Monday, July 31st, 2017
The rehabilitation process throughout the first several months of stroke recovery can be confusing and often daunting, with peaks and valleys that either encourage or slow the healing process. Varying levels of paralysis are common, and adjusting to ongoing therapy requires a shift in mindset and a complete lifestyle overhaul.
Yet, some of the most significant improvements often occur during these early days, reflecting the initial plasticity of the brain. Therefore, gaining momentum during this neurologically progressive time is key to facing the often-frustrating period ahead—a stage known as a plateau. During this stage, it may feel as if the initial spike in progress was the end of successful rehabilitation and that no further improvement is possible. But for some, the plateauing phase is quite common and even to be expected, and understanding this will help both the patient and caregivers to avoid losing hope, motivation, and persistence during this difficult time.
Over the past two decades, research has reaffirmed the frequency and common intricacies of plateauing in newer stroke patients. In the past, it was more likely for doctors to assume that patients only regained motor function in the first few months after a stroke, and that once the plateau occurred, ongoing exercises and therapy were ineffective.
However, recently published reports now show that patients can regain motor recovery and function up to 23 years after a stroke. Medical professionals are now finding that this complex recovery period often continues to occur for months and even years after a patient has left rehab—and primarily resumes only if patients and caretakers build a recovery plan and have access to evidence-based technology to prevent the plateau phase after leaving traditional rehabilitation. Designing a home-exercise program, often by upgrading the previous inpatient therapeutic regimen, is the key to maintaining progress or restarting growth if the plateau phase has begun.
When a stroke occurs, a specific area of the brain suffers an infarction, obstructing the blood supply and killing the functionality of a section of the brain. Though this specific area is not recoverable, the area directly surrounding the infarction-impacted region still holds potential for rehabilitation. In the moments directly after the stroke, however, the area simply does not work.
During the initial healing phase known as the subacute phase, which is usually the first three to six months after the stroke, the most consistent and encouraging signs of progress occur in these regions. This natural healing stage often takes place when patients are being coached along in rehab; but if the plateau stage occurs towards the end of the natural healing phase, it’s common for patients to be sent home for a shift in care.
For this group of patients, this is a difficult transition for several reasons: familiar exercises must be altered and adjusted, the home routine requires greater adaptability, and patients face the discouragement of no longer seeing an uptick in progress, often deterring patients and caretakers from pushing on. Progressing through the discouragement is more easily accomplished when patients and caretakers understand the plateau stage. A solid plan of ongoing, managed care is necessary for continuing to bolster the still-developing parts of the mind.
It is important to keep in mind that traditional therapy that isn’t evidence-based can be ineffective and can actually cause a plateau. Sometimes a patient’s recovery is only as good as the therapist, and if the therapist isn’t modifying the treatment to the patient’s specific needs and incorporating the latest proven interventions because they haven’t been trained or educated, the patient will most likely plateau. If the therapist is well educated on the latest advances and interventions in stroke recovery the patient has a much better chance of avoiding the plateau phase. So, a plateau phase may not be an absolute, it’s a possibility.
After reassuring research, the medical community confirms that working with a managed care professional with a series of ongoing exercises does promote improvement in a stroke patient’s long-term recovery. When signs of recovery seem to stall altogether, here are a few common practices for jumpstarting at-home care.
The brain’s cortical plasticity is a key component in this stage of recovery, and Saebo offers several tools for employing this factor. Motor function and utilization of the hands can be continuously developed with the assistance of the SaeboGlove or SaeboFlex, easing therapy at home with minimal assistance and instruction. The SaeboFlex and SaeboGlove include a proprietary tension system that encourages the extension and grasping strength of the hands of healing stroke patients. This action simultaneously supports brain growth and reprogramming, encouraging the plasticity of the mind through task-oriented exercises.
If patients are unable to functionally use their affected hand, they will develop learned non-use and will eventually reach the plateau phase due to avoidance. The SaeboFlex and and SaeboGlove are two tools that may prevent or minimize the plateau phase and allow patients to engage their affected hand in functional tasks that would otherwise be impossible.
Similar to the SaeboGlove and SaeboFlex’s use of cortical plasticity, Constraint-Induced Movement Therapy (CIMT) encourages the regrowth of neurological pathways damaged during a stroke. This promotes more meticulous use of the affected hand. By keeping the functional hand from taking full responsibility for daily tasks—usually with a mitt—this method involves preference of the developing side of the brain. Though CIMT is an intensive process, which must be guided and supervised for several-hour stretches at a time, positive results may be seen for years to come.
Maintaining a regimen of exercises that both meets the needs of ongoing recovery and the patient’s comfort is essential to progressing past the plateau stage after traditional rehab. The factor of neuroplasticity allows the brain to constantly adapt, but persistence and regularity is key. When followed correctly, an increase in motor function and strength is probable in many patients. Continuing physical exercise assists with many aspects of the healing process, supporting flexibility, coordination, and balance. Though physical activity does not prevent the occurrence of a second stroke, it will keep the body in key health for recovery.
During the difficult transition to home care, supportive family and medical professionals are the vital factor in helping patients maintain motivation and feel guided toward success. As a patient is just beginning the rehabilitation process, it is almost solely in the hands of the assistant to set the tone of the session, and this mutual understanding will drive the exercises forward, making it easier to set and meet small goals along the way. Roadblocks and frustrations are common, but with a structured and steady plan, these stages will pass and times of progress will return.
When difficult emotions arise, it is crucial to realize that this is completely normal. Stroke recovery is a long, often slow process, and frustration, anger, and depression are understandable obstacles to encounter. Know that these feelings and physical plateaus will pass with time when both patients and caretakers allow themselves self-care and patience. It is also helpful for families to keep this in mind, as maintaining a genuinely flexible and positive atmosphere during rehabilitation will help all parties see these changes and efforts as a long-term process.
When heading into long-term stroke treatment, awareness of evidence-based treatment interventions may prevent or decrease the plateauing stage. But with consistent at-home tools and exercises, progress will return, even if it feels slower than in previous phases. The recently damaged brain is taking the necessary time to heal and regrow, and this requires setting short-term goals and celebrating small victories. Reaching the plateau stage is an opportunity to reconsider the next best way forward with your therapist—progress is still ahead, even if the methods and system require a new outlook.
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.