The First Three Months after a Stroke

Time is of the essence when treating a stroke, also known as a ‘brain attack’. If you believe you are experiencing a stroke, you should always seek emergency medical attention. Any of the following symptoms that appear out of the blue should raise suspicions that you may be having a stroke:

  • Facial drooping
  • Arm or leg weakness
  • Blurry or loss of vision
  • Loss of balance
  • Difficulty speaking or understanding speech

Anyone who thinks they could be having a stroke needs to be assessed by emergency medical providers. If an ischemic stroke has been diagnosed quickly enough, patients may be eligible to receive emergency treatments that reverse the stroke. Surgical interventions may also be provided for other types of stroke.

When stroke is promptly treated, the average hospital stay for most patients is only 1-2 weeks long. Throughout their first few days in the hospital, they will be closely watched. It is recommended that the patient start stroke rehabilitation exercises within 24 hours or as soon as their symptoms stabilize in hospital.

But, what happens after stroke patients are released from hospital? Understanding the recovery time after a stroke might help you plan ahead and achieve better results.

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Specialized home care to optimize recovery after stroke and brain injury in Edmonton, Alberta
After Stroke Care — Home Care Program in Edmonton, AB

We provide innovative stroke rehabilitation services in Edmonton, Alberta. In the first weeks after a stroke, be sure to seek out qualified health professionals who follow Canadian Stroke Best Practices and those with experience enhancing stroke outcomes in the community.

After Discharge from Hospital

Top 8 Strategies to Prevent a Second Stroke

  1. Manage Blood Pressure
  2. Manage Blood Sugar
  3. Improve Heart Health
  4. Eat Heart Healthy Foods
  5. Increase Physical Activity
  6. Lose Weight
  7. Quit Smoking
  8. Reduce Alcohol Use

Did you know?

  • 1 in 4 stroke survivors will have another stroke within one year
  • Stroke survivors often have untreated disease conditions (e.g. high blood pressure or diabetes) that increase their risk of having another stroke

One of the most important things you can do after a stroke is to closely review your overall health status to reverse common causes of stroke.

After a stroke, chronic conditions need to be strictly managed. This includes high blood pressure, atrial fibrillation (heart flutter), arterial disease, high cholesterol, and diabetes.

It’s also critical that you are referred to a stroke rehabilitation team with knowledge of Canadian Stroke Best Practices. After being released from the hospital, many people stop participating in stroke rehabilitation. This is an unfortunate outcome that will delay recovery from stroke, as stroke recovery is most effective in the first 3-6 months after a stroke. The sooner stroke rehabilitation is started in the community, the better.

When it comes to healing the brain, if you don’t use it… you will lose it. It is imperative that work is started as soon as possible to regain abilities (like speech, swallowing, hand dexterity, and walking) as soon as possible after discharge from hospital.

The First Month After a Stroke

The first month living at home after a stroke is often the hardest. Caregivers are likely to report stress trying to meet many new care needs at home. Mobility limitations are often the most stressful for caregivers to manage, but other losses can also be challenging.

Depending on the type of stroke that occurred, the first month of stroke recovery may be marked by:

  • Severe fatigue and sleep difficulties
  • Changes in behaviour or personality
  • Depression, irritability or anxiety
  • Muscle weakness, paralysis or spasticity
  • Difficulty speaking or swallowing
  • Memory problems or slow thinking/speech

It is not advisable to replace the patient’s daily activities with services that “reduce or replace the work of care,” despite the fact that many home care providers are ready to carry out a variety of duties for the patient. The first month after a stroke is crucial for restoring lost function, and the patient must be supported to take on as much of the work of care as possible in the first month of rehabilitation.

To best help post-stroke patients accomplish tasks, home care providers should take extra time to break down complex tasks into component parts. Trained health professionals may utilize evidence-based techniques — such as mirroring and forced constraints — to accomplish this.

If someone is struggling to swallow after a stroke, speech-language therapy may also be helpful.

Of note, the first month is the most important time to invest in stroke recovery.

Shifting from a Sprint to a Marathon (Months 1 – 3)

After the first month of stroke recovery, rehabilitation goals should shift from expecting a complete return to normal and instead focus on reducing any loss of function that remains.

Compensation strategies to enhance independence are key during months 1 to 3 of stroke recovery. This can include teaching clients how to use their non-dominant head to perform things like brushing their teeth. Every self-care deficit should be closely assessed by a health professional, in case a workaround is possible.

During this time, patients also need extra support to complete daily activities as independently as possible. Shifting to a coaching approach can be valuable. This may involve chopping veggies while the patient completes the rest of a cooking recipe. Or, the caregiver might remain on stand-by while the client attempts to shower on their own.

While supervised stroke therapies are still important, the patient’s hard work will result in a more robust recovery between months 1 and 3.

Like any marathon, the stroke patient will need to overcome their mental blocks. Depression is common during this time, and stroke can have negative emotional impacts on both the patient and caregiver. Mental health challenges are particularly detrimental for stroke recovery during this time, and can be accompanied by both grief and the loss of motivation. This can interfere with the patient’s own resiliency and recovery time, and should be promptly addressed.

There is No Finish Line (After Month 3)

There is, unfortunately, no finish line for stroke recovery.

After the third month, patients should be encouraged to continue the process of stroke recovery. The race goes on, although the process of stroke recovery will become a bit more difficult, just like in any marathon.

Here are some long-term outcomes that patients can aim for after the third month:

  • Full Recovery — The brain sometimes miraculously heals itself, spontaneously regaining abilities that seemed lost. A full recovery occurs due to a variety of factors, although neuroplasticity (resulting from the patient’s hard work & some biological ingenuity) usually re-circuits contralateral regions of the brain to replace lost functions.
  • Functional Recovery — Functional recovery is not a full recovery, as some function appears to be lost permanently. While some function is lost, the patient was successful in adapting to new ways of doing things. For example, they learn new ways to cut food and eat using a single hand.
  • Intermittent Recovery — Sometimes, brain functions are partially restored after a stroke in a way that requires continued focus and perseverance. This is common with speech recovery, for example. Some people may regain their ability to speak fluently but lose functioning during times of stress, fatigue or distraction. Relaxation exercises (like deep breathing and rest periods) may help patients restore full functioning in times of stress.

Published by Adam Henley

Adam is a Registered Nurse with experience in chronic disease management, symptom measurement, hematology/oncology, primary care behavioural health and geriatrics. He combines counselling, nutrition & exercise with traditional home nursing care. Adam cares to live health together with clients in a manner consistent with Parse’s Theory of Human Becoming. At the heart of his care, Adam offers evidence-based strategies to transform health together.

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