What You Need to Know About the Stroke Recovery Timeline

NeuroRehab Team
Wednesday, February 19th, 2020



 

You are eager to return to your normal life, so you are ready to learn more about the typical timeline for recovery after a stroke. Keep reading to get some answers to common questions:

  • Am I going to get better after my stroke?
  • How long is rehab after a stroke going to take?
  • What can I do to help my stroke recovery?

What is a Stroke?

A stroke is an injury to the brain due to a lack of blood flow. This is caused by either a blockage or leak in a blood vessel. The lack of blood flow injures an area of the brain. Your symptoms throughout your body are related to the specific area and the amount of damage in the brain.

Your timeline for recovery is also affected by the amount of damage in the brain. Every stroke survivor has their own unique stroke recovery timeline and outcomes. More significant damage means more time for recovery.

If a blood clot in the brain is the cause of the stroke, a special medication can break up the blood clot. This restores the blood flow, minimizes the damage to the brain, and improves the recovery outcomes. This medication only works when given in the first three hours, so it’s important to seek treatment for a possible stroke immediately.

Right after a stroke, the brain is in shock, and your impairments are at their worst. Your recovery begins as the brain heals, makes new connections, and regains the ability to control the body. You start by regaining control of muscles and then you can focus on improving coordination and strength.

Your stroke recovery can include regaining skills and having to learn to do things in a different way. The ultimate goal is to return to your everyday activities, even if you need to do them differently.

 

Typical Rehabilitation Experience

There’s no need to navigate the recovery process alone. Physical therapists, occupational therapists, and speech therapists are experts in recovery. They can provide exercises, teach you new ways to do things, and suggest helpful aids.

 

Don’t Be Stuck with the Wrong Stroke Therapist. 7 Must-Ask Questions When Interviewing.

 

You are likely to meet a rehabilitation team during your time in the hospital. They evaluate the impact of the stroke, and help you make decisions on the next step for your recovery. There are a variety of options to meet your level of need:

  • Inpatient rehabilitation
  • Nursing home rehabilitation
  • Outpatient Rehabilitation
  • Home with family members
  • Home independently

Inpatient rehab and nursing homes provide more direct care, and increased time with therapy. Home health sends therapists and nurses to your home. For outpatient therapy, you attend therapy sessions at a clinic.

 

A Roadmap to Recovery of Muscle Control: The Brunnstrom Stages

The Brunnstrom Stages of stroke recovery describe the progression of neuromuscular recovery. It lays out a typical pattern of recovery, but it doesn’t provide an estimation of time for each stage. It also doesn’t assume that you can move through every stage. Your recovery could end a stage earlier than the full resolution of symptoms.

The benefit of this approach is that it focuses on using the muscle patterns at your current stage. Your goal is to use what you have, and then start moving towards the next stage.

This model describes how muscle control returns in a sequence of steps following a stroke. Starting with no muscle control, then gaining involuntary muscle control, followed by gaining voluntary muscle control.

Involuntary control is when your body moves without you thinking to make it happen – most commonly known as reflexes. Examples of  involuntary control are blinking or pulling your hand away from something hot.

Voluntary control is when your brain is able to think and direct the actions of your muscles. This is the basis of all normal movements such as walking, picking up a cup, or sticking out your tongue.

 

 

Stage 1: Flaccidity 

Flaccidity, or flaccid paralysis, is when you lack control, so your limb is limp. This initially happens when the brain is still recovering and is not able to communicate with the muscles.

If this continues, the muscles will atrophy (i.e., weaken). This is when the muscles get smaller due to lack of use. Electrical muscle stimulation can help to activate the muscles and reduce muscle atrophy.

Even in this early stage of stroke recovery, there is still much you can do.

  • Prevention of injury by getting help when walking or sitting because decreased muscle control makes falls more likely.
  • Use good positioning to protect the soft tissue of your shoulder and ankle. Some people need special shoulder slings to prevent overstretching of the shoulder.
  • Passive range of motion to help prevent joint stiffness and keep the muscles moving.
  • Mental practice where you visualize performing a movement to help your brain form new connections.
  • Mirror box therapy creates the illusion that the affected arm/hand is moving normally.

Some people experience hand swelling because they are not able to move their fingers. If this is a problem for you, soft gloves with compression can help. Check out some options for edema products.

 


 

Stage 2: Spasticity appears

In the second stage, small movements develop which are not under voluntary control. This is the start of a connection between the brain and the muscles. These are mainly reflexes such as twitches or moving an arm when the muscle is stimulated by touch or hot or cold.

You might notice the development of spasticity. Spasticity is muscle tightness that makes it more difficult to move the joints passively. Movement in this stage might be a small twitch, or your fingers curling when you sneeze.

For this stage, there are a number of ways to keep moving and reduce spasticity.

The return of small movements is exciting, even if you can’t control them yet.

 

Stage 3: Spasticity increases

This stage represents the peak of spasticity, as signals from the brain cause the muscles to continually contract. You might experience more involuntary movements, because there are more uncontrolled signals from your brain. For instance, you might try to move your hand, and instead, the whole arm moves in an awkward way.

