Stroke Rehabilitation: What to Expect

The goal of stroke rehabilitation is to help a person regain physical functioning, relearn lost skills, and improve overall quality of life. Outcomes will vary from person to person based on stroke severity and other factors that affect the recovery process.

This article will discuss what to expect during stroke rehabilitation, including types of treatment, rehabilitative activities, healthcare providers involved, where it takes place, and general timeline of treatment.

Physical Stroke Rehabilitation

There are many activities a person recovering from a stroke will accomplish in rehab. this can include strengthening motor skills and improving mobility, gait, and range of motion.

Motor Skill Exercises

Motor skill exercises will focus on improving your coordination and ability to control your movements. This includes fine motor skills that require the dexterity of your hands to grasp, grip, and pinch, as well as gross motor skills to move your arms and legs. Both physical and occupational therapists will work with you to improve your motor skills.

Mobility Training and Gait Training

Mobility training and gait training will focus on improving your functional strength to perform movements such as:

• Getting in and out of bed
• Standing up from a chair
• Getting on and off the toilet
• Walking
• Going up and down stairs.

An assistive device like a cane, hemi walker, or standard walker may be provided to you to assist with walking and maintaining your balance.

Constraint-Induced Movement Therapy (CIMT)

Constraint-induced movement therapy involves restricting or constraining one arm to encourage use of the other arm to work to complete certain tasks or skills. One side of the body is often affected following a stroke, causing muscle weakness and decreased coordination, which leads individuals to overcompensate with their other fully functioning side.

Restraining the unaffected arm, usually by placing it in a large mitten, forces patients to use their affected arm with reaching activities and fine motor movements to improve muscle activation, strength, and coordination.

Range of Motion Therapy

Range of motion exercises work on improving the flexibility of your muscles and mobility of your joints, especially if increased muscle tone and contractures have developed after a stroke that limits arm, wrist, hand, leg, and ankle movements.

Technology-Assisted Stroke Rehabilitation

Functional electrical stimulation involves the therapeutic use of delivering an electrical current to muscles via electrodes placed on the skin. This helps to stimulate the nerves in weakened muscles to improve function. An example is strengthening the rotator cuff muscles to stabilize a recurrent shoulder dislocation.

Robotic Technology

Robotic technology is used in stroke rehabilitation in the form of a wearable exoskeleton. These devices are placed on the outside of the arms or legs to assist the body to perform specific movements such as grasping objects and walking. Robotic technology is best used in conjunction with other treatments to help improve motor function and walking ability in patients after a stroke.

Virtual Reality

Virtual reality training involves interactive video games where a patient is in the first-person view of virtual scenarios. Research suggests that virtual reality training compared to conventional therapy may be more beneficial for improving upper body function and performance with everyday activities.

Wireless Technology

Wearable wireless technology can be used to monitor walking frequency, duration, and speed in patients post-stroke to track improvements over time and facilitate increased participation in treatment at home.

Cognitive and Emotional Stroke Rehabilitation

Occupational and speech therapy, and psychological treatment are part of cognitive and emotional stroke rehab.

Occupational Therapy

Occupational therapy involves working on fine motor movements as well as hand and upper body use to complete daily activities. It also works on activities to improve cognitive abilities, such as:

• Attention
• Memory
• Planning
• Decision making
• Problem-solving

Speech Therapy

Speech therapy helps with pronunciation of certain sounds, words, and sentences to improve speech as well as cognitive processing to verbalize thoughts and concepts.

Psychological Treatment

Psychological counseling can help provide social and emotional support to cope with the challenges with stroke rehab and recovery.

Medication may need to be prescribed following a stroke to help manage changes to your mood and emotional state including depression, anxiety, or increased agitation and aggression.

Experimental Therapies

Alternative medicine, biological therapies, and noninvasive brain stimulation are experimental treatments offered in stroke rehabilitation, however, more research is needed.

Alternative Medicine

Complementary and alternative medicine is a form of holistic medical treatment that aims to strengthen the body's immune system and reduce inflammation. These treatments include:

• Acupuncture
• Ayurveda
• Homeopathy
• Naturopathy
• Traditional Chinese medicine

While more research is needed to determine if alternative medical treatments are beneficial for managing stroke symptoms, preliminary studies suggest that herbal medicines and acupuncture have the potential to reduce inflammation, decrease blood clotting, and improve motor and sensory nerve function.

Biological Therapies

Research into biological therapy, including the alteration of genes that control fibronectin, a protein found in blood plasma, is currently being studied for the prevention of blood clotting that causes strokes.

