Questions Concerning Stroke Convalescence

One of the many health problems that increases as we age is stroke, which is for the brain what a heart attack is for the heart. Strokes are common: Almost 800,000 people in the United States experience a stroke each year; 80% represent new strokes.

The majority (90%) of strokes are caused by the sudden loss of blood supply to the brain. A smaller percentage, 10%, are caused by bleeding into the brain. Both result in potentially devastating loss of normal movement and or cognitive function.

Every stroke is individualized and may cause little or a great deal of disability. This column addresses the concerns, uncertainty, and questions that patients and care givers have about convalescence from a stroke.

Course of Improvement

The brain is resilient. It can improve after an injury, which is why the time from first symptoms of stroke to treatment is so important. If blood flow can be restored quickly to the injured area, more function will return and more quickly.

In most cases, function will return in the first few days and weeks after a stroke. This plateaus around six months but can continue for up to two years. In general, the initial pace and degree of recovery tend to be predictive of the ultimate outcome: Significant return of function soon after the stroke is usually a good prognostic sign.

Rehabilitation

Early and frequent rehabilitation in and out of the hospital begins as soon as possible. The rehabilitation includes physical, occupational and speech therapists, as well as neurologists and physiatrists (physicians who specialize in rehabilitation.)

Often a social worker joins to facilitate the move from the hospital. Initial rehabilitation addresses activities of daily living such as personal hygiene, dressing, toileting, eating, patient transportation, and walking. Prolonged attention is required later to work on cognitive function and emotional stability.

Lingering Effects of a Stroke

The long-term consequences of a stroke vary with each patient. It is common, however, for patients to have impairment of higher-order functions such as thinking, concentrating, memory and speech.
Patients can also experience physical weakness that affects walking, arm movements and swallowing. Depression, impulsivity, and alterations in personality are common. These problems are addressed by professionals as part of the rehabilitation.

Preserving Dignity

Stroke patients and their care givers are keenly sensitive to the loss of independence that can occur after a stroke. A stroke patient is the same as the person without the stroke, but much has changed in this person’s life. Although stroke patients may require help with activities such as toileting, being treated with respect and included in all decision making about their care is key. The more that patients can express their preferences or control aspects of their care, the more likely their dignity will be preserved.

Socialization

Moderate stimulation in the form of seeing others, moving, walking, and interacting with others is helpful to patients in rehabilitation. Seeing family and friends in moderation is also important. Support groups for patients and care givers may also help. Driving or going for car rides in the community is another option.

Several types of private vehicles are better than others for facilitating transportation.

Sensory overload from talk radio or TV and too much visitation or disruption are not helpful. Planning a daily schedule that includes variety is recommended for the patient and care giver. 

Prognosis

Regarding rehabilitation and recovery, where one starts usually dictates where one ends. A natural fear is another stroke: Around 20% of people who have a stroke will have had a prior stroke. The temporary loss of function known as a transient ischemic attack is a warning that a more serious stroke may occur. 

Your physician should be notified at once. Preventing strokes involves controlling high blood pressure, maintaining a healthy weight, exercising regularly, significantly limiting alcohol intake, controlling diabetes, not smoking, and following a Mediterranean Diet. 

Another question is what a stroke means for a patient’s lifespan. Data are related to gender and age and are outlined in the information below. A stroke increases the chance that it may lead to further illness or death. This does not mean, however, that a patient will have a fatal stroke in the immediate future. Thus, the patient and care giver are advised to work with the rehabilitation team on areas that will lead to a long and satisfying life. 

Financial Considerations

Stroke tends to require intense medical care that can be expensive. In-patient care and in-hospital rehabilitation expenses are covered for Medicare patients. For younger patients, most insurance will cover the same costs. After a stroke, Medicare covers the medical and rehabilitation costs incurred in the hospital or in a skilled nursing facility. 

Medicare will also cover durable medical equipment such as walkers prescribed by your physician and skilled nursing care if you meet skilled nursing facility requirements. If the patient is a veteran and meets eligibility requirements, services may be covered by the Veterans Administration.

Medicare does not cover services such as assistance with bathing, feeding, and toileting over a prolonged time. These costs for continuing care in the home vary according to need, amount of time, and expertise required. Commercial agencies will provide the care on an hourly basis that varies widely from about $20 to $130 per hour. Hopefully once out of the hospital or skilled nursing facility, patients will not require excessively burdensome assistance.

The Bottom Line

Stroke is common and can cause life-altering disability. In most cases it is the result of a life-long process of atherosclerosis that involves the intracranial arteries. Rehabilitation, however, often leads to improvement.

We can adjust and accommodate to the new life situation as we have at earlier stages and times in our lives when we encounter unpleasant surprises.

Life Expectancy After First Stroke

First stroke at age 60 to 69 | 6.8 years for men, 7.4 years for women

First stroke at age 70 to 79 | 5.4 years for men, 6.4 years for women

First stroke after the age of 80 | 1.8 years for men, 3.1 years for women