Stroke rehabilitation in adults is an important process that can help people recover from the physical and mental effects of a stroke
Stroke recovery is a complex and ongoing process, so it can be difficult to predict exactly how long it will take to recover. The length of time it takes to recover from a stroke can vary greatly depending on the severity of the stroke, the part of the brain that was affected, and the age and overall health of the person who suffered the stroke.
In some cases, recovery can occur quickly, while in others it may take months or even years to see some recovery or regain certain skills or abilities.
Working with a multidisciplinary team of healthcare professionals, including Physiotherapists, Personal Trainers, Occupational Therapists, and speech-language therapists, can help to optimize recovery and improve the quality of life for stroke survivors.
In this blog we’ll be looking at the following:
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How Much Can I Recover After My Stroke?
Suffering a stroke is a traumatic and often debilitating experience.
As a stroke survivor, what can you do to maximize the extent of your recovery once you have been discharged from Physiotherapy in the NHS?
A stroke is defined as a neurological condition in which the blood supply to the brain is interrupted. During a stroke, energy-hungry neurons begin to die after only two minutes, which ultimately leads to sensory and motor damage.
Over 120,000 stroke survivors are living in Scotland today. Some of them experience the following difficulties:
Weakness in arms and legs
Problems with speaking, understanding, reading, and writing
Losing bowel and bladder control
Pain and headaches
Fatigue – tiredness that does not go away
Problems with memory and thinking
Numb skin, pins, and needles.
Current research suggests that most recovery is seen in the first weeks after a stroke, with the recovery slope reaching a plateau between three and six months.
However, we know that of the 120,000 stroke survivors in Scotland alone, very few of these stroke survivors use stroke rehabilitation services, despite 29% of stroke survivors wanting more Physiotherapy once discharged home.
Furthermore, many stroke survivors undergo spontaneous recovery long after their stroke, which can be further facilitated with rehabilitative services.
Every stroke is different but there are some reliable predictors of stroke recovery. These include:
The seriousness of the stroke
Type of stroke – intracerebral hemorrhage (ICH) strokes have a better recovery than cerebral infarction strokes.
Access to rehab services
While some health variables are out of our control, some of the most significant ones are within our control.
With stroke survivors, for example, we know that exercise after stroke can be very effective; as can improving other lifestyle factors such as nutrition, sleep, and stress.
Knowing what to do is the easy part – understanding how to do it consistently, to create healthy habits is much more complicated.
Capability and motivation are critical to achieving long-term sustainable health behavior change.
Very few people, including stroke survivors, have either the opportunity, motivation, or capability to reach their physical activity potential. This may help explain why activity levels in the UK are so low.
At Health by Science, we provide greater opportunity through Physiotherapy, Personal Training, and delivering stroke rehab classes. Through our classes, social media, blogs, and more, we also aim to increase the capability and motivation of stroke survivors, so that they can help themselves.
So how much can you recover after your stroke?
The answer is, nobody knows. Your rehabilitation potential is influenced by some things you can’t control, such as your age and the severity of your stroke. It is also often said that our genes are like a loaded gun, but it’s our lifestyle that pulls the trigger.
However, as a stroke survivor, you will minimize the risk of another stroke and maximize the chances of reaching your rehabilitation potential by focusing on exercise, nutrition, sleep, stress, and mindset, which will maximize your chances of improving your mobility and the overall quality of your life.
Health by Science is here to help you do just that.
We offer a free Physio assessment for all stroke survivors and free access to try our classes.
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What Kind Of Rehab Do You Need After A Stroke?
Physiotherapy provided 5-7 days a week for 30 to 60 minutes per day has been shown to result in significant improvements in independence and motor function after stroke when compared to no Physiotherapy.
As a result, national guidelines now recommend that stroke patients receive at least 30 minutes of Physiotherapy a day while a patient is in hospital. It is also recommended that participation in exercise should be ongoing and not time-limited.
In other words, IF YOU DON’T USE IT, YOU LOSE IT!
Unfortunately, there are very few opportunities for stroke survivors to receive Physiotherapy for 30-60 minutes of training per day 5-7 days a week, once discharged from the NHS.
