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NeuroAxis Rehabilitation Services

Timeline for Your Physical Recovery: What to Expect After a Stroke

Quick Facts:

Your therapy and goals can be a little different at various stages of your recovery, depending on your own strengths and weaknesses, time since your stroke, and eve the type of facility you are at.
The 6 Brunnstrom stages can help you understand what to expect during your physical recovery and motivate you to keep working towards your goals.
Working with your Brain's ability to change and improve (neuroplasticity) is crucial at every stage of your recovery.

When you ask a medical professional “When will I get better after a stroke?” do you wind up with a variation on the unhelpful answer “we don't know when, everyone is different”? While that is true, every stroke and every recovery journey is different from another, there are also quite a few similarities that can help you understand what you’re going through and what you can expect as you recover.

What to Expect: Medical Intervention

When you or a loved one initially suspect you had a stroke*, the most crucial thing is getting medical attention as quickly as possible by calling 911 or going to the hospital. The amount of time that passes after first having a stroke will determine what kind of medical intervention - if any - you can get that might help with the severity of your stroke. Some medications can work by dissolving blood clots in the brain (if you’re having an ischemic stroke) or managing bleeding in your brain (for a hemorrhagic stroke). You may be admitted to the hospital after your stroke for further testing, monitoring of your symptoms and/or surgery.

B.E. F.A.S.T. TIP: Be on the lookout for certain characteristics to know what a stroke can look like and who should seek medical attention right away. These signs include:

Balance Difficulties

Eye Sight Changes

Face Drooping

Arm Weakness

Speech Difficulty

Time to call 911

What to Expect: Therapy and Facilities

If medically appropriate, your therapy (PT/OT/SLP depending on your needs) will often start in these initial days after getting to the hospital. These therapists will help you test out your skills after a stroke and can be some of the first people to help you move, talk, and process information. They will work with you to determine if you are safe enough with the skills you have and support you have to go home, even if you aren’t back to “normal.” They will also work with you if you aren’t able to return home immediately from the hospital and recommend you complete additional therapy at a nursing home or inpatient rehab center, depending on how much therapy you can tolerate at that point. You’ll most likely get more therapy at these places than you would during your acute hospital stay: possibly 30 min-2 hours a day in a nursing home and 3+ total hours of therapy a day in inpatient rehab. A case manager may be involved in coordinating your transition from the hospital to one of these levels of care and can talk to you about your options. All of these changes and transfers to different parts of the hospital and different facilities can be overwhelming. Don’t hesitate to ask questions if something is confusing or doesn’t seem quite right.

In a nursing home (SNF) or inpatient rehab (IPR), your therapy and medical team will work with you on all of the skills that can help you return home safely if that is your goal. When you regain these skills and/or are able to safely compensate for your weaknesses or have someone that can safely help you at home, you could be headed home. At this point, therapy is still SO very important to continue! Your therapists and doctors could recommend home health or outpatient therapy depending upon your medical needs, skills and strengths, and how easy it is for you to leave your home.

Another amazing option is a mobile outpatient company that provides the more focused therapy you would receive at an outpatient clinic with the convenience of never needing to leave your home or facility you’re staying at. NeuroAxis provides this service with therapists who are specialists in neurological and stroke rehabilitation!

What to Expect: Your Physical Recovery

Intensive therapies are critical in the initial months after your stroke, although progress can happen at any time (see Blog Post below). As mentioned before, stroke recovery looks a bit different for everyone, but something called the 6 Brunnstrom Stages can help you understand what to expect during each stage of your physical recovery and motivate you to keep working towards your goals. Your therapist can also have an understanding of these stages to know what direction you could be progressing and what type of exercises and interventions may be most appropriate to keep you moving forward in your recovery. These stages are:

Weakness and Flaccidity

Often some degree of weakness, or flaccidity, in one side of your body can occur initially right after having a stroke. This can last for days, months, or even years as your recover. Eventually, you will experience some tightness in your muscles, leading you into the 2nd stage.

Tightness and Spasticity

A tight and stiff arm and/or leg might immediately come to mind, but spasticity also can affect your trunk/abdomen, face and mouth muscles, and your whole body. Reaching or walking might be tough because of spasticity in your arm or leg, but it’s also important to address tightness throughout your body and system. Also important to note that the muscles in the same limb could have different amounts of stiffness or spasticity, which can also interfere with how you can coordinate your movements.

Even More Spasticity

Spasticity Decreases, More “Normal” Movements

You might notice it’s getting easier to do daily tasks. Important at every stage but especially here to REALLY get those reps in. Keep using your affected side a lot. It could still be easier to do things with your strong side or keep using the compensatory techniques to avoid using your weaker limb. But the more you practice and use the weaker and less coordinated body parts, the better. Don’t fall into the trap of learned non-use.

More Control Over your Movements, Spasticity Continues to Decrease

Back to “Normal”

Coordination improves and your movements are smoother. Your body might continue to feel more like “yours” and looks, feels, and functions pretty well in your daily life.

These stages are great for outlining your physical progress. It's also important to know that a stroke can affect many parts of you and your body, not just your physical abilities. Please work with your health team to address all changes that are bothering you or holding you back after a stroke: from thinking and concentration difficulties to emotional and mental health troubles. Your OT and SLP can provide you with exercises and strategies to manage these difficulties. In addition to your primary physician and neurologist, it might be beneficial to look into adding a neuropsychologist/psychiatrist to your healthcare team.