Non-invasive Brain Stimulation

Non-invasive brain stimulation via transcranial direct current stimulation (tDCS) to specific brain regions has the potential to improve cognitive function and motor control, although further research is needed to validate consistent results.

Stroke Rehabilitation and Timing

Early rehabilitation is crucial following a stroke. According to the American Stroke Association, the most rapid progress with recovery occurs within the first three months after a stroke.

The stages of stroke rehabilitation will vary depending on the severity of your stroke and resulting impairments. The duration of stroke rehab can vary according to the following averages:

• Initial hospital stay: 4-7 days
• Inpatient rehabilitation facility: Between one week to 30 days with rehabilitation services provided every day
• Home healthcare: up to 60 days 
• Outpatient rehabilitation: variable depending on individual needs, lasting several weeks or months, usually starting at a frequency of 2-3 times per week for a minimum of four weeks

Where Does Stroke Rehabilitation Take Place?

After a stroke there are many different options for rehabilitation ranging from inpatient units, nursing facilities and at-home care.

Inpatient Stroke Rehabilitation Units

Inpatient rehabilitation units are specialized medical facilities where patients stay overnight for an extended period of time and have a structured schedule of daily physical, occupational, and speech therapy.

Patients in inpatient units usually have a lot of difficulty with completing daily activities, talking, and moving, and need intensive rehabilitation. Most patients who have a stroke attend inpatient rehab. 

Outpatient Units

Outpatient units can be located within hospitals or private practices where patients arrive for their rehabilitation session and return home the same day. Most patients follow up with outpatient facility after the initial inpatient stroke rehabilitation. If your stroke was not very severe, you may begin with outpatient therapy after being discharged from the hospital. 

Skilled Nursing Facilities

Skilled nursing facilities, or nursing homes, provide stroke rehabilitation services for long term residents. This is typically for patients who have residual impairments from a prior stroke or limitations from a recent stroke, and are unable to attend an outpatient program.

Home-Based

Home-based therapy services can be provided within your home if there are significant mobility, safety, or transportation issues preventing you from attending an outpatient program.

Stroke Rehabilitation Medical Team

There are many medical professionals who will be part of your healthcare team after a stroke and during rehabilitation, including:

• Physicians are the primary medical providers that will direct and oversee your care after you have a stroke. They will order magnetic resonance imaging (MRIs) or computed tomography (CT scans) of your brain to check for damage, prescribe medication, and provide treatment guidance.
• Rehabilitation nurses execute the orders determined by your physician, including administering any prescribed medications and monitoring your vital signs, while you are in the hospital or at an inpatient facility.
• Physical therapists will train you in getting in and out of bed, walking, often with an assistive device like a walker or a cane, and exercises to build up your strength and balance to improve your ability to move on your own. 
• Occupational therapists will provide you with exercises and activities that will help improve your fine motor movement as well as daily tasks, such as dressing, bathing, and eating.
• Speech language pathologists, or speech therapists, provide treatment that helps improve your speech and pronunciation of certain sounds, words, and sentences. They will also evaluate your swallowing to see if the muscles of your throat have been affected and whether a specialized soft or pureed diet is needed to prevent choking.
• Social workers coordinate care for patients between different providers, help determine a discharge plan after the hospital, and make sure the patient is set up with the appropriate services or equipment.
• Psychologists provide talk therapy and counseling to help patients cope with life after having a stroke and the challenges of rehabilitation. 
• Therapeutic recreation specialists use games, dance, music, sports, and arts and crafts to help improve mental and emotional wellbeing.
• Vocational counselors help people decide upon career paths and find jobs, especially after illness or disability.

Coping After a Stroke

Recovery and successful outcomes from stroke rehabilitation depend on a variety of factors, including:

• Physical factors: Severity of the stroke, resulting physical and cognitive impairments, and comorbid medical conditions that can impact recovery
• Emotional factors: Your emotional state and level of motivation to engage in treatment
• Social factors: The level of support from friends and family during recovery
• Timing: How early rehabilitation started
• Quality: The type of rehabilitation services provided
  

Summary

Stroke rehabilitation involves inpatient, outpatient, and at-home treatment across a variety of different disciplines including physical therapy, occupational therapy, speech therapy, psychotherapy, and medical management.

Your rehabilitation journey will include a team of healthcare providers, including physicians, nurses, physical therapists, occupational therapists, speech therapists, and psychologists, to help you rehabilitate. Treatment duration and outcomes largely depend on the severity of your stroke.

Stroke rehabilitation can be a long process, but early initiation and timing of treatment are crucial for recovery. The brain has a short window to change, especially after an injury like a stroke. The longer you wait to undergo rehabilitation from a stroke, the less likely you are to maximize your recovery potential.