Stroke Recovery and Post-Stroke Problems

As the leading cause of disability in the U.S., stroke affects people of all ages. A stroke can affect a person's cognitive and physical abilities.

After a stroke, people often need specialized rehabilitation to heal. For those who have lost significant function, it's vital to get treatment as soon as possible.

If you or a loved one has suffered a stroke, the UPMC Rehabilitation Institute can help.

Your rehab team at UPMC:

• Tailors treatment plans for your individual needs.
• Focuses on helping you regain your function and self-reliance so you can safely return to your community.
• Provides a full range of advanced rehab services.

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Contact the UPMC Rehabilitation Institute

Contact the UPMC Rehabilitation Institute to learn more about inpatient rehab.

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The Effects of Stroke

A stroke is a brain injury that occurs when the blood supply to the brain stops.

It can cause problems with:

• Thinking and memory.
• Swallowing.
• Language and speaking.
• Walking or balance.
• Daily activities.
• Mental health.

Swallowing Tests and Rehab After Stroke

Trouble swallowing impacts many people after a stroke.

Prompt testing and treatment for swallowing problems is vital for your recovery.

Your speech-language pathologist at UPMC:

• Will work with you to see if you have a swallowing disorder.
• May order a swallow test.
• Will work with other members of the stroke rehab team on a diet plan for you until your swallowing improves.

Modified barium swallow study after stroke

This moving x-ray watches the swallowing process to see what happens to food as you swallow it.

During the modified barium swallow study after your stroke, your speech-language pathologist will:

• Have you swallow foods and barium of different consistencies, such as liquids, pudding, or cookies. Barium has artificial flavors and sweeteners, so it shouldn't taste bad. But some people say it has a bitter or chalky taste.
• Watch to see where the food goes when you swallow. If it goes into the esophagus, this is normal. If food goes into the airway, this is abnormal.
• Make note if you cough (aspirate) if food goes into the airway. If you don't cough, this is a “silent aspiration." Both types can cause pneumonia.

If the test shows you shouldn't eat or drink by mouth, you may need a feeding tube until you can safely swallow.

A minimally invasive fiberoptic endoscopic exam after stroke is another test that tells us what happens before and after you swallow.

Stroke Recovery Stages and Timeline

Everyone recovers from a stroke differently. Most people will need some form of rehabilitation.

The goal of stroke rehab is to get you back to living as much of a normal daily life as possible. Your stroke's severity and the damage it does affect how much rehab you will need.

What are the stages of stroke recovery?

The stages of stroke recovery include:

• Initial treatment.
• Rehab when needed.
• Preventing another stroke.

What does the stroke recovery timeline look like?

Factors that affect how long it will take you to recover from a stroke include:

• Your age.
• Any other health problems.
• The type of stroke you had.

Stroke recovery focuses on overcoming post-stroke side effects and symptoms.

Here's a typical recovery timeline.

Initial stroke treatment

Stroke recovery begins the moment you enter the ER. That's when treatment will start to save your life and limit your stroke's damage.

Doctors may admit you to the intensive care unit (ICU) or acute care.

Within 24 hours

For stroke survivors who are medically stable, rehab often starts 24 hours post-stroke.

First few weeks after stroke

Most stroke survivors stay in the hospital for five to seven days.

During that time, your doctor will assess your post-stroke side effects. You'll also start intensive inpatient stroke rehab focused on getting you back home.

Three to four months post-stroke

The most rapid recovery from a stroke takes place within the first three to four months.

If you're in acute rehab, you can expect to see improvement week to week.

Stroke rehabilitation timeline

Stroke rehab takes time. After six months, your rate of recovery slows down, but it doesn't end.

Some stroke survivors can continue to improve for up to 18 months post-stroke, depending on the rehab they receive.

You may need stroke rehab for weeks, months, or years.

Types of rehab can include:

• Speech therapy. To help you improve communication, speech, and swallowing.
• Physical therapy. To help you with movement, physical function, and coordination skills, such as walking and balance.
• Occupational therapy. To help you regain skills needed for daily living, such as eating, drinking, dressing, bathing, reading, and writing.
• Recreational therapy. To help you regain social skills.
• Psychotherapy. To help you with post-stroke depression or other mental health challenges.

Stroke prevention

Having a stroke puts you at high risk of having another one, with one in four strokes each year being repeats.

The first week after a transient ischemic attack (TIA) or "mini-stroke" is when the risk of a major stroke is greatest.

