Stroke affects each person in different ways, so recovery must be individualized. But one constant is that recovery steps should be started as soon as possible so the brain can begin to adapt and, to some degree, repair itself. The adult brain can’t regrow damaged areas, but thanks to brain plasticity, it can repurpose other parts to take on tasks that were previously handled by damaged sections.
Numerous studies have shown that stroke rehabilitation programs lead to the best outcomes. Very simply, people who participate in them do better than people who don’t. In general, stroke rehab has three main areas of focus: occupational therapy, physical therapy, and speech therapy. How much time a person spends on each depends on how the stroke affected them and what skills they need to relearn to regain independence and go back to living their best life.
Even people who experience a mild stroke should be carefully evaluated by members of their hospital’s stroke rehab team, not just the attending doctor or hospitalist, to map out the best course of action. That team might include a physiatrist, a doctor who specializes in rehabilitation; a neurologist who specializes in stroke care; a physical therapist who will work on movement; an occupational therapist who will work on everyday activities, like getting dressed and eating; a speech therapist who will work on speech and comprehension problems as well as any swallowing difficulty; and possibly a psychologist.
Some people are able to go home directly from the hospital after a few days and start rehab. Some stay in acute care in the hospital for a couple of days or longer, depending on the severity of the stroke, and then transition to an inpatient rehabilitation unit in the same hospital, a separate rehabilitation hospital, or a skilled nursing facility (also called a subacute rehabilitation program). The average stay in a rehabilitation unit or hospital is under two weeks, but it can vary between one and four weeks. Once a person is strong enough to go home, they might have a short course of home care and then go to outpatient therapy two or three times a week to continue working on activities that were started at the hospital.
The duration of formal stroke rehab varies from weeks to months. What’s key is to think about rehab the same way you would about going to school: The teacher gives you information, but then you have to do homework to get all the benefits. Even if you have the best physical therapist in the world, you’re getting only an hour or less with them three times a week. That leaves many other days—and many hours—during which you can work on your own.
Essential post-stroke activities
Weakness is the most widely known effect of stroke, and exercise is our No. 1 treatment. A study published in JAMA Network Open in May 2023 showed just how pivotal physical activity is to successful recovery. The researchers found that people who spent four hours a week exercising after their stroke doubled their chances of a good functional outcome when evaluated after six months.
Walking. Stroke-recovery exercise is different from exercise you’d do at a gym. When it comes to rehab, walking is the most important exercise. It helps you regain balance and endurance and gets you back in the community. Your physical therapist will also work with you on other aspects of physical rehab, such as range-of-motion and specific motor-skills exercises.
Upper body. For the upper body, focus on doing occupational activities. That might involve opening and closing a drawer and feeding yourself or simply moving the affected arm if that’s all you can do at first. Stimulating the recovery of the affected limb is critically important. It involves both getting back lost function and compensating for what you don’t have. While we want you to use your weak side as much as possible, we also want you to be able to live your life, so there may be times you need to rely on your unaffected limbs.
Cognition and communication. Other activities address cognitive and communication issues, such as speech disorders and aphasia (difficulty reading, writing, and expressing and understanding language). You may have a hard time focusing your attention or seeing on the left side if you had a stroke affecting the right side of the brain. Outside of formal therapy with a speech therapist, it will help to practice with family members and loved ones.
Socializing. An activity that’s often neglected, but that can have a huge impact on recovery, is socializing— spending time in a socially engaged and stimulating environment. More than doing crossword puzzles, Wordle, and Sudoku, you want to engage your mind by chatting with friends and family. Keeping up your end of a conversation uses your brain cognitively. Social engagement also helps with the depression and anxiety that many people feel after a stroke. Some people put their life on hold until they achieve what they view as a full recovery, but you don’t have to be exactly the person you were before to see your friends, go out to eat, or travel—even if you need to make certain accommodations.
If you have barriers to socialization—maybe loved ones live far away or you’re homebound, seek out a stroke support group. This is a great way to start connecting with others, sharing best practices, gaining a sense of camaraderie, and regaining your self-confidence. There are even specially focused groups, such as those for people with aphasia. One such group in the northern New Jersey area puts on an annual musical (many people still have the ability to sing despite aphasia). Joining a theater group isn’t something commonly thought of after stroke, but it can get you out into the community and allow you to have fun.
The Plateau Myth
There’s a misconception (fueled by some studies) that people reach a plateau after three to six months of rehab. We now know that intense therapy done even a year after a stroke brings results. Most people still have untapped capacity for improvement. Though insurance may cover only a certain number of months of therapy, you can keep challenging yourself. There’s no clock ticker that goes off at the three- or six-month mark and no reason to put added pressure on yourself to reach all your goals in that time frame.
Keep at your post-stroke activities and you’ll achieve more than you think. Remember that the brain needs consistent stimulation over time to rewire itself.
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