Saturday, March 07, 2015

There are two Ways to Recover from Stroke

Peter G. Levine
Stronger After Stroke
Friday, February 27, 2015

There are two ways to recover from stroke. And they correspond to two of the four phases of stroke.

Let me start with four phases of stroke:
1. Hyperacute
2. Acute
3. Subacute
4. Chronic
For the sake of brevity let's cross off the top two:
1. Hyperacute
2. Acute
Recovery doesn't really happen during those two.

(I'll put why those two phases are important - outside of recovery per se- at the bottom of this entry).

Recovery – broadly defined as "getting better" – happens during the subacute and chronic phases.

The subacute phase: (from approximately the first week to approximately the third month – although this can vary wildly from survivor to survivor)

Most recovery during this phase is what would be called "spontaneous recovery" or "natural recovery." Recovery during this phase is driven by healing in the brain. Specifically it has to do with neurons that are temporarily "stunned" by the stroke becoming "unstunned" and coming back online. As they come back online recovery happens. That is, it's "spontaneous." It is true that people who get therapy during the subacute phase will get better than people who don't get therapy. In fact, people who get intensive therapy – therapy that involves a lot of work and a lot of repetitions – will get better than people who just get regular therapy. But even with no traditional therapy, survivors will almost always have some significant amount of recovery during the subacute phase. Lte's put it this way...

The subacute phase: Recovery Happens

The chronic phase (from approximately three months to the end of life).

During the chronic phase a lot of recovery can happen. This phase was traditionally known as the phase in which nothing could happen – but that has been proven to be broadly untrue. What confuses people is that recovery doesn't happen as easily during the chronic phase as it did during the subacute phase. There is (usually) no "spontaneous" recovery during the chronic phase. The survivor has to claw and scratch for every bit of recovery. And while during the subacute phase spontaneous recovery is driven by neurons flooding back, during the chronic phase brain plasticity (rewiring) comes into play. And brain plasticity during chronic phase is just as difficult for the survivor as it is for the rest of us. It involves a lot of hard work, a lot of dedication, a lot of repetitions, and a lot of  focus.

The hyperacute and acute phases.

Important things happen during these two phases, to be sure. Things like saving lives and saving brain. But these two phases are not conducive to the effort needed to drive recovery. In fact, if too much effort is made, you can enlarge the area damaged by the stroke. So during these two phases, listen to the healthcare professionals around you, and convalesce. But once the subacute phase starts, its time to "put the pedal to the metal."

How will you know when the subacute phase starts? Spontaneous recovery happens!

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