Stroke Rehabilitation Challenges

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

The first thing people want to know after having a stroke is ‘when will I recover?’. Recovery means different things to different people. For some, it’s to regain the ability to do the things they want and need to do again. Others want the body to function the same way as they did before the stroke. 

There are some challenges stroke victims face everyday and we wish to recognise and acknowledge them to have a better chance in facing them with the right mindset. 

Difference in the Expectation of Recovery and Therapy

Perhaps the most challenging hurdle is the expectation of recovery and understanding the role of therapy in the recovery process.  Engaging in therapy is only one part of stroke rehabilitation. The client needs to do their “homework” outside therapy sessions, incorporate their new strategies into their daily lives and allow for the natural healing process. Unrealistic expectations about how fast healing can or should happen can lead to disappointment and demotivation. Understanding that the body’s natural healing process does not run based on our own deadlines. Progress can often feel slow.

Keeping an open mind is essential. 

Everyone’s journey in recovery is unique to the individual. Therefore, comparing it to the experience of others might not help give an accurate expectation. 

Time, patience and realistic expectations of goals are required. Therapists help to manage clients’ expectations and clients are encouraged to share their thoughts and goals so that we are all on the same page.

Therapy Sessions are simply Guided Recovery

Therapists are merely guides to your recovery, helping you get the most out of mother nature’s healing processes and to translate that healing into function. Your effort and your body does everything else, connecting new and existing pathways back in the brain. Sure, you can let time slowly let your body takes its course but time is of essence if it’s hindering your function towards normality.

Regaining smooth movements requires repetition. Brain synapses are strengthened typically by doing a minimum of 300 to 400 repetitions per body function. Yes, this can be boring, so  do talk to the therapist about what you enjoy or is meaningful to you, and come up with ideas together on how to make the stroke treatments engaging to you to maintain motivation. 

Often, there are a plethora of areas to work on and we can only work on one area at a time. Therefore, during treatments, the therapist will work on a variety of areas with less repetitions. It will be then be up to you to work on the rest of the repetitions as homework. The client needs to take ownership of their therapy. The therapy sessions alone will not yield the best results.

Grieving the Loss of Function

Most people relate the stages of grief to the loss of someone close. But we grieve the loss of function in a similar fashion. Acknowledging that feelings such as denial, bargaining and blame may be due to grief can open up the conversation in getting the right support during the recovery process, whether it’s from friends, family, support groups or a counsellor.

This is an important step to get into the right mindset even before any physical therapy happens as the openness in one’s heart will greatly benefit your actions and decisions.

Therapy and life balance

We must also remember to balance therapy with life. Recovery cannot only be all about the therapy 100% of the time too. It has to be incorporated with general living such as getting back to leisure activities, meaningful work, practising doing things on your own and even going out again. Therapy will be so much more effective when rehab and living are intertwined and holistically done together.

Other challenges that clients may face are post-stroke depression, body image changes and changes in intimacy. All of these are expected and should not be treated as taboo subjects. They should be openly discussed with the therapist and trusted caregivers. Normalising the willingness to talk about what a client is feeling is also key to recovery.

Stroke Statistics in Singapore

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

Between 2010 and 2020, there has been a rise in incidence rates (how quickly a disease occurs in a population) for those aged 40-49 years at 33.7% and 50-59 years at 13.7%.

The number of stroke episodes increased from 5,890 episodes in 2010 to 8,846 episodes in 2020.

Types of Stroke

A stroke can happen in two ways. One, when the blood flow to the brain is restricted due to blockage of blood vessels – this is called an ischaemic stroke. Two, when there is internal bleeding in the brain due to rupture of blood vessels – these are hemorrhagic strokes.

Effects of Stroke

Most people associate strokes with semi-paralysis of the body. While this is common, there are other invisible causes – meaning the person seems normal, they can still walk and move normally, but might be forgetful or have difficulty in recognising faces and names. This type of stroke affects brain functions such as hearing, speech, vision, thinking and memory skills. 

