What therapy might I get?

Recovering from a stroke is normally a long process. In most cases, the greatest amount of recovery occurs in the first 2-6 months, but slow improvement can occur for several years. The recovery time is different for each person but generally takes longer with more severe strokes.

The things that you will do during rehabilitation vary from person to person. It will depend on how you are affected after the stroke and what goals you have set for yourself with the team.

Different members of the stroke team will work with you on different parts of your recovery but it is important that everyone communicates regularly about how you are going.

During rehabilitation, you and your family will be involved in setting goals and making decisions. You may be asked to practice exercises several times a day. Rehabilitation takes hard work from you, your family and the professionals involved. Recovery after a stroke can be slow so you need to persist and take each day at a time.

Activities of daily living

It is common for people to have difficulties with everyday activities such as dressing, cooking, cleaning and shopping. This might be because of difficulties you are having with movement or with thinking and remembering things.

An occupational therapist will work with you to test the effects of the stroke and then work out what sort of therapy will most help you recover. This may include:

practice activities such as showering, dressing and cooking
advice about equipment, aides or techniques that will make life easier and safer for you to do everyday things (eg. special plates that don’t move on the table or a chair in the shower)
arranging changes to your home to make it easier for you to get around and manage day-to-day tasks safely. The occupational therapist may actually visit your home to assess what is needed and help set up the right services.
advice and practice in getting around the community including assessing driving ability or advice about using other forms of transport

Other members of the team, especially the nurses, will also help you to do your everyday activities for yourself.

Moving and walking

Some people will have trouble moving and walking after stroke because of weakness or poor coordination. The physiotherapist will assess your ability to move in the first few days and start therapy as soon as possible. Therapy may involve:

practicing to roll in bed, sit up, stand up, walk and use your hand and arm
exercises to improve your strength, sensation (ability to sense or feel things), coordination or fitness
using machines that help strengthen muscles, increase fitness (eg. treadmill or bike),reduce swelling and stiffness, reduce pain, give you information about how you are doing or provide support as you walk (eg a harness support system)
stretching or supporting your muscles to reduce their stiffness or pain
teaching you how to safely walk with the help of certain aids (eg a frame or stick)
choosing to limit the use of your good arm to encourage you to use the affected arm.

Research has found that generally the more you do the better you get. You should try and do as much as you can during therapy but also by yourself or with the help of family or friends.

The rehabilitation team members can show you things that you can practice by
yourself. You may also be involved in a group exercise class so you can practice with other people. Always ask questions to understand what you are doing, and why and how you can best help yourself.

Cognitive changes

A stroke may cause problems with thinking, remembering or concentrating. These problems are called ‘cognitive problems’. If you have cognitive problems you may:

be easily distracted or irritated
be tired or vague
have trouble doing more than one thing at a time
have trouble planning ahead or solving problems
forget names or faces or not recognise things

Problems can be made worse by stress, tiredness or by being in a group of people.

If you have cognitive problems, you should see an occupational therapist or a neuropsychologist. These people will work with the rest of the team to provide appropriate ways to help you improve including:

teaching you to use memory aids such as diaries, pagers, tape recorders and wall calendars
simple advice to family and friends – for example, keeping instructions short and concise, and reducing the amount of distractions when you are communicating.

Perception

Perception is making sense of what we see or hear. Problems seeing are common after stroke affecting the right half of the brain. These problems are not the same as poor eye sight. The eyes may be unaffected but messages going back to the brain from the eyes are not processed properly. If you have perceptual problems you may have trouble:

Noticing things that are on one side of the body
Recognising familiar faces
Recognising colours
Understanding what you see
Getting dressed
Getting around without getting lost or bumping into things
Finding things

Many of these problems will improve with time. An occupational therapist or neuropsychologist will usually test to see if you have any of these problems. They mayhelp by giving you exercises, teaching you ways to help you manage the problem (eg.reminders to look to one side of the body), teaching your family and carers how to assist you, giving you special glasses to wear or by using computers to practice on, in order to improve your sight.

