This topic covers
rehabilitation after a stroke. For information on stroke itself, see the topic
Stroke.
What is stroke rehabilitation?
The best way to get
better after a stroke is to start stroke rehabilitation ('rehab'). In stroke
rehab, a team of health professionals works with you to regain skills you lost
as the result of a stroke. Rehab can help you to:
Do as well and be as independent as
possible.
Learn to live with the changes to your brain and body
caused by the stroke.
Adjust to living within your home, family,
and community.
Rehab starts while you are still in the hospital. After
you leave the hospital, you can continue treatment at a rehab center or at
home. Most rehab programs offer at least 3 hours of therapy a day, 5 or 6 days
a week.
A key part of rehab is taking steps to prevent a future
stroke. To stay in good health, you may need to take medicines and make some
lifestyle changes. Work with your rehab team to decide what type of exercise,
diet, or other lifestyle choices are best for you.
You have the
greatest chance of regaining your abilities during the first few months after a
stroke. So it is important to start rehab soon after a stroke and do a little
every day.
Who is on a stroke rehab team?
A team of health
professionals will work together to help you recover from a stroke. A rehab
team may include doctors and nurses who specialize in stroke rehab, as well as
rehabilitation therapists such as:
A
physical therapist to work on problems with movement,
balance, and coordination.
An
occupational therapist to help you practice eating,
bathing, dressing, and writing, and other daily tasks.
A
speech-language therapist to help you relearn language
skills and also help if you have problems with swallowing.
A
recreational therapist to help you return to activities that you enjoyed before
the stroke.
Other health professionals, such as a
dietitian to help you plan a healthy diet and a
vocational counselor to help you find a job or get back to work.
What kinds of problems can people have after a stroke?
The problems you have after a stroke depend on what part of your brain
was affected and how much damage the stroke caused. People who have had a
stroke often have:
Problems with movement and sensation. You
may have pain, numbness, or tingling in your arms and legs; muscle stiffness or
spasms; weakness; and trouble with walking and moving. You may have problems
with your sense of touch or how well you feel hot and cold, trouble swallowing
and eating, and urinary or bowel problems.
Problems seeing things
on one side of the body. If you do not turn your head to that side, you may
forget or ignore that side of your body.
Problems with language
and thinking. You may not be able to understand written or spoken language,
read or write, or express your thoughts. You may also have problems with memory
and learning.
Emotional problems. A stroke can cause feelings of
fear, anxiety, anger, sadness, and grief, both for survivors of a stroke and
their loved ones.
Does a stroke cause permanent problems?
A stroke
damages parts of the brain that control different things in the body, such as
speech and movement. But other parts of the brain can take over for the damaged
areas. Many people are able to get back most of the skills and abilities they
lost.
Some people do have permanent problems after a stroke. But
more than half of people who have a stroke regain their ability to take care of
themselves.1
How long does rehab take?
For most people, rehab
is a lifelong process. The road to recovery can be long and frustrating, so
keeping a positive outlook is key. Try everything you can to get better, and
get relief from pain if you need to. Your stroke rehab team is there to help in
as many ways as it can. A strong support network of family and friends is also
very important.
You may recover the most in the first few weeks or
months after your stroke. But you can keep getting better for years. It just
may happen more slowly. And it may take a long time and a lot of hard work.
Don't give up hope.
What else should you think about?
It is common to feel sad and hopeless after
a stroke. It may be hard to deal with your emotions. Tell your rehab team how
you feel. Get treatment for
depression if you need it.
It is important
to get the support you need. Let your loved ones help you. Get them involved in
your treatment. Talk to others who have had a stroke, and find out how they
handled problems.
A stroke affects your loved ones too. They may
be as scared and worried as you are. Urge them to find a caregiver support
group and learn ways to relieve their stress.
Medical insurance
may not cover rehab or devices you need after you leave the hospital. Have a
caregiver check on Medicare or other programs.
Your disabilities and your
ability to get better after a
stroke depend on:
Which side of the brain was affected (whether
it is your dominant side).