Length Of Critical Rehab

Immediately after stroke onset, it is important for stroke survivors to receive immediate medical attention in the acute setting. This can help reduce stroke damage and improve recovery outcomes. During this time, stroke survivors should also be monitored for any changes in their condition such as difficulty swallowing or loss of movement in an arm or leg.

During the next 24 hours, additional assessments from medical professionals to identify any additional needs such as physical therapy, occupational therapy, speech therapy or dietetics should be carried out. In addition to medical assessments, stroke survivors should also be evaluated for problems such as confusion and depression which are common after stroke onset.

In the following three days post-stroke onset, it is important for stroke survivors to be continuously monitored closely by their doctors to ensure their  condition stabilises. It is also important at this stage that  family members who can provide emotional support during this difficult time are well informed and gain as much knowledge of the condition as possible.

During the first week post-stroke onset it is important for stroke survivors to continue being monitored closely by medical professionals and once the condition stabilises, occupational and physiotherapists should come in for assessments and give assistance with activities of daily living such as dressing and bathing. provide simple physical exercises so that functional gains can be made early on in their recovery journey. In addition to formal therapies it may be important for stroke survivors to participate in activities that will help their recovery such as listening to music or engaging in crafts so that they remain engaged mentally and emotionally during this period of adjustment.

The month following post-stroke onset should involve continued assessment by medical professionals while focusing on improving mobility so that stroke survivors are able to take more steps independently. Rehabilitation exercises should focus on a range of motion exercises that will strengthen muscle groups used during walking so that further progress can be made towards independence when walking outside the hospital setting. Assistive devices such as walkers may also need to be identified during this phase so that full independence can eventually be achieved when navigating around outside environments.

From three months up until six months post-stroke onset rehabilitation exercises should focus on improving coordination between movements while incorporating everyday tasks into rehabilitation sessions so that skills practised have real life applications outside of the hospital setting. During this time, massage therapy may also become part of the treatment plan along with home based therapies where therapists demonstrate activities or techniques from within the most natural environment of the patient – their home – which further reinforces skills learned within a safe environment away from a clinical setting but still under professional guidance.

As we move onto one year since stroke onset many rehabilitation goals set out initially may now have been achieved however some patients may still require ongoing rehabilitation services depending on level of functioning prior to injury including activities related to memory improvement, self-care abilities and communication skills if required due to aphasia or apraxia associated with their condition. Any ongoing support needed at this stage must be tailored specifically according to individual needs while incorporating family members into care plans where required so that progress made up until now remains consistent throughout one year post stroke onset with minimal regression occurring due to lack of reinforcement of skills.

At every stage of stroke rehabilitation, it is important to ensure stroke survivors are being provided with the necessary therapies and support systems that will enable them to make the best recovery possible while improving 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 so that stroke survivors can maximise their potential for a successful recovery.

This article has been written to provide readers with an overview of critical rehab length following stroke onset however it is always important for stroke survivors and families alike to consult with medical professionals prior making any decisions about treatment plans related to stroke recovery as each case differs greatly from one another depending upon individual needs.

Stroke recovery is an ongoing journey but with the right care it is possible to achieve long-term success.

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 recovery rehabilitation in Singapore. Such resources include:

– Time

Time is of the essence when it comes to recovery. The sooner you can start your rehabilitation process, the faster the recovery can be. Some considerations for clients are their work commitments like if they still need to work or if they can take time off for intensive therapy. And to adjust 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. This 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 such as installation of railings or handlebars, wheelchair access, space for therapeutic activities and reducing falls risk. Clients will need to assess their ability to function at home such as if they are limited by steps or stairs or reaching too high or bending too low for things. Such issues will need modifications for effective access.

– Social Support

We encourage dialogue and involvement with caregivers who are family members, trusted friends and helpers. Emotional and physical support are 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 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 recovery journey.