Recovery

Positive factors that help predict good candidates for rehabilitation:

• A patient should be able to sit up for at least an hour.
• The patient should be able to learn and be aware.
• Spasticity may be a good sign, because it indicates live nerve action.
• Patients who are able to move their shoulders or fingers within the first 3 weeks after having a stroke are more likely to recover the use of their hands than patients who cannot perform these movements. The ability to feel light pressure on the affected hand, however, makes no difference for future hand movement.
• Family members or close friends are available to be active participants in the rehabilitation process.

Factors that predict a poor response to rehabilitation:

• Dysphagia (the inability to swallow) is associated with a higher mortality rate, possibly because of increased risk for infection and malnutrition. Dysphagic patients are given nutrition using a stomach tube or a feeding tube inserted down through the nose.
• Incontinence.
• The inability to recognize nonspeech sounds that occur right after a stroke.
• A poor hand grip that is still present after 3 weeks is an indicator of severe problems.
• Having had very severe seizures after the stroke.

Factors that do not rule out rehabilitation:

• About 30% of patients experience aphasia (an impaired ability to speak). However, this disability does not necessarily affect the ability to think. Aphasia can also be temporary.
• Although confusion is common among people who have had strokes, partial or even complete recovery is very possible.

Some Approaches to Rehabilitation

Physical therapy should be started as soon as the patient is stable, as early as 2 days after the stroke. Some patients will experience the fastest recovery in the first few days, but many will continue to improve for about 6 months or longer. Because stroke affects different parts of the brain, specific approaches to managing rehabilitation vary widely among individual patients:

• Exercise program. Recent guidelines from the Veteran’s Administration recommend that patients get back on their feet as soon as possible to prevent deep vein thrombosis. Patients should try to walk at least 50 feet a day. Assisted devices or bracing are sometimes used to help support the legs. Treadmill exercises can be very helpful for patients with mild-to-moderate dysfunction. Exercise should be tailored to the stroke survivor's physical condition and can include aerobic, strength, flexibility, and neuromuscular (coordination and balance) activities.
• Retraining muscles. Stretching and range-of-motion exercises are used to help treat spastic muscles. Bilateral Arm Training with Rhythmic Auditory Cueing (BATRAC) is a new approach that may benefit patients who have arm paralysis. It may even help patients who have had stroke paralysis for many years. The BATRAC technique involves moving a bar with both arms in a sustained rhythmic pattern. A study in the Journal of the American Medical Association reported that BATRAC helped patients get back use of their paralyzed arm. The research also showed that patients who received BATRAC had greater activity in the motor cortex region of the brain. Patients had a stroke at least 4 years before participating in the study.
• Speech therapy and sign language. People who have had a stroke often have aphasia, a brain condition that makes it difficult to speak and understand language. Aphasia can come in many different forms. A person maybe unable to speak at all, or just have difficulty saying the right word.  Intense speech therapy after a stroke is important for recovery. Some experts recommend 9 hours a week of therapy for 3 months. A 2005 study indicated that a shorter period (3 hours a week for 10 days) also works well. Language skills improve the most when family and friends help reinforce the speech therapy lessons.
• Biofeedback techniques combined with physical therapy. This combination has been beneficial in certain cases. Electrical stimulation of the throat, for example, may help patients with dysphagia recover their ability to swallow faster. Stimulation of the wrist and finger is also showing promise for improving motor capabilities.
• Swallowing exercise. A promising study reported that swallowing improved when patients performed a simple exercise 3 times a day for 6 weeks. They lay flat and raised their heads three times, holding them up for 1 minute with a 1 minute rest in between. This was followed by 30 consecutive head lifts.
• Attention training. Problems in attention are very common after strokes. Direct retraining teaches patients to perform specific tasks using repetitive drills in response to certain stimuli. (For example, they are told to press a buzzer each time they hear a specific number.) A variant of this approach trains patients to relearn real-life skills, such as driving, carrying on a conversation, or other daily tasks.
• Occupational training. Occupational therapy is important and improves daily living activities and social participation.