Healing after a stroke

introduction

In the event of a stroke, certain areas of the brain are insufficiently supplied by a blockage of an artery or, in rare cases, by a cerebral hemorrhage. As a result, the cells in this area perish and neurological deficits arise.
But the sudden neurological failures are not only stressful, they are also frightening. Some patients experience life-threatening situations during a stroke that pose a challenge to the body and the psyche. But when the acute events are over, the patient can expect a long journey from examinations, rehabilitation and medication. The aim here is to help people as best as possible, to regain all their abilities and to offer good prophylaxis against a new stroke.

An early start of therapy (Time is Brain) is particularly important for a cure or a reduction in symptoms. In this way, the cells can be saved before they die.
The affected vessel is also important. In a so-called major stroke, important vessels supplying the brain are affected and patients suffer a severe deficit. With a minor stroke, on the other hand, only slight neurological deficits remain. Various rehabilitation measures can have a positive effect on recovery.

Also read the article on the topic: Stroke therapy

This is the typical healing process

An early start of therapy (Time is Brain) is particularly important for a cure or a reduction in symptoms.In this way, the cells can be saved before they die.
The affected vessel is also important. In a so-called major stroke, important vessels supplying the brain are affected and patients suffer a severe deficit. With a minor stroke, on the other hand, only slight neurological deficits remain. Various rehabilitation measures can have a positive effect on recovery.

The healing process after a stroke goes through different phases. Here, the earlier treatment begins in the hospital, the higher the chances of a quick recovery.
The patient with a stroke arrives first in the emergency room, where therapy is started as soon as possible after the diagnosis has been made. Unless other diseases prohibit, a strong blood thinning (lysis) is given via the vein and, if necessary, the blocked vessel is cleared with a catheter (thrombectomy). Symptoms can improve significantly during therapy.

Ideally, the treatment should then take place in a stroke unit. Stroke Units are facilities that specialize in the treatment of strokes.

In the acute phase, the vital parameters such as heart rate, blood pressure and breathing rate must first be stabilized. A well-controlled blood sugar and a temperature below 37.5 ° are just as important. This can prevent the development of brain edema. Brain edema is a major complication that has an adverse effect on the healing process.
If the acute phase is over, the patient should continue to be stabilized. In addition, the first rehabilitation measures should be initiated. These include physiotherapy, occupational therapy and speech therapy. The existing neurological functions are to be protected in this way. Complications such as spasticity - cramping of the muscles - should also be prevented.

But what exactly happens in the brain during the healing process? New scientific findings have shown that after a stroke there is a reorganization in the brain. In medical terminology, this process is called neural plasticity. Rehabilitation therapy tries to promote this reorganization through different therapeutic concepts. Clinical advances depend on it. Furthermore, the coordination of motion sequences should be improved in this way.
Another important point of rehabilitation is the integration of the patient into everyday life and professional life. The patient should learn to deal with his or her handicap.

In addition to all the rehabilitation measures, prophylaxis is also essential. It should be done 48 hours after the stroke with ASS® or Clopidogrel®. In the further course of healing, risk factors should be eliminated. These include abstaining from nicotine, abstaining from excessive alcohol consumption and weight loss. Blood pressure and blood sugar must also be well controlled and checked regularly.

This article might also interest you: Signs of a stroke

Duration of healing

No general statement can be made about the duration of healing. The healing is strongly dependent on the beginning of therapy, the affected vessel and the location of the damaged area.

In a minor stroke, only small vessels supplying the brain are affected. The neurological deficit is minor. The patients recover accordingly quickly.

In the case of a major stroke, however, one of the main vessels is affected. A large number of brain cells perish here. As a result, patients suffer from severe deficits such as paralysis, speech disorders, visual disturbances (see also: Visual disturbances after a stroke) or disturbances of consciousness. Due to the plasticity of the brain, cells from other brain areas can take over the functions that have been partially lost. This results in clinical improvement, but the symptoms do not go away completely. Some patients even remain in need of help or care for their entire life. The greatest progress can be made within the first 6 months, as the main part of the reorganization of the brain takes place during this period.

