Understanding chronic stroke treatment from a rehabilitation perspective

Victoria Malloy, OTR/L, and Brianna Clark, PTA

After enduring a stroke or cerebrovascular accident (CVA), patients and families may find treatment and follow-up appointments overwhelming. Doctors may prescribe additional medications and patients may undergo inpatient rehabilitation, outpatient rehabilitation or at-home rehabilitation. While you may find that some of those appointments slow down after a few months as you recover and return to most of your daily activities, that does not mean stroke treatment and recovery cannot continue.

You can make recovery after a stroke or CVA for years after the stroke occurs. Let’s take a closer look at recovering from a stroke.

What are the levels of stroke recovery?

There are various levels of stroke or CVA recovery.

• From 1 day to 2 weeks after a stroke/CVA, you are in the acute phase of CVA/stroke recovery, where doctors focus on a patient’s medical stabilization and cardiac function/health.
• Between 2 weeks to 3 months following a stroke/CVA, you are in an active recovery phase where a lot of recovery can occur, but not all. The main priority is focusing on returning to independence and your normal routines and activities.
• From 3 months to 6 months, recovery can be a little bit slower but can occur with repetition, practice and training.
• Starting at 6 months and beyond, further recovery is possible with rehabilitation. Consistent and updated home exercise programs are also helpful. Tune-ups are recommended as new challenges present themselves in daily lives. Discuss any independence or challenges with your neurologist or primary care physician; you can request an updated prescription for physical, occupational or speech therapy to help you move forward.

Lasting effects and deficits of a stroke

Even after the initial recovery phase, you may still experience challenges or deficits because of a stroke/CVA.

Are you still having trouble getting up out of a chair or going upstairs to your bedroom after a full day of activity?

Whether you have had a mild or severe stroke, you may experience lasting effects and deficits such as weakness in your upper or lower extremities, general deconditioning or fatigue, balance challenges and/or trouble ambulating. After an initial evaluation from a physical therapist, you can start on improving tasks such as stair training, floor transfers, bed mobility and transfers in and out of a chair. The goal is to help improve overall levels of independence and functionality and educate on ways to enhance quality of life. Muscular and cardiovascular endurance may also be affected well after a stroke. Physical therapy can help increase your tolerance to exercises as well as your ambulatory tolerance (i.e., walking). Whatever your goals are, outpatient rehabilitation can help you pursue them no matter how much time has passed since your stroke.

Are you still having difficulty using your hand for eating? Is your handwriting not up to your standards?

You feed yourself multiple times a day and doing so requires both hands at times, along with a lot of motor control and coordination. Coordination training is very important following a stroke. Additionally, building strength in areas where you feel weak to increase your precision for eating is something occupational therapy can assist you with even years after a stroke occurs. Some people may also find handwriting tiresome following a stroke/CVA; occupational therapy can also assist in this area. You can continue making recovery and improvements in fine motor coordination for years after a stroke.

What to expect

You have the right to choose your outpatient therapy provider. To get started – or, in some instances, re-started – with the process of beginning outpatient rehabilitation, you need a prescription from your doctor for physical, occupational and/or speech therapy. In the case of Good Shepherd, our treatment team will schedule an initial evaluation to assess your needs and to help you develop functional goals. Then, we obtain outcome measures to gather a baseline of your strengths and weaknesses; this helps therapists figure out a starting point for your therapy.

Additionally, Good Shepherd has an expert team of physical medicine and rehabilitation doctors (physiatrists), who specialize in how the body functions, including after stroke.

It’s a journey

After a stroke, you may have had a few months of occupational, physical and/or speech therapy in an outpatient, inpatient or home setting. At one point, you may have made as much progress as you could, but now there are still things you would like to work on.

Through any one of Good Shepherd’s outpatient locations, our team can personalize treatment to improve your skills and get you back to everyday tasks and activities.

Wherever you are in stroke recovery, call 1-888-447-3422 (44-REHAB) or contact us online to become a patient.