar stroke-induced condition, known as post-stroke crying or neurologic emotionalism, is a neurologic not psychologic disorder. If depression is prolonged, it can impair recovery. One study showed that people who suffered strokes and became depressed were three times more likely to die within 10 years than stroke victims who were not depressed. There is a significantly increased risk of suicide in patients with stroke, especially in women and those younger than 60. Antidepressants, particularly fluoxetine (Prozac) and other selective serotonin reuptake inhibitors (SSRIs), have been beneficial in relieving post-stroke crying. SSRIs have also improved recovery in general, and mood in particular, in patients who are depressed. Antidepressants may also help restore mental abilities.
Some physicians also recommend agents called tricyclic antidepressants, including amitriptyline (Elavil) and nortriptyline (Pamelor). In one 2000 study nortriptyline (Pamelor) not only improved mood but also had positive effects on mental functioning, suggesting perhaps that some dementia associated with stroke may actually be due to depression. Tricyclics may also be useful for neurologic emotionalism. Generalized anxiety disorder is also common and debilitating. Some research, in fact, indicates that many patients suffer from feelings identical to post-traumatic stress syndrome (PTSD). Symptoms of generalized anxiety disorder and PTSD often overlap, but drug treatments differ and may offset each other. It should be noted that many drugs for psychologic disorders affect the central nervous system and can actually delay rehabilitation. Skilled professional help is needed to determine the most effective and safest treatments.
Many survivors are afraid that they will have another brain attack. However, with proper medical treatment, it is quite unlikely that a person who has had a stroke will experience another. The risk of a second stroke is higher for people who are not receiving proper medical treatment for their first stroke. Effective treatment to reduce the risk of another stroke includes making lifestyle changes to decrease risk factors and taking medication, such as aspirin, as directed by a doctor.