Wednesday, July 11th, 2018
The months after a loved one experiences a stroke are often challenging. It’s a transition that requires a whole new outlook on care, routine and priorities. Additionally, seeing an elderly loved one undergo such a physical and emotional change is painful for the whole family and community. Yet understanding the vast research surrounding successful stroke rehabilitation promotes hope for a clear path forward. Explore this guide when preparing for the stages of rehabilitation that follow a stroke.
Known as the Brunnstrom Stages of Recovery, named after the physical therapist who studied the phases of motor function after a stroke, stroke survivors and their families have a road map of anticipated stages that can help them lay out a rehabilitation and healing plan accordingly. Beginning with the stages of flaccidity and hypotonia — or muscle weakness — patients will initially experience an inability to move affected muscles. Even if the muscles themselves are healthy immediately following the stroke, the neurological connection is interrupted. Without immediate assistance and exercise, these unused muscles will lose tone.
The shock of a single stroke is difficult enough to deal with, but it’s important for stroke survivors to be aware of the possibility of a second occurrence. A patient’s future risk rises significantly after the initial stroke, but early awareness and even prevention are possible.
Immediate intervention, both physical and psychological, puts both stroke survivors and caretakers on the right path to recovery. It also shields against the risk of a second stroke. Unfortunately, strokes become about 40% more common after an initial occurrence, and early detection is key to survival. The FAST acronym is a helpful tool for quickly spotting the signs: Face Drooping, Arm Weakness, Speech Difficult, Time to call 911.
There are also many understandable changes outside of the physical symptoms. Stroke survivors need sympathetic support when dealing with the confusion, depression, and PTSD aspects of going through the frightening experience of a stroke. Pseudobulbar affect, for example, stems from damage to the emotional areas of the mind, causing sudden changes without a clear trigger. By understanding the physical and mental exhaustion linked with the recovery process, it will be easier to organize a practical plan for moving forward.
Create a timeline and rehabilitation plan together with your doctor, to promote ongoing motivation as you move through the stages together. By immediately addressing whole-body symptoms, there are greater chances for consistent, noticeable improvement. Also, be sure to follow your doctor’s specific recommendations to prevent another stroke, as stroke survivors are at high medical risk for at least five years after the first.
In addition to the stages of rehabilitation, it’s important to build and maintain a lifestyle that prevents a second stroke. Creating new habits based around stoke rehabilitation encourages drive and confidence. Utilize the “3 R’s” of habit formation — reminder, routine, reward — to build a new pattern of habits. Identify a reminder, or an everyday trigger to remind the brain of the action. Establish a routine by embedding the action within normal daily activities. Finally, reward yourself for completing the action with positive affirmation or other similarly healthful and quick reward. Caretakers can use this model to help loved ones take advantage of the early stages of particularly high plasticity in the brain. This is when the mind’s rejuvenation capabilities are at their peak. Consider healthy diet changes, an appropriate exercise routine, limiting alcohol and smoking, and a medication regimen to balance blood pressure and any other relevant conditions.
As mentioned above, the stage just after the stroke is a time of tremendous cortical plasticity. The brain is most likely to retain changes and new habits during this early period. Consistent movement and repetition re-strengthens and “rewires” the lost connections caused by a stroke, both when assisted by a caregiver and — wherever possible — practiced independently by the patient. Focusing on specific, possible problem areas in the body, such as feet and hands, can help avoid or treat common symptoms like foot drop and hand spasticity. Rebuilding function in both of these commonly affected regions acts as a gateway to regaining full independence.
As your older loved one enters the healing phase after a stroke, keep an eye out for these common symptoms and stages. Know that there are plenty of innovative and affordable tools to assist with each symptom.
Between 25 and 40% of stroke survivors experience a temporary loss of language due to their stroke. This outcome is known as aphasia — the loss of ability to either express ideas through speech or properly receive information. Both receptive and expressive aphasia tend to occur when the stroke affects the left hemisphere of the brain.
As an important reminder and a note of comfort, your loved one has not lost any level of intelligence, even when their communication skills have temporarily decreased. Only the pathway to language has become blocked. To ease your loved one’s understandable frustration with not being able to express their wants and needs, figure out simplified ways for them to communicate — through simple phrases, images or symbols. Once you’ve created a system that works, begin working with a Speech-Language Pathologist to strengthen this zone of the brain-body connection.
The events surrounding a stroke cause up to a quarter of survivors to experience symptoms of PTSD. Post-Traumatic Stress Disorder is most commonly found in survivors of combat or other psychologically distressing events, but a stroke can also trigger similar responses in the mind. The traumatic details replay in the person’s memory, leading to a range of symptoms such as hyper-alertness, anxiety, guilt and depression.
