Last Updated: May 6, 2015
For Pedro Antaran, an 83-year-old Seattle resident, the stroke
came in the morning, with little warning. After waking up to make
coffee, he noticed that his right leg felt different than usual. "I
felt that my leg was heavy, and I could not lift it," he recalls.
"I thought in my mind that maybe this was a stroke." He asked his
wife to call 911-and soon afterward was at the hospital.
Antaran's fast reaction helped ensure an early intervention to
the stroke, which in turn has aided his remarkably short recovery
from stroke. He still suffers from some minimal neurological
effects (he sometimes has difficulty recalling the name of objects,
for instance). But less than four months after his stroke, Antaran
is already living at home, walking without a cane, and traveling
throughout Seattle by bus.
Stroke is the fourth leading cause of death in the United
States, according to the Center for Disease Control. Commonly
caused by a blood clot, a stroke is a vascular accident to the
brain, where the brain is deprived of adequate blood flow and
oxygen. Without early intervention, the lack of blood flow and
oxygen results in cell death within the brain. Depending on which
area of brain tissue is affected, a stroke can have serious effects
on speech, cognitive abilities, and basic motor skills.
According to Dr. David Clawson, medical director of
rehabilitation at Seattle's Swedish Medical Center, where Antaran
was taken following his stroke, prevention is the first step in
mitigating the aftereffects of a stroke. By recognizing the
symptoms of a stroke, an early intervention-and potentially being
able to reverse the effects of the stroke-is far more likely. Each
minute that the brain undergoes restricted blood flow increases the
likelihood that the stroke will produce significant side effects.
"Time is the equivalent of brain tissue [during a stroke]," Clawson
says. "The longer it takes to get medical care the more likely [the
patient] is to have loss of brain tissue."
Clawson advises that seniors and their family members
familiarize themselves with the acronym FAST, which outlines
possible stroke symptoms and how to respond:
- Facial weakness: Droopiness in facial muscles
or partial paralysis, often on one side of the face, can indicate
the beginnings of a stroke.
- Arms: When a stroke is suspected, ask the
afflicted individual to raise both arms and keep them up.
Difficulty keeping both arms level is a potential symptom of
- Speech: Slurred speech or the inability to
pronounce words (a condition known as aphasia) can indicate the
beginnings of a stroke.
- Time: Family members, Clawson warns, need to
recognize that symptoms of stroke are an emergency, and that a
quick reaction can be the difference between a full recovery and a
lifetime of disability.
Rehabilitation After Stroke
The goal for rehabilitation following a stroke is to return the
patient to the highest level of functionality possible. Due to the
neurological effects of a stroke, in which the ability of patients
to perform everyday actions is often severely limited, the
rehabilitation process involves teaching a patient how to perform
those actions-like speech, walking, eye-hand coordination, and
using the restroom-that were lost during the stroke. In instances
in which full recovery from stroke might not be possible, certain
compensatory strategies will be taught. For example, the stroke may
have severely limited a patient's ability to use his or her right
arm, so a therapist might help the patient learn to get in and out
of bed without the use of that arm.
Following a stroke, the type of rehabilitation for which a
patient is ready depends on the type and the extent of the stroke.
The most intensive approach to rehabilitation is found in an
inpatient rehabilitation facility.
According to Clawson, inpatient rehabilitation engages patients
in a variety of therapies aimed at restoring neurological function.
Patients live at the facility, where they participate in physical
therapy, occupational therapy, and speech therapy, with two
sessions per day for each. In addition to this regimen, patients
work with nurses and physicians who are familiar with the
complications of stroke, along with social workers who help with a
discharge plan for the patients' return to their homes.
