Stroke Recovery: Outpatient Rehabilitation
What to expect when someone is recovering from a stroke
After a stroke, someone you're caring for may be able to regain some -- maybe even most -- of his former abilities, or learn to adapt to compensate for those he's lost. And you and the rest of his family and friends are an essential part of his recovery and rehabilitation.
Stroke recovery: A long-term process
In the stroke world, the term recovery refers to the actual return of neurological function. When a stroke survivor regains the use of a weakened limb, that's an example of recovery. Spontaneous recovery occurs during the first days to weeks after a stroke, as brain circulation improves and swelling decreases.
Then neuroplasticity -- the brain's ability to modify its own functional organization -- takes over. The brain can't regenerate neurons that have been lost, but it can adapt to injury by forming new connections between existing neurons. And the latest research suggests that the brain can actually grow new neurons, although the implications of this aren't yet clear.
Although most neurological recovery takes place within the first few months after a stroke, the road to recovery doesn't end there. With rehabilitation, stroke survivors can learn new ways to compensate for lost abilities. So even if the patient doesn't regain use of his weakened arm, he might learn techniques for dressing himself with one arm.
Outpatient rehabilitation after a stroke
Once the stroke survivor is discharged from the hospital, he'll either go to a long-term care community or begin rehabilitation. Rehabilitation can take place either at home or at a rehabilitation facility.
Even after you decide where he'll be during rehabilitation, you'll likely still have to deal with some uncertainty about his future. Three months after a stroke, 50 to 70 percent of survivors are able to live independently, 15 to 30 percent are permanently disabled, and 20 percent need long-term institutional care. But his situation will depend on the severity of his stroke and the general state of his health. There's no way to plan exactly how his recovery will go.
Nevertheless, rehabilitation can enable him to make progress over the next year or even longer, even though most of his spontaneous neurological recovery will occur in the first few months. Long-term rehabilitation can help:
- Make the most of the functional abilities he still has and those that he regains spontaneously
- Learn new strategies to compensate for abilities he has lost
- Forge new neuronal connections to bypass injured brain cells
- Minimize medical complications and reduce the risk of a second stroke
How the stroke may affect him
Although rehabilitation is a lifelong process, at some point the appointments with therapists and nutritionists will end. That's when you and the person you're caring for begin the real journey of living life in the aftermath of his stroke.
According to the National Heart, Lung, and Blood Institute's (NHLBI) Framingham Study, survivors of an ischemic stroke aged 65 years or older had the following disabilities at six months:
- Fifty percent had some paralysis.
- Thirty percent couldn't walk without assistance.
- Twenty-six percent needed help for activities of daily living.
- Nineteen percent had difficulty speaking, writing, or understanding language.
- Thirty-five percent suffered from depression.
- Twenty-six percent were institutionalized in a long-term care facility.
The Framingham Study also reveals that the median survival period after a first stroke is 6.8 years for men and 7.4 years for women 60 to 69 years of age. This median survival period decreases dramatically as the survivor's age increases.
Of course, none of this tells you how long someone will live or what his quality of life will be, but it does give you a framework for your expectations.