However, current research suggests that exercise is beneficial regardless of the time that has elapsed since your stroke. One day of training is better than no days; two days is better than one, three is better than two, etc.
What Exercise is Best After Stroke?
Any movement is good, but it’s vital that you enjoy the exercise and challenge yourself so that you improve
Physiotherapy appears to be most effective when combined with balance training, strength training and cardiovascular training. One popular form of delivering this type of stroke rehabilitation in adults is Group Circuit Class Therapy (CCT), which we use at Health by Science.
These circuits focus on the repetitive practice of functional (meaningful) tasks such as walking, sit-to-stands and other exercises that are continually progressed as you get better and better.
This type of training has been shown to help stroke survivors walk further, faster, and with more independence and confidence. What’s more, the study suggests that “the effects may be greater later after the stroke and are of clinical significance”.
Take-Home Message – The more you move, the more you improve!
This type of training has been shown to help improve hemiparetic upper limbs (weakened on one side of the body) as well as overall mobility (the ability to stand, walk, or run) within a single session.
There is also evidence to show that increases in walking capacity and ability gained through exercise may translate into positive healthy behaviour change, which in turn significantly reduces the risk of having another stroke.
The hardest part of any exercise programme is turning up because consistency is the most critical variable.
That’s why our primary outcome measure is consistency, and we work with our stroke survivors to monitor this.
Once you’ve been coming along for a while, it’s essential that you know if you’re improving, and by how much.
The majority of our stroke survivors notice the benefits immediately, whether that be improved mobility (finding it more comfortable to walk) or a general sense of well-being (feeling good about themselves).
To gather objective data on just how much our stroke survivors have improved we keep a personal exercise record of each stroke survivor and provide you with a copy of your exercises so that you can practise at home.
Home-based Stroke Rehabilitation Exercise Programmes
To help our stroke survivors track their progress both in and out of the gym, we provide you with a personal exercise record. This includes an individualised exercise programme for class circuit training, as well as a home-based exercise programme, which shows you how many repetitions you should aim for, with a video or picture of each exercise.
Within the programmes, we encourage you to record your progress (number of repetitions, time spent training etc), as well as other personalised outcome measures. This helps you to record and track how much you are improving, which in turn helps improve your confidence and motivation.
What Does a Training Session Look Like?
The exercises will vary individually between stroke survivors depending on their ability and goals. Here are some examples of the exercises we commonly use.
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Can A Brain Heal Itself After Stroke?
Neuroplasticity is defined as the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganising its structure, function, and connections (ref).
In other words, your brain is changeable, like plastic, so it can change when you stress it in the right way with Physiotherapy, as summarised in the video below.
The current research highlights the fantastic ability of the human brain to undergo change and help your recovery after stroke.
It’s hard to say how much of your recovery is due to true recovery (repaired neurons) and how much is due to behavioural compensation (creating new neuron pathways) or a combination of the two.
Your motor and sensory pathways are organised into functional maps via neurological pathways, which are highly changeable based on your experience.
In other words, practice makes perfect and the more you move, in a variety of ways, the more you improve.
Although these “maps” of movement are lost after a stroke, they can be “redrawn” with behavioural compensation using the remaining 1,000 trillion unused synapses and newly created pathways or maps.
So “recovery” refers not to getting back to your pre-stroke state but rather improving your performance for whatever activities you wish to do.
When learning (or re-learning) new skills, there are similarities between motor recovery after stroke and the skill acquisition in young children, although stroke survivors may have change impeding processes such as age or hypertension.
Is There A Critical Period Of Recovery?
Research suggests that there is probably an important period of heightened neuroplasticity during the first three months after a stroke.
Although recovery after stroke is unlikely to be the same to the pre-stroke performance (because of the loss of critical neurons), stroke survivors continue to demonstrate the ability to improve their recovery and performance, many years after their stroke due to spontaneous recovery and exercise rehabilitation.
While some variables are out of your control which can affect your progress (such as age or genes), you can maximise your chances of a successful recovery by enriching your environment.
For example, we know that stroke rehabilitation in adults is very effective, as well as improving other lifestyle factors such as nutrition, sleep, stress, and mindset.
