Stroke Rehabilitation
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). You may need certain medicines or injections of substances that block nerve reactions. For more information, see treatment for stroke-related spasticity.
- 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 walking and coordinating body movements.
- Problems swallowing and eating (dysphagia). For more information, see dysphagia. See also:
- 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 (aphasia). Aphasia 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. For more information, see changes in perception after a stroke.
- Problems recognizing your affected side. After a stroke, some people have problems seeing to one side. For example, people with right-sided paralysis may have trouble seeing to the right. Most people learn to adjust by turning their head toward their affected side. If you do not turn your head to the affected side, you may forget or ignore that side of your body. 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 problems from neglecting the affected side of the body after a stroke.
- You may recognize objects on the unaffected side of your body but not on the affected side. Some people may see objects and not be able to attach a meaning to them. For example, you may examine a fork curiously without remembering how to use it for eating.
- Objects may look closer or farther away than they really are. You may notice this more when you are eating or dressing, or you may bump into furniture.
- Emotional problems. Fear, anxiety, anger, sadness, frustration, and grief are common after a stroke. About one-third of people older than 65 who have had a stroke have symptoms of depression.1 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. Parts of the brain that have not been affected by the stroke may be able to take over for the damaged areas, performing 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 you are 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. Studies show that people who have the greatest desire to improve and who have a good support network of friends and family will improve the most with rehab, regardless of where the rehab takes place.2
Recovering from a stroke can be very frustrating. It is common to face depression and have occasional 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 difficult 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.
A lifelong process
For most people who have had a stroke, rehab is a lifelong process that also includes medicines—such as daily aspirin—and lifestyle changes to improve overall health and prevent future strokes. Controlling other risk factors for stroke, such as high blood pressure, will also be important.
Establishing 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.
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| Author: | Monica Rhodes | Last Updated: July 6, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation | |
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