My Loved One Had a Stroke: Information About Rehabilitation

When a loved one has a stroke, it can be a very scary time. Life can change and having a lot of unknowns is very stressful. Sometimes people recover most of their function – other times they do not. This article aims to provide you with some information on what to expect during your loved one’s stroke recovery.

Understanding Terms: Ischemic vs Hemorrhagic Stroke

If your loved one had a stroke, you are likely being flooded with a lot of new and confusing terminology. Everyone falls into one of two categories: hemorrhagic or ischemic. A hemorrhagic stroke occurs when a blood vessel in the brain bursts. This results in blood directly on the brain, as well as swelling in the skull. This stroke is less survivable. Our skull is solid and fixed, and cannot expand. If there is swelling inside the skull this can compress the brainstem, the part of the brain that keeps us breathing.

An ischemic stroke is caused by a clot in the brain. This means that blood can no longer flow through a specific vessel in the brain. Since blood brings oxygen throughout the body, this means that a part of the brain becomes deprived of oxygen and starts to die.

Both types of stroke are life threatening and can often leave patients with serious impairments . Some of the most common impairments include:

1. Hemiparesis: one side of the body is paralyzed. This can be the arm, arm and leg, and/or involve the face and throat. Involvement of the throat results in difficulty swallowing.
2. Aphasia: Difficulty speaking (expressive aphasia) or difficulty understanding (receptive aphasia). Someone with expressive aphasia can understand what you are saying, but struggles to get the words out to respond. Someone with receptive aphasia is able to speak but will respond inappropriately. For example, if you ask them what day it is they may begin telling a story about a lunch date.
3. Ataxia: lack of coordination and difficulty sequencing movements. These individuals have difficulty with things like bringing food to their mouth, walking, etc.
4. Amnesia: Difficulty recalling recent events. These individuals are not oriented to their location, situation, etc.
5. Perseverance: Repetition of the same sentence or story over and over again.

This is by no means an exhaustive list. These are just some of the more common findings.

People Younger than 35 Have the Best Prognosis. People Older than 75 Have Poorer Prognosis

There are MANY factors that contribute to recovery following a stroke. These factors include but are not limited to:

1. Location of the stroke: Which arteries were involved?
2. Hemorrhagic vs ischemic stroke: Hemorrhagic has lower survival rate but survivors usually recover better than those who sustained ischemic stroke
3. When was the stroke? : The more time that has passed (think: weeks/months/years), the less likely a person is to improve. More on this in a bit.
4. How quickly was the stroke medically addressed?: If an ischemic stroke was sustained, was it caught early enough to receive tPA (Activase)? This drug is a “clot buster” but is mostly effective if given within 3 hours of stroke onset.
5. Patient Age: Individuals younger than age 35 have the best chance of having a return to prior level of function. Patients over 75 have a much lower chance.

Although age plays a significant role in recovery, I have seen some patients in their 80s recover extremely well. I’ve also seen patients in their 40s have a very poor recovery. As I mentioned, many factors play a role so age is important but it’s not everything.

The First Three Months Following A Stroke Are the Most Critical In Recovery

The first three months following a stroke have the most rapid recovery. It’s incredible. I have worked with patients who improve in their movement and overall cognition overnight (during the course of working together in therapy). Physical, occupational, and speech therapy are CRUCIAL during this time in order to give someone a chance at maximum recovery. Recovery during this time is intense and needs to be built into daily life as much as the patient can tolerate. For this reason, I strongly recommend treatment in a center that specializes in neuro rehabilitation. These centers, located in hospitals, typically have the best available equipment for treating these patients.

Here are some questions to ask if you are searching for a center for your loved one:

1. Do you have an anti-gravity treadmill? : These treadmills reduce bodyweight and can be an excellent bridge to helping stroke survivors regain the ability to walk.
2. How many times a day will my loved one receive treatment?: Some centers are only staffed enough to provide therapy once a day during the week. Larger centers are typically able to maintain enough staff to provide physical, occupational, and speech therapy up to twice a day.
3. What therapies do you offer?: Are PT, OT, and speech therapy available to treat your loved one daily if all 3 are needed? Every stroke patient has different needs, so make sure your facility is able to meet yours.
4. What kind of population is best treated by this facility?: Some facilities, such as those that provide swingbed care or skilled nursing, are not always a good fit for stroke recovery. They may lack the experienced staff or appropriate equipment to provide the intense care that is required during the 3 month recovery period following an acute stroke. Other facilities are enormous neuro rehabilitation centers, whose staff only work with patients with neurologic conditions. These are the places that tend to be best equipped for rehabilitation.

A quick note here: Not every stroke patient will require a stay in a facility for rehabilitation. It all depends on the patient’s age, the area of the brain affected by the stroke, how large the affected area in the brain is, etc.

Summary: Intense, Daily Care is Required to Maximize Recovery Potential

There is a small, beautiful window of time in the first 3 months following a stroke where the most recovery happens. After the first 3 months a patient will still make progress, but it slows significantly. Without therapy, a patient cannot maximize their recovery.

Something I would like to note: If you are in a center like this and your loved one is not receiving as much of a certain kind of therapy, this *usually* means they do not need as much of that specific therapy.

For example: Let’s say I have a patient who can move very well but is extremely disoriented. Their disorientation makes them get lost and confused when they are walking around. The child of this patient (picture a patient in their 80s with a child in their 50s) may see that physical therapy is not treating their parent on a daily basis, but occupational therapy is. This kind of situation always warrants a conversation. Are they not seeing the patient because they don’t have the availability? Is it because the patient doesn’t need as much PT? Sometimes, a patient requires much more occupational and speech therapy then physical therapy. Other times, the patient only requires physical and occupational therapy but their swallowing is fine so speech therapy is not required.

Don’t be afraid to ask questions – the big question being, “Why?” You deserve to have someone sit and explain everything to you. Strokes are very complicated and watching your loved one change overnight is incredibly stressful.