Stroke rehabilitation: What to expect as you recover
Medically reviewed on May 24, 2017
The goal of stroke rehabilitation is to help you relearn skills you lost when a stroke affected part of your brain. Stroke rehabilitation can help you regain independence and improve your quality of life.
The severity of stroke complications and each person's ability to recover vary widely. Researchers have found that people who participate in a focused stroke rehabilitation program perform better than most people who don't have stroke rehabilitation.
What's involved in stroke rehabilitation?
There are many approaches to stroke rehabilitation. Your rehabilitation plan will depend on the part of the body or type of ability affected by your stroke.
Physical activities might include:
- Motor-skill exercises. These exercises can help improve your muscle strength and coordination. You might have therapy to strengthen your swallowing.
- Mobility training. You might learn to use mobility aids, such as a walker, canes, wheelchair or ankle brace. The ankle brace can stabilize and strengthen your ankle to help support your body's weight while you relearn to walk.
- Constraint-induced therapy. An unaffected limb is restrained while you practice moving the affected limb to help improve its function. This therapy is sometimes called forced-use therapy.
- Range-of-motion therapy. Certain exercises and treatments can ease muscle tension (spasticity) and help you regain range of motion.
Technology-assisted physical activities might include:
- Functional electrical stimulation. Electricity is applied to weakened muscles, causing them to contract. The electrical stimulation may help re-educate your muscles.
- Robotic technology. Robotic devices can assist impaired limbs with performing repetitive motions, helping the limbs to regain strength and function.
- Wireless technology. An activity monitor might help you increase post-stroke activity.
- Virtual reality. The use of video games and other computer-based therapies involves interacting with a simulated, real-time environment.
Cognitive and emotional activities might include:
- Therapy for cognitive disorders. Occupational therapy and speech therapy can help you with lost cognitive abilities, such as memory, processing, problem-solving, social skills, judgment and safety awareness.
- Therapy for communication disorders. Speech therapy can help you regain lost abilities in speaking, listening, writing and comprehension.
- Psychological evaluation and treatment. Your emotional adjustment might be tested. You might also have counseling or participate in a support group.
- Medication. Your doctor might recommend an antidepressant or a medication that affects alertness, agitation or movement.
Experimental therapies include:
- Noninvasive brain stimulation. Techniques such as transcranial magnetic stimulation have been used with some success in a research setting to help improve a variety of motor skills.
- Biological therapies, such as stem cells, are being investigated, but should only be used as part of a clinical trial.
- Alternative medicine. Treatments such as massage, herbal therapy, acupuncture and oxygen therapy are being evaluated.
When should stroke rehabilitation begin?
The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills.
However, your doctors' immediate priorities are to:
- Stabilize your medical condition
- Control life-threatening conditions
- Prevent another stroke
- Limit any stroke-related complications
It's common for stroke rehabilitation to start as soon as 24 to 48 hours after your stroke, while you're in the hospital.
How long does stroke rehabilitation last?
The duration of your stroke rehabilitation depends on the severity of your stroke and related complications. Some stroke survivors recover quickly. But most need some form of long-term stroke rehabilitation, lasting possibly months or years after their stroke.
Your stroke rehabilitation plan will change during your recovery as you relearn skills and your needs change. With ongoing practice, you can continue to make gains over time.
Where does stroke rehabilitation take place?
You'll probably begin stroke rehabilitation while you're still in the hospital. Before you leave, you and your family will work with hospital social workers and your care team to determine the best rehabilitation setting. Factors to consider include your needs, what insurance will cover, and what is most convenient for you and your family.
The options include:
- Inpatient rehabilitation units. These facilities are either freestanding or part of a larger hospital or clinic. You may stay at the facility for up to two to three weeks as part of an intensive rehabilitation program.
- Outpatient units. These facilities are often part of a hospital or clinic. You may spend a few hours at the facility a couple of days a week.
- Skilled nursing facilities. The type of care available at a nursing facility varies. Some facilities specialize in rehabilitation, while others offer less-intense therapy options.
- Home-based programs. Having your therapy at home allows greater flexibility than other options. One drawback is you likely won't have access to specialized rehabilitation equipment. In addition, insurance strictly controls who qualifies for home-based therapy.
Talk to your doctor and family about the best option for you.
Who participates in your stroke rehabilitation team?
Stroke rehabilitation involves a variety of specialists.
Specialists who can help with physical needs include:
- Physicians. Your primary care doctor — as well as neurologists and specialists in physical medicine and rehabilitation — can guide your care and help prevent complications. These physicians can also help you to gain and maintain healthy lifestyle behaviors to avoid another stroke.
- Rehabilitation nurses. Nurses who specialize in caring for people with limitations to activities can help you incorporate the skills you learn into your daily routines. Rehabilitation nurses can also offer options for managing bowel and bladder complications of a stroke.
- Physical therapists. These therapists help you relearn movements such as walking and keeping your balance.
- Occupational therapists. These therapists help you relearn hand and arm use for daily skills such as bathing, tying your shoes or buttoning your shirt. Occupational therapists can also address swallowing and cognitive issues, and safety in your home.
Specialists who focus on cognitive, emotional and vocational skills include:
- Speech and language pathologists. These specialists help improve your language skills and ability to swallow. Speech and language pathologists can also work with you to develop tools to address memory, thinking and communication problems.
- Social workers. Social workers help connect you to financial resources, plan for new living arrangements if necessary and identify community resources.
- Psychologists. These specialists assess your thinking skills and help address your mental and emotional health concerns.
- Therapeutic recreation specialists. These specialists help you resume activities and roles you enjoyed before your stroke, including hobbies and community participation.
- Vocational counselors. These specialists help you address return-to-work issues if that is a goal.
What factors affect the outcome of stroke rehabilitation?
Stroke recovery varies from person to person. It's hard to predict how many abilities you might recover and how soon. In general, successful stroke rehabilitation depends on:
- Physical factors, including the severity of your stroke in terms of both cognitive and physical effects
- Emotional factors, such as your motivation and mood, and your ability to stick with rehabilitation activities outside of therapy sessions
- Social factors, such as the support of friends and family
- Therapeutic factors, including an early start to your rehabilitation and the skill of your stroke rehabilitation team
The rate of recovery is generally greatest in the weeks and months after a stroke. However, there is evidence that performance can improve even 12 to 18 months after a stroke.
Stroke rehabilitation takes time
Recovering from a stroke can be a long and frustrating experience. It's normal to face difficulties along the way. Dedication and willingness to work toward improvement will help you gain the most benefit.