Stroke Rehab Can Begin Early and Continue Long After Hospital Discharge

Stroke rehabilitation may begin as soon as the day after a stroke when a patient is medically stable, according to an updated American Heart Association/American Stroke Association guideline published in August in the journal Stroke. The guidance describes recovery as a broad, long-term process rather than a short period of hospital-based therapy.

Medical Xpress, which reported on the guideline, said early rehabilitation can involve basic activities such as sitting up, brushing the teeth, washing the face or stretching an affected limb. This acute phase generally refers to the first week after a stroke and can also help patients and caregivers understand resulting impairments and potential recovery goals.

Rehabilitation may focus on restoring abilities, including walking, arm use and language, but it can also help people adapt to lasting limitations. Occupational therapists may teach strategies or use tools that allow someone with arm weakness to prepare food with one hand. Recreational therapy can help survivors find alternative ways to participate in activities they value.

The guideline also gives greater attention to mental health, sleep and fatigue. Post-stroke depression and anxiety can affect both survivors and their families, while emotional difficulties may reduce willingness to participate in rehabilitation. The report noted that researchers still do not know as much about assessing and treating post-stroke depression as they do depression in the general population.

Sleep problems can include insomnia, sleep apnea, excessive daytime sleepiness and restless legs syndrome. Poor sleep may affect thinking, memory, mood and engagement in therapy. Sleep is also described as important for learning skills practiced during rehabilitation, although the guideline says treatment options for post-stroke sleep problems remain limited and screening is an important first step.

Cognitive rehabilitation addresses attention, memory, problem-solving and information processing. Therapists may tailor exercises to a person’s goals, such as practicing organizational tasks for a worker hoping to return to a job. Technology can be used when it is closely connected to a specific task, while survivors with memory difficulties may learn compensatory strategies such as creating lists on a phone.

Physical activity and nutrition are additional parts of recovery. The report said aerobic exercise has been associated in some studies with improved cognition and that physical activity can help reduce the risk of another stroke. Nutritional support is particularly relevant early in recovery, when swallowing difficulties can raise the risk of malnutrition.

Recovery rates vary by ability and outcome. Motor gains are often greatest during the first three months, while improvements in language and cognition may continue longer. The experts quoted in the report said progress can remain possible decades after a stroke, with rehabilitation involving neurologists, nurses, occupational therapists, speech-language pathologists, psychologists and other specialists. The guideline was last updated in 2016.