For more information, see: stroke

Other important prognostic factors are the occurrence of complications such as brain edema, cardiac arrhythmias or pneumonia. The question of the extent to which the brain was damaged before the stroke is also essential. If small micro-infarcts have taken place, the healing process is delayed. Because of this, younger patients also have a better prognosis and can recover from a stroke relatively quickly. They have a higher reserve capacity because their brain was not previously damaged.

After a stroke, patients learn new functions through continuous training. A certain area of ​​the brain, the hippocampus, plays an important role in the learning of functions. If it is intact, the chances of recovery are higher. In addition, the patient can compensate his neurological deficits more quickly than patients with a damaged hippocampus.

An improvement in symptoms is possible in the first few hours thanks to this high variability in recovery. More than half of the patients admitted to a stroke unit can be discharged directly at home on discharge.

The speed at which the patient recovers is strongly related to the side diseases. The healthier the patient, the faster and better he can do the training. If the symptoms are mild, patients can recover within a few days.

However, over a quarter of the patients are severely affected and require longer inpatient monitoring and subsequent admission to a rehabilitation clinic. An interdisciplinary team also works there with physiotherapists, occupational therapists, speech therapists, medical staff and social workers. Together, the functions that are affected by a stroke are trained and promoted.

Find out more about the duration of a stroke in the spinal cord at: Stroke in the spinal cord

This improves the chances of recovery from a stroke

The chances of recovery are quite individual and depend on the affected vessel and the damaged area. However, there are some criteria that significantly improve the prognosis.

Early treatment is particularly important. Therapy can only be started in the first 4.5 hours, which is why an immediate medical presentation is crucial. If the beginning was uncertain or more than 4.5 hours have passed, you should still present yourself to a hospital immediately. Admission to a stroke unit significantly improves the patient's prognosis and is important in order to find the cause of the stroke and to initiate prophylaxis and rehabilitation.

The treatment takes place here with a drug-based lysis therapy or mechanical recanalization. In lysis therapy, the blood clot that is blocking the blood vessel is dissolved using medication. In the case of recanalization, on the other hand, the whole thing is done intraoperatively and then a stent (a kind of metal spiral) is inserted so that the vessel does not close again.

Treatment in a stroke unit is also important. Stroke Units are facilities that specialize in the treatment of strokes. Optimized therapy and patient monitoring takes place there. In addition, early rehabilitation measures are initiated there.

In addition to these secured measures, there are other criteria that increase the chances of a cure. This includes the motivation to perform the physical therapists' exercises and the avoidance of risk factors such as nicotine or excessive alcohol consumption. A healthy lifestyle and physical activity can also have positive effects.

Of course, after a stroke, avoiding and treating complications such as swallowing disorders, cardiac arrhythmias or infections are very important. A quick start of the rehabilitation measures prevents complications. Patients should get out of bed early if they are stable on the kraal. Preferably within the first two days after the event. This can prevent thrombosis and pneumonia. Exercising movement early is also crucial, as up to 80% of patients suffer from paralysis.

Since the stroke is not only a physical, but often also an emotional burden for those affected, the social support of relatives is particularly important. This can make it easier to get started in everyday life and in professional life.

Also read the article on the topic: Stroke therapy

What are the chances of recovery from a stroke of the speaking center?

If the language center is damaged, the chances of recovery are quite different. The chances depend on the type of disorder and its severity.

Every third stroke patient is affected by a speech disorder (aphasia). There are basically different language disorders. The patient may have difficulty speaking but understands what is being said.
But he can still have the ability to speak, but what he says doesn't make sense. Severely affected patients can sometimes neither understand nor speak (global aphasia). In general, however, one can say that early rehabilitation has a positive effect. It is best to start rehabilitation therapy immediately after the acute treatment.

First of all, you should determine the type of disorder in order to be able to carry out targeted therapy. In the further course, speech therapists, speech therapists and linguists support the patient with individually adapted exercises.

