Topic Overview

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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 as you can 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. Some 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?

You and
your family, loved ones, and caregivers are the most important part of the
rehab team. A team of health professionals will work with each other, you, and
your caregivers 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, writing, and other daily tasks.
  • A
    speech-language pathologist to help you relearn speech and 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.
  • A
    psychologist or
    counselor to help you deal with your
    emotions.
  • 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.

A
social worker or case manager will help you and your
caregivers arrange for the help and equipment you may need at home after you leave the
rehab center.

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 with vision. You may have problems seeing in some or all of the normal areas of vision.
  • Problems with not being aware of one 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 rehab can help you learn new skills that will help you take care of yourself as much as possible.

How long does rehab take?

How long you will be in a rehab program depends on what kind of help you need. 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. They are part of your rehab team. 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.
  • You may have questions or concerns about having sex again. Rehab may include help and support.
  • Medical insurance
    may not cover the rehab or devices you need after you leave the hospital. Have a
    caregiver check on Medicare or other programs.

Frequently Asked Questions

Learning about stroke rehabilitation:

Getting treatment:

Ongoing concerns:

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What to Expect After a Stroke

Initial disabilities

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). If you have spasticity, you may need certain medicines or injections of
    substances that block nerve reactions.
  • 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 starting and coordinating body movements (apraxia).
  • Problems swallowing and eating (dysphagia). For more information, see
    dysphagia. See also:

    Stroke Recovery: Coping With Eating Problems.
  • 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. These may involve speaking, reading, writing, or understanding the spoken word. Aphasia is a problem that 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. 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. For more information, see
    changes in perception after a
    stroke.
  • Problems with vision. You may have problems seeing in some or all of the normal areas of vision. For more information, see vision problems after a stroke.
  • Emotional problems. Fear,
    anxiety, anger, sadness, frustration, and grief are common after a stroke.
    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. Areas damaged by a stroke may be able to work again. And parts of the brain that have not been affected
by the stroke may be able to take over for the damaged areas, doing 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 your health is 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 to leave the hospital,
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 ready or able to go to a rehab facility. People who have the greatest desire to improve and who have a good support
network of friends and family will be the most likely to improve with rehab, regardless of
where the rehab takes place.

Recovering
from a stroke can be very frustrating. It is common to face
depression and have some 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 hard 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.

Building 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. Ask your doctor or rehab team about local support groups.

Preventing another stroke

There are many things you can do to prevent another stroke. They include taking medicines and making lifestyle changes to improve your overall health. Controlling other risk factors for stroke,
such as
high blood pressure, is also important.

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 hard 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 (rehab) 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.

Your rehab team can provide more information about local community resources, such as in-home help. They
may be able to offer advice about insurance coverage as
well.

Here
are ways that you can help with your loved one’s recovery:

  • Give support and encouragement for
    taking part in the rehab program.
  • Visit and talk with your loved
    one often. Encourage your loved one to do activities, such as playing
    a game with you. Keep in touch with your loved one’s friends
    as much as you can, 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 ideas and help.
  • 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.

Stroke: Should I Move My Loved One Into Long-Term Care?

Preventing Another Stroke

You can help prevent a stroke if you
control risk factors and treat other medical conditions that can lead to a
stroke.

Know your stroke risk

Your doctor can help you know your risk. These are some of the common risk factors for stroke:

  • You have atrial fibrillation.
  • You smoke.
  • You have high blood pressure.
  • You have high cholesterol.
  • You have diabetes.
  • You are overweight.
  • You do not exercise on a regular basis.
  • You drink large amounts of alcohol.

Treat any health problems you have

  • Manage high blood pressure or high cholesterol by working with your doctor.
  • Manage diabetes. Keep your blood sugar levels within a target range.
  • If your doctor recommends that you take aspirin or a blood thinner, take it. This can help prevent a stroke.
  • Take your medicine exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.

