Neuro-Ophthalmology & Neuro-Otology
Jul. 25, 2020
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Stroke is a medical emergency that requires immediate attention. In the United States, about 800,000 people each year suffer a stroke and approximately two-thirds of these individuals survive and require rehabilitation. The goals of rehabilitation are to optimize how the person functions after a stroke and the level of independence, and to achieve the best possible quality of life.
Advances in emergency stroke treatment can limit damage to the brain, which occurs either from bleeding into and around the brain (hemorrhagic stroke) or from lack of blood flow to a region where nerve cells are robbed of vital supplies of oxygen and nutrients and subsequently die (ischemic stroke).
The disability that a person with stroke experiences and the rehabilitation that is needed depends on the size of the brain injury and the particular brain circuits that are damaged. The brain has an intrinsic ability to rewire its circuits after a stroke, which leads to some degree of improved function over months to years. Even though rehabilitation doesn’t reverse brain damage, it can substantially help a stroke survivor achieve the best long-term outcome.
What is post-stroke rehabilitation?
Rehabilitation helps someone who has had a stroke relearn skills that are suddenly lost when part of the brain is damaged. Equally important in rehabilitation is to protect the individual from developing new medical problems, including pneumonia, urinary tract infections, injury due to fall, or a clot formation in large veins.
Research shows the most important element in any neurorehabilitation program is carefully directed, well-focused, repetitive practice—the same kind of practice used by all people when they learn a new skill, such as playing the piano or pitching a baseball. The neurorehabilitation program must be customized to practice those skills impaired due to the stroke, such as weakness, lack of coordination, problems walking, loss of sensation, problems with hand grasp, visual loss, or trouble speaking or understanding. Research using advance imaging technology shows that the functions previously located in the area of damage move to other brain regions and practice helps drive this rewiring of brain circuits (called neuroplasticity).
Rehabilitation also teaches new ways to compensate for any remaining disabilities. For example, one might need to learn how to bathe and dress using only one hand, or how to communicate effectively with assistive devices if the ability to use language has been affected.
What factors can affect the outcome of stroke rehabilitation?
What disabilities can result from a stroke?
The types and degrees of disability that follow a stroke depend upon which area of the brain is damaged. Generally, stroke can cause five types of disabilities:
Paralysis or problems controlling movement (motor control). Damage to cells and connections in the brain following a stroke can cause various problems with movement and sensation, including:
Sensory disturbances, including pain. Several sensory disturbances can develop following a stroke, including:
More rarely pain can occur due to stroke-induced damage to the nervous system (neuropathic pain), the most common which is called “thalamic pain syndrome” (caused by a stroke to the thalamus, which processes sensory information from the body to the brain).
Problems using or understanding language (aphasia). At least one-fourth of all stroke survivors experience language impairments, involving the ability to speak, write, and understand spoken and written language. In right-handed individuals these strokes usually involve the left side of the brain. A stroke-induced injury to any of the brain’s language-control centers can severely impair verbal communication. There are several types of aphasia:
Problems with thinking and memory. Stroke can damage the parts of the brain responsible for memory, learning, and awareness. A stroke survivor may have a dramatically shortened attention span or may experience deficits in short-term memory. Some people also may lose the ability to make plans, comprehend meaning, learn new tasks, or engage in other complex mental activities. Common deficits resulting from stroke are:
Emotional disturbances. After a stroke someone might feel fear, anxiety, frustration, anger, sadness, and a sense of grief over physical and mental losses. Some emotional disturbances and personality changes are caused by the physical effects of brain damage. Clinical depression—a sense of hopelessness that disrupts the ability to function—is commonly experienced by stroke survivors. Post-stroke depression can be treated with antidepressant medications and psychological counseling.
What medical professionals specialize in post-stroke rehabilitation?
The rehabilitation plan will change during the recovery process, depending on which part(s) of the body or abilities were affected and the type and severity of damage. A stroke rehabilitation team includes a variety of specialists:
When can a stroke patient begin rehabilitation?
Rehabilitative therapy typically begins in the acute-care hospital once the condition has stabilized, often within 48 hours after the stroke. The first steps often involve promoting independent movement to overcome any paralysis or weakness. A therapist will help with assisted or self-performed range of motion exercises to strengthen and increase mobility in stroke-impaired limbs. A stroke victim may need to learn how to sit up and move between the bed and a chair to standing and walking, with or without assistance. Beginning to reacquire the ability to carry out basic activities of daily living, such as bathing, dressing, and using a toilet, represents the first stage in the return to independence.
