Aging Begins at 30

Stroke 3: The Long Road to Normality

Survivors from stroke and their families need education and rehabilitation to increase independence and recovery. This is done by a skilled team of doctors, physical therapists, occupational therapists, and speech pathologists. A realistic balance between hope and reality can be reached with kindness and humor. Progress is measured by repeated numerical rating scales. Nothing always works. Teaching how to stand, sit, balance and get up off the floor is first. Next muscle elongation on the involved side, working both sides together, limb rotation, adequate knee control, and protection of the paralyzed shoulder helps most victims. Speech restoration treatment is needed in many. Exercises to improve mental functions are often helpful.

Complications caused by the stroke itself include confusion, incontinence, depression, speech difficulties and memory problems. Neurologic upsets such as increased muscle tone, contractures or shortening of muscles, and shoulder damage can occur. Vascular disease in other organs may cause heart failure, heart attacks, and leg vein clots. Pneumonia may also occur.

Recovery involves overcoming a clumsiness of body and a protest from the mind. Patient's and their family's attitude toward disability is as important as the paralysis present. Stroke has an acute beginning and a chronic end. The functions of the brain recover over weeks or months. Major improvements occur over the first six weeks. Further recovery after six months does occur but progress is slow.

The patient usually spends two or three weeks in the acute ward and two to three months in rehabilitation. Stroke clubs made up of patients, relatives, and friends are very helpful in adapting to the limitations imposed by the stroke. Many patients are depressed and frustrated and the interchange of helpful ideas is very supportive. Frustration, anger, and withdrawal from social activity are common. Day hospital attendance helps a lot. Studies show 80% of patients working or occupied before the stroke changes to 66% not occupied afterwards. Meals-on-Wheels and home visiting nurses improve the outcome for those without able-bodied partners. Avoiding social isolation in the patient who is homebound is often as important as the specific content of their follow-up care. It is a long and difficult recovery phase but well worth every hard-gained improvement.

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See related Patient Topics Brain and Nervous System, Heart and Circulation, Seniors' Health or Stroke.

See related Provider Topics Brain and Nervous System, Heart and Circulation, Seniors' Health or Stroke.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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