Stroke Rehabilitation

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.

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.
  • Heart-Healthy Eating

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:

• Managing Bladder and Bowel Problems After a Stroke.
• Stroke: Tips to Help With Memory Problems.
• Managing Getting Dressed After a Stroke.
• Preventing Falls.
• Preventing Injury and Swelling in Affected Limbs After a Stroke.
• Pressure Injuries.
• Spasticity.
• Driving a Car After a Stroke.
• Stroke Recovery: Coping With Eating Problems.