Where can a stroke patient get rehabilitation?
Before discharged from the hospital, a stroke victim and family members will coordinate with hospital social workers to locate a suitable living arrangement. Many stroke survivors return home, but some move into a medical facility or other rehabilitation program.
What is the role of technologies in stroke rehabilitation?
Evidence about technologies for stroke rehabilitation is the fastest growing area of therapeutic research. As technology advances, innovative methods and devices will be used to guide new therapeutic approaches and augment existing ones. With the surge in technological advances over the past 10 years, the number of stroke rehabilitation randomized control trials has increased. The National Institutes of Health (NIH) has been at the forefront of increasing research on technology in rehabilitation scenarios. Below are examples of how technology is being studied to play a role in the rehabilitation process:
How can someone help prevent another stroke?
About 200,000 strokes per year in the United States occur in people who have previously experienced one or more strokes. Stroke prevention is vital to stroke rehabilitation. Recent research has shown improvements in preventing another stroke through behavior modification combined with pharmaceutical interventions. Stroke survivors speak with their healthcare professionals about what types of supervised behavior modifications that can be made in order to decrease the effect these risk factors may have on overall health. Some of the most important treatable risk factors for stroke are:
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS), a component of the National Institutes of Health (NIH), supports research on disorders of the brain and nervous system, including stroke and post-stroke rehabilitation. Several other NIH Institutes also support rehabilitation efforts. For example, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, through its National Center for Medical Rehabilitation Research, funds work on mechanisms of restoration and repair after stroke, as well as development of new approaches to rehabilitation and evaluation of outcomes. Most of the NIH-funded work on diagnosis and treatment of dysphagia is through the National Institute on Deafness and Other Communication Disorders. The National Institute of Biomedical Imaging and Bioengineering collaborates with NINDS and NICHD in developing new instrumentation for stroke treatment and rehabilitation. The National Eye Institute funds work directed at restoration of vision and rehabilitation for individuals with impaired or low vision that may be due to vascular disease or stroke. More than 300 research projects have been funded by NIH since 2012 involving stroke rehabilitation.
More information about stroke rehabilitation research by NINDS and other NIH Institutes and Centers can be found using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and resources from these projects.
Research studies involving individuals with stroke and healthy individuals help researchers find better ways to safely detect, treat, and ultimately prevent stroke. Trials take place at medical centers across the United States and elsewhere. For information about NINDS-funded trials for people who have had a stroke, see www.clinicaltrials.gov and search for “post-stroke AND NINDS” as well as “stroke AND NINDS.”
NINDS supports research on ways to enhance repair and regeneration of the central nervous system. NINDS-funded scientists are studying how the brain responds to experience or adapts to injury to one section of the brain by having another part or parts take over and reorganize its functions (neuroplasticity)— using noninvasive imaging technologies to map patterns of biological activity inside the brain. Other NINDS-sponsored scientists are looking at brain reorganization after stroke and determining whether specific rehabilitative techniques, such as constraint-induced movement therapy and transcranial magnetic stimulation, can stimulate brain plasticity, thereby improving motor function and decreasing disability. Other scientists are experimenting with implantation of neural stem cells, to see if these cells may be able to replace the cells that died as a result of a stroke.
Given the burden of stroke and stroke rehabilitation to the U.S., NIH formed the NIH StrokeNet network (https://nihstrokenet. org/) to conduct clinical trials and research studies to advance acute stroke treatment, prevention, and recovery and rehabilitation. This network of 30 regional centers across the U.S., which involves more than 400 stroke hospitals nationally, is designed to move early phase ideas into the development of new potential treatments for people with stroke and those at risk for stroke. In addition, NIH StrokeNet provides an educational platform for stroke physicians, clinical trial coordinators, and stroke researchers.
Where can I get more information?
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
P.O. Box 5801
Bethesda, MD 20824
Information also is available from the following organizations:
American Stroke Association: A Division of American Heart Association
7272 Greenville Avenue
Dallas, TX 75231-4596
Eunice Kennedy Shriver National Institute of Child Health and Human Development National Center for Medical Rehabilitation Research Information Resource Center
P.O. Box 3006
Rockville, MD 20847
Department of Veterans Affairs
Resources & Education for Stroke Caregivers’ Understanding & Empowerment (RESCUE)
National Rehabilitation Information Center
8400 Corporate Drive, Suite 500
Lanham, MD 20785
"Post-Stroke Fact Sheet", NINDS, Publication date April 2020. NIH Publication 20-NS-4846.
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
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