A stroke is a serious, life-threatening medical condition which is caused by a part of the blood supply to the brain being cut off. This is a medical emergency and when it comes to treatment and recovery, time is the most important factor in setting the pace for recovery. The sooner treatment begins, the less damage the damage to the brain and the better the chances of recovery. This is why as soon as a stroke is suspected, emergency services must be called as there is no time to wait for a GP appointment.

What causes a stroke?

Most strokes stem from 2 main causes:

• ischaemic– where a blood clot terminates the blood supply to the brain (85% of cases)
• haemorrhagic– where a blood vessel supplying the brain weakens and bursts.

A transient ischaemic attack (or mini-stroke) is a similar condition which occurs when the blood supply to the brain is temporarily interrupted. It can last anything between a few minutes and up to 24 hours. TIAs require urgent treatment, as they increase the risk of having a full stroke in the near future. Other medical warning signs that increase the risk of having a stroke include high blood pressure, high cholesterol, atrial fibrillation and diabetes.

What happens in the hospital after a stroke?

When a person first arrives at the hospital with a suspected stroke, the doctor will usually carry out several investigations which may include:

• a brain scan within an hour of arriving at the hospital to determine the cause of the stroke, what part of the brain has been affected and the severity of the stroke.
• blood tests to check cholesterol and blood sugar levels
• checking the pulse for an irregular heartbeat
• checking blood pressure
• swallow tests

Once a stroke has been diagnosed and its severity assessed, a treatment plan is put into place by the stroke team. It is important to implement an effective treatment plan to prevent long-term disability and even death.

Stroke treatment usually involves medication for treatment and prevention of further strokes in cases of both ischaemic and haemorrhagic strokes. Occasionally, for haemorrhagic strokes, emergency surgery may be required to clear blood from the brain and repair any damaged blood vessels. This is usually done using a surgical procedure known as a craniotomy.

How long does stroke recovery take?

While the damage caused by a stroke happens quickly and aggressively, it is important for caregivers to understand that the path to recovery is often slow and uncertain. Medical intervention can help to maximize brain repair and functional recovery but because a stroke affects each individual differently, the stroke team can only estimate each individuals response to treatment based on the location and severity of the stroke. Generally, the aim of stroke treatment is to help the individuals overall outcome, rather than to speed up the rate of recovery.

After a stroke, most patients experience a series of side effects including blood pressure fluctuations, but these tend to stabilize within the first 2-3 days of treatment.

Once the body stabilizes, with close medical monitoring and management, the brain should begin to heal. Medical management focuses on preventing the stroke from progressing. Part of the treatment plan will include keeping the body’s systems optimal - fluid control, blood pressure management, and blood sugar regulation to help maximize neuronal protection after a stroke. The brain’s functions and recovery of brain cells should begin to improve within a few days and this process will continue for months and even years before reaching stability.

What kind of therapy required?

Therapy is an important step in stroke recovery. Therapy such as speech and swallow therapy, physical therapy and occupational therapy help the brain regain its normal functions by stimulation. While undergoing therapy, it is also important for caregivers to pay attention to the patient’s mood as mood affects stroke recovery and a stroke, in turn, affects moods.

What can I expect from stroke rehabilitation?

The aim of rehabilitation is to help the patient relearn skills that were lost when the brain in part was affected by the stroke. Stroke rehabilitation begins the journey to regaining independence and improving quality of life.

While each individuals path to stroke recovery is unique, research shows that patients who undergo focused stroke rehabilitation programs tend to fare better than patient’s who don’t.

Stroke rehabilitation tends to begin quite early – as soon as 24 - 48 hours after the stroke, while the patient is still in the hospital and includes both physical activities and cognitive exercises

The sooner the patient begins stroke rehabilitation, the more likely they are to regain their lost skills and abilities.

The amount of time spent in stroke rehabilitation depends on the severity of the stroke and any other related illnesses. Some stroke survivors recover quickly, but most need some form of long-term stroke rehabilitation, lasting possibly months or years after their stroke.

The choice of what approach to take for rehabilitation depends on the individual’s unique condition and needs, but there are several options to consider which include inpatient rehabilitation units, outpatient units, nursing facilities and home-based programs such as those provided by HP Homecare.

Having a home-based care program is a popular choice for many stroke patients as this does not just provide a specialised service within the comfort of the patient’s home but it also helps to free up family members, as all are affected in one way or the other by a stroke.

The way we at HP Homecare would approach this would be to begin with a visit to meet with the patient and the in-hospital care team to create a tailored care plan. A team of carers will then be allocated for training according to the specifications of the care plan, and following discharge, these carers will visit regularly during the specified hours to deliver the care. If the care contract involves 24/7 care, a team of carers will be allocated a 12-hour shift pattern around the patient.

Carers are just a small part of the wider team involved in helping a patient through stroke recovery. Other members of the team include:

• Several doctors. The GP, neurologists and specialists in physical medicine and rehabilitation can guide the patients’ care, help prevent complications and also help the patient gain and maintain healthy lifestyle behaviours to avoid another stroke.
• Rehabilitation nurses. These nurses specialise in caring for people with limited capacity to carry out routine activities, and they offer options for managing bowel and bladder complications of a stroke.
• Physical therapists. These therapists help the patient relearn movements such as walking and keeping your balance.
• Occupational therapists. These therapists help the patient relearn hand and arm use for daily skills such as bathing, tying your shoes or buttoning your shirt. Occupational therapists can also address swallowing and cognitive issues, as well as issues surrounding safety in the home.

Specialists who focus on cognitive, emotional and vocational skills include:

• Speech and language therapists. These specialists help improve the patient's language skills and ability to swallow. Speech and language pathologists can also work to develop tools to address memory, thinking and communication problems.
• Social workers. Social workers help connect the patient to financial resources, plan for new living arrangements if necessary and identify community resources.
• Psychologists. These specialists assess the patients thinking skills and help address any mental and emotional health concerns.
• Therapeutic recreation specialists. These specialists help the patient resume activities enjoyed before the stroke, including hobbies and community participation.
• Vocational counsellors. These specialists help the patient address return-to-work issues if that is a goal.

The rate of recovery is generally greatest in the weeks and months following a stroke. However, there is evidence that performance can improve even 12 to 18 months after a stroke.

Recovering from a stroke can be a long and frustrating experience. It's normal to face difficulties along the way but the patient’s commitment and a choosing the right team can be instrumental in helping towards an effective full recovery.