Written by Benjamin K. Mattox, DrPH, PA-C
Stroke is an incredibly common medical condition, and folks who experience strokes are forced to deal with a number of harmful symptoms, from trouble speaking and walking to numbness and paralysis in the extremities. Fortunately, technology has come a long way and stroke-related deaths are far less common than they used to be, thanks to the range of treatments and preventative measures available. The methods outlined below should aid you greatly during your stroke rehabilitation period regardless of the cause, and with the help of a medical professional, you should be able to overcome your symptoms, with no sweat. For more information and to find additional beneficial products, head over to our handy dandy Caregiver University: Stroke Recovery blog. And be sure to browse all Stroke Recovery products for sale.
As the fifth leading cause of death among Americans, strokes are also a leading cause of serious long-term disability, reducing mobility in more than half of stroke survivors aged 65 or over. Also known as a cerebrovascular accident (CVA), there are different types of strokes:
Ischemic Stroke - Accounting for about 87-percent of all strokes, an ischemic stroke happens when there is an obstructed vessel supplying blood to the brain, also referred to as a blood clot. Fatty deposits lining those vessel walls (atherosclerosis) can result in cerebral thrombosis or cerebral embolism, stopping the flow of blood to the brain.
Hemorrhagic Stroke - Making up about 13-percent of stroke cases, hemorrhagic strokes occur when a weakened blood vessel ruptures, bleeding into the surrounding brain. Usually caused by aneurysms and arteriovenous malformations (AVM) along with uncontrolled hypertension (high blood pressure), the accumulated blood compresses the surrounding brain tissue, resulting in a stroke. Hemorrhagic strokes can happen within the brain (intracerebral) or between the brain and the surrounding membrane (subarachnoid).
Transient Ischemic Attack (TIA) - Often called a mini-stroke, a transient ischemic attack results from a serious, temporary clot. It causes temporary blockage of blood flow to the brain and doesn’t typically cause permanent damage. But a TIA is a warning stroke and should be addressed immediately at the first sign of symptoms. TIAs are often signal a major stroke in the future.
Brain Stem Stroke - Taking place in the brain stem, a stroke in this area can affect both sides of the body, sometimes leaving an individual in a “locked-in” state where they can’t speak or move their body below the neck. Because of their complex symptoms, brain stem strokes can be more difficult to diagnose. But like other stroke recovery processes, the sooner blood flow can be restored, the better the recovery prognosis.
Cryptogenic Stroke - Sometimes the cause of a stroke can’t be determined and this is referred to as a cryptogenic stroke.
Because it’s an emergency situation, the faster you receive treatment for a stroke, the better the outcome. But in the days, weeks, and months following a stroke event, the process can be slow and erratic, with different people recovering in a variety of ways. Although the recovery process looks different for everyone, understanding a sense of the typical stroke recovery timeline helps you or a loved one to better know what to expect.
Initial Treatment - Once you’re admitted to a hospital emergency room for a stroke, the medical staff will stabilize your condition and determine the type of stroke. Depending on the type, medications may be given to reduce the long-term effects of the stroke if you are treated in a timely fashion (Remember the F.A.S.T. reminder for stroke symptoms and call 9-1-1 and get to a hospital if any of those are present). Depending on the severity of the stroke, you may need to spend time in acute or intensive care.
Start Rehab - Initializing rehabilitation as quickly as possible after the cause of the stroke is treated is absolutely key to successful stroke recovery. Within 24 hours of the event, you may have a rehab team that includes neurologists, physiatrists, occupational and physical therapists, and speech-language pathologists, all working in conjunction to provide the best therapeutic options to optimize recovery from a stroke.
Hospital Stay - In general, the length of a hospital stay following a stroke is usually around 5-7 days. The medical team evaluates the effects of the stroke which then helps them determine the best rehab plan for the patient. Long-term effects, such as cognitive problems, speech impairments, swallowing difficulties, sleeping problems, and emotional symptoms like depression can be managed with the help of various therapists, along with re-learning how to walk, attending to personal hygiene, toileting adaptations, preparing meals, and dressing skills.