There are options for recovery at this stage. Botox injections or other medications can be beneficial for reducing the spasticity. Stretching and braces after Botox are important for getting the full benefit of these treatments. You can review options for braces to control hand tightness and braces for ankle tightness.

It continues to be important to move your joints to prevent stiffness and muscle tightness. Consult a physical or occupational therapist to learn techniques for stretching that don’t activate your spasticity.

You can also find ways to use spasticity to do functional tasks. For instance, you might try using the automatic flexion response in your arm to help carry items.

 

Stage 4: Spasticity Decreases

Great news! This stage means decreasing stiffness and improved voluntary control. You begin to be able to isolate certain movements, instead of moving an entire limb. Movements might still be awkward, but at least you are starting to control them.

This is a great stage to learn some new exercises. You can start building strength as motor control improves. You might begin by using your hand to help your weak limb move. As you gain strength, you can start to move using just your brainpower.

You should also continue useful strategies from earlier stages. You will see ongoing progress by continuing electrical stimulation, mental practice, mirror therapy, stretches and exercises. Your program will continue to grow as you add new ability and skills.

 

Stage 5: Complex Movement Returns

Things really start to get more exciting as your voluntary movements become more complex. The jerky, uncontrolled movements rapidly go away as better muscle control increases. You can resume daily tasks that include more complicated movements – things like grasping a cup and reaching into a cupboard to put it away.

There are lots of opportunities to practice new movements and gain skills during this stage of recovery. As you begin to regain control, you can find more complex exercises. Check out some ideas for stroke recovery hand exercises.

Work on trying a variety of daily tasks with affected extremity. Task-specific training is very effective – just because you weren’t able to do something yesterday, doesn’t mean you won’t be able to do it today.

You should continue stretching to address and resolve any ongoing spasticity or tightness.

 


 

Stage 6: Spasticity Disappears

You are making great progress now. In this stage, the spasticity is finally gone, and joints can move independently. Movement patterns continue to get more complex, and coordination can really improve.

During this stage, you want to focus on improving general skills, such as coordination and endurance. Continue to find fun activities that are challenging. You may even want to start an exercise program including resistance or walking.

 

Stage 7: Normal Function Returns

At full recovery, you now have full motion and control! Focus on building a healthy lifestyle and rejoicing in how far you have come.

 

Stroke Recovery Timeline for Specific Skills

Rapid improvement in the first few weeks is associated with better overall recovery3. If you stay in the flaccid stage for a long time, less muscle return is expected, and the overall recovery is longer.

As a general rule, the most significant recovery occurs in the first 3 to 6 months. But slow ongoing recovery continues for 2 years or more as the brain continues to learn and form new connections. Here is some research related to more specific skill recovery after a stroke.

 

Grip strength

Hand strength is important for grasping and carrying daily items. Research has shown that grip strength improves a lot in the first year after stroke1.

The research also shows that:

  • Patients show the most rapid improvement in the 4 weeks following a stroke.
  • There’s a steady improvement in grip for up to 6 months.
  • Progress slows from 6-12 months.
  • Six months after a stroke, about 45% of patients are able to incorporate their affected hand into daily activities3.

 

Walking

Your ability to walk might be one of your biggests goals after a stroke. A study found that stroke survivors showed the most improvement in walking during the first 3 months of physical therapy, and then slower gains until 6 months2.

  • 65% of survivors with initial paralysis of the leg are able to regain some use of the leg for walking3.
  • 75-85% of all survivors are able to walk with minimal or no physical help3.

Check out our blog on returning to walking after a stroke.

 

Self-Care

You might be wondering when you will get back to doing the normal things to care for yourself. Things like bathing, dressing, and toileting. Your ability to complete self-care will improve as you get better muscle control and learn new ways to do things.

  • Gains in self-care ability tends to decrease by 3-4 months after stroke3.
  • 25% of patients return to normal levels of everyday participation and physical function3.

 

Stroke Recovery is a Journey with a Broad Timeline 

Everyone’s timeline for stroke recovery is truly unique. The brain has an amazing ability to learn and form new connections. This is great, because it makes ongoing improvements possible. But it also makes it difficult to predict an exact timeline to recovery.

Understand the research, but also remember that consistent practice, positive attitude, and hope are powerful tools for recovery.

 

Looking for intensive therapy to maximize your recovery after a stroke?  Check out Stroke Hand and Upper Limb Clinic.

 

  1. Stock R, Thrane, G, Askim T, Anke, A. Mork PJ. (2019). Development of Grip Strength One Year after Stroke. Journal of Rehabilitation Medicine 51(4), 249-256. Retrieved from  https://www.ncbi.nlm.nih.gov/pubmed/30848829

 

  1. Rose, D. K., Nadeau, S. E., Wu, S. S., Tilson, J. K., Dobkin, B. H., Pei, Q., & Duncan, P. W. (2017). Locomotor Training and Strength and Balance Exercises for Walking Recovery After Stroke: Response to Number of Training Sessions. Physical therapy, 97(11), 1066–1074. doi:10.1093/ptj/pzx079 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075074/

 

  1. Dobkin, B. (2005). Rehabilitation after Stroke. New England Journal of Medicine, 352(16), 1677-1684. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106469/


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