But, as Clawson warns, not all patients are ready or able to
take part in inpatient rehabilitation. "If you look at the number
of hours in a day that you're actually doing therapeutic
activities, it's quite a few," he says. For those patients who
aren't able to participate, a skilled nursing
facility can provide a range of therapeutic programs in a
different setting. Some patients are best served by home
health therapy, where a physical therapist and an occupational
therapist come to the home and provide additional rehabilitation in
that setting. Other options include an assisted
living apartment, which enables a certain degree of
independence while providing services like cooking, laundry, and
bathing. When a patient has not sufficiently recovered following
rehabilitation, especially when issues like mobility, bowel
control, and the ability to provide self-care persist, the
patient's best option might be the long-term care provided by a nursing home. The end goal, however, is
returning the patient to the greatest level of independence that is
possible, regardless of which path to recovery best serves the
For most patients, recovery from stroke takes six months to one
year of focused, intensive rehabilitative therapy. Clawson points
out that the earlier a patient can begin to engage in
rehabilitation, the higher the odds of a full recovery. "Our idea
of the brain has changed in the last decade," Clawson explains. "We
used to think that after childhood, anything you lose in the brain
is a done deal. We're beginning to understand now that the brain
has the ability to develop new nerve cells." In other words,
following the neurological damage caused by a stroke, the brain has
the ability to rewire itself. As a result, the medical community
has developed new therapies designed to fully engage the part of
the brain that's been affected by the stroke. For instance, a
physical therapist might restrain the use of an arm unaffected by
the stroke in order to make the patient practice more activities
with the affected arm. Clawson believes that this new insight will
transform our understanding of how much a patient can recover from
Motivation & Emotional Health in Recovery
Rehabilitation, as Pedro Antaran says, is not an easy process.
While rehabilitating from his stroke at Seattle Keiro Skilled
Nursing, a program of elder care service provider Nikkei Concerns,
Antaran remembers continuously checking the time for his sessions
to be over. But I learned to endure the exercise. Later on I found
out that it's a very important thing. You overcome these little
bits of hardships," he says.
Susan Lopez, an occupational therapist and rehabilitation
manager at Seattle Keiro who helped Antaran with his recovery, says
that the emotional process of recovery from stroke, which for many
patients includes depression, cannot be understated. In particular,
patients must be motivated in order to make the most of their
rehabilitation. "We make sure that we're working on goals that the
patient has established, and not our own goals," Lopez says. "You
have to establish that rapport and really know the patient and what
they want. If it's our [own] goal, it's not going to help." Lopez
explains that setting short-term goals can help patients see their
progress and further motivate them. And because it is often
difficult to communicate with patients with cognitive or speech
deficits, the support of family members can be critical to an
can also affect recovery from stroke. According to Clawson,
depression is very common and can be related to the brain injury
itself and its neurological aftereffects. He insists that
depression should be treated aggressively so that it does not
interfere with the recovery process. Antidepressants will enable
some patients to remain on track for recovery, while counseling can
also be effective, if the patient's speech or cognitive capacity
has not been greatly affected by the stroke. Encouraging a
patient's independence, however, is paramount-an essential
component to motivation and emotional health during recovery from
stroke. "You do everything you can to enhance [the patient's] level
of independence and their sense of control. That's the big key,"
Clawson explains. "Anywhere they can have control, let them have
Preventing Reoccurrence of Stroke
Approximately 25% of stroke victims will have another stroke
within five years. That's why the final step in recovery from
stroke includes taking the right steps to decrease the likelihood
of experiencing a second stroke. The risk factors for stroke
blood pressure, abnormal blood clots (often brought on by high
cholesterol), stress, smoking, and poor nutrition. For many
individuals, obesity can be an issue, as well as genetics and
diabetes. If an individual has already experienced a stroke, a
physician can provide guidance that will take into account each
individual's unique risk factors. The best defense against stroke
reoccurrence for any recovering patient, however, is a healthy
lifestyle combined with regular social interaction. "Human beings
are social, and we're very interconnected," explains Clawson. "Our
brains don't work as well when we're disconnected socially."
In the end, recovery from stroke is, to use an old phrase, about
putting mind over matter. "It's not the strength of your body
that's hurt with your stroke. It's your mind," Antaran says. Though
strokes have physical consequences, most patients will explain that
the most difficult dimension of recovery is the need to relearn
skills that were once part of everyday life. But with the right mix
of motivation and skilled therapeutic care, a determined patient
can experience recovery of both the body and the mind.