Leaving the Hospital - Dependent upon your level of functional impairment, your medical team will formulate a discharge plan that either sends you home or to a skilled nursing facility and/or rehab facility for inpatient or outpatient care. Continuing this rehab is crucial to a successful patient prognosis, and if you’re well enough to be at home, your doctor may order in-home healthcare visits with certain therapists to keep this therapy going.
The First 90 Days - As the most important time for recovery and when patients typically see the most improvement, the first 3 months following a stroke event see patients starting to regain movement and mobility. This is also the timeframe that some patients may experience a phenomenon known as spontaneous recovery as the brain finds new ways to complete tasks, resulting in a lost ability or skill suddenly returning.
Also known as the Brunnstrom Approach, the Brunnstrom stages of recovery describe the sequence of motor development and reorganization of the brain following a stroke. As a built-in organizational system, the brain automatically engages lower functioning reflexes in order to get any movement, then starts to sort out what is useful and what connections we require to build at a higher level. The Brunnstrom approach informs people who have had a stroke of the best movement actions to take advantage of to optimize post-stroke rehabilitation.
Stage 1: Flaccidity - Muscles on the affected side aren’t able to move and they may feel floppy and limp. At this stage, there aren't any signals being sent from the brain to the muscle to activate it. The suggested exercise for this stage is passive range of motion, using your other arm, equipment, or a therapist to assist with moving your arms, legs, hands, and feet. This sends signals from the muscles and skin about touch and movement, reminding your brain that the affected side is awake and ready to learn again.
Stage 2: Spasticity - Muscles may start to tighten reflexively and have a hard time relaxing. This spasticity is generally involuntary and the brain is still experiencing difficulty in sending any signals to the muscles for voluntary movement. While the passive range of motion exercise continues to be crucial in this stage of recovery, starting an active-assisted range of motion therapy plan will be helpful as well. This allows your body to do what it can which will improve your recovery progress, while you use passive ROM to do what it still cannot.
Stage 3: Increased Spasticity - Certain muscles may tighten more during this stage, with multiple muscles firing together when an individual tries to move the affected side of the body. This is the stage where you need to use your passive or active-assistive ROM exercises more purposefully, increasing the amount and intensity of the signals sent to the brain by incorporating these exercises into the things you already do every day. For example, you may be trying to work on feeding yourself, but can’t get your hand close enough to your mouth. Purposely thinking about moving your shoulder as you practice this movement with passive or active-assistive ROM helps you progress further in your stroke recovery. Check out the amazing SaeboMAS Mobile Arm Support for Stroke Recovery.
Stage 4: Decreased Spasticity - Involuntary muscle tightness and spasming start to decrease during this stage of motor recovery as the brain becomes more successful at sending signals to specific muscles to activate. This is the perfect time to start focusing on isolating movements to strengthen those brain connections to certain muscles by using a completely-active range of motion exercises. Even though the damage done to the brain after a stroke cannot be repaired, the inherent neuroplasticity of the brain allows it to be trained to use other non-damaged areas to do the same functions. This requires constant repetition of specific exercises and movements to improve how the brain sends signals.
Stage 5: Continued Decreased Spasticity - The brain is becoming even more successful at sending signals in this stage, and muscle tightening and spasticity are minimal. The affected side is able to move in a more complex way from the rehab progress previously made with passive ROM, active-assisted ROM, and active ROM, and this is the time to start adding resistance to these movements to gain strength. Adding in weights, specific strengthening equipment, resistance bands, and other kinds of supportive exercise and therapy devices will help you to recover better strength and control.
Stage 6: Coordination Returns - Spasticity disappears completely, with coordination making fast gains in this stage. Motor control may be almost fully restored in this stage of stroke rehab, and adding in more involved coordination exercises that involve both sides of the body will help tremendously at this time to optimize recovery. In this stage, it’s a good time to start practicing activities you want to get back to doing, as your brain will be more motivated to practice coordination if you enjoy the activity.
There are several risk factors for a stroke, and many are within your control. Because 1 in 4 stroke survivors have a higher tendency to suffer another stroke, it’s important to know your own personal risks for developing a stroke event to improve your chances of prevention. Knowing the risks that are not within your control enables you to place your focus on the risk factors you are able to control.
Age - The chances of having a stroke increase with age, although many people under 65 also experience strokes, including babies and children.
