Overview
Is this topic for you?
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 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. If you don't look to that side, you may
forget or ignore that 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
more than half of people who have a stroke regain their ability to take care of
themselves.1
How long does rehab take?
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.
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. 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.
- 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.
Frequently Asked Questions
Learning about stroke rehabilitation: | |
Getting treatment: | |
Ongoing concerns: | |
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 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. 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.
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, 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 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. 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.
A lifelong process
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.
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.
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. They
may be able to offer advice about insurance coverage as
well.
- 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.
Preventing Another Stroke
There are several things
you cannot change that increase your risk of
stroke. But there are also several things you have
some control over that can help you avoid another stroke, including:
- High blood pressure.
- Heart disease.
- High
cholesterol.
- Diabetes.
- Obesity.
- Excessive
use of alcohol.
- Use of tobacco products.
- Too much
caffeine.
- Use of certain illegal drugs, such as cocaine.
To prevent another stroke and to stay in good health, you
may need to take medicines and you may need to make lifestyle changes. These
changes may include:
- Getting regular exercise that increases your
breathing and your heartbeat.
- Limiting your intake of caffeine,
animal fats, sugars, and processed
foods.
- Eating plenty of
fruits, vegetables, and high-fiber foods.
- Quitting the use of
tobacco products.
- Limiting your alcohol consumption.
These simple steps may help you live a longer, healthier
life. It is never too late to enjoy the benefits of healthy lifestyle choices.
They can reduce your risk for another stroke and can also help prevent a heart
attack and many other health problems. Talk with your doctor or other members
of your rehab team to find out what type of exercise, diet, or other lifestyle
choices are best for you.
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
After a
stroke and during
rehabilitation, you need medicines to help prevent
another stroke. You may need medicines to thin your blood and prevent clots
from forming and medicines to lower blood pressure and cholesterol.
Medicines you may take after a stroke
include:
Medicines for Stroke Rehabilitation
After a
stroke, you may need medicines to decrease pain, treat depression, or help
speed your recovery. These may include:
- Medicines for pain and depression after a stroke. Examples are:
- 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 (Desyrel, for example) 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) and buspirone
(BuSpar) 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), risperidone (Risperdal), 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.
- Methylphenidate (Ritalin, for example) to
improve mood and speed recovery. This medicine is sometimes used for a
short time in the first stages of rehab.
- Dextroamphetamine (Dexedrine, for example) to improve
attention span and help learning and memory. Experts are still
researching the benefits and risks of this drug for people who have had a
stroke.
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 will depend on the type of
disabilities, which are determined by the part of your brain that was affected
by the
stroke.
A stroke in 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.
Perception problems may
include:
- Not noticing people or things on the affected
side and turning your head or eyes to the unaffected side. Someone with these
types of problems may not be able to steer a wheelchair through a large doorway
without bumping the door frame.
- Not being aware of body parts on
the affected side.
- Having difficulty forming numbers and letters,
confusing similar numbers, or not being able to add numbers.
- Having
trouble spelling words and reading.
- Confusing the inside and
outside of clothing or the right and left sides of clothing.
- Having
a hard time perceiving whether you are sitting or standing.
People with perception problems—even minor ones—should not
drive a car. A stroke can also affect mobility, communication, vision, and
decision making, all skills that are needed for driving.
Some tips
for working with someone who has perception problems include the
following:
- Cut down on clutter to prevent a fall. Also,
make sure that rooms are well lit. Put night lights in the bedroom and
bathroom.
- Mark lines on door frames or full-length mirrors so that
the person can see what is vertical.
- Do not overestimate the
person's abilities. Watch to see what can be done safely.
- If your
loved one has trouble performing a task, be patient, and walk him or her
through the steps.
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:
Also see:
Other Places To Get Help
Organizations
| National Institute of Neurological Disorders and
Stroke |
| NIH Neurological Institute |
| P.O. Box 5801 |
| Bethesda, MD 20824 |
| Phone: | 1-800-352-9424 |
| Phone: | (301) 496-5751 |
| TDD: | (301) 468-5981 |
| Web Address: | www.ninds.nih.gov |
| |
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders. |
|
| American Stroke Association |
| 7272 Greenville Avenue |
| Dallas, TX 75231 |
| Phone: | 1-888-4-STROKE (1-888-478-7653) |
| Web Address: | www.strokeassociation.org |
| |
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). |
|
| Family Caregiver Alliance |
| 180 Montgomery Street |
| Suite 900 |
| San Francisco, CA 94104 |
| Phone: | 1-800-445-8106
(415) 434-3388 |
| Email: | info@caregiver.org |
| Web Address: | www.caregiver.org |
| |
This organization supports and assists
people who are providing long-term care at home. It also provides education,
research, services, and advocacy. |
|
| HeartHub for Patients |
| Web Address: | www.hearthub.org |
| |
HeartHub for Patients is a website from the American Heart
Association. It provides patient-focused information, tools, and resources
about heart diseases and stroke. The site helps you understand and manage your
health. It includes online tools that explain your risks and treatment options.
The site includes articles, the latest news in health and research, videos,
interactive tools, forums and community groups, and e-newsletters. The website includes health centers that cover heart rhythm problems,
cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart
failure, high blood pressure, peripheral artery disease, and stroke. HeartHub for Patients also links to Heart360.org, another American Heart Association
website. Heart360 is a tool that helps you send and receive medical
information with your doctor. It also helps you monitor your health at home. It
gives you access to tools to manage and monitor high blood pressure, diabetes,
high cholesterol, physical activity, and nutrition. |
|
| National Stroke Association |
| 9707 East Easter Lane, Building B |
| Centennial, CO 80112 |
| Phone: | 1-800-STROKES (1-800-787-6537) |
| Fax: | (303) 649-1328 |
| Email: | info@stroke.org |
| Web Address: | www.stroke.org |
| |
This association provides education, information,
referrals, and research on stroke. Information specific to survivors,
caregivers, family, women, and children is included. |
|
References
Citations
- Roger VL, et al. (2011). Heart disease and stroke statistics 2011 update: A report from the American Heart Association. Circulation, 123(4): e18–e209.
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.
- Finestone HM, Greene-Finestone LS (2003).
Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional
management for stroke patients. Canadian Medical Association Journal, 169(10): 1041–1044.
- 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.
- Kaplan PE, et al. (2003). Rehabilitation of Stroke. Burlington, MA:
Butterworth–Heinemann.
- 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 (an 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.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
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| Specialist Medical Reviewer | Richard D. Zorowitz, MD - Physical Medicine and Rehabilitation |
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| Last Revised | October 26, 2012 |
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