Adopt a healthy lifestyle

  • Don’t smoke or allow others to smoke around you. For more information, see the topic Quitting Smoking.
  • Limit alcohol to 2 drinks a day for men and 1 drink a day for women.
  • Stay at a healthy weight. Being overweight makes it more likely you will develop high blood pressure, heart problems, and diabetes. These conditions make a stroke more likely.
  • Be active. Ask your doctor and your rehab team what type and level of activity is safe for you. They can help make an exercise program that is right for you. A program might include ½ to 1½ hours a week of moderate exercise. One way to do this is to be active 30 minutes a day, 1 to 3 days a week. It’s okay to be active in 10-minute blocks throughout the day.
  • Eat heart-healthy foods. These include fruits, vegetables, high-fiber foods, and foods that are low in sodium, saturated fat, and trans fat. Eat fish at least 2 times each week. Oily fish, which contain omega-3 fatty acids, are best. These fish include salmon, mackerel, lake trout, herring, and sardines.

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 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.

Medicines for Stroke Prevention

Your doctor will probably prescribe several medicines after you have had a stroke. Medicines to prevent blood clots are typically used, because blood clots can cause TIAs and strokes.

The types of medicines that prevent clotting are:

  • Anticoagulant medicines.
  • Antiplatelet medicines.

Cholesterol-lowering and blood-pressure-lowering medicines are also used to prevent TIAs and strokes.

For more information on medicines prescribed after a stroke, see Stroke.

Medicines for Stroke Rehabilitation

After a
stroke, you may need medicines to decrease pain, treat depression, or help
speed your recovery.

You may take medicines for other problems, such as sleeping or anxiety. These medicines may include:

  • 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 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. Alprazolam (Xanax, for example) and buspirone
    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, for example), risperidone (Risperdal, for example), and olanzapine (Zyprexa, for example), are
    antipsychotic medicines that work by changing the effects of brain chemicals.
    The anticonvulsant valproic acid (Depakote, for example) is sometimes used to treat agitation.

Also see
the topic Spasticity.

Adapting After 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 you make will depend on how the stroke affected your ability to function.

Your rehab team can help you learn how to adapt, be safe, and return to daily activities.

In rehab, you may learn how to use assistive devices or orthotics. These are tools that help you hold objects, open and close things, transfer weight while shifting positions, or walk. These tools may be hard to get used to, but they help you return to your daily life and everyday tasks.

Your rehab team can give you tips on how to safely return to your daily activities. For more information, see:

Other Places To Get Help

Organizations

American Stroke Association
www.strokeassociation.org

National Stroke Association (U.S.)
www.stroke.org

References

Other Works Consulted

  • Bates B, et al. (2010). Veterans Affairs/Department of
    Defense clinical practice guideline: Management of stroke
    rehabilitation. Available online: https://www.healthquality.va.gov/Management_of_Stroke_Rehabilitation.asp.
  • Duncan PW, et al. (2005). Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke, 36: e100-e143.
  • Gonzalez-Fernandez M, Feldman M (2011). Rehabilitation of the stroke patient. In ET Bope et al., eds., Conn’s Current Therapy 2011, pp. 923-926. Philadelphia: Saunders.
  • Langhorne P, et al. (2011). Stroke rehabilitation. Lancet, 377(9778): 1693-1702.
  • Miller EL, et al. (2010). Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient. A scientific statement from the American Heart Association. Stroke, 41(10): 2402-2448.
  • Simpson DM, et al. (2008). Assessment: Botulinum neurotoxin for the treatment of spasticity (and evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 70(19): 1691-1698.
  • Stein J (2015). Stroke. In WR Frontera et al., eds., Essentials of Physical Medicine and Rehabilitation, 3rd ed., pp. 864-869. Philadelphia: Saunders.
  • Stein J, Brandstarter ME (2010). Stroke rehabilitation. In WR Frontera et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 5th ed., vol. 1, pp. 551-574. Philadelphia: Lippincott Williams and Wilkins.
  • Towfighi A, et al. (2016). Poststroke depression: A scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online December 8, 2016. DOI: 10.1161/STR.0000000000000113. Accessed April 5, 2017.
  • Winstein CJ, et al. (2016). Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, published online May 4, 2016. DOI: 10.1161/STR.0000000000000098. Accessed June 3, 2016.

Credits

ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Martin J. Gabica, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Adam Husney, MD – Family Medicine
Specialist Medical Reviewer Richard D. Zorowitz, MD – Physical Medicine and Rehabilitation

Current as ofJune 7, 2017