Family history - If your brother, sister, grandparent, or parent has had a stroke, especially before reaching age 65, this may increase your own stroke risk. Genetic disorders like CADASIL that block blood flow to the brain may also raise your risk.
Race - Black, Hispanic, and Latino people have a higher rate and unique risks for stroke than White people.
Gender - Women have more strokes and die more from strokes than men, with women living longer than men and being older when they experience a stroke. Factors that increase these risks for women include pregnancy, gestational diabetes, post-menopausal hormone therapy, and oral contraceptive use, especially when it’s combined with smoking.
Prior TIA, Stroke, or Heart Attack - People who have had transient ischemic attacks (TIAs) are almost 10 times more likely to have a stroke than someone of the same age and gender who hasn’t. Individuals with a prior stroke also increase their chance of having another stroke, as does anyone who has suffered a heart attack.
High Blood Pressure (Hypertension) - It’s important to know your numbers and manage high blood pressure, as this is the leading cause of stroke. Consider purchasing a quality Blood Pressure Monitor so you can closely monitor yourself while at home.
Diabetes - Controlling diabetes and keeping your blood sugar within normal ranges helps tremendously in reducing your stroke risk. Just having diabetes, however, can raise your risk of stroke, so it’s best to prevent diabetes as well.
High Blood Cholesterol - Larger, built-up amounts of cholesterol in the blood can cause blood clots that lead to a stroke. Manage high cholesterol, reducing LDL while you increase HDL to lower your risk of a stroke event.
Smoking - If you quit smoking, it can greatly reduce your chance of a stroke, as the nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system. Smoking combined with the use of birth control pills significantly increases the risk of a stroke. Nothing good comes from smoking, but you already know that. This is your sign that you need to quit. Let TODAY be the day you quit smoking!
Physical Inactivity - Exercise, movement, and activity not only reduce your chance of developing a stroke, but also help decrease your risks for heart disease, high blood pressure, diabetes, high blood cholesterol, and obesity. Browse all Exercise, Gym, & Fitness Equipment and consider what a reasonable work-out routine looks like for you. And remember, SOMETHING is better than NOTHING.
Obesity - Excess body weight and obesity are linked with an increased risk of stroke, along with raising the risk of high blood pressure, diabetes, and heart disease. Just losing a few pounds can make a world of difference for some people, and help lower those negative risks.
Diet - Daily diets full of trans fats, saturated fats, and cholesterol often raise blood cholesterol levels, while too many calories lead to obesity, and too much salt can increase blood pressure - all of which raise your stroke risk. Whereas a diet with five or more servings of fruits and vegetables every day may reduce the risk of stroke.
Carotid Artery Disease - Located in your neck, the carotid arteries supply blood to the brain but can be narrowed by fatty plaque build-ups in artery walls (atherosclerosis), leading to blood clots that result in strokes. Following the advice of your physician will help manage this condition and help to lower your risk.
Peripheral Artery Disease - Also known as PAD, peripheral artery disease is also caused by a fatty buildup of plaque in the artery walls but pertains to the blood vessels carrying blood to leg and arm muscles. This narrowing leads to carotid artery disease, which raises the risk of stroke. Better management of this condition, including specific exercise, can help in lowering the risk of stroke.
Atrial Fibrillation - A heart rhythm disorder, atrial fibrillation, also referred to as AFib, increases the risk of stroke fivefold. Sometimes linked to sleep apnea, which also increases the risk of stroke, AFib causes incorrect upper chamber heartbeats, which can lead to blood pooling and the development of a clot. Medical treatment and following your doctor’s advice can lower this risk.
Other Heart Disease - Individuals living with coronary heart disease or heart failure have an increased risk of stroke than those with healthy hearts. An enlarged heart (cardiomyopathy), some types of congenital heart defects, and heart valve disease can all heighten the stroke risk, as well. Medical management of these conditions can help lower stroke risk.
Sickle Cell Disease - Also known as sickle cell anemia, this disorder primarily affects Black and Hispanic children, lowering the oxygen carried by the blood cells to the body’s tissues and organs. These “sickled” red blood cells also tend to stick to blood vessel walls, blocking arteries to the brain, and resulting in strokes. Managing flare-ups aids in reducing the stroke risk from this disease.