Communication

Communication problems can affect the way you speak, understand what is said to you or read and write. If you have communication problems, you will be assessed by a speech pathologist.

Therapy may include relearning how to communicate in different ways. You may attend therapy in a group with other people with communication difficulties.

A speech pathologist may recommend certain computerised or non-computerised aids that can help you to communicate. A speech pathologist will also teach your family and friends ways of communicating with you which make it easier to get your message across.

Ideally you should be receiving at least several hours of therapy per week in the early stages of recovery after your stroke. If you have dysphasia/aphasia (reduced ability to communicate using language) you may get this therapy by yourself, in a group or through exercises the speech pathologist gives you.

Food, diet and swallowing

A stroke can interfere with the many muscles that control swallowing. As a result, you may have trouble eating and drinking. You may experience:

choking or coughing
chewing problems
not wanting some foods or drinks
weak or 'wet' voice
chest infections, due to food and drink going “down the wrong way” (ie. into the lungs)

Your ability to swallow will be assessed early after the stroke possibly by a nurse or doctor and then by a speech pathologist. If your swallow has been affected, you may be given specially thickened drinks or soft or pureed food to reduce the likelihood of food and fluids going into your lungs. If your swallow is very badly affected, it may not be safe for you to eat or drink and you may be fed with a tube.

Therapy by a speech pathologist may involve showing you safer ways to swallow, doing exercises to help you swallow or by stimulating your throat. A dietitian will work with you to make sure you are getting the best nutrition to help you recover.

Emotional and psychological effects

It is very normal to have different feelings in the weeks and months after your stroke. At first you might be relieved that you have survived. You may then feel angry, anxious, sad and frustrated. You may have mood swings and outbursts, such as crying for no apparent reason.

These changes in emotions may be your reaction to your situation, or sometimes they are a direct consequence of the brain damage caused by the stroke. Your friends or family may also say your personality has changed. Depression is very common after stroke.

If you experience these problems, don’t suffer alone. A psychologist, social worker or another team member should give you opportunities to talk about the impact of stroke including its effect on relationships (including sexual relationships).

Talking to a trusted friend or family member is also important. The Stroke Association in your state can provide support for you and your carer. Your doctor may also discuss the possibility of medications (such as antidepressants) or other treatments with you.

Bladder and bowel control

After a stroke it is common for people to have difficulty controlling their bladder or bowel. This is known as incontinence. The nurses and the doctor will assess and monitor the problem.

By the time of discharge from hospital, most people will have recovered from this problem. If you are having trouble with your bladder or bowel it is important that you ask for help.

There are a number of possible ways to help. These include the use of bladder retraining, regular or timed toileting, medication, education about eating and drinking the right things or the use of containment aids (eg. pads).

Occasionally a tube (catheter) may need to be inserted to help drain the bladder. If this is needed, it should be done every now and then rather than inserted for long periods of time.

Other medical aspects

Pain:

Occasionally the stroke will change the signals from the nerves causing pain without any real reason (known as central post-stroke pain). If this occurs then the doctor will usually try different medications to reduce the pain. You may also try other things (TENS machines, acupuncture or counselling) although it is unclear if these work or not.

Blood clots:

Sometimes you can develop a clot in your leg (called a deep vein thrombosis or DVT) or occasionally in your lungs (called a pulmonary embolism or PE). To prevent this you should try to walk if possible and drink lots of water.

If you had a stroke due to a clot in the brain you should also be taking medication to prevent your blood from clotting (eg aspirin). Sometimes you may also be asked to wear special long stockings but only if you are in bed all the time and are not walking yet. Ask your nurse of doctor if you have any
questions.

Seizures:

Occasionally people have seizures after a stroke. If this happens to you your doctor will give you medication to prevent further fits.

Breathing problems:

Often you may have difficulty breathing as a result of your stroke, especially at night (called obstructive sleep apnoea). If this happens then your doctor may suggest you wear a special mask over your nose or mouth that helps you breathe. If this doesn’t work then you may try a device you put in your mouth to keep your airways more open.

Last Updated ( Friday, 10 October 2008 )

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