Stroke rehabilitation: What to expect as you recover from stroke

Stroke rehabilitation (stroke rehab) is an important part of recovery after stroke. Find out what's involved in stroke rehabilitation.
Getting back on your feet is likely one of your top concerns after a stroke. Whether it's returning to work, walking your dog or regaining enough dexterity to tie your shoes, or dress or feed yourself without assistance — all of these are goals of stroke rehabilitation.
Stroke rehabilitation, also called stroke rehab, is a key part of your post-stroke care plan. Each year, more than 700,000 people in the United States have a stroke, and about two-thirds of them will need some type of stroke rehabilitation.
The severity of stroke complications and each person's ability to recover lost abilities varies widely. However, stroke rehabilitation can usually help you achieve the best long-term results.

What is stroke rehabilitation?
The goal of any stroke rehabilitation program is to help you relearn skills lost when stroke damaged part of your brain. Participating in stroke rehabilitation helps you regain as much independence as possible and achieve the best quality of life.
Stroke rehabilitation can include physical and occupational therapy or exercises that help you control your movements. These therapies or exercises also might help you learn new ways to perform tasks or compensate for any weakness in your limbs or other areas of your body. For example, your stroke rehabilitation therapy might include learning to bathe, dress or eat with only one hand. Speech therapy may be needed to learn ways to communicate if your speech has been affected.
It takes time to relearn skills. The most important key to success for any stroke rehabilitation program is well-focused and repetitive practice. The saying "Practice makes perfect" applies to stroke rehabilitation just as it does to learning any new skill.

What's involved in stroke rehab?
Stroke rehabilitation can involve physical therapy or exercise, as well as relearning language and communication skills with speech therapy. Stroke rehabilitation may include some or all of the following therapies:
Therapy for communication disorders. After a stroke, you may have problems speaking, listening, writing or comprehending speech or other forms of communication — a disorder known as aphasia. Aphasia is a common stroke complication, affecting about 40 percent of stroke survivors. Speech therapy can help you regain some or most of your lost ability. The process can be slow and is often frustrating, but with practice you'll likely improve. You may practice basic skills, such as naming objects or explaining the purpose of an object.
Strengthening motor skills. Muscle weakness after a stroke is common. Your therapist may work with you on exercises that improve your strength. Weakened muscles in the throat may also cause problems swallowing (dysphagia). Exercises, new swallowing techniques, and changes in food consistency may help correct this.
Mobility training. More than half of stroke survivors have difficulty walking. Therapy options include the use of walking aids such as braces, walkers or canes to support part of your body's weight while you relearn how to walk.
Range of motion therapy. You may have cramped or contracted muscles after stroke — a disorder known as spasticity. Physical and occupational therapy use exercises and other treatments to help lessen muscle tension and regain range of motion.
Psychological therapy. After stroke, you may feel depressed and have difficulty managing your emotions. Antidepressant medications, counseling with a mental health professional and participation in support groups may help.
Constraint-induced therapy. This therapy involves restricting the use of an unaffected limb while you practice moving the affected limb. Forcing you to use the affected limb more can help improve your limb function. This therapy is also known as "forced-use" therapy because it forces you to use the affected limb.
Electrical stimulation. This involves the use of electricity to stimulate weakened muscles, causing them to contract. This may help with muscle re-education in some individuals.

When should stroke rehabilitation begin?
Stroke rehabilitation should begin as soon as possible after a stroke. The first priority is to stabilize your medical condition and get life-threatening conditions under control. Doctors will also take measures to prevent another stroke and limit any stroke-related complications. However, once these steps have been taken, it's common for stroke rehabilitation to start during your hospital stay. The sooner you begin stroke rehabilitation, the more likely you are to regain lost abilities and skills.

How long does stroke rehabilitation last?
The length of your stroke rehabilitation depends on the severity of your stroke-related complications. While some stroke survivors recover quickly, most stroke survivors need some form of stroke rehabilitation long term, possibly months after their stroke. Your stroke rehabilitation plan will change during your recovery as you relearn skills and your needs change.
The length of time you spend doing stroke rehabilitation during each therapy session will also vary depending on your recovery and severity of your symptoms. You may spend as little as one hour a day three days a week, or up to three to five hours a day, seven days a week.

Where will stroke rehabilitation take place?
You'll probably begin stroke rehabilitation while you're still in the hospital. Before you leave the hospital, you and your family will work with hospital social workers and your care team to determine the best rehabilitation setting for you depending on your needs, what insurance will cover, and what is most convenient for you and your family. These options include:
Inpatient rehabilitation units. These are facilities that are either free-standing or part of a larger hospital or clinic. You may stay here for two to three weeks as part of an intensive rehabilitation program. Expect to receive at least three hours of therapy on most days.
Outpatient units. These facilities are often part of a hospital or clinic. You may spend several hours a day, three days a week, at such units relearning skills.
Nursing facilities. The type of care available at a nursing facility — sometimes referred to as a nursing home — varies widely. Some facilities specialize in rehabilitation, while others offer less intense therapy options. Talk with your doctor and family about the best option for you.
Home-based programs. This type of program — having therapy done in your home — allows greater flexibility than other options. One drawback is you likely won't have access to specialized rehabilitation equipment in your home. In addition, insurance strictly controls who qualifies for home-based therapy.

Who participates in your stroke rehabilitation team?
Stroke rehabilitation involves a variety of specialists. Some of those who will likely help with your recovery include:
Physicians. Ranging from your primary care doctor to specialists in physical medicine and rehabilitation (physiatrists) to neurologists, physicians help guide your care and prevent complications.
Rehabilitation nurses. These nurses specialize in caring for those with disabilities. They help carry forward skills learned in physical, occupational and speech therapy into your daily routines.
Physical therapists. These therapists help you relearn physical tasks, such as walking and keeping your balance.
Occupational therapists. These therapists work with you to relearn daily skills, such as bathing, tying your shoes or buttoning your shirt. They can also address safety issues in your home by suggesting changes or proper home equipment.
Speech and language pathologists. These specialists help you improve your language skills and ability to swallow.
Social workers. Social workers work with you on financial decisions, as well as help you arrange new living arrangements if necessary.
Psychologists. These specialists work to ensure your mental and emotional health concerns are addressed.
Therapeutic recreation specialists. These specialists can help you relearn skills needed to do hobbies or other activities you enjoyed before your stroke.

What factors affect the outcome of stroke rehabilitation?
Because stroke recovery varies so widely from person to person, it's hard to predict how many abilities you might recover and how soon. However, in general, successful stroke rehabilitation depends on:
The amount of damage to your brain
How skilled your stroke rehabilitation team is
Cooperation of your friends and family — having a good support network has a big impact on your recovery
Timing of your rehabilitation — the sooner you start, the better you'll do
Stroke rehabilitation takes time
Recovering from a stroke can be a long and — at times — frustrating experience. The difficulties you face are normal. Dedication and willingness to work toward improvement will help you gain the most benefit.