By: Rukhsar Jabbar. M.Sc. Physiotherapy. Freelance Health Writer and Datelinehealth Africa (DLHA) volunteer. Medical review and editorial support provided by the DLHA Team.
African female stroke survivor undergoing walk rehabilitation under physical therapist supervision.
Several reports indicate that broad stroke awareness and knowledge within African communities are poor. So, it is not unexpected that many Africans face unfamiliar challenges after a stroke. But knowledge of stroke recovery timeline is essential.
The consequences that stroke survivors could endure for the remainder of their lives include impairments in thinking or memory, mobility, sensory (e.g., vision or hearing), speech, swallowing, or emotional well-being (e.g., personality changes, depression).
In addition to affecting the person, these deficits may have long-term consequences for communities, families, and caregivers. Enhancing physical function and maximizing functional independence, engagement, and social reintegration through the coordinated administration of treatments and measures in an interdisciplinary manner are some of the major objectives of stroke rehabilitation. [1]
There are two main categories of recovery after a stroke: neurological recovery and functional recovery. The origination and development of the type of stroke suffered and its location in the brain affect neurological recovery, while motivation, external environment, and ongoing rehabilitation affect functional recovery. [2]
The goals of this article are:
As stroke is a medical emergency, immediate access to hospital care is critical. Medical staff at the hospital will inquire about your past medical history and the timing of your symptoms. The type of stroke you experienced will be revealed through clinical assessment and brain imaging.
A thrombolytic agent called tissue plasminogen activator (tPA), [3] and commonly known as a "clot-busting" medication, may be administered to you if you arrive at the hospital within three hours of the onset of ischemic stroke symptoms to disintegrate blood clots.
Unfortunately, the majority of African stroke victims arrive at the hospital too late to receive tPA treatment. This is the reason it's critical to identify stroke symptoms and indicators as soon as possible.
To learn more about stroke symptoms, go to: What are the symptoms of stroke?
Treatment options for stroke in the acute phase are covered here.
After an acute stroke, the median length of hospital stay is currently 7.3 days. Discharge planning may be initiated by your care team about 72 hours after admission. It is important that you and your family participate well in the discharge planning process and have a say in when you are discharged and what services you have.
You may receive written information regarding patient diagnosis, medication, and treatment plan at the time of discharge, along with a designated point of contact for questions and guidance. [1]
The service called Early Supported Discharge (ESD), begins within a day of leaving the hospital for patients with mild to moderate disabilities and is provided by a special team of expert.
The team includes nurses, therapists, and other support staff who visit the patient daily. ESD has been shown to improve patient outcomes, satisfaction, and save money for the healthcare system compared to regular care.
Before discharge, a team member might visit the patient's home or assess their environment. While some programs have a time limit, like three months, the length of ESD depends on the patient's needs. [1]
The aim of ESD is to encourage home rehabilitation in replacement of part of services provided during in-patient care in the hospital.
The first three months of the phase of early recovery following a stroke is very important. This is a period when some of the impaired functions begin to show spontaneous improvement and the goal of rehabilitation at this time is to help restore function as close as possible to pre-stroke levels or develop ways to work around a functional impairment.
An example of rehabilitation support at this time is working with the patient to relearn holding a toothpaste tube so the strong hand can unscrew the cap.
To help this relearning process, a number of rehabilitation therapy programmes would have been set in motion before the one month mark of recovery and they continue well beyond. These include:
In-Hospital Rehabilitation
Physical Therapy
Occupational therapy
Speech therapy
Starting in-hospital rehabilitation training 24–48 hours following the beginning of an acute ischemic stroke appears to be preferable to doing so 72–96 hours later.
Early mobilization following a stroke provides the advantage of reducing the difficulties brought on by bed rest, as numerous studies have demonstrated. [4]
Early mobilization is primarily justified by the need to avoid or minimize consequences associated with immobility, including deep vein thrombosis, infections, and falls. [5]
Early mobilization, positioning, Activities of Daily Living (ADL) training, functional mobility training, Range of Motions (ROMs), splinting, and bed mobility are crucial therapies during the acute period of stroke therapy. [7]
Early mobilization following suitable monitoring can lessen mental decline, tension, and anxiety, lessen the negative effects of bed rest and deconditioning, and raise the patient's level of consciousness. [6]
Occupational therapy intervention during the acute period of stroke aims to modify the patient's mood following the abrupt shock of the stroke and restore the patient's residual physical function.
Occupational treatment begins 24–48 hours after the stroke occurs. To get better results, the occupational therapist aims to allow the patients to participate in extensive task-oriented training in addition to strengthening and conditioning their upper limb muscles. [7]
Stroke survivors should be screened for swallowing difficulty (within 24 hours) and communication impairment (within 48 hours) to achieve the best possible outcomes. [8]
In cases where the patient's primary communication problem is related to speech rather than language, different communication assistance can be utilized. [8]
At the six months mark and beyond, post-stroke improvements are still possible but will be much slower. The majority of stroke survivors would have reached a relatively steady state at this point. For some, this means a full recovery. For others ongoing impairments, also called chronic stroke disease may persist.
The goal of rehabilitation at this period is to ensure that the patient continues to achieve independent living with the community and to address issues that may work against that goal early.
The majority of stroke recovery rehabilitation during this period occurs in the outpatient and at home.
Issues that need to be looked into at this time include Adequacy of Home exercise, Home Modifications and Assistive Devices and Family and Caregiver Support.