Which part of the brain was damaged by
the stroke.
How much of the brain was damaged.
Your
general health before the stroke.
Impairments after a stroke may include problems with
muscles and movement. These include:
Weakness on one side of the body.This may cause you to have trouble walking, grasping objects, or
doing other tasks. The side of the body that is affected is opposite from the
side of the brain that was damaged by the stroke.
Joint pain and rigidity. A person with a very weak arm may
have shoulder pain caused by a tight or locked-up joint. Movement of the joint
is essential to keep it from "freezing" and to make sure that you can move it
easily when your strength returns.
Muscle stiffness or spasms (spasticity). You may need certain medicines or injections of
substances that block nerve reactions. For more information, see
treatment for stroke-related spasticity.
Problems with your sense of touch or your ability to feel hot and cold. You may also have problems judging the position
of parts of your body.
Pain, numbness, or tingling in your limbs.
Trouble with walking and coordinating body movements.
Problems swallowing and eating (dysphagia). For more information, see
dysphagia. See also:
Urinary or bowel problems. You may have trouble holding your urine (urinary incontinence)
or trouble emptying your bladder (urinary retention). Or you may have
constipation or problems controlling bowel movements. Although this can make
you feel embarrassed or discouraged, these issues are usually not permanent.
For more information, see
how to manage bladder and bowel problems after a stroke.
Other problems involve how you process information and your
emotions. These include:
Speech and language problems (aphasia). Aphasia usually results from damage to the left side of the
brain, which is the area responsible for language. Some people who have aphasia
may not be able to understand written or spoken language, read or write, or
express their own thoughts. For information on coping with communication
problems, see
how to manage speech and language problems after a stroke.
Memory and cognitive problems. You may have damage to parts
of your brain that control awareness, learning, and memory. You may have
trouble focusing or remembering. It may be difficult to make plans, learn new
activities, or do other complex tasks. You may not be able to acknowledge the
physical impairments caused by your stroke. For more information, see
memory problems,
changes in speed of action, and
changes in judgment after a stroke.
Problems with perception. You may have trouble judging
distance, size, position, rate of movement, form, and how parts relate to the
whole. For more information, see
changes in perception after a
stroke.
Problems recognizing your affected side. After a
stroke, some people have problems seeing to one side.
For example, people with right-sided paralysis may have trouble seeing to the
right. Most people learn to adjust by turning their head toward their affected
side. If you do not turn your head to the affected side, you may forget or
ignore that side of your body. Some people have trouble recognizing body parts
on the affected side. This is especially true for people who do not have
feeling in the affected arm or leg.
You may recognize objects on the unaffected
side of your body but not on the affected side. Some people may see objects and
not be able to attach a meaning to them. For example, you may examine a fork
curiously without remembering how to use it for eating.
Objects may
look closer or farther away than they really are. You may notice this more when
you are eating or dressing, or you may bump into furniture.
Emotional problems. Fear,
anxiety, anger, sadness, frustration, and grief are common after a stroke.
About one-third of people older than 65 who have had a stroke have symptoms of
depression.1 Depression is a serious condition that
requires treatment. For more information, see
changes in emotions and
recognizing and dealing with depression after a
stroke.
Recovering what was lost-The first steps
The brain is a remarkable organ that has the ability
to rewire itself to some degree. Parts of the brain that have not been affected
by the stroke may be able to take over for the damaged areas, performing some
of the tasks formerly controlled by the affected areas.
Much of
your improvement in motor functioning-walking, using your arms and legs-comes
in the early phase of stroke recovery. This is one of the reasons that it is so
important to start
rehabilitation as soon as possible.
Your
first stage of rehab usually begins 24 to 48 hours after your stroke, as soon
as you are stable and while you are in the hospital. For most people, rehab
begins with the goal of getting out of bed and into a chair. As you gradually
regain strength and function, nurses or therapists will help you regain skills
and relearn tasks that were lost because of the stroke. The intensity and focus
of initial rehab will vary with each person. It is a process based on your own
needs. If you have other health problems (such as a heart condition, for
example), you may need to go a bit slower than someone who was healthy before
his or her stroke.
