Quick Enquiry

The aim of rehabilitation is to achieve functional independence; restoring as far as possible the lifestyle and dignity of the individual.  Stroke affects many people who survive and then go through a process of recovery that medical science would see as reasonably predictable. However, the aim of therapy is to amplify and enhance recovery and break these predictable patterns for the better.  The good news is that it is not hard to find individuals whose patterns of recovery are better than expected.  A nice goal would be to change our collective belief about what is possible.  Here is what the textbooks might tell us to expect.

Hemiparesis (weakness on one side of the body) and the natural process of recovery of movement have been the most researched of all stroke impairments.  Close to 90% of people who have a stroke will demonstrate hemiparesis at first.  The process of recovery is seen as following a relatively predictable sequence of events.

Initially there is a total lack of voluntary movement or flaccidity on the affected side.

Within 48 hours of loss of movement, reflexes become more active in the involved arm and leg.

As muscle tone returns, the arm and leg position themselves in resting postures known as synergy patterns and some minimal voluntary movements may be possible.
 
* Arm flexor synergy: Shoulder flexion, adduction, internal rotation; elbow flexion; wrist flexion; finger flexion
* Arm extensor synergy: Shoulder, elbow, wrist, finger extension
* Leg flexor synergy: Hip flexion, adduction; knee flexion; ankle dorsiflexion
* Leg extensor synergy: Hip, knee extension; ankle plantar flexion

Voluntary movement may eventually return, and spasticity decreases with increased voluntary movement. However, muscle stretch reflexes always remain increased despite total recovery.

If progress continues, more complex movement combinations are learned as the basic synergies lose their dominance.  As this occurs spasticity decreases further.

Ultimately if improvement continues then spasticity disappears, as individual joint movements become possible and coordination approaches normal.

To complete this description we could say that at the onset of hemiplegia the arm is more involved than the leg, and eventual motor recovery in the leg occurs earlier and is more complete than in the arm. Predictors for poor return of movement include absence of motion after 4 weeks.  Most clinicians would say that most recovery takes place in the first three months and that only minor additional recovery occurs after six months post onset. 

However, in practical terms we know that many people have the potential for improvement even many years after a stroke.  It’s becoming a consensus even if in scientific terms the evidence is not in the research literature.

Researchers are beginning to confirm the theories of motor recovery despite brain damage after stroke, which were first presented in the early 1980's.  Plastic responses may occur in areas of the brain outside the damaged areas that can result in partial return of lost function.

Although findings such as these continue to support the need for rehabilitation services months or even years after a stroke occurs, these research studies have small numbers of subjects.  Large randomized clinical trials need to be completed in the future to convince the medical community that intensive rehabilitation interventions contribute to the improvement and maintenance of post-stroke functional skills.