Rehabilitation guide
A stroke happens when the blood flow to the brain is suddenly disrupted, and it can make moving, speaking or everyday tasks difficult. The brain can relearn lost functions, and rehabilitation that starts early, is regular and involves plenty of repetition is what drives this recovery.
Brain tissue is damaged when a blood vessel in the brain is blocked by a clot (ischaemic stroke) or tears and bleeds (brain haemorrhage). Depending on the area affected, there may be weakness on one side of the body, difficulty speaking and swallowing, problems with vision and balance, and difficulty with attention and memory.
Stroke is the second leading cause of death worldwide, and the third when death and disability are counted together. There are around 94 million stroke survivors worldwide.
The brain can hand over the jobs of the damaged area to surrounding areas and new connections. This is called neuroplasticity, and it grows stronger the more you practise meaningful tasks with plenty of repetition. Recovery is fastest in the first weeks and months: in a classic Danish study, 95% of patients reached their best level of everyday living skills within the first 12.5 weeks.
But the door does not close. In an intensive arm rehabilitation programme for 224 people whose stroke had happened an average of 18 months earlier, arm function improved to a clinically meaningful degree, and the gains kept growing over the following 6 months.
Stroke rehabilitation is a team effort: physiotherapy, occupational therapy, speech and swallowing therapy, and care from doctors and nurses all work together. The patient and their family are part of this team too.
Exercises at home
These movements are taken from the basic exercises commonly used at home after a stroke. Work out with your physiotherapist which ones suit you and at what level. For standing exercises, always have something sturdy to hold on to and, if possible, someone with you. Stop if you get chest pain, shortness of breath, dizziness or any new weakness.
Lie on your back with both knees bent and the soles of your feet flat on the floor. If your affected knee drops out to the side, ask someone to support it gently. Squeeze your buttocks and lift your hips off the floor, hold for 3–5 seconds, then lower slowly. This also makes it easier to shift position and roll over in bed.
10 reps, 1–2 times a daySit on a sturdy chair with your feet flat on the floor. Place a cup or another light object in front of you, a little further away than arm's length. Lean forward from your hips to reach the object, touch it and come back. Gradually increase the distance, and try reaching in different directions too.
10 reps, twice a daySit at a table and rest your affected arm on a towel on the tabletop; if needed, support it from above with your unaffected hand. Slide the towel forwards to stretch your arm out, then draw it back. Try sliding it to the sides and in circles too.
10–15 reps, 2–3 times a daySitting on a sturdy chair with armrests, shuffle your hips forward and bring your feet back a little; make sure your affected foot is flat on the floor too. Lean forward and stand up with your weight spread evenly over both legs, then sit back down with control. Push up with your hands if you need to.
5–10 reps, twice a dayHold on with both hands to something sturdy, such as the kitchen counter, with your feet shoulder-width apart. Slowly shift your weight onto one leg, then onto the other. Take extra time to put weight through your affected leg.
10 reps on each sideStand upright holding on to the counter. Lift both heels together to rise onto your toes, hold for 2 seconds, then lower slowly. This strengthens your calf muscles and helps you push off from the floor as you walk.
10 reps, 1–2 times a dayThe right support is not about doing things for the person that they can do themselves; it is about helping them do those things safely. Family members and carers are part of the process too.
Video
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck. Do the exercises at the level your physiotherapist recommends.
Home exercises to improve walking and balance after a stroke.
Exercises you can do at home when there is very little movement in the arm and hand.
Recovery is fastest in the first weeks and the first 3 months. In a classic study, 95% of patients reached their best level of everyday living skills within the first 12.5 weeks. But with regular, goal-directed practice, improvement is still possible months or even years later.
Yes. In an intensive arm rehabilitation programme for 224 people whose stroke had happened an average of 18 months earlier, there was clinically meaningful improvement, and the gains continued over the following 6 months. Goal-directed practice with plenty of repetition is worthwhile at any stage.
It should start in the acute phase, that is, while you are still in hospital, with your doctor's approval. However, intensive and frequent mobilisation started within the first 24 hours gave no extra benefit; the timing and intensity are tailored to each person.
Do not lift the person by pulling on their affected arm; when sitting or lying, support the arm on a pillow or a table. Exercises using an overhead pulley are not recommended because they can harm the shoulder. If pain has already started, your physiotherapist will plan positioning, exercises and, if needed, additional treatments.
For suitable patients, yes. Patients who were discharged early and continued rehabilitation at home with the support of a team had a lower risk of death or dependence on others, and their hospital stay was about 6 days shorter. Working in your own home also makes it easier to adapt the exercises to real everyday tasks.
The most effective steps are keeping your blood pressure under control, taking your medicines regularly, stopping smoking, staying active and eating healthily. Worldwide, 84% of the stroke burden is linked to modifiable risk factors.
The first four signs may mean a new stroke: call 112 straight away, even if the symptoms pass. In an untreated stroke, about 1.9 million nerve cells are lost every minute. For the other situations, see a doctor without delay as well.
Sources
İhsan Eren