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Stroke Rehabilitation

While it is true that stroke is devastating and can sometimes be a lethal event, it is important to remember that it is not always deadly. There are millions of stroke survivors alive today. Approximately 30% of stroke survivors incur some type of permanent disability. A range of therapies are available to help patients work towards recovery of lost functioning (in as much as that is possible) and to prevent them from experiencing future strokes. A diagnosis of stroke should be viewed as a wakeup call and not a death sentence.

In general, the severity of the stroke determines the amount of time a person will need to spend in post-stroke rehabilitation. The brain can be thought of as being composed of a series of modules that each specialize in handling specific tasks. Some of these modules are housed on the right side of the brain and some of them reside on the left side of the brain. Damage to any of these modules can result in a person becoming unable to perform the related abilities. For example, a stroke in the right side of the brain can lead to vision problems, paralysis of the left side of the body, and memory loss. Conversely, a stroke on the left side of the brain can lead to right side paralysis, memory loss, and speech and language recognition and production problems.

Physical tests and scans of stroke-related damage can suggest the types of impairments patients are likely to experience based on the location of the injury. However, neuropsychological assessment, performed by specially trained clinical psychologists (who are experts in measuring the relationship between the brain and behaviors such as memory, decision making, concentration, abstract thinking, etc.) may be warranted to determine the true extent of impairments and remaining strengths.

While the brain cannot grow substantial new tissue to replace dead areas, it can sometimes recruit and engage other areas and modules to take over some of the functions formerly controlled by damaged or destroyed modules (a concept referred to as "neuroplasticity"). Rehabilitative therapies can help with this process.

  • Physical Therapy. Physical therapists can help stroke patients to relearn important everyday activities such as sitting, standing up, walking, and balancing by having patients participate in specially designed exercises and stretches that promote muscle utilization and the formation of new learning in undamaged parts of the brain.
  • Occupational Therapy. Occupational activities are daily activities like eating, drinking, using the restroom, preparing food, bathing, reading and writing. Unfortunately, stroke survivors often end up losing the ability to smoothly perform some of these deceptively complex activities. Occupational therapists can help people relearn these important activities of daily life to the greatest extent possible.
  • Speech Therapy. Some stroke patients find that they have lost some of their ability to produce or understand speech and language. Patients may find that they can no longer understand written words, that they cannot pronounce understandable words, or that they can speak volumes of words but fail to convey the meanings they intend. Speech therapists can work with a stroke patient to help them regain some of their communication abilities to the extent that is possible.
  • Psychotherapy: Depressive symptoms (e.g., sleep and appetite disturbances, feelings of hopelessness or helplessness, inability to concentrate, etc.) occur in approximately 40 to 50% of stroke survivors. Approximately 20% of individuals will go on to develop Major Depression, a prolonged and severe set of depressive symptoms that impact daily functioning (for more information about Major Depression, please visit our topic center here). While many people develop depressive symptoms within the first couple of months after a stroke, others will develop symptoms up to a year afterwards. Psychotherapy and/or anti-depressant medication are effective strategies for treating depression in most people. Studies have shown that treating depression after a stroke decreases the chance of death in the post-stroke period. Furthermore, individuals who have been treated for depression are better able to focus on and take advantage of their other rehabilitation therapies.

Physical, occupational, and speech therapies, as well as treatment for depression (if applicable) are all important for stroke patients, but they are ongoing processes and often require considerable time, effort, and expense. Stroke patients also need to lean on a strong support group of family and loved ones to provide encouragement and assistance during the often difficult rehabilitation stage.

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