From the Guidelines
Patients with stroke recover better during the first 2 to 6 months compared to after 6 months due to a phenomenon called neuroplasticity, which is heightened during this early recovery period. This is supported by the most recent and highest quality study, which suggests that intensive physiotherapy of one to two hours a day resulted in improvements in activities of daily living, and people who have had a stroke reported faster recovery, especially within the first six months, compared with usual care 1.
Key Factors Influencing Recovery
The recovery process after a stroke is influenced by several factors, including:
- The brain's ability to reorganize itself through neuroplasticity, which is most pronounced in the first few weeks after stroke and gradually diminishes over the following months 1
- The intensity and frequency of rehabilitation therapies, such as physiotherapy, occupational therapy, and speech and language therapy, with a recommended total therapy time of at least three hours on at least five days a week 1
- The presence of comorbid conditions, caregiver support, and access to assistive devices, which can all impact the recovery process 1
Importance of Early Rehabilitation
The importance of early, intensive rehabilitation after stroke cannot be overstated, as it capitalizes on the brain's heightened ability to rewire itself during this critical window of enhanced neuroplasticity. Offering needs-based rehabilitation to people after stroke, for at least three hours a day, on at least five days of the week, and covering a range of multidisciplinary therapies, is crucial for maximizing recovery potential 1.
Ongoing Recovery Efforts
While the pace of recovery may slow after 6 months, ongoing rehabilitation efforts can still lead to improvements, albeit at a slower pace. It is essential to continue providing support and therapy to individuals after stroke, even after the initial 6-month period, to help them achieve their maximum potential for recovery and independence 1.
From the Research
Recovery Patterns in Stroke Patients
- Stroke patients tend to recover better in the first 2 to 6 months after the incident, with significant improvements in functional abilities [(2,3)].
- The brain's neuroplasticity, which is heightened shortly after acute stroke, plays a crucial role in rehabilitation and recovery [(2,4)].
- Early rehabilitation, initiated within 2 weeks after stroke, has been shown to be beneficial for some deficits, including upper extremities and severe aphasia 2.
Timeframe for Recovery
- Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks 3.
- Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks 3.
- After 6 months, patients aged 70 years and older tend to show functional decline, whereas younger patients may continue to experience improvements 5.
Factors Influencing Recovery
- Age is a significant determinant of functional recovery, with older patients tend to have limited recovery and decline in functional abilities over time 5.
- Multidisciplinary neurorehabilitation, started early and continued over time, can help optimize recovery and improve quality of life 6.
- Novel approaches to early treatment, including constraint-induced movement therapy and intensive early post-stroke therapy, may be beneficial for patients with specific deficits [(2,4)].