When you are ready for more intense therapy,
your treatment may continue at a rehab facility. This may be in another part of
the hospital where you were first treated, at a separate facility, or at home
if it is safe for you and you have the right support. You may go to a skilled
nursing facility if you are not well enough for a more intense program. Or a
nursing home may be the best place for your rehab to continue. Studies show
that people who have the greatest desire to improve and who have a good support
network of friends and family will improve the most with rehab, regardless of
where the rehab takes place.2
Recovering
from a stroke can be very frustrating. It is common to face
depression and have occasional setbacks. You may make
strong improvement at first and then feel like you have lost some of what you
gained. Overcoming
problems with speech and language may seem very slow,
because it may be difficult for you to measure your progress. You may feel a
deep sense of grief for the loss of an active lifestyle prior to your stroke.
But your stroke rehab team is there to help in as many ways as possible.
Discussing your frustrations with the team and your family will be an important
part of your recovery.
A lifelong process
For most people who have had a stroke, rehab is a
lifelong process that also includes medicines-such as
daily aspirin-and lifestyle changes to improve overall
health and prevent future strokes. Controlling other risk factors for stroke,
such as
high blood pressure, will also be important.
Establishing a network of support outside your family may be helpful.
Stroke support groups may be offered through your local chapter of the American
Stroke Association (a division of the American Heart Association) or the
National Stroke Association. These will include people who are learning to cope
with many of the same things that you and your family are facing. Loved ones
who help take care of you will also benefit from support networks.
Concerns of the Caregiver
Taking care of a loved one
who has had a
stroke can be difficult for many reasons. You may be
afraid that your loved one will have another stroke or will not be able to
accept or overcome disabilities. You may worry that you are not prepared to
care for someone who has just had a stroke, or you may have your own health
concerns that make it difficult for you to care for another person. You may
also become depressed over losing the lifestyle that you previously enjoyed
with your loved one. And you may worry about the costs of
rehabilitation and a loss of income.
Before your loved one returns home, the
rehab team will train you or other family members to
help with therapy. You may learn to help your loved one get up from a fall, get
dressed, get to the bathroom, eat, and do other activities. If you have your
own health concerns that prevent you from being able to help, you may need
in-home help, or your loved one may need to go to a nursing home or
assisted-living facility. But even if you can't provide physical help, your
love and support are still key to your loved one's recovery.
Here
are ways that you can help with your loved one's recovery:
Give support and encouragement for
participation in the rehab program.
Visit and talk with your loved
one often. Play cards together or watch TV. Try to keep in touch with your
loved one's friends as much as possible, and encourage them to visit.
Participate in educational programs and attend rehab sessions as
much as possible.
Help your loved one learn and practice new
skills.
Find out what your loved one can do independently or needs
help with. Avoid doing things for your loved one that he or she is able to do
without help.
You will also need to take care of your own
well-being.
Eat well, get enough rest, and take time to do
things that you enjoy. Get out of the house as much as possible.
Make sure that you do not ignore your own health while you are
caring for your loved one. Do not try to do everything yourself. Keep up with
your own doctor visits and make sure to take your own medicines regularly. Ask
other family members to help. Find out if you qualify for adult day care or for
home health care visits to help with rehab.
Locate a support group
to attend. You can find them through local chapters of the American Stroke
Association (a division of the American Heart Association) or the National
Stroke Association. Also, check with the rehab team for recommendations. They
may be able to offer advice about insurance coverage as
well.
Schedule time for yourself. Get out of the house and do
things that you enjoy, run errands, or go shopping.
For more information on caregiving, see the topic
Caregiver Tips.
There are several factors
you cannot change that increase your risk of
stroke. But there are also several things you have
some control over that can help you avoid another stroke, including:
High blood pressure.
Heart disease.
High
cholesterol.
Diabetes.
Obesity.