Ways to help prevent stroke include:

• Treating the causes of stroke, including diabetes, AFib, heart disease, high blood pressure, and high cholesterol.
• Taking medications as prescribed by your doctor.
• Following a healthy lifestyle, including a healthy diet, regular exercise, and avoiding smoking.
• Exploring surgery if needed.

What Are Common Problems After a Stroke?

Common post-stroke physical problems include:

• Weakness, paralysis, and trouble with balance or coordination.
• Pain, numbness, or burning and tingling feelings.
• Fatigue, which may continue after you return home.
• Inattention (or neglect) to one side of the body. In extreme cases, you may not have awareness of your arm or leg.
• Urinary or bowel incontinence.
• Speech problems or trouble understanding speech, reading, or writing.
• Trouble swallowing.
• Memory problems, poor attention span, or difficulty solving problems.
• Vision problems.
• Depression, anxiety, or mood swings with emotional outbursts.
• Trouble recognizing limitations caused by the stroke.

Right vs. Left Side of the Brain

There are different effects when a stroke happens on the right side of the brain versus the left.

A right-side stroke causes problems on the left side of the body, such as muscle weakness or stiffness. A stroke that occurs in the left side of the brain will affect movement on the right side of the body.

What are post-stroke side effects?

A stroke to the right side of the brain can cause:

• Left-side weakness.
• Impulsive behavior.
• Overconfidence in abilities.
• Vision problems.

A left-side stroke can cause:

• Right-side weakness.
• Speech and language problems.
• Slow behavior.

Other post-stroke side effects

You may need focused rehab and treatment to address other conditions after a stroke.

Shoulder-hand syndrome

Shoulder-hand syndrome happens when muscles decrease in size and strength and cause the shoulder to detach from its socket.

Symptoms may include:

• Tingling.
• Varying feelings of hot and cold.
• Changes in sensation.

Preventing and treating the syndrome is crucial to the rehab process. Range-of-motion exercises can help.

Learned non-use

A rare occurrence often seen in people after having a stroke is "learned non-use."

This happens when you accept the loss of function of a muscle or muscle group and only use your "good side."

Treatment for this condition allows the brain to "rewire" connections to help regain function and movement.

Spasticity

Spasticity is a frequent outcome of stroke.

Your limbs may change position. Your neck, arms, or legs can become stiff, painful, or shortened, limiting mobility and interfering with daily life.

Spasticity treatment at the UPMC Rehabilitation Institute can help improve your quality of life.

What Are Common Speech Problems After Stroke?

The speech-language experts at the UPMC Rehabilitation Institute assess and treat speech, language, and other communication disorders.

Dysarthria

This collective term describes speech changes caused by any of the following:

• Muscle weakness.
• Lack of coordination.
• Increased muscle tone.
• Presence of involuntary movements.
• Muscle stiffness.
• Apraxia of speech.

This is a specific type of neurology-based speech change.

It happens when the brain isn't able to provide normal sensory and motor control to the:

• Jaw.
• Lips.
• Tongue.
• Soft palate.
• Vocal cords.

Signs of speech apraxia include:

• Distorting sounds and words. You may add new sounds or leave sounds out. Or you might put the wrong stress, tone, or rhythm on a word.
• Saying one word when you meant another. For instance, saying "chicken" when you meant to say "kitchen."
• Struggling to say the right word. It might take several tries before you can say it correctly.
• Having trouble saying longer, more complex words.
• Speaking more slowly.
• Being inconsistent in speech. You're able to say the word correctly one day, but not the next.
• Not being able to make sounds at all, in extreme cases.
• Aphasia.

Aphasia is a language-processing disorder that happens because of damage to the brain.

Aphasia affects your ability to:

• Understand spoken and written words and sentences.
• Recall words.
• Form sentences.

Aphasia does not affect your:

• Level of intelligence.
• Ability to think.
• Hearing.

You and your caregivers may find aphasia very frustrating. It's like trying to learn and speak a foreign language when living in a foreign country.

Can a Stroke Cause Cognitive Impairment?

Post-stroke cognitive impairment is common among stroke survivors for all subtypes of stroke.

Stroke can damage the parts of the brain that handle your:

• Attention span.
• Memory. You can have problems with short-term memory. A stroke can also put you at an increased risk of dementia.
• Social skills.
• Thinking. You can have task apraxia — trouble following instructions or completing complex tasks.
• Visual processing.
• Communication.

What Are the Effects of Post-Stroke Depression?

Depression is a frequent problem after a stroke.

