The Golden Rules for maximizing recovery after stroke

July 25, 2019

The long and arduous process of rehabilitation begins immediately after a stroke. But where should you get started and what are the most important things for you to know? We have tried to make answering these questions a little easier for you. Filtering through the most recent scientific discoveries and busting through the many misconceptions regarding stroke recovery, we have created some Golden Rules. Under each rule, you will find links to Strokemark articles that offer more detailed information.

The Golden Rules are not doctrine, and individual differences mean that for some people some rules are more important than others. However, these provide practical guidelines for the subacute and chronic phases after a stroke.

We look forward to hearing from you about your post-stroke experiences and what rules are important to you. Please let us know!

1. Think and act like a professional athlete

A stroke causes significant disruption of brain and muscle function that you have to rebuild. And to regain this function takes a lot of hard work. This process requires you to adopt the same principles of top athletes. You have to optimize your entire training to achieve your goals, and every aspect of your life becomes training. So even though you might not be spending hours in a gym, the focus you need and the stick-to-it-ness that you need are exactly like an athlete’s.

Train a lot – whether it is your body or your mind.  And take appropriate rest periods in between to maximize your benefits. Remember to vary your training to prevent your body or mind from getting insufficient stimuli or even being overtrained.

You have to set specific goals: when do you want to achieve what, and is it realistic? A good therapist or physician is, of course, essential, just like a good coach is vital to a top athlete. And, the support of friends and family is crucial. Life has changed after a stroke, and you need all the help you can get.

2. Provide the right conditions to recover

Some recovery after a stroke happens on its own as the body starts to heal itself. But, for optimal recovery, you have to create the right circumstances.

Making sure you get enough sleep and proper nutrition are among the most important conditions. A good night’s sleep is essential for both natural recovery and recovery through extra training during rehabilitation. Are you rested in the morning when you wake up? Do you not get enough sleep? Or do you get too much? Do you snore excessively? The answers to these questions provide insight into sleep quality and can be an indication of problems such as sleep apnea.

It may seem unnecessary to talk about food and nutrition because everyone knows that a healthy diet is essential. Yet, it turns out that many people do not eat enough after a stroke, or do not get the proper nutrition. Improving muscle mass and strength and improving bone density are examples of training goals that require specific nutritional adjustments.

3. Improve your concentration

Concentration often declines after a stroke. Cognitive functions and the correct execution of movements both depend strongly on concentration. In fact, focus during training is one of the most important parameters when relearning moves and functions again. The better the concentration, the better the learning process. There are many exercises available to improve focus, and more and more apps offer activities that you can try at home.

4. Improve the adaptive capacity of your brain

In order to enhance functions after stroke, the mind must be prepared to adapt. After a stroke, the body itself allows for adaptations, but you can still help the brain with all kinds of techniques. Physical activity appears to be very important for this. Aerobic exercises such as walking, cycling, or swimming activate the brain and prepare it for better learning. Many devices and tools on the market can help you engage in aerobic exercises even if you have limitations.

Therapists can also stimulate the brain from the outside to help it adapt better. The effectiveness of new techniques such as DCS and TMS is increasingly validated, and more therapy centers are offering these forms of brain stimulation. It turns out that a combination of activation of the affected side of the brain and deactivation of the healthy half produces the best results.

5. Improve your strength

One of the most underestimated training methods is strength training. Recent scientific insights show that many improvements in the chronic phase after stroke are possible through strength training. After a stroke, the muscle mass in the affected side decreases, reducing the strength of arm and leg muscles and even general functions such as glucose management. Therefore, make sure you have a good training schedule, in which you train all the large muscle groups 2 to 3 times a week.

6. Make your heart work

A new trend that optimizes training for healthy people also benefits people who had a stroke. High-Intensity Training, abbreviated to HIT, causes a considerable increase in heart rate in just a few minutes. A few times a week a few minutes of training can produce surprising results. Of course, the exercises have to be adapted to each person, but almost everyone can design and participate in a HIT plan under the supervision of a therapist. And, as an added benefit, the brain learns better when heart rate increases during physical exercise!

7. Avoid unnecessary movements

One of the consequences of a stroke is that movements aren’t the same as they used to be. To still be able to perform specific functions, the body finds solutions that are simple and use less energy. This is exactly why the “healthy” side often takes over tasks that the affected half should perform.  The body also compensates for missing functions in aphasia cases. The arms and hands make up for the deficiencies in verbal communication.

Constraining movements on the healthy side appears to help focus exercising the affected side better and more specifically. This method is especially effective when you practice a lot and for long periods.

8. Train often and for long periods of time

Many scientific studies show that people who train long and hard make the most progress. Even in the chronic phase, people make progress when they continue to train, often for hours a day. At Strokemark we also hear the best success stories from patients who practice and don’t give up. It can take a bit of time before you see the benefits.

We understand that it is not possible for most rehabilitation centers and practices to offer hours of therapy per day. However, there are many good opportunities to continue practicing at home. Mirror therapy and mental imagery are examples of exercise methods that you can do yourself at home. There are also more and more websites and apps available that offer tips for at-home practices.

9. Don’t get frustrated

Rehabilitation after a stroke takes a long time. Changes and improvements in function go slowly and are often noticed first by family and friends, and not by the stroke patient. The whole recovery process can, therefore, be very frustrating. Various stories of successful recovery show, however, that frustration is not necessary. If a certain exercise fails, try again the next day. Keep working until you succeed. Refer to Golden Rule number one: an athlete has long-term goals and can also have a bad training day once in a while. Achieving certain goals can take weeks or months. So think long-term and keep your eyes on the prize!

10. Don’t give up!

As far as we are concerned, this, together with Golden Rule number one, is the most important and best-substantiated point on this list. A few years ago the message from doctors and therapists was that you had a six-month window for recovery. After that time, they believed that there was little or no hope for further improvement. This thinking is outdated and has given way to a much more hopeful message: recovery is possible even years after a stroke.

Numerous case studies show that if people start with a new form of therapy or training method, there is a sudden recovery after years of stagnation. More and more scientific studies are now focusing on the chronic patient group because, slowly but surely, everyone is becoming aware of the potential for recovery.

At Strokemark we want to make everyone aware of their recovery possibilities. Our goal is to make the newest knowledge accessible to everyone and give practical tips to help patients reach their full recovery potential. Whether you just had a stroke or had a stroke 20 years ago, we want you to know that there is hope. And we are here to help you find that.

Editorial note:

These Golden Rules can help you keep your recovery on track.