Stroke Rehabilitation Challenges

After experiencing a stroke, recovery can be challenging, and it’s not impossible.

And the first thing people ask after having a stroke is – “When will I recover?”.  Recovery means different things to different people.  For one, it’s to regain the ability to do what they want and need to do again.  Whereas recovery to another person means the body can function the same way as it did before the stroke. 

As we are aware that stroke victims face challenges every moment, we hope that they manage them with the right mindset. 

The Difference in the Expectations of Recovery and Therapy

Perhaps the most challenging hurdle is the expectation of recovery and understanding the function of therapy in the recovery process.  And engaging in therapy is only one part of stroke rehabilitation.  Most importantly, the client does “homework” outside therapy sessions and incorporates the new strategies into his daily life.  In this way, we would allow the natural healing process to occur.   Otherwise, unrealistic expectations about the healing speed will lead to disappointment and demotivation.   Hence, we must understand that the body’s natural healing process does not follow our deadline.  Realistically, there are times when stroke recovery rehab therapy progress can be slow.

As such, it is essential to have an open mind. 

Everyone’s journey in stroke recovery is unique to the individual.  Therefore, it is not realistic to compare your recovery journey to the experience of others.  Because such comparison does not help provide an accurate expectation. 

Most importantly, you would need time, patience, and realistic expectations of goals in your stroke recovery rehab therapy journey.  Besides this, therapists would help manage clients’ expectations.  In addition, clients are encouraged to share their thoughts and recovery goals so that we are all on the same page.

Therapy Sessions are just Guided Recovery Sessions.

Well, therapists are merely guides to your stroke recovery rehab therapy.  In other words, they help you get the most out of mother nature’s healing processes and translate that healing into function.  Eventually, it’s your effort that helps your body connect new and existing pathways back in the brain.  Slowly, your body will take its course of healing.  However, time is of the essence if it’s hindering your function towards normality.

Regaining smooth movements requires repetition.  Brain synapses are strengthened typically with a minimum of 300 to 400 repetitions per body function.  Yes, this can be boring.  To counter monotony and maintain motivation, you may discuss with the therapist what you enjoy or what is meaningful to you.  The objective is to generate ideas on making your stroke recovery rehab therapy treatment more engaging. 

Often, there is a plethora of areas to work on.  We can only work on one at a time.  Firstly, the therapist will work on various areas of the body with fewer repetitions.  Subsequently, it is up to you whether you want to work on the rest of the repetitions as homework.   Why would you need to do therapy homework?  Because the therapy sessions with the therapist are insufficient to yield the best results.  Therefore, it is your onus to embrace ownership of your therapy homework for the therapy treatment to be more effective.   

Grieving the Loss of Function

Most people relate the stages of grief to the loss of someone close.  Similarly, we grieve the loss of the body’s function in the same fashion.  During the grieving process, it is important to acknowledge denial, bargaining, and blame with support from friends, family, support groups, or counsellor.  When we accept these feelings, it helps open up the conversation that we need during the recovery process.

Hence, this is a crucial step to get into the right mindset before starting physical therapy.  Openness in one’s heart will ultimately benefit your actions and decisions.

Therapy and life balance

Recovery is not all about therapy all the time.  It incorporates general living.  For example, returning to leisure activities, engaging in meaningful work, practising doing things independently, or going out again.  In short, we need to balance therapy with life.  When stroke recovery rehab therapy intertwines with daily living, it is more effective holistically.

Other post-stroke challenges that clients may face are depression, body image changes, and changes in intimacy.  And we should openly discuss them with the therapist and trusted caregivers.  As such, we should not treat these challenges as taboos.  Normalising the willingness to talk about a client’s feelings is vital to stroke recovery.

Stroke Statistics in Singapore

According to data from Singapore’s Ministry of Health, the median age at the onset of stroke was 69 years in 2020. 

Between 2010 and 2020, there has been a rise in incidence rates.  Incidence rate is defined as how quickly a disease occurs in a population.  And the increase is 33.7% for the 40-49 age group and 13.7% for the 50-59 age group.

Over the 10 years from 2010 to 2020, the number of stroke episodes has increased by 50% from 5,890 to 8,846. 

Types of Stroke

A stroke can happen in two ways:

1.  Ischaemic stroke occurs when the blood flow to the brain is restricted due to blockage of blood vessels.

2.  Hemorrhagic stroke takes place when there is internal bleeding in the brain due to a rupture of blood vessels.

Effects of Stroke

Most people associate strokes with semi-paralysis of the body.  While this is common, there are other invisible effects.  Although the person seems normal in walking or moving, he is forgetful or has difficulty recognising faces and names.  This is the result of the stroke affecting the brain functions such as hearing, speech, vision, thinking, and memory skills. 

Length Of Critical Rehab: First Week Post-Stroke Onset

Immediately after stroke onset, stroke survivors need immediate medical attention in the acute setting.  This helps reduce stroke damage and improve recovery outcomes.  During this time, stroke survivors should also be monitored for changes such as difficulty swallowing or loss of movement in an arm or leg.