Yes, some brands exclusively produce stroke recovery products. Our favorite brand is Saebo. Saebo offers products for foot drop, electrical stimulation, hand therapy, and more.
How long the stroke recovery process takes is dependent upon many factors, including if the stroke was milder or more massive in scope. Most people will experience more than 50-percent improvement, with the majority of patients able to walk again, although they may require an assistive device like a walker or cane. Adhering to the prescribed regimen of specified exercises and movements as quickly as possible after the acute danger of the stroke has passed is key to the best patient outcomes. Performing multiple repetitions of a functional task on a daily basis promotes neuroplasticity, enabling the brain to make new connections, and results in a quicker and more complete stroke recovery timeline.
At this time, about 10-percent of stroke patients recover almost completely, 25-percent recover with minor impairments, approximately 40-percent experience moderate to severe impairments requiring specialized care, and about 10-percent of stroke patients require skilled care in a nursing home or other long-term facility. Around 15-percent of people who suffer a stroke die shortly afterward. The people who tend to regain the most function in the quickest way are those following a well-organized, multidisciplinary approach to post-acute rehab.
Massage devices help support stroke recovery in that it helps reduce muscle tension and tightness, alleviate muscle spasms, pain, and inflammation, and assist in improving joint function, nerve processes, and circulation. It helps relax the mind as well, relieving anxiety caused by the trauma of stroke, often resulting in improved sleep.
Once you have gotten through the majority of your stroke rehab recovery, it’s more important than ever to focus on the risk factors that are within your control. Reducing the risks that tend to cause strokes, such as managing high blood pressure and diabetes, quitting smoking, and incorporating more exercise and movement into your life can make a significant difference in your quality of life and help you prevent another stroke from occurring.
There are multiple recovery mechanisms involved following a stroke that all have their importance, but the neuroplasticity gained through constant, repetitive functional rehab training is one of the best determinants of successful recovery after a stroke. It’s no surprise that avoidance or non-compliance with this kind of rehab tends to result in low or limited recovery.
Acupuncture can aid in the stroke recovery process by helping with sleep, digestion, and relaxation of the mind to relieve stress and anxiety. It has been used to reduce pain, inflammation, and edema in stroke patients, and one recent study showed that when it’s combined with exercise, acupuncture can relieve shoulder pain resulting from a stroke.
The recovery timeline for a stroke will be different for everyone and can take weeks, months, or even years to recover more fully, while some people will experience long-term or lifelong disabilities. Constant, repetitive movements and rehab exercises tend to bring the best results to optimize individual recovery.
Smoking has long been linked to an increased risk of strokes, along with other health issues, and a new study suggests that those who smoke or have recently quit are at a higher risk of being severely impaired after a stroke than their peers who never smoked. People who were current smokers at the time of their stroke were 29-percent more likely to have poor functional outcomes afterward than nonsmokers. Make today THE DAY you quit smoking! Here’s your sign!
Recovery from a stroke can seem like a very slow process, but if you’re following your rehab plan, progress is happening, even if it's so incremental, you don’t notice it at first. Making and keeping recovery goals along with tracking and assessing your daily progress will keep reminding you of the improvements you are making, including an improved range of motion, coordination, and balance.
All things said, having a stroke is scary and the recovery period is difficult - there’s just no way around it. It’s a condition that affects a monumental amount of people, from the survivors to their friends and loved ones, to the healthcare providers who treat them. That being said, there are lots of tools available to make the journey easier, and we’ve outlined a lot of those tools above. There’s even more, though. Check out our Stroke Recovery products for sale for some awesome products that can ease the burden of rehabilitation for you and your loved ones.
Interested in learning more about stroke rehab? Then check out Caregiver University: Stroke Recovery for product reviews, buying guides, and other articles that you will be sure to bookmark!
Benjamin K. Mattox, DrPH, PA-C
Orthopedic surgery physician assistant, doctor of public health, and owner of a public health consulting firm. With over a decade of Active Duty Navy Experience, Deployments with the Navy SEALS, and as a Professor for Purdue University - Dr. Mattox is a highly qualified and experienced clinician with a firm understanding of orthotic needs, rehabilitation, home access needs, gait therapy, and veteran-specific health needs.