The overall psychological health of your loved one will greatly affect their focus and confidence during recovery, so it’s vital that the caregiver places the same emphasis on their mental wellness as their physical progress. Have patience as you move through this challenging time together, with the help of your medical team — who may prescribe antidepressants or anti-anxiety medication — and your psychotherapist. The changes you and your loved one will face during this time can be sudden and scary, so it’s important to fully address the emotions as they come up.
The strenuous rehabilitation immediately following a stroke can be frustrating for those in the best of health. Especially with the added effects of medication-related fatigue, emotional exhaustion becomes common and understandable during recovery. When rest fails to provide necessary energy for the day, it may be best to seek medical advice.
Your medical team may recommend a change in medication, psychological support, or an adjusted approach to rehabilitation. In the early stages, building a proper routine is all about finding a balance between rigorous recovery and patience.
The shock and changes in your elderly loved one’s life can take a serious and immediate toll. You loved one’s level of daily independence has been completely turned on its head, and hope for recovery may seem distant and frustrating at first.
It’s important to be patient and sympathetic with both yourself and your loved one. Many stroke survivors experience some sort of personality shift, due to both changes in the brain and the emotional weight of what has taken place. The Pseudobulbar Affect, mentioned above, often causes these shifts to take place without warning or a clear trigger. Both crying and laughter may seem to come out of nowhere. This can be shocking at first, but remember that both the physical and emotional areas of the brain may have been affected by the stroke. Your loved one is still themselves, despite confusing changes.
Though this shift is frightening, concrete tools for maintaining hope and motivation are critical for warding off depression. Private therapy and group sessions can both be helpful, depending on each person’s preference. Diet, exercise, and keeping a long-term plan in sight at all times are other ways to combat this shock. Mark all progress with a moment of celebration, to establish momentum heading into each new stage of therapy. If lifestyle changes and counseling are insufficient, talk to a doctor about possible medications to treat depression and address any continuing negative symptoms. Setbacks are inevitable, but progress toward a pre-stroke level of function will continue with perseverance.
The repetitive nature of post-stroke rehabilitation can lead to early burnout, but remember that the mind is a powerful tool. Stave off emotional fatigue by incorporating both sentimental reminders and personal interests into your routine. Play your loved one’s favorite music during their rehabilitation time, or utilize family photos for exercises that involve writing or moving objects around a table. Blend rehabilitation tasks with recognizable daily activities, such as organizing favorite pieces of jewelry into a box, helping to cook a favorite meal, or engaging in a game, all while using the affected arm as much as possible. This acts as a reminder that you’re moving toward independence and normality with each day.
Doctors may help you pair these ideas with a proper diet and exercise routine, taking the current health of the patient into account. Finding ways to get fresh air and time outdoors can be difficult, but will do wonders for raising motivation. Though repetition in exercise is key, diversity of scenery keeps things fresh and new.
Throughout the physical rehabilitation process, stroke survivors may feel inclined to depend on the non-affected side of the body. Though this is normal, it’s important to catch this habit early in rehab. A lack of balance in usage discourages reintegration of the affected side, continuing the degeneration of muscles and neurological connections.
Some therapists may recommend a tactic known as Constraint-Induced Movement Therapy, or CIMT. In this technique, doctors work with your loved one to comfortably restrain the stronger arm, encouraging the use of the damaged side. Though challenging, this temporary approach takes full advantage of the brain’s neuroplasticity during the early stages of rehabilitation. The SaeboMAS works in tandem with CIMT, supplying support to the damaged limb in the early, more challenging stage. Even unsuccessful attempts at a given task strengthen the neurological connections to the limb, and affordable supports such as SeaboMAS bridge the gap between attempting and fully completing the activity.
Stroke survivors often experience the most noticeable results from rehabilitation during the first three-to-six months of the recovery phase. This rapid progress significantly increases motivation during the difficult initial period, encouraging full engagement during this particularly elastic stage. Once past the sub-acute phase, however, patients often enter the plateau stage, where progress significantly slows down. This change does not indicate that progress has stopped; it has simply slowed to a steadier pace. This is common, and it’s important to mentally prepare for the change. A steady routine will help tremendously during this transition. Routine exercises are still crucial, even if the results are not as obvious as they were in the initial stages.
The months following a stroke are difficult, but knowledge of what lies ahead calms anxieties and initial fears. Rehabilitation is highly possible with the right approach, and though it may be a long journey, there is a clear path forward, especially with innovative medical advancements offering greater understanding of and support during post-stroke healing stages.
When supporting your elderly loved one during this time, each day is a step toward their return to independence. Though this may take time, moments of self-sufficiency — even with small tasks — will revitalize both you and your loved one. Know that progress is always possible and moves steadily with proper research, hope and medical support. Here at Saebo, we are committed to stroke support and recovery for all survivors and their families. Saebo offers a wide range of products that combine cutting-edge technology with evidence-based rehabilitation techniques. Our offerings and network of Saebo-trained therapists can help you or a loved one to obtain all the necessary tools to maximize stroke recovery.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.