Physical and psychological symptoms of depression can include:

• Sudden mood changes.
• Feeling anxious, worried, pessimistic, or hopeless.
• Having thoughts of death.
• Loss of energy.
• Increase or decrease in appetite.
• Problems sleeping or sleeping too much.
• Trouble concentrating, remembering, thinking, or making decisions.
• Headache.
• Digestive problems.
• Sexual problems.

Talk to your doctor if you have concerns about depression. You may find that antidepressant medications can help.

You can also get a referral to a psychologist or psychiatrist in addition to (or instead of) medicine.

Socializing with other people who have had strokes may also help improve mood.

Stroke Rehab Resources

There's hope and help for survivors of stroke.

The following local, state, and national resources offer practical, emotional, and financial services and support for stroke survivors and their caregivers.

Community resources for stroke survivors

Western Pennsylvania

Many groups in western Pa. offer support to stroke survivors.

• The UPMC Center for Assistive Technology:
• Wheelchair seating assessments.
• Driving training and exams.
• Modification recommendations for the car and home.
• Assistive technology suggestions for home or work.
• UPMC Rehabilitation Institute: Inpatient and outpatient rehab, as well as physician services, at more than 90 locations.
• Community LIFE: Adult day care in Allegheny and Westmoreland counties.
• LIFE Pittsburgh: Community-based alternative to nursing home care and assisted living.
• Three Rivers Adaptive Sports: Recreational activities for people with disabilities, including:
• Water and snow skiing.
• Fishing.
• Bowling.
• Reach them at 412-848-8896.
• Community Living and Support Services (CLASS): Also has a program for attendant care. Reach them at 412-683-7100.

State stroke programs

Stroke survivors can find help through many programs throughout Pa. as well.

• Office of Vocational Rehabilitation: This state agency helps people with disabilities return to work or volunteer. Reach them at 412-392-4950.
• Pennsylvania Department of Aging: With offices in every county, the department can help stroke survivors older than 60.
• Pa. Department of Human Services: Offers cash assistance, Medicaid, and transportation to doctor or therapy appointments.

National stroke resources

• Partnership for Prescription Assistance: Offers prescription help for people who don't have insurance. Reach them at 1-888-477-2669.
• The Social Security Administration's Ticket to Work Program: Lets disabled people work without losing Social Security benefits. Reach them at 1-800-772-1213.

For stroke caregivers: taking care of your life, too

Caregivers can take the form of spouses, partners, children, brothers, sisters, and friends. They may provide care for only a few months or for many years.

Although you may find caregiving rewarding, you may also find it frustrating and stressful.

You may have a range of emotions after your loved one has had a stroke, such as:

• A sense of isolation.
• A fear that you can't provide adequate care.
• Guilt.
• Frustration.
• An intense sadness.
• A fear of abandonment by family and friends.

These feelings are all normal.

There are a few key things to remember as a caregiver:

• You deserve good health and quality time to yourself. These two things are often the best gifts you can give to your loved one.
• Caregiving is not a one-person job. Look for, ask for, and demand help if necessary. Ask your family members and friends to help with respite care.
• Accept help and suggest things for people to do. Likewise, be aware of what you can and cannot do. Set realistic goals and priorities.
• Learn about new stroke treatments and ideas.
• Be aware of depression. If you feel depressed, do not delay getting help.

Stroke resources for loved ones and caregivers

UPMC Stroke Institute

412-647-8080

UPMC Presbyterian
200 Lothrop St.
Pittsburgh, PA 15213

Resources you can turn to for support or to learn more about caring for a loved one after stroke may include:

• Community organizations.
• Local colleges, churches, and senior centers.
• Hospitals and nursing homes.
• Adult daycare centers.
• County social services offices and public health agencies.

Visit the following websites to learn more about stroke and caregiving:

• American Stroke Association.
• Family Caregiver Alliance®.
• National Alliance for Caregiving.
• National Family Caregivers Association.
• National Stroke Association™.

Contact the UPMC Rehabilitation Institute

Call 1-877-287-3422 to learn more about our stroke rehab program or to refer a patient.

Our Stroke Rehab Experts

• Jessica Berry, MD
• Shaun Darrah, MD
• Kerry DeLuca, MD
• Kevin Franzese, DO
• Gary Galang, MD
• Max Hurwitz, DO
• Molly Krause, DO
• Grace O'Neale, MD
• Jennifer Shen, MD
• Debbie Tan, MD
• Maria Twichell, MD
• Kali Webb, DO

Looking for...

• Inpatient Rehabilitation.
• Outpatient Physical, Occupational, or Speech Therapy.
• Rehabilitation Doctors.