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This topic covers rehabilitation after a stroke. For information on stroke itself, see the topic Stroke.
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 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.
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 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.
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:
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
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.
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.
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 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.
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.
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, such as 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.
Here are ways that you can help with your loved one's recovery:
You will also need to take care of your own well-being.
For more information on caregiving, see the topic Caregiver Tips.
You can help prevent a stroke if you control risk factors and treat other medical conditions that can lead to a stroke.
Your doctor can help you know your risk. 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 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.
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.
After a stroke, you may need medicines to decrease pain, treat depression, or help speed your recovery. These may include:
Also see 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 stroke.
Depending on the amount of disability, many people may need help at home with a variety of daily activities. For more information, see:
CitationsGo AS, et al. (2014). Heart disease and stroke statistics—2014 update: A report from the American Heart Association. Circulation, 129(1): e28–e292. DOI: 10.1161/01.cir.0000441139.02102.80. Accessed January 24, 2014. Other Works ConsultedBates 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 Elsevier. 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.
ByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal MedicineSpecialist Medical ReviewerRichard D. Zorowitz, MD - Physical Medicine and Rehabilitation
Current as ofSeptember 9, 2014
Current as of: September 9, 2014
Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine & Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation
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