Excessive
use of alcohol.
Use of tobacco products.
Too much
caffeine.
Use of certain illegal drugs, such as cocaine.
To prevent another stroke and to maintain good health, you
may need to take medicines, and you may need to make lifestyle changes. These
changes may include:
Getting regular exercise that increases your
breathing and your heartbeat.
Limiting your intake of caffeine,
animal fats, sugars, and processed foods and eating plenty of fruits,
vegetables, and high-fiber foods.
Quitting the use of tobacco
products.
Limiting your alcohol consumption.
These simple steps may help you live a longer, healthier
life. It is never too late to enjoy the benefits of healthy lifestyle choices.
They can reduce your risk for another stroke and can also help prevent a heart
attack and many other health problems. Talk with your doctor or other members
of your rehab team to determine what type of exercise, diet, or other lifestyle
choices are best for you.
If you or your loved one has already had
a stroke, you need to watch carefully for symptoms of another stroke. Immediate
medical attention and treatment with
t-PA (tissue plasmogen activator) within 3 hours may
help prevent or reduce permanent brain damage. If signs of a
stroke develop suddenly, call 911 or other emergency services immediately. For more information on stroke symptoms and when
to seek medical attention, see the topic
Stroke.
Medications for Stroke Prevention
After a
stroke and during
rehabilitation, you need medicines to help prevent
another stroke. You may need medicines to thin your blood and prevent clots
from forming and medicines to lower blood pressure and cholesterol.
Medicines for sleeping.After a
stroke, you may have trouble sleeping (insomnia). Your
doctor may prescribe different types of medicines to help you sleep, including
the antidepressants trazodone (Desyrel) and mirtazapine (Remeron), which have
sedation as a side effect. Other sleep medicines, such as chloral hydrate, may
be effective but have the potential for addiction.
Medicines for anxiety. Various medicines may be used to treat
anxiety after a stroke. Benzodiazepines, such as lorazepam (Ativan, for
example), are minor tranquilizers or sedatives that slow down the central
nervous system. Benzodiazepines are sometimes used to treat
seizures as well. Alprazolam (Xanax) and buspirone
(BuSpar) are antianxiety medicines that relieve anxiety and
nervousness.
Medicines for agitation.
Doctors use various types of medicines to treat agitation. Neuroleptics, such
as haloperidol (Haldol), risperidone (Risperdal), and olanzapine (Zyprexa), are
antipsychotic medicines that work by changing the effects of brain chemicals.
The anticonvulsant valproic acid is sometimes used to treat
agitation.
Methylphenidate to improve mood and speed recovery. This medicine is sometimes used for a short time in the
first stages of rehab.
Dextroamphetamine to improve attention span and help learning and memory.Experts are still
researching the benefits and risks of this drug for people who have had a
stroke.
After a stroke,
rehabilitation will not only focus on helping you
recover from disabilities but also on making changes in your lifestyle, at
home, at work, and in relationships. Changes will depend on the type of
disabilities, which are determined by the part of your brain that was affected
by the
stroke.
A stroke in the right side of the
brain can cause difficulty with performing everyday tasks. This type of stroke
affects the ability to judge distance, size, position, rate of movement, form,
and the way parts relate to the whole.
Perception problems may
include:
Not noticing people or things on the affected
side and turning your head or eyes to the unaffected side. Someone with these
types of problems may not be able to steer a wheelchair through a large doorway
without bumping the door frame.
Not being aware of body parts on
the affected side.
Having difficulty forming numbers and letters,
confusing similar numbers, or not being able to add numbers.
Having
trouble spelling words and reading.
Confusing the inside and
outside of clothing or the right and left sides of clothing.
Having
a hard time perceiving whether you are sitting or standing.
People with perception problems-even minor ones-should not
drive a car. A stroke can also affect mobility, communication, vision, and
decision-making, all skills that are needed for driving.
Some tips
for working with someone who has perception problems include the
following:
Cut down on clutter to prevent a fall. Also,
make sure that rooms are well lit. Put night lights in the bedroom and
bathroom.