These exercises improve language comprehension and facilitate verbal utterance. The aim of these exercises is to stimulate nerve cells. This encourages reorganization and allows neighboring areas of the brain to take over functions that have been lost.

Two factors are particularly important for the recovery of speech functions: time and graded training. The graduated training includes speech therapy, if possible for at least five hours per week. This significantly improves the chances of regaining the language. The patient's own initiative also plays a major role here, because independent practice can accelerate or maintain healing. Unfortunately, it is still the case that around two thirds of those affected do not have a complete reduction in language disorders.

In addition to the type of disorder, the level of the disorder is also important. When basic structures are damaged, they cannot be compensated as well. If complex structures are damaged, the simple, basic structures can work well together and take over these complex functions. So the foundation must still be intact.

Initiative also plays a crucial role during the healing process. The exercises should be done regularly. The greatest progress is made in the first 6 months. But even years after the stroke, symptoms can improve. It is definitely worthwhile to persevere with the exercises.

For more information, see: Stroke of the language center.

What are the chances of recovery from a cerebellar stroke?

A stroke of the cerebellum manifests itself clinically with various symptoms, such as unsteady gait, dizziness, coordination and speech disorders. Therefore it can be distinguished quite well from a stroke of the cerebrum.

Balance disorders with dizziness and unsteady gait are also possible. In addition, the patient can see double vision, which affects balance even more. Finally, speaking is also controlled by the cerebellum. In the event of failure, a speech disorder (dysarthria) can occur, which sounds similar to an increased consumption of alcohol.

As with any stroke, symptoms can go away in a very short time or persist for weeks to months. Permanent residual symptoms are also possible.

The chance of recovery depends on the size of the infarct. With a small infarct, the chance that the neurological deficit will regress is relatively high. In the case of larger heart attacks, however, a larger area is damaged, so that many functions are impaired.
The time of treatment is also decisive for the prognosis. Because the earlier the therapy starts, the more cells can be saved before they perish. Rehabilitation should be started immediately after the acute treatment. This promotes early recovery and can improve the prognosis. In addition, existing functions can be protected.

Movement sequences should be practiced during rehabilitation. In the case of speech disorders, special exercises should be carried out by speech therapists and speech therapists. Initiative is decisive for the prognosis - if the exercises are carried out regularly, progress can be made faster.

Read more on the topic: Cerebellar infarction

What are the chances of recovery from paralysis after a stroke?

The prognosis for paralysis after a stroke depends on various factors. The time of therapy, the severity of the disorder and the reserve capacity of the brain play an important role here.

Clinical improvement in symptoms can usually be seen after two months. However, it is a lengthy process that requires a lot of discipline. Because the more often the physiotherapist's exercises are repeated, the higher the chances of a cure or at least an alleviation of the symptoms. The exercises stimulate the reorganization of nerve cells - neighboring areas can take over the function of the damaged area.

It is particularly important to start rehabilitation early and intensively. Various studies have shown that intensive early rehabilitation is decisive for the regression of symptoms. In this way, motor functions can be relearned in the event of paralysis. However, it must also be said that paralysis is a serious neurological disorder that in rare cases heals completely.

The patient must get off the bed on the wheelchair and from the wheelchair to walk on their own as quickly as possible. As already mentioned above, this is not only very positive for movement training, it also prevents complications. The number of steps in each workout seems to have a big effect.

Paralysis of the upper extremities occurs in 80% of those affected. In the first two months, patients can relearn how to move their fingers. If the function of the hand has not recovered after half a year, the chances of an improvement are significantly lower. Here, too, it is very important to integrate the hand into everyday activities and to practice it repeatedly. It is important to prevent cramps (spasticity) in patients with paralysis.

The previous illnesses, such as diabetes mellitus or cardiac arrhythmias, are also decisive for the prognosis. These increase the risk of complications and decrease the chance of recovery. For this reason, patients should be checked regularly, especially during the acute phase. Blood sugar, blood pressure and body temperature should be kept stable. All of this can have a positive effect on recovery and thus increase the chances of recovery.

Read more about this in the article: What is the life expectancy after a stroke