So the more enriched your environment is, the more improvement you’re likely to see.
So in summary, you can improve after your stroke. How much? Nobody knows.
The NHS does a fantastic job of helping stroke survivors get home. This is because they deliver evidence-based exercise rehabilitation on a daily basis.
Once home and adapted to home life, however, the rate of recovery typically declines. We would argue that this may be due to a plateau in training volume.
For example, within the NHS, Physios will challenge and push stroke survivors to stress the body so that it adapts.
This is one of the fundamental principles of any exercise intervention, Overload, also known as SAID (Specific Adaptations to Imposed Demands).
Through our stroke rehabilitation programme, Health by Science can help improve your recovery by positively stressing the body, in a safe environment guided by our team of professional and experienced Physiotherapists.
So while it’s impossible to know what you’re ultimately capable of, you’ve got nothing to lose by trying our programme and potentially a considerable amount to gain, both physically and mentally.
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How Do You Retrain Your Brain After A Stroke?
In her book, Carol Dweck describes how, for 20 years, her research has shown some critical differences between those with a ‘growth mindset’ vs those with a ‘fixed mindset’.
The great news is that we can apply the findings outlined below to Physiotherapy stroke rehabilitation in adults. Everyone has the capacity to change their mindset.
If you have a growth mindset, you’re more likely to believe you can develop yourself. You’re open to accurate information about your current abilities, good or bad, and see this as an opportunity to learn, rather than a personal attack on your ego. This ability is critical for learning, as you need to be realistic and honest about your skills right now if you’re to use the most appropriate strategies to move forward.
If you have a fixed mindset, however, things are black and white, good news or bad news, and you’re likely to take things more personally. As a result, people with a fixed mindset are likely to distort the facts to suit their desired interpretation. This means that some outcomes are magnified, others explained away and, before you realise, you don’t know yourself at all.
It could be argued that the language used by a Physiotherapist or other health professionals, constructs the beliefs, and thus health behaviours, of stroke survivors.
Many of our stroke survivors report being told that…
“The first three months are key because you won’t improve beyond that.”
“You will never speak again.”
“You will never walk without a walking aid.”
While the stroke survivors may not have been told this explicitly, they seem to have interpreted it in this manner.
Either way, it’s essential to provide some control over their destiny to maximise their odds so that they may reach their rehab potential and not shy away from interventions like exercise, due to limiting beliefs..
Developing a growth mindset with a sense of purpose is something which we can all aspire to, chronic health condition or not. The point is you may never reach your goal, but it’s the pursuit of the target, the journey and the enjoyment you take with it, which is the most rewarding thing.
We help develop a growth mindset in our clients using exercise. They come in with assumptions about what they can and can’t do, often based on what they have been told is possible.
We challenge limiting beliefs by achieving three fundamental principles of exercise:
In other words, turn up and work hard with our professional guidance and measurements.
When clients achieve these behavioural goals, they see evidence with every session, which in turn helps to refute their limiting beliefs. We then use this as an excellent analogy for life and other mental challenges.
We all need stress to adapt. Too little and we decondition and eventually die. Too much and we get ourselves ill. But if we get the right amount, in line with the principles of science, then we can continually grow, no matter how small or seemingly insignificant that growth may be.
However, it’s important to measure progress which is why we use positive feedback loops (link to Does Physiotherapy After Stroke Work?) in our stroke rehabilitation classes.
Being in this growth mindset is like ‘the pursuit of mastery’ described by Daniel H Pink in his book, ‘Drive’.
Pink argues that there is substantial evidence to suggest that it is not just in the outcome that the reward lies, but that pursuing mastery with a firm purpose is the critical fuel for motivation in life.
That is the critical difference between outcome goals (such as standing up or walking independently) and behavioural goals (such as turning up to Physiotherapy classes and working hard).
These behavioural goals are a ‘gift’ which allows our stroke survivors to improve their chances of achieving their goals by making small incremental improvements on the road to success.
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How Do You Set Goals After A Stroke?
At Health by Science, we understand that there can be many reasons why people may find this difficult, and we have undertaken extensive research into understanding and finding solutions to these issues.