Patients receive a home exercise program (HEP) six months following their stroke, along with information on how to maintain exercise intensity, avoid falls, change postures, and promote health. [6]
The use of restorative techniques will eventually decline as patients get back to their homes. Occupational therapy mostly uses compensatory techniques to guarantee that patients can engage in everyday tasks. [7]
Since occupational therapists' one-on-one monitoring will gradually diminish during this time, the patient’s strong motivation and active engagement will be critical in ensuring the quality of family rehabilitation. [7]
All older adults are concerned about falls, but those who have had a stroke and live at home are more than twice as likely to fall as those who do not live in a community.
One of the several problems that stroke survivors and their families deal with is home safety & because of their physical and mental impairments, stroke survivors are particularly concerned about the safety of the interior of their homes.
However, they also report issues with the exterior of their homes, such as steep wheelchair ramps.
It is frequently necessary to make adjustments to the home environment to enable the person to function at their best. Rugs can be removed, furniture can be rearranged, and in the case of a two-story property, the bottom floor can be designated as the primary living area. [9]
Family functioning is an essential part of stroke protection because families play a critical role in the recovery of stroke victims. Family members first take on the role of caregiving following a stroke. Family members, especially close relatives, can provide care, assistance with appointments, and direct or indirect supervision while the primary caregiver is engaged in other activities. [10]
Anyone living under one roof who is a parent or legal caregiver, family member, relative, or family caregiver qualifies for a family-based intervention program. The program encourages physical exercise as well as emotional support, love, warmth, and family connection by combining health education with family-friendly activities. [10]
During this phase, timely access to outpatient specialist neurologic care clinics connected to hospital services and general care is crucial for post-stroke care.
The initial appointment is usually scheduled for six months after the stroke and a follow-up visit once a year. These appointments are meant to track the patient's neurological condition and evaluate the presence and management of any stroke-related consequences, such as epilepsy, depression, or post-stroke cognitive impairments. [11]
To prevent secondary problems from immobilization and preserve a functional condition, patients in the chronic phase (>6 months after the stroke) should still have access to physical therapy.
Stroke rehabilitation demands a long-term commitment (for at least 3–5 years following the stroke). Even if rehabilitation is not started right away, there are many advantages to undertke it because functional gains following a stroke can last for a long time, even though the patient's rehabilitation requirements will change over time. [11]
For stroke patients as well as those who care for them, the recovery timeline is crucial. It acts as a road map, providing direction, clarity, and hope in what can appear to be uncharted territory.
Every stage has its own set of challenges and successes, from the first emergency medical reaction to the prolonged rehabilitation period and lifestyle adjustment. Stroke survivors can make significant improvements and restore their quality of life with tenacity, resolve, and the help of family, friends, and medical experts.
1. Rodgers H, Price C. Stroke unit care, inpatient rehabilitation and early supported discharge. Clin Med (Lond). 2017 Apr;17(2):173-177. doi: 10.7861/clinmedicine.17-2-173. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297619/.
2. Lee KB, Lim SH, Kim KH, Kim KJ, Kim YR, Chang WN, Yeom JW, Kim YD, Hwang BY. Six-month functional recovery of stroke patients: a multi-time-point study. Int J Rehabil Res. 2015 Jun;38(2):173-80. doi: 10.1097/MRR.0000000000000108. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415968/.
3. Centers for Disease Control and Prevention (CDC). Treat and Recover from Stroke. [Internet. Last reviewed: May 4, 2023]. 2023 [cited 2024 Feb 11]. Available from: https://www.cdc.gov/stroke/treatments.htm.
4. Wang F, Zhang S, Zhou F, Zhao M, Zhao H. Early physical rehabilitation therapy between 24 and 48 h following acute ischemic stroke onset: a randomized controlled trial. Disability and Rehabilitation, 44:15, 3967-3972, DOI: 10.1080/09638288.2021.1897168.Available from: https://www.tandfonline.com/doi/full/10.1080/09638288.2021.1897168.
5. Bernhardt J, English C, Johnson L, Cumming TB. Early Mobilization After Stroke: Early Adoption but Limited Evidence. Stroke. 2015;46:1141–1146. https://doi.org/10.1161/STROKEAHA.114.007434. Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.114.007434.
6. Shahid J, Kashif A, Shahid MK. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sci. 2023 Apr 25;13(5):717. doi: 10.3390/brainsci13050717. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10216461/.
7. Li W, Xu D. Application of intelligent rehabilitation equipment in occupational therapy for enhancing upper limb function of patients in the whole phase of stroke. Medicine in Novel Technology and Devices. 2021. Vol 12 https://doi.org/10.1016/j.medntd.2021.100097 Available from: https://www.sciencedirect.com/science/article/pii/S2590093521000412.
8. Dilworth C. The role of the speech language pathologist in acute stroke. Ann Indian Acad Neurol. 2008 Jan;11(Suppl 1):S108-S118. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204112/.
9. Schulz CH, Hersch GI, Foust JL, Wyatt AL, Godwin KM, Virani S, Oswald SK. Identifying Occupational Performance Barriers of Stroke Survivors: Utilization of a Home Assessment. Physical & Occupational Therapy. In Geriatrics 2012. 30(2) 109-123. https://doi.org/10.3109/02703181.2012.687441. Available from: http://www.tandfonline.com/doi/full/10.3109/02703181.2012.687441.
10. Deepradit S, Powwattana A, Lagampan S, Thiangtham W. Effectiveness of a family-based program for post-stroke patients and families: A cluster randomized controlled trial. Int J Nurs Sci. 2023 Sep 27;10(4):446-455. doi: 10.1016/j.ijnss.2023.09.020. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10667323/.
11. Sarzynska-Dulgosz I. An optimal model of long-term post-stroke care. Front Neurol. 2023 Mar 23;14:1129516. doi: 10.3389/fneur.2023.1129516. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076665/.
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Published: March 2, 2024
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