Stroke survivors often suffer from a myriad of complications after their stroke. In an effort to help you get the most out of your rehab (and reach your maximum potential) there are some critical tips and/or “foundational” points of emphasis. Things you didn’t know…..you didn’t know and should know. 🙃 So, that being said, here ya go. Or maybe here I go 🤷🏻♀️
What is a stroke?
Big picture, a stroke is when blood has been cut off to a certain area of the brain. Blood carries oxygen, which is the “fuel” that keeps the nerve cells functioning. When the oxygen supply is cut off to neurons in the brain, those cells die.
Each area in the brain has a specific function. For example, the cortex is responsible for movement, When nerve cells in a particular area of the brain die, we will lose the ability to perform that function.
Generally speaking, a stroke can cause:
- loss of arm/leg movement,
- loss of smell and taste
- impaired thinking abilities (cognition)
- impaired speech
- difficulty swallowing
- vision impairments
What happens immediately following a stroke?
Rehab typically starts in the first few days and will continue for several months. During that time, you will learn anything and everything necessary to get your life back. This will include things like physical exercises and home adaptations. Speaking as a therapist, I will be the first to tell you, you will learn more exercises and “adaptations” than you thought humanly possible. And “generally speaking” (not actual medical advice 🤷🏻♀️), it might come from people half your age that might have a little to much “pep in their step”. Oh, and just a heads up, you may have the urge to call him or her a few “colorful” names (NOT on their birth certificate). 😬
In all seriousness, I will also be the first to tell you, everyone you meet on a rehab unit wants the best for you and by the time you leave, you will be like family.
What to know immediately following a stroke?
Immediately following a stroke, there are some key BIG PICTURE concepts that will help to lay the foundation for your journey back. And it is a journey. A long, slow, and sometimes frustrating journey. Knowing this is not to get you discouraged but to prepare you for the mental highs and lows that are sure to come.
All that being said, you are entering into the biggest project of your life. The goal? Get back the functions that you lost. How you go about this, and how far you go will depend on your ability to hyperfocus on restoring movement, push through mental barriers, overcome obstacles, stay positive, and avoid pitfalls.
Restoring Movement after a Stroke
Neuroplasticity is a term that gets thrown around quite a bit in the “stroke survivor world”. Neuroplasticity, more specifically, functional neuroplasticity is the brains ability to alter a neuron’s functional properties. In stroke rehab, we rely on activity dependent plasticity.
Activity dependent plasticity refers to positive brain changes (building new nerve networks) that occur in response to new experiences. After brain damage, the brain is the most “ripe” for these positive brain changes to happen. This is not a spontaneous or passive process. That being said, these new experiences (that cause the brain to form new nerve networks) need to begin (immediately following damage). Along those same lines, the “experience” needs to be consistent with whatever “function” you want the brain to retain and “cement back onto the hard drive” (aka learning retention). In other words, whatever “new experiences” occur after a stroke, is what the brain is going to retain.
For example, do nothing, and neurons will continue to die. On the other hand, challenge your thinking, movement, speech, swallowing, vision with new experiences, and nerve networks will rebuild (activity dependent plasticity).
Along the same lines with neuroplasticity, it is important to understand learned non-use. Learned non-use is what happens when immediately following a stroke you compensate by doing everything with the uninvolved side of the body. The more you do this, the stronger the nerve networks become on the undamaged side of the brain. This is also activity dependent neuroplasticity. However, with a less favorable outcome. In the case of learned non use, the stronger these networds get, the harder it will become to retrain the involved arm and leg. This will cause what we call contralesional remodeling or axonal sprouting. As the word suggests, the brain “remodels” on the side of the brain OPPOSITE to the damaged side. No Bueno.
That being said, make every effort to use the weaker arm and leg. This will not be easy and it may mean that you need to get help with certain activities (ie: dressing). But remember the goal….build new connections on the damaged side of the brain. And remember the rationale…….how do we do this? With new experiences that will build the CORRECT nerve networks. In other words, “forced-use” of the involved side. With as many activities as humanly possible.
Pushing Through Mental Barriers
As mentioned above, stroke rehab is hard. And it is completely understandable to go through phases of being angry, sad, and…..frustrated. It is important to be aware of these emotions and address them. Talk to loved ones about how you are feeling. If you can’t or don’t want to open up to family, find a support group. Keeping that negative energy inside of you is not good for you or your recovery. On the other hand, talking to someone may help you process how you are feeling and allow you to get to a point where you can accept where you are at. And in my experience, that is truly when the real physical progress begins….
It is easy to “write things off” and tell yourself “I can’t do that with one hand”. I call this a self limiting mindset. In other words you may miss out on opportunities to get back to activities you enjoyed (prior to your stroke). Instead, enter each day with a curious mind. Every time you are faced with a new challenge or obstacle, view it as a problem to be solved. Break the activity down into its smallest components and start tackling them.
For example, you want to stand to pull your pants up. Ok, maybe you can’t do this in your closet by yourself, but maybe you could start by doing it holding on to a counter top in your kitchen. Or maybe you need to do it standing from your bed (which is a little bit higher and may be easier to go from sitting to standing). That is just one example of trying versus limiting your potential by assuming you can’t.
Setback #1: Falls
Falls are more common than I care to talk about. Worse, in many cases they result in a broken bone. And if there could be an “even worse”, there is. In most cases the broken bone is on the “involved side” of the body. And in most cases, means that arm or leg is immobilized. Yup, the very thing I said above about making every effort to use the involved arm? No. Can. Do………for up to 3 months.
So here is the down and dirty…..If a therapist says “you are impulsive”, trust them and do what they say (to keep you safe). If a therapist says “x” activity is not safe for you to do alone……trust them. I promise you they are not trying to “sabotage” your recovery. And finally, when in doubt ALWAYS err on the side of caution.
Setback #2: Hospitalization (after discharge)
Hospitalizations can also be a HUGE setback (after you are already home). The most common reasons this happens (aside from a fall) are dehydration, blood pressure issues, uniary tract infection (UTI), and/or non-healing wounds/bed sores. So to ensure you do not end up back in the hospital take all preventative measures:
- Take medications as prescribed
- Set reminders for refill prescriptions
- Get help with bathing and toileting to ensure you are keeping everthing nice a clean
- Change positions often and do frequent skin checks to make sure you are not developing a pressure sore.
Now this is a tough one. And just to be clear, in NO WAY am I suggesting that “staying positive” will be easy. I mean, I can’t deny that if you have just suffered a stroke or brain injury there is plenty to NOT “be positive” about. And it is normal to grieve the loss of your former life and future plans. At the same time, research has proven time and time again, that a positive attitude is essential to success in life. Additionally, there is a consensus in the literature that a positive attitude also has health benefits. And beyond the science, I am witness to this in real time. After 20 years of treating patients who have suffered a stroke, the ones who can find it within themselves to stay have the greatest outcome.