Our approach to stroke rehabilitation in adults is dynamic, innovative and directly linked to the very latest neurorehabilitation evidence.
Based on this research, we encourage our stroke survivors to set manageable and achievable goals, guiding them along their journey with our scientifically backed stroke rehabilitation programme.
The Science Behind Our Ethos
Motivation can typically be divided into two different types, extrinsic and intrinsic.
Extrinsic motivation typically conveys reasons people consider as a ‘should’ (eg doctor’s orders or peer pressure)
Intrinsic motivation refers to autonomous (self-determined) motives which people consider as enjoyment (eg getting fresh air by walking outdoors or enjoying an activity with friends).
Having autonomous behaviour based on intrinsic motivation for physical activity has been shown to result in better outcomes when it comes to exercising consistently. For example, intrinsic motivation is better for helping you to self-regulate and sustain your exercise habits, compared with more controlled extrinsic behaviour.
Although extrinsic motivation may be enough to motivate you to begin exercising, it is not as good, compared with autonomous, intrinsic motivation, when it comes to you exercising long-term and experiencing overall enjoyment.
Outcome Goal Setting
We encourage our stroke survivors to set their own goals (both short-term and long-term) using these principles of motivation.
‘SMART’ goals (Specific, Measurable, Attainable, Realistic, Timely) are recommended by NICE (National Institute for Health and Care Excellence) as they “help people take goals which are vague and translate them into focused and achievable actions. They are likely to be more manageable and memorable as a result.”
Before we use SMART goals, however, we encourage our stroke survivors to set ‘BHAG’ goals.
BHAG stands for ‘Big Hairy Audacious Goals’ and refers to setting a clear and energising target to strive for (like a mission statement). Used with proven success as a motivational tool in business, we believe the same principles apply to our stroke survivors. Therefore, a BHAG encourages our stroke survivors to define visionary long-term goals that are more in line with their strong ‘why’, and which are emotionally compelling.
These are specific to each of our stroke survivors, for example:
A SMART goal, on the other hand, focuses on short to medium-term goals or what you hope to accomplish over the next days or months. This could be as simple as turning up consistently to the stroke rehabilitation in adults class.
Our belief is that rather than perhaps creating false hope in some instances, this approach helps stroke survivors to visualise something significant, personal and emotional which in turn, improves their motivation.
As a result, even the most modest of outcomes are more positive than they might otherwise be, with the stroke survivor enjoying a greater sense of self-worth and achievement than if they had not done anything.
Helping them to visualise something significant, personal and emotional, improves their motivation. We then set SMART goals with them, based on the next step needed in pursuit of their more meaningful long-goal.
Outcome Goals vs Behaviour Goals
As we mentioned above, our stroke survivor’s outcome goal may be to take part in a triathlon. However, week to week we prefer to set aside outcome goals and instead focus on behavioural goals.
There is only so much in the world we can control. Activity levels, illness, medication, stress, nutrition, mindset and sleep – all these can have an impact on how fast a person might recover from their stroke.
Aiming to lose a pound of body fat a week or lift heavier weights every session might just not be doable at certain times in our life. A crisis at home might wreak havoc on your plan to walk an extra hundred steps a day. Getting home late with no option but a take-out might cause you to fall short on those seven-a-day servings of vegetables.
All the above would count as outcome goals.
You can’t always control the outcome. But you can usually control the behaviours which may help you get the outcome you want.
A behavioural goal might be to get you to do some stroke rehabilitation exercises twice a week, even if you can only manage 10 minutes of home exercises; or to go on a trip to the freezer section of your nearest supermarket and stock up on frozen peas and spinach; or plan a shopping list full of ingredients for quick, healthy meals; or to make lunches for the week….or perhaps just to go outside every day.
Setting behavioural goals means setting commitments to small actionable tasks, increasing our stroke survivors’ sense of power and control.
Just setting outcome goals can mean feeling like a failure if things get out of your control.
Behavioural goals, when achieved with consistency, should lead to success in outcome goals.
And, by focusing on their behaviours instead of those outcomes, our stroke survivors, will feel their whole journey has been a success, no matter how bumpy the road.
The Pursuit of Mastery