From the Guidelines
Recovery after a stroke can be expected to reach its potential within 3-6 months, with the most significant improvement typically occurring in the first 3 months, as evidenced by the 2016 guidelines for adult stroke rehabilitation and recovery from the American Heart Association/American Stroke Association 1. The recovery process varies widely among individuals and is influenced by several factors, including the stroke's severity and location, the patient's age, pre-stroke health status, and access to rehabilitation services.
- Early, intensive rehabilitation is crucial and should begin as soon as medically stable, ideally within 24-48 hours after the stroke.
- A comprehensive rehabilitation program typically includes physical therapy, occupational therapy, and speech therapy if needed, with sessions occurring 3-5 times weekly for several months.
- Medications like antiplatelet drugs (aspirin 81-325mg daily or clopidogrel 75mg daily) or anticoagulants may be prescribed to prevent future strokes, as recommended by the guidelines 1. The brain's neuroplasticity—its ability to form new neural connections—is the biological basis for recovery, allowing healthy brain regions to potentially take over functions from damaged areas through consistent therapeutic activities that challenge and stimulate the nervous system.
- The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority, as stated in the 2016 guidelines 1.
- The success of rehabilitation depends on caregiver training and support, as well as education for the patient and caregiver regarding secondary stroke prevention and means to achieve rehabilitation goals, as highlighted in the 2015 guidelines for the management of spontaneous intracerebral hemorrhage 1.
From the Research
Recovery Expectations After a Stroke
The amount of recovery that can be expected after a stroke varies from person to person, but research suggests that most functional gains are achieved during the first 12 weeks after the stroke 2.
- Functional recovery occurs at least until 24 weeks after acute stroke, with significant improvements in the first 12 weeks 2.
- Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks 2.
- The location and volume of the stroke lesion, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks, are relevant biomarkers of post-stroke recovery 3.
Factors Influencing Recovery
Several factors can influence the recovery potential after a stroke, including:
- Early use of thrombolysis aimed at arterial recanalization and reperfusion of ischemic brain tissue 3.
- Neurorehabilitative training, which critically improves clinical recovery due to augmentation of postlesional plasticity 3.
- Multidisciplinary neurorehabilitation that meets individual needs can help to optimize recovery 4.
- Associated disorders, such as mood disorders, epilepsy, and neurodegenerative diseases, may induce secondary cerebral changes or aggravate the functional deficits and compromise the potential for recovery 3.
Predicting Recovery
The proportional recovery rule asserts that most stroke survivors recover a fixed proportion of lost function, but research suggests that this rule may not be as accurate as previously thought 5.
- Baseline scores may not be the only predictor of recovery, and other factors such as the location and volume of the stroke lesion, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks, should also be considered 3.
- The use of correlation coefficients between baseline scores and recovery may be inflated, and more nuanced approaches to predicting recovery may be needed 5.