Wherever and whenever you happen to be in your stroke recovery journey, you can count on the fact that continued practice can keep you moving forward. Recovering from a stroke absolutely can take a lot of patience, time, concentration, dedication, and energy. Please be gentle with yourself and know that you are doing the best you can with what you can do now.

Interested in discovering for yourself what specialized stroke rehab can do for you? Check out the services we offer here and don’t hesitate to contact us for more information!

References:

https://www.ninds.nih.gov/about-ninds/impact/ninds-contributions-approved-therapies/tissue-plasminogen-activator-acute-ischemic-stroke-alteplase-activaser#overview

https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/stroke-recovery-timeline

https://www.stroke.org.uk/effects-of-stroke/neuroplasticity-rewiring-the-brain

https://www.healthpartners.com/blog/stroke-recovery-timeline/

https://www.flintrehab.com/stroke-recovery-timeline/

https://www.medicalnewstoday.com/articles/stages-of-stroke-recovery

https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-016-0178-x

NeuroAxis Rehabilitation Services

Benefits of Therapy for Chronic Stroke

Why You Should Keep Going to Therapy for Months - and Even Years - After Your Stroke

Please…Keep Going to Therapy.

Maybe you heard or were told before that you hit a plateau or that you only can get better for 3-6 months after a stroke. After that, you’re out of luck and you’re stuck only with the function you recovered in that time period. Maybe your arm or leg is still really stiff or weak or your speech is still hard for others to understand. PLEASE don’t be discouraged. The most important thing for you to know and understand right now is that you can continue to make progress even years after your stroke.

No, you’re not wasting your time. Yes, you can still get better, stronger, and more independent.

There is Always Hope.

Even though there are expected milestones and an expected stroke recovery progression, when it comes to stroke recovery, how fast and how much you get better can vary from person to person. But the one thing that is true for everyone: there is always hope and improvements are always possible.

Why is this Possible?

The reality is that it can be easier for things to improve in the weeks and months immediately after your stroke. Which is why good therapy is also so important in these initial stages and why you may have been told to expect the most progress until that point. This is because of multiple factors at play, including initial changes in the amount of certain neurotransmitters, brain enzymes, and growth factors called BDNF in the brain after a stroke. These changes could make it easier for you to recover and relearn skills you lost. You could experience something called “spontaneous recovery” where some partial movements and skills return quickly or seemingly without much effort. You also might be more motivated at the start of your recovery journey when improvements could be happening quickly and you just want to get back to “normal” as soon as possible.

But something that you always have to your advantage, one of the biggest reasons you can improve and recover function and independence, is called neuroplasticity. Neuroplasticity is the brain’s ability to create new pathways and connections in order to adapt, learn, and change your habits, movements, knowledge, anything!

For example, even if a certain part of your brain was damaged by your stroke and you can no longer move one of your arms, your brain can find alternate pathways and create new connections that could help you do the same thing (ie. move your arm).

There are plenty of real-life examples of people who continue to get better (or in some cases, are just starting to get better) years after their stroke. Scientific research also concludes that progress does NOT stop after only a few months and supports the fact that “continued improvement in the chronic phase of stroke can occur with regular, progressive skills practice of goal-directed tasks in the home.”

So, How Can I Keep Improving?

Neuroplasticity is a universal ability for any brain. But amazing occupational, physical, and speech therapy is able to capitalize on these principles and really use your brain’s own neuroplasticity to your advantage so you can regain even more function and independence.

There are different approaches that your therapist can use to encourage you to develop or hone your skills through neuroplasticity. These can vary depending on your own current personal strengths, weaknesses, and interests. Some of these might include:

Doing a LOT of repetitions. This is a great way the brain can relearn something and could be done with part of an activity (like pulling one sleeve over your arm) or with the whole task (putting on a whole shirt).
Making sure these repetitions are purposeful, functional, goal-oriented, and important to YOU. Don't hesitate to ask your therapist about a certain activity you would love to get better at.
Using assistive technologies during your activities. Cool things like electrical stimulation, computer programs/virtual reality, and robotics can help out your current movements and abilities to do those purposeful repetitions even better.
Practicing real-world situations. Making sure you can safely do things you’ll encounter in your daily life, like walking, getting in the car or on the toilet, having conversations with loved ones, and getting back to hobbies and things you enjoy.
Encouraging you to talk with your doctor to make sure your overall health - physical, mental, emotional - is taken care of. When you’re healthy, stroke recovery progress can be even better!

It might take longer - or even a whole lot longer - than you or your loved ones would like, but remember that there is always hope. You can always improve. You can always regain function and independence and get back to what you love. Progress after a stroke doesn’t end after 3-6 months.

For even more info and tips about neuroplasticity, click here for our free guide to “10 Principles of Neuroplasticity”

References and Further Reading:

Stages of Stroke Recovery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979857/

https://www.medicalnewstoday.com/articles/stages-of-stroke-recovery#brunnstrom-stages

https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/stroke-recovery-timeline

Brain-Derived Neurotrophic Factor (BDNF):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646383/

Spontaneous Recovery:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/stroke-recovery-timeline

Neuroplasticity:

https://www.britannica.com/science/neuroplasticity

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4026979/