Stroke Recovery and Arm Rehab: Important Questions

After a stroke, you probably have a lot of questions and concerns about how -- and even if -- you will recover. When will you be able to move your arms? Is your independent life gone forever?

It's difficult to predict to what degree someone will recover after a stroke, says Randie M. Black-Schaffer, MD. Schaffer is medical director of the Stroke Program at Spaulding Rehabilitation Hospital in Boston. "How quickly a patient recovers in the first few weeks," she says, "can give us an indication of how much damage occurred, and we can make some educated guesses based on that."

According to the National Institute of Neurological Disorders and Stroke, how well you recover depends upon the type of stroke you had, how much brain damage occurred from the stroke, your age, and how quickly rehabilitation begins.

Black-Schaffer advises learning all you can about what caused your stroke and what you can do to avoid further health problems. Use the following questions as a guide when you talk with your doctor about what to expect in the months and years ahead.

1. What caused my stroke?

Eighty percent of all strokes occur when blood flow to the brain is suddenly cut off -- usually by a blood clot or some other obstruction. This is called an ischemic stroke. A hemorrhagic stroke occurs when a blood vessel ruptures in the brain.

Knowing the type of stroke you had can help your doctor determine the underlying cause. For example, an ischemic stroke may be caused by a blocked artery due to the buildup of plaque -- a mixture of cholesterol and other lipids, or blood fats. People with atherosclerosis, or hardening of the arteries from plaque buildup, are more at risk for this type of stroke. High blood pressure is a common culprit in hemorrhagic stroke. Both of these conditions increase the risk of stroke, and managing them can help prevent a second stroke.

2. Am I at risk for a second stroke?

The overall risk of a second stroke is highest right after a stroke. Three percent of survivors have a second stroke in the first 30 days, and one-third will have another within two years.

"However, individual risk factors are highly variable," Black-Schaffer says. "That's why it's vital to talk with your doctor to understand your specific risk factors and develop a plan to minimize them."

High blood pressure is the number one cause of stroke and the biggest risk factor for stroke. Having heart disease, high blood cholesterol, or diabetes also puts you at risk. Lifestyle factors that put you at risk include smoking cigarettes, obesity, physical inactivity, heavy alcohol consumption, and illicit drug use.

3. What is the stroke recovery process?

Although your stroke rehabilitation program will be tailored to your specific needs, most people follow a similar path. You'll begin to do assisted exercises in the hospital once your medical condition has stabilized.

From there, you may go to an in-patient rehab facility where you will receive intensive therapy to help you become more independent. Once you are able to return home, you may receive outpatient therapy or home therapy to help you recover as much as possible.

Formal rehabilitation takes place for about three to six months. But studies have shown that stroke patients who continue to practice the skills they learned in rehabilitation continue to see progress long after a stroke has occurred.

4. How long will my recovery from stroke take?

Stroke recovery is different for every patient. Although some people with a mild stroke recover quickly, for most stroke survivors, recovery is a lifelong process.

"While the biggest gains will be made in the first three months after a stroke, patients can continue to recover ... even years later," Black-Schaffer says. "The key is to get into a daily pattern of exercise."

5. Am I at risk for depression after a stroke?

Becoming depressed after a stroke is very common. So ask your doctor about the symptoms of depression so that you and your caregivers know what to look for. Post-stroke depression is thought to be caused in part by biochemical changes in the brain. It's also a completely normal reaction to the losses caused by a stroke. Whatever the reason, treatment is essential. Fortunately, depression can be effectively treated with medication and/or counseling.

6. What medications will I be taking and do they have any side effects?

Strokes are most often caused by blood clots, so your doctor will probably prescribe anticoagulant or antiplatelet medication, commonly known as blood thinners, to help prevent future strokes. You may also need to take medications to help lower high blood pressure or high cholesterol, treat a heart condition, or manage diabetes.

Be sure to talk with your doctor about your medications so that you understand why you are taking them. Ask about potential side effects and possible food and medicine interactions. To help you keep track, you or your caregiver should write down the name and dose of all your medications, including when and how to take them.

7. When should I call my doctor?

Talk with your doctor about what symptoms or situations may indicate a call. However, if you notice any of the following signs of stroke, call 911 immediately. Don't delay -- minutes count when it comes to preventing damage from stroke.

• sudden numbness, paralysis, or weakness, especially on only one side of your body
• sudden dizziness, problems with walking, or loss of balance or coordination
• sudden changes in vision
• drooling or slurred speech
• sudden confusion or difficulty speaking or understanding speech
• a sudden, severe headache that is different from past headaches or has no known cause

8. Where can I get support as a stroke survivor?

Getting support from other stroke survivors can help with your recovery. You can contact the American Stroke Association at 800-242-8721 for help in finding a support program in your area or to find out about online support groups. Another resource for finding out about support groups is the National Stroke Association. Their phone number is 800-787-6537.

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