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This topic covers
rehabilitation after a stroke. For information on stroke itself, see the topic
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:
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 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
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:
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
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:
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
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
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
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.
Learning about stroke rehabilitation:
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Your disabilities and your
ability to get better after a
stroke depend on:
Impairments after a stroke may include problems with
muscles and movement. These include:
Other problems involve how you process information and your
emotions. These include:
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.
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.
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 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. 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.
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
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.
For most people who have had a stroke, rehab is a
lifelong process that also includes taking medicines to prevent another stroke and lifestyle changes to improve overall
health and prevent future strokes. Controlling other risk factors for stroke,
high blood pressure, is also important.
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.
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.
are ways that you can help with your loved one's recovery:
You will also need to take care of your own
For more information on caregiving, see the topic
You can help prevent a stroke if you
control risk factors and treat other medical conditions that can lead to a
These are some of the common risk factors for stroke:
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
stroke develop suddenly, call 911 or other emergency services immediately.
For more information on stroke symptoms and when to seek medical attention, see
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:
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.
stroke, you may need medicines to decrease pain, treat depression, or help
speed your recovery. These may include:
the topic Spasticity.
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.
For example, a stroke on the right side of the
brain can cause difficulty with doing 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.
Some people who have had a stroke tend to be slow, cautious, and
disorganized when they are doing unfamiliar tasks. They appear anxious and
hesitant, which is often quite different from the way they were before the
Depending on the amount of disability, many people may
need help at home with a variety of daily activities. For more information,
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 (toll-free).
Go AS, et al. (2013). Heart disease and stroke statistics–2013 update: A report from the American Heart Association. Circulation, 127(1): e6–e245.
Other Works Consulted
Bates B, et al. (2010). Veterans Affairs/Department of
Defense clinical practice guideline: Management of stroke
rehabilitation. Available online: http://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 (2008). Stroke. In WR Frontera et
al., eds., Essentials of Physical Medicine and Rehabilitation, 2nd ed., pp. 887–891. 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.
November 4, 2013
E. Gregory Thompson, MD - Internal Medicine & Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
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