RECOVERY AND REHABILITATION AFTER STROKE
Recovery from stroke is a lifelong process. Learn as much as you can about stroke and get help to plan your recovery. For many, recovery begins with formal rehabilitation. No matter where you are in your stroke recovery journey – remember, there is always HOPE.
What to expect as you recover
Getting back on your feet is likely one of your top concerns after a stroke. You may want to do basic things such as bath, go to the toilet, dress or feed yourself and tie your shoes without assistance. Some others may want to return to work or learn to drive again.
All these are goals of stroke rehab, which is a key part of your post-stroke care plan. Recovery also depends on the severity of your stroke. While each person’s ability to recover lost skills varies widely, stroke rehabilitation can usually help you achieve the best long term results.
What is stroke rehabilitation?
The goal is to restore as much independence as possible by improving physical, mental and emotional functions. This must be done in a way that preserves your dignity and motivates you to re-learn skills that the stroke may have affected, such as eating, dressing and walking, talking or driving.
Rehab normally starts in the hospital, as soon as you are medically stable. It may begin within one day after your stroke, and should be continued after release from the hospital. For some, rehab can take place weeks, months or years later as their condition improves.
Rehab options depend on several factors, including ability to tolerate intensity of rehabilitation (hours/stamina), degree of disability, available funding, support, insurance coverage, and your location or how accessible you are to rehab centres.
After a stroke parts that are slightly damaged can heal and recover within the first few weeks. The brain may also grow new cells after the stroke. Undamaged areas of the brain may also compensate, and take over some of the tasks of the damaged areas. The brain is also always able to learn new skills hence it will also be able to relearn the functions that were lost.
During rehab these processes are stimulated, and the nerves learn to function. Stroke recovery can be difficult to predict; most people will make most of their recovery in the early weeks and months following the stroke. However, recovery can continue after this time.
The goal of any stroke rehabilitation programme is to help you relearn skills lost when stroke damaged part of your brain. Participating in stroke rehabilitation helps you regain as much independence as possible and achieve the best quality of life. It takes time to relearn skills. The most important key to success is well-focused and repetitive practice.
Rehab includes some or all of the following:
- Physiotherapy to facilitate recovery of motor function to help you to regain use of your weak limbs. These may include exercises to:
- Improve control, strengthen and stretch of your muscles
- Increase endurance
- Enhance balance and coordination
- Mobility training – More than half of stroke survivors have difficulty walking. Therapy options include the use of walking aids such as braces, walkers or canes to support part of your body’s weight while you relearn how to walk.
- Speech therapy for communication disorders. After a stroke, you may have Aphasia which means having problems speaking, listening, writing or comprehending speech or other forms of communications. It is common, affecting about 40 percent of stroke survivors. Speech therapy can help you regain some or most of your lost ability. Therapy also helps with swallowing issues. The process can be slow and is often frustrating, but with practice you’ll likely improve.
- Counselling – After stroke, you may feel depressed and have difficulty managing your emotions. Anti-depressant medications, counselling by a health professional and participation in support groups may help.
- Training to improve memory, insight, reasoning and perception by an occupational therapist.
When to begin
Stroke rehabilitation should begin as soon as possible after a stroke. The first priority is to stabilise your medical condition and get life-threatening conditions under control. Doctors will also take measures to prevent another stroke and limit any stroke-related complications. Once these steps have been taken, it’s common for stroke rehabilitation to start during your hospital stay. The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills.
How long to do rehab
The length of your rehab programme depends on the severity of your stroke. While some stroke survivors recover quickly, most stroke survivors need some form of stroke rehab longterm, possibly months after their stroke. Your rehab plan will change during your recovery as you relearn skills and your needs change.
The length of time you spend exercising with your therapist during each therapy session will also vary depending on your recovery and severity of your symptoms. You may spend as little as one hour a day three days a week, or up to three to five hours a day, seven days a week. To optimise recovery you need to keep practising what has been taught on your own or with your caregiver.
Rehab options
You’ll probably begin stroke rehabilitation while you’re still in the hospital. Before you leave the hospital, you and your family will work with your medical team the best rehabilitation setting for you depending on your needs, what is most convenient for you and your family. These options include:
- Inpatient Facilities – freestanding or part of a larger hospital or clinic. In Malaysia, inpatient rehab may occur in some of the larger hospitals. There are presently two dedicated government hospitals – Hospital Rehabilitasi Cheras, in Kuala Lumpur and Pusat Rehabilitasi PERKESO Tun Abdul Razak, in Malacca. There are also private rehabilitation hospitals. You may stay at these facilities for two to six weeks as part of an intensive rehabilitation program. Expect to receive at least three hours of therapy on most days.
- Outpatient Centres – are often part of a hospital, clinic or in NASAM. You may spend several hours daily or three days a week, at such units relearning skills.
- Nursing Homes – some provide rehab c Best to check if it’s done by professionals and what is being offered. Most offer less intense therapy facilitated by nursing staff.
- Home-based – therapy done in your home allows greater flexibility. You won’t have access to specialised rehab equipment. It can also be very costly. There are hospitals and therapists providing home-based therapy.
Your stroke rehab team
A variety of specialists are involved your recovery. These may include:
At some NASAM centres we also have counsellors to help with social and emotional issues related to stroke recovery and caregiving. Many stroke survivors and carers are also available to share their experiences and helpful tips.
Results of stroke rehabilitation
Each stroke and every stroke survivor is different. Because stroke recovery varies so widely, it is hard to predict how many abilities the stroke survivor will recover. However, in general, successful, stroke rehabilitation depends on:
- Amount of damage to the brain
- Your will to recover
- Skills of your stroke rehab team
- Cooperation from family and friends – having a good support network has a big impact your recovery
- Timing of rehabilitation – the sooner you start the better you do
