Recovery After Stroke

[ photo by Henry & Co ]

Recovery after stroke.

I recently had a patient in rehabilitation following a severe stroke. Let’s call him John (not his real name). John’s stroke was a hemorrhagic stroke, meaning a vessel within his brain ruptured, causing the stroke.

Prior to this stroke, he had been pretty healthy. He was on medication for hypertension, and the blood pressure had been well controlled, to his knowledge. He was overweight, but otherwise, he did not have any other health issues. John was recently retired, and his wife was still working.

One day, while she was at work, she had not been able to get in touch with him. Her son went to check on him at home because it was not like him to not answer his phone. His son found him down on the floor with right sided weakness and difficulty speaking. Fearing that John had suffered a stroke he was rushed to the hospital where the CT scan confirmed he had had a left middle cerebral artery stroke.

He remained in the hospital for just over a week where he received additional work-up for the stroke. This included several scans and optimization of his blood pressure. He was seen by a team of therapists for physical therapy, occupational therapy and speech therapy in the acute care hospital. He was having some trouble with swallowing, so the speech therapist placed him on a diet of chopped foods. He also had great difficulty expressing himself through his speech. Once he was medically stable, he was transferred to acute rehabilitation, which is where I first met him. 

Stroke recovery treatment.

John’s stroke rehabilitation stay was long--double the average length of an acute rehabilitation stay. His stay was complicated by urinary retention (commonly seen after a stroke), difficult to control blood pressures, pain in the stroke-affected side, pain in the non-affected side (due to the added stress of bearing the brunt of all transfers and movement), poor sleep, profound drowsiness, and depression.

My list could keep going for quite a few more problems, but I really just wanted to make a point that acute inpatient rehabilitation, or any rehab for that matter, is not without its bumps. I have had only a handful of stroke recovery patients in my career that haven’t had at least a couple of hiccups in their rehabilitation. The reason I am writing about John’s rehab is because of how he continued to progress through these stroke rehabilitation challenges. His is a classic picture of how I often describe the stroke rehabilitation trajectory for a patient. 

Stroke recovery timeline.

Envision a line of someone starting at point A and climbing up at an angle to point B. Now, I am assuming you are seeing a nice straight line making its way up to that next point. Erase that straight line and imagine it moving up and down though still SLOWLY making its way up. This is how I describe rehab, especially after a stroke, to my patients and their family members.

This is the course that John’s stroke rehabilitation took.  I tell patients this very important detail to hopefully avoid at least some discouragement along the way. If the three steps forward-two steps backwards process is normalized a bit, then it doesn’t make it such a huge shock to the patients and their family members when this occurs. Instead, it’s better to look back at where your loved one started and where they are now. You often have to look at the big picture rather than the day by day progress. With that being said, however, those little baby steps must be celebrated. Take every victory that comes during stroke rehabilitation!

John’s initial discharge date was set for approximately three weeks out from his admission, which is the longer side of the typical duration of acute inpatient rehab for someone who is recovering from a severe stroke. Once we were just over two weeks into his rehab, however, he took off. Most of the bumps I had listed above occurred in those first 10 days. The way he was progressing initially looked like he was going to need to go to a skilled nursing facility for subacute rehabilitation at his time of discharge. He would need this type of environment because we did not think he was going to get to the level necessary for him to be able to safely discharge to home with his wife. He was still needing the assistance of two people for most of his ADLs and his transfers.

Oftentimes, this is what happens after a severe stroke. That certainly is not a failure, however. Some people sometimes just progress slower than others, and those additional days in subacute rehab with daily therapy allow for continued improvement in those first few months during recovery after a stroke. 

Moving on to the next stage of recovery after stroke.

Now, back to John. Instead of giving up despite all of those initial set-backs, he kept trying. He needed some serious pep talks on some days, but at the end of the day, he had completed every task the therapists had asked of him. Once he turned that corner, it was looking like he would be able to go directly home from acute rehab instead of the original plan of subacute rehab. We ended up extending his stay by another week, putting him in rehab for 29 days total. Again, that stay was longer than the norm, but those extra days got him home! 

In the days leading up to his discharge, John’s wife completed a long list of family training tasks to ensure she would be able to safely assist him at home. Arrangements were made for John to have therapy through home health. In addition, they would also have a home health aid to help with the non-medical tasks and a social worker to help navigate the continued rehabilitation process.

I don’t want to paint too rosy a picture in telling this story, though. Both John and his wife were very nervous about him going home. A little bit of nervousness is good in my opinion because I know the patients and their family members are still realistic about the situation. Things  are not going to be the same as they were before the stroke happened, but things can still be good. John knew he was entering a new stage of his life, but by the time he left us, he was beginning to see that this new normal could still be fulfilling.  

Have you or a loved one suffered a stroke? What was their stroke recovery like? Share your thoughts in the Comments section. Have specific questions about recovery after a stroke? Feel free to reach out to me directly with your questions.

© 2021 Jessica Kluetz, DO