Mark lines on door frames or full-length mirrors so that
the person can see what is vertical.
Do not overestimate the
person's abilities. Watch to see what can be done safely.
If your
loved one has trouble performing a task, be patient, and walk him or her
through the steps.
People who have had a stroke tend to be slow, cautious, and
disorganized when they are doing unfamiliar activities. They appear anxious and
hesitant, which is often quite different from the way they were before the
stroke.
Depending on the amount of disability, many people may
need help at home with a variety of daily activities. For more information,
see:
DisabilityInfo.gov provides information and resources for people
with disabilities. This includes programs such as education, employment,
housing, health, and transportation.
Organizations
American Stroke Association, a division of the American
Heart Association
7272 Greenville Avenue
Dallas, TX 75231
Phone:
1-888-4-STROKE (1-888-478-7653)
Web Address:
www.strokeassociation.org
This association provides information and referrals to local
self-help groups for people who have had a stroke and for their families.
Pamphlets and other information can be obtained by calling the Dallas
office.
Family Caregiver Alliance
180 Montgomery Street
Suite 1100
San Francisco, CA 94104
Phone:
1-800-445-8106 (415) 434-3388
E-mail:
info@caregiver.org
Web Address:
www.caregiver.org
This organization supports and assists people who are
providing long-term care at home. It also provides education, research,
services, and advocacy.
National Rehabilitation Information Center
(NARIC)
8201 Corporate Drive
Suite 600
Landover, MD 20785
Phone:
1-800-346-2742 (301) 459-5900
Fax:
(301) 459-4263
TDD:
(301) 459-5984
E-mail:
naricinfo@heitechservices.com
Web Address:
www.naric.com
NARIC is a research, referral, and information center for
rehabilitation technology and products for people with disabilities.
National Stroke Association
9707 East Easter Lane, Building B
Centennial, CO 80112
Phone:
1-800-STROKES (1-800-787-6537)
Fax:
(303) 649-1328
E-mail:
info@stroke.org
Web Address:
www.stroke.org
This association provides education, information, referrals, and
research on stroke.
American Heart Association (2007). Heart disease and
stroke statistics-2007 update. Circulation, 115(5):
e69-e171. Also available online:
http://www.americanheart.org/presenter.jhtml?identifier=1928.
Brandstarter ME (2005). Stroke rehabilitation. In JA
DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 2, pp. 1655-1676. Philadelphia:
Lippincott Williams and Wilkins.
Other Works Consulted
Bates B, et al. (2005). Veterans Affairs/Department of
Defense clinical practice guideline for the management of adult stroke
rehabilitation care: Executive summary. Stroke, 36(9):
2049-2056.
Duncan PW, et al. (2005). Management of adult stroke
rehabilitation care: A clinical practice guideline. Stroke, 36: e100-e143.
Finestone HM, Greene-Finestone LS (2003).
Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional
management for stroke patients. Canadian Medical Association Journal, 169(10): 1041-1044.
Kaplan PE, et al. (2003). Rehabilitation of Stroke. Burlington, MA:
Butterworth-Heinemann.
Kasner SE, Morgenstern LB (2004). Cerebrovascular
disorders. IN DC Dale, DD Federman, eds., ACP Medicine,
section 11, chap. 4. New York: WebMD.
Studenski S, Brown CJ (2004). Rehabilitation of
geriatric patients. In DC Dale, DD Federman, eds., Scientific American Medicine, section 8, chap. 10. New York: WebMD.
Credits
Author
Monica Rhodes
Editor
Kathleen M. Ariss, MS
Associate Editor
Michele Cronen
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
American Heart Association (2007). Heart disease and
stroke statistics-2007 update. Circulation, 115(5):
e69-e171. Also available online:
http://www.americanheart.org/presenter.jhtml?identifier=1928.
Brandstarter ME (2005). Stroke rehabilitation. In JA
DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 2, pp. 1655-1676. Philadelphia:
Lippincott Williams and Wilkins.
