Stroke Rehabilitation

Overview

Stroke rehabilitation is a crucial piece of stroke recovery. Following a stroke, multiple bodily functions can be affected: cognition and emotion, speech and language, gross and fine motor skills, and vision, to name a few. Rehabilitation allows you to regain lost skills and improves your post-stroke quality of life.

The main goals of stroke rehabilitation are:

Restore as much function as possible
Prevent complications and secondary strokes
Adapt to any residual disabilities and relearn necessary skills
Regain as much independence as possible

The correct type of skilled stroke rehabilitation enhances and augments one’s ability to perform essential daily tasks like walking, eating, drinking, caring for oneself, and communicating with others.

Stroke Rehabilitation Timeline

Stroke rehabilitation is an inclusive and individualized process designed to help survivors reclaim their independence.

At Barrow Neurological Institute, this process begins in the emergency department with a throughline to outpatient care. During each step along the way, our stroke rehabilitation patients have access to cutting edge technology for and research on recovery from stroke.

Generally, the stages of stroke rehabilitation include:

Acute rehabilitation: This begins in the hospital as soon as a person is stable and focuses on preventing complications like blood clots, bedsores, or muscle atrophy. Depending on the severity of the stroke, you or your loved one may have a hospital stay that ranges from days to weeks, or even months.
Subacute or inpatient rehabilitation: This begins in an inpatient rehabilitation facility, typically around two to four weeks after a stroke. Intensive therapy to regain lost functions will start, and specialists will provide you with psychological and emotional support.
Outpatient or home-based rehabilitation: This focuses on fine-tuning skills and adapting to daily life after discharge from subacute or inpatient rehabilitation. During this phase, psychological and emotional support are encouraged to continue.

Keep in mind that not every stroke patient completes each stage of rehabilitation. Between 10 and 20 percent of stroke survivors recover well enough to be discharged to their homes without needing inpatient or outpatient rehabilitation. However, this is more likely to happen in the case of mild strokes, known as transient ischemic attacks (TIAs) or minor ischemic strokes. The majority of stroke patients—between 80 and 90 percent—require some form of rehabilitation, with outpatient rehabilitation being the most common.

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Inpatient Stroke Rehabilitation

If you need more intensive therapy after you’ve been discharged from the hospital, you may be admitted to an inpatient facility for more intensive stroke rehabilitation. In this setting, you’ll have access to a myriad of professionals, such as:

Physical medicine and neuro-rehabilitation physicians
Neuropsychiatrists and neuropsychologists
Physical, speech, and occupational therapists
Neuroscience nurses
Dieticians
Eye specialists
Social workers and discharge planners

Inpatient Stroke Disclosures

Outpatient Stroke Rehabilitation

Once you’re ready to return home, you may need to continue your stroke rehabilitation in an outpatient program. In outpatient rehabilitation, you’ll have access to the same types of specialists as in an inpatient program, but in an outpatient setting—whether that’s at your home or in a provider’s office. Outpatient stroke rehabilitation aims to shift support to your transition back to work, home, school, and regular activities.

At Barrow Neurological Institute, outpatient neuropsychological testing is available to evaluate you or your loved one’s cognitive progress and make more informed decisions regarding readiness to return to driving, work, school, and independent living.

