Stroke Recovery: Outpatient Rehabilitation
What to Look for, What to Ask When Recovering From a Stroke
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.
What you can do to help a stroke survivor
- Get to know the members of his rehab team. And remember that as a close friend or relative, you are one of the key members of that team. Your active participation and encouragement during the rehabilitation process can make a world of difference.
- Set realistic goals and expectations. If you'll be a primary caregiver, talk to the rehabilitation team about his prognosis for recovery. And don't just talk to them about it once -- revisit the subject every few months. One thing that's certain is that rehabilitation is a fluid process. You, the person you're caring for, and the rest of the rehabilitation team should expect to reevaluate his program -- and your expectations -- on a regular basis.
- Help the patient make the most of what he has. As a caregiver, one of your main goals is to help the person you're caring for live the best life possible. You can encourage and facilitate his independence in a number of ways, not the least of which is modifying his home to make everyday activities easier.
- Enjoy the time you have together. It's easy to get caught up in all the details of his rehabilitation, treatment, and restrictions. What's not so easy is living in the moment. Try to help him remember and do some of the things he used to like to do. If he can walk, take a gentle stroll with him, even if he needs to move slowly. If he can't, perhaps he'd like to get out in the wheelchair with you pushing. An ice cream cone may not be the best thing for his cholesterol, but as a one-time treat, the joy it brings him may outweigh its detrimental effects. Of course, you have to weigh the risks and benefits -- letting him smoke a cigarette, for instance, is not a good idea -- but don't let his illness keep him from appreciating life's healthier pleasures, especially when you can share them.
- Give him the opportunity to leave a personal legacy. Most people think of a legacy as the property a person leaves behind when he dies, but the word has a deeper meaning. According to geriatric expert David Solie, an older person is driven by the need to create and leave behind a nonmaterial legacy that gives greater meaning to a lifetime of experiences and relationships. For more information on how you can help an older adult leave a legacy, see Your Parent's Legacy: A Beginner's Guide.
- Seek help if you think he's depressed. As many as half of stroke survivors will become depressed, according to James Castle, a neurologist at Stanford University. Depression may make him more susceptible to pain and fatigue and may even delay his recovery. Although it's not always easy to sort out clinical depression from the normal sadness accompanying a catastrophic event like a stroke, there is a difference. Be on the lookout for these warning signs:
- Frequent crying episodes
- Feelings of hopelessness or worthlessness
- Poor appetite or increased appetite
- Sleeping too much or not enough
- Increased agitation and restlessness
- Loss of interest in life
- Expressing thoughts of dying or suicide
The person you're caring for should be evaluated for depression if he has had several of these symptoms for more than two weeks. For more information about depression after stroke, see What to Do When Your Parent Experiences Depression After a Stroke.
- Accept his limitations -- and your own. You aren't responsible for his feelings or decisions. You can't force him to follow his doctor's dietary recommendations, stop smoking, or seek treatment for depression. Your job is to encourage and support him when appropriate and state your misgivings when you think he's endangering his health. When you're thrust into the position of caregiver, it's not always easy to remember that he's an adult. In the end, how he chooses to live the rest of his life is up to him.
- Take care of yourself. Remember the safety demonstration flight attendants give before a plane takes off? "Make sure your oxygen mask is in place before helping others with their masks." You're no good to a stroke survivor if you're a physical and emotional wreck. Don't feel guilty for taking time to care for yourself. Your needs and happiness may be overshadowed by his illness for a time, but if you neglect your own life for too long, you do a disservice to yourself and everyone who loves you -- including the person you're caring for.