Some people who've had a stroke can return home after a few days in the hospital. Others will not get home for many weeks if they need treatment in a rehabilitation facility. A few stroke survivors require long-term nursing care. For most people who have had a stroke, living at home is possible only if they can manage activities of daily living, such as dressing, eating, and using the toilet. You also have to follow medical advice and take prescribed medications. But you will probably need help even if you can perform routine daily activities. Don't try to do it alone, at least not right away. Plan to have a relative, friend, or home health aide stay with you for at least the first night that you're home, and possibly longer. If you've been in a rehabilitation facility, chances are that someone in charge of discharge planning will visit your home ahead of time to evaluate what equipment and assistance you will need.
Stroke can disrupt cognitive abilities, including memory, learning, and awareness. Cognitive rehabilitation is a type of therapy that uses strategies to compensate for lost abilities, rather than to recover them. If you have short-term memory loss, for example, you may be shown ways to compensate for that loss -- through the use of cue cards, simplifying routines, or detailed lists. There is some debate about the role of cognitive rehabilitation, because there is little solid research to demonstrate its effectiveness.
Regaining the skills for everyday living is the goal of the widely established practice of occupational therapy. Working with an occupational therapist in stroke rehabilitation can help you learn practical techniques to make dressing, washing, driving, gardening, and other routine activities more manageable. For example, one method is to break down a complex activity into small parts, then practice each part in sequence until you can coordinate them. Occupational therapists also teach you ways to compensate for your physical disability -- for example, by using Velcro closures instead of buttons on your shirts, or using walkers, wheelchairs, or other devices as needed.
As a rule, you stand a greater chance of regaining gross motor movements, such as grasping a fork or shaking someone's hand, than fine motor movements, such as typing or playing piano. Gross motor movements are easier and require less control from the brain.
Virtual reality environments allow stroke survivors to practice newly regained skills with the visual feedback of real-world situations, while remaining in a safe and controlled environment. For example, a patient wears a visual device that simulates a three-dimensional visual scene, such as the inside of an elevator. Diodes placed on the patient's arms track movements within the virtual space, allowing the patient to practice pointing and touching a target. Another virtual environment may conjure a busy sidewalk, allowing patients to practice walking while avoiding stationary and moving targets in a distracting environment.
There are few findings so far on the effectiveness of virtual reality therapy for stroke rehabilitation, but one early study in the journal Stroke documented positive changes in brain reorganization as well as locomotor recovery.
Large stroke rehabilitation programs are increasingly using intensive repetitive therapy to aid stroke recovery. Moving patients' limbs to simulate natural arm and leg movements may help to restore neurological pathways as it strengthens muscles and improves circulation.
One promising technique for people with moderate weakness in one arm following a stroke is constraint-induced movement therapy (CIMT), which involves not just exercising the weak arm but also restraining the stronger arm to force the other one to work harder. Research suggests that CIMT may help the brain rewire itself, and help people to gain more mobility and dexterity. A multicenter study sponsored by the National Institutes of Health followed patients who underwent either a two-week CIMT program or usual care. The results, published in The Journal of the American Medical Association, showed that CIMT participants enjoyed significantly greater improvements in arm motor function one year after the intervention. After two years, CIMT participants retained those functional improvements and continued to gain strength in their affected arm. This translated into continuing improvements in activities of daily living.
Your exercise regimen during stroke rehabilitation will depend on your specific type of disability and may include some or all of the following: walking on a treadmill, walking up or down stairs, using hand or leg weights, and repeatedly bending and extending your arms and fingers. If you can't bear weight on your legs, you may practice walking and other exercises while partially supported by a harness, or in a swimming pool, where water can support some of your weight (hydrotherapy). The amount of time you spend in physical rehabilitation will depend on your needs and your stamina, but expect it to last at least a few weeks.
When you start rehabilitation, you will probably notice significant progress on a daily basis. By the time a few weeks have passed, you may have advanced from being unable to sit up to being able to walk independently and take care of yourself. The amount of progress you see and how quickly it occurs depend on the severity of your stroke and the part of the brain affected. If your main problem is moderate muscle weakness, chances are that your recovery will progress more quickly than if you have more severe problems -- for example, language deficits that make it hard for you to understand when therapists and other people talk to you.
Stroke rehabilitation is hard work. Even spending many hours each day for several weeks on repetitive exercises may not produce a full recovery. Most people who need a rehabilitation program are left with some lingering weakness or disability. But for many people, significant recovery is possible. If you start rehabilitation unable to walk because of muscle weakness and severe balance problems, there's a good chance that you will gradually be able to walk on your own at least some of the time, use a wheelchair for the rest of the time, and be self-sufficient enough to wash yourself without assistance.
A recreational therapist helps you to get back to leisure activities that you enjoyed before your stroke. In doing so, recreational therapists can have a positive impact on your quality of life. For example, a recreational therapist will help you find ways to play cards or read books if you have weakness or disability in an arm or hand following your stroke. This type of therapist will also help you use your leisure time to enhance your health and independence.