Outpatient Stroke Disclosures

Types of Stroke Rehabilitation

Physical rehabilitation: This type of stroke rehabilitation focuses on improving strength, balance, and mobility through exercises to strengthen weakened muscles and improve range of motion. Examples include:
- Constraint-induced movement therapy (CIMT): This form of physical therapy encourages the use of an affected limb by limiting the use of the unaffected one.
- Functional electrical stimulation (FES): FES uses gentle electrical currents to stimulate weakened muscles, improving their strength and coordination.
- Hydrotherapy: In hydrotherapy, water-based exercises reduce stress on joints and muscles while improving mobility.
- Robotic therapy: Here, robotic devices assist in repetitive movements, especially for arm and leg rehabilitation.
Speech and language rehabilitation: This rehabilitation category helps those with speech, language, or swallowing difficulties caused by stroke. Examples include:
- Speech therapy: This treatment focuses on treating difficulty speaking, understanding, reading, or writing, as well as slurred or weak speech. Exercises help improve word-finding ability, pronunciation, and overall communication.
- Swallowing therapy: In this type of therapy, exercises strengthen throat muscles and improve swallowing, which helps reduce the risk of choking.
- Augmentative and alternative communication (AAC): Tools like communication boards or speech-generating devices assist those with severe speech difficulties.
Cognitive rehabilitation: This group of rehabilitation targets the brain functions affected by stroke, like memory, attention, and problem-solving. Examples include:
- Cognitive exercises: Puzzles, memory games, and problem-solving tasks improve brain function after a stroke.
- Occupational therapy (OT): Relearning small but critical everyday skills like dressing, cooking, and using writing tools or silverware is integral to stroke recovery.
- Computer-based therapies: Digital programs designed to enhance specific cognitive skills are used in this form of rehabilitation.
Vision and perception rehabilitation: This rehabilitation addresses vision problems and spatial awareness issues. Examples include:
- Visual field training: Here, exercises to compensate for lost vision or improve scanning skills are practiced.
- Glasses and eye patching: Prism glasses with special lenses for double vision can be used alongside eye-patching to adjust the field of view.
- Occupational therapy (OT): Occupational therapy helps stroke survivors adapt to visual impairments in daily activities.
Psychological and emotional rehabilitation: This type of rehabilitation zeroes in on mental health and emotional well-being, which are often impacted by stroke. Examples include:
- Therapy: Individual counseling for depression, anxiety, or post-traumatic stress disorder after a traumatic experience is a key part of rehabilitation.
- Support groups: These groups connect stroke survivors with others who have had similar experiences to provide emotional support.
- Medication: Your doctors may prescribe antidepressants or anti-anxiety medications.

It’s important to remember that after a stroke, depression and anxiety have a greater likelihood of developing. About one in three people develops depression, while one in four develops anxiety within the first year after having a stroke. Your emotional health is equally important as your physical health. If you suspect you or someone you love may be struggling with either condition, please get in touch with a healthcare provider.

With consistent therapies, family or friend support, and adaptive strategies, many stroke survivors achieve significant improvements in function and well-being.

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Common Questions

How long will stroke rehabilitation last?

The length of rehabilitation depends on the severity of a stroke and a person’s overall health and recovery rate.

For mild strokes, rehabilitation can take weeks to three or more months.
For moderate strokes, rehabilitation can stretch from several months to a year.
For severe strokes, rehabilitation can be ongoing for years, with some individuals requiring lifelong therapy.

There is good news: The brain has a remarkable ability to rewire itself through neuroplasticity, which allows undamaged parts of the brain to take over functions lost due to the stroke—and rehabilitation encourages this process through repetitive therapies and practice.

What are the chances of a full recovery?

Many stroke survivors will experience significant improvement, but full recovery depends on the severity of the stroke, the brain areas affected, and how early rehabilitation begins.

Some individuals regain all pre-stroke abilities, especially following mild strokes or with timely treatment. Many stroke survivors experience a partial recovery, meaning they can have lasting impairments, like weakness or paralysis on one side, difficulty with balance, coordination, or swallowing, or speech and language problems. In some cases, strokes result in severe disability, such as memory loss or reduced executive function and dependence on caregivers for daily activities.

Every stroke is different, so there is no perfect recovery pattern. However, faster treatment for all strokes leads to better outcomes. The effective management of risk factors, like high blood pressure or obesity, and comprehensive rehabilitation following a stroke also lead to better outcomes.

What are some of the challenges of stroke recovery?

Survivors of stroke often report feeling impatient with the speed of their recovery. While some abilities can return quickly, others take months or even years. It’s important to remember that while recovery takes time, persistence leads to results. Setting small, realistic goals and tracking progress to stay motivated are encouraged. A strong support system will also help maintain motivation.

Poststroke fatigue (PSF) is a prevalent condition caused by damage to the brain that affects energy levels and the ability to sustain activity. Muscle weakness or paralysis following a stroke can also make movement difficult. To help combat PSF, energy conservation techniques—like taking frequent breaks, prioritizing tasks, and avoiding overexertion—can help minimize its effects. So, too, do good sleep hygiene and a balanced diet.

Lastly, while stroke rehabilitation can be expensive, and insurance may not cover some therapies, medications, or home modifications, there are resources available. They include partnering with a social worker to help navigate insurance, disability benefits, and financial aid. Community resources, like nonprofits or stroke foundations, may also offer assistance.