During the next 24 hours, medical professionals should identify whether there are needs for physical therapy, occupational therapy, speech therapy, or dietetics.  In addition, stroke survivors should also be evaluated for problems such as confusion and depression that are common after stroke onset.

In the following three days post-stroke onset, stroke survivors need monitoring closely by their doctors to ensure their condition stabilises.  It is also vital at this stage that family members who provide emotional support are well-informed and gain as much knowledge of the condition as possible.

During the first week post-stroke onset, stroke survivors require close monitoring by medical professionals.  Once the condition stabilises, occupational and physiotherapists should come in for assessments.  They also assist with activities of daily living – dressing and bathing.  In addition, the therapists provide simple physical exercises so that functional gains can be made early in the stroke recovery journey.  Very importantly, stroke survivors are encouraged to participate in activities that help their recovery.  Such activities may include listening to music or engaging in crafts so that they remain engaged mentally and emotionally during this adjustment period.

Length of Critical Rehab: 1 Month to 6 Months Post-Stroke Onset

The month following post-stroke onset should focus on improving mobility so that stroke survivors can take more steps independently with continued assessment by medical professionals.  Having said so, we would recommend rehabilitation exercises should focus on a range of motion exercises that strengthen muscle groups used during walking.  The objective is to regain independence when walking outside the hospital setting.   During this phase, we may need to identify if the stroke survivor requires assistive devices such as walkers to ensure independence can eventually be achieved when navigating around outside.

From three months until six months post-stroke onset, we should focus on improving movement coordination in the physical rehabilitation exercises.  Meanwhile, the occupational rehabilitation sessions should be everyday tasks.  The objective is to regain real-life skills outside of the hospital setting.  Lastly, the patient may need massage therapy as part of the treatment plan.  All these can be done at home.  And it is known as home therapy.  Therapists demonstrate activities or techniques in the patient’s home.  It is the most natural and safe environment for the patient to recover from a stroke under professional guidance.

Length of Critical Rehab: 1 Year Post-Stroke Onset

As we move onto one year since stroke onset the rehabilitation goals set out initially may now have been achieved.  However, some patients may still require ongoing rehabilitation services.  And this depends on the level of functioning before injury.  If the patient suffers from aphasia or apraxia, he will need rehab services that involve activities for memory improvement, self-care abilities, and communication skills.  At this stage, we will tailor support specifically to individual needs.  We will incorporate family members into care plans.  Hence, we ensure the progress is consistent throughout the one-year post-stroke onset with minimal regression occurring due to a lack of reinforcement of skills.

Length of Critical Rehab: Overview Post-Stroke Onset

At every stage of stroke rehabilitation, it is important to ensure stroke survivors are being provided with the necessary therapies and support systems that help them in their recovery.  The objective is to improve their overall quality of life post-stroke onset.  With this in mind, stroke rehabilitation must be tailored specifically according to individual needs and monitored closely by medical professionals throughout all stages of recovery.  As such, stroke survivors maximise their potential for a successful recovery.

We have written this article to provide readers with an overview of critical rehab length following stroke onset.  It is always important for stroke survivors and families to consult with medical professionals before deciding on treatment plans for stroke recovery.  The reason is that each case differs greatly from one another with different individual needs.

As stroke recovery is an ongoing journey, it is possible to achieve long-term success with the right care.

Cost of Stroke Recovery Rehabilitation

Many people think of cost in monetary terms but we at Lifeweavers want our clients to consider resources needed for stroke recovery rehabilitation in Singapore. Such resources include:

– Time

Time is of the essence when it comes to recovery. The sooner you start your rehabilitation, the faster the recovery can be.  Clients need to consider their work commitments.  Do they still need to work or can they can take time off for intensive therapy? And to adjust to other life commitments they may need to attend to.

– Insurance Coverage

Unfortunately, in Singapore, a lot of insurance policies do not include post-stroke home therapy coverage.  Despite a plethora of research showing how continuous home therapy is essential in regaining function and re-integrating into the community after a stroke and many other health conditions. #justsaying

Do check this before buying an insurance plan. 

– Space at Home

Clients will need to consider home modifications.  For example, the installation of railings or handlebars, wheelchair access, space for therapeutic activities, and reducing fall risk. In addition, clients will need to assess their ability to function at home.  Especially, if they are limited by steps or stairs reaching too high or bending too low for things.  They will need to modify their environment for effective access.

– Social Support

We encourage dialogue and involvement with caregivers who are family members, trusted friends, and helpers.  Emotional and physical support is vital to recovery. Support groups for both clients and caregivers are things to consider too. 

– Access to Stroke Recovery Rehabilitation Services

Gold standard rehabilitation requires a high frequency of continuous rehab to beat the odds. Whether public or private, it is not easy to get a comprehensive therapy plan with all the professionals required.  For one, the healthcare system has a constant lack of therapists.  And if we’re talking about therapists experienced in stroke recovery, the number is even lesser.

DO ensure you get as much rehab as you can afford to maximise the chances of recovering to get back a productive life. 

These are the realities that clients must consider when embarking on their stroke recovery journey.

Please feel free to WhatsApp us for a free consult on our Stroke Recovery Rehab Therapy.