Physical rehab restores sense of normalcy for stroke victims
By the faculty of Harvard Medical School for The Harvard Medical School Adviser

Q: My husband's recent stroke left him weak on one side of his body and unable to walk. What should he expect during rehabilitation, and is there any chance he'll ever be able to walk again?

A: A stroke, or "brain attack," occurs when a blood vessel supplying the brain becomes blocked or bursts, damaging nearby brain cells. The symptoms people experience after a stroke depend on the location and extent of that damage (see illustration). Rehabilitation is treatment designed to help people regain some or all of the abilities that were impaired by the stroke. For many people, a rehabilitation program can make the crucial difference between being able to function day-to-day or remaining dependent and impaired.

Rehabilitation can entail building strength in the arms and legs, learning how to walk again, improving speech and bringing back memory. The therapy can also teach people how to adapt to a permanent disability. For example, people learn to use a wheelchair or how to get in and out of the shower by grabbing special bars.

Rehabilitation after a stroke is hard work. Even people who spend many hours each day for several weeks on repetitive exercises may not recover fully. Most people who need a rehabilitation program are left with some lingering weakness or disability. But many people do improve quite a bit. Even if your husband starts rehabilitation unable to walk because of muscle weakness and balance problems, there's a reasonable chance that he will gradually regain the ability to walk on his own, at least some of the time. And rehabilitation can help many stroke survivors learn to feed and wash themselves without assistance.

Your husband's exercise regimen will depend on his disability. It may include walking on a treadmill, walking up or down stairs, using hand or leg weights and repeatedly bending and extending his arms and fingers. If he can't bear weight on his legs, he may practice walking and other exercises while partially supported by a harness or in a swimming pool. The duration will depend on his needs and stamina, but expect his rehab to take weeks to months.

A promising new technique for people with moderate weakness in one arm is constraint-induced movement therapy. This therapy involves not just exercising the weak arm, but also restraining the stronger arm to force the weak one to work harder. The patient's good arm is placed in a sling (or the good hand is covered with a mitt) for up to six hours a day for two weeks. During that time, the patient does intense exercises with the weak arm or hand. Early research suggests that constraintinduced movement therapy may help the brain rewire itself, allowing people to recover some mobility and dexterity. The technique is being evaluated in a large ongoing trial at six rehabilitation centers around the country.

Another promising technique is functional neuromuscular stimulation. This therapy uses electrical stimulation from electrodes to induce muscle contractions. E a r l y research suggests it might improve stroke survivors' ability to walk when done with rehabilitation exercises.

Another common treatment, known as occupational therapy, helps people learn practical techniques to make dressing, washing, driving, gardening and other routine activities more manageable. One method is to break down a complex activity into small parts, and then have patients practice each part in sequence until they can coordinate them. Occupational therapists also teach ways to compensate for one's physical disability -- for example, by using Velcro closures instead of buttons on shirts, or using walkers, wheelchairs or other devices as needed. As a rule, people are more likely to regain simpler movements such as grasping a fork or shaking someone's hand than more involved movements, such as typing or playing piano.

Despite the challenges of rehabilitation, the time and effort is usually worthwhile. Caring for a stroke survivor is very taxing as well. Take care of yourself by eating well, getting enough rest, and taking time to do things that you enjoy. Don't be afraid to ask for help from other family members and friends or to hire some help if you can. Stroke rehabilitation can be a long, hard road, but each step is a step forward.

Copyright 2007 the President and Fellows of Harvard C o l l e g e . Developed by Harvard Health Publications (www.health.harvard.edu ). Distributed by UFS. Submit questions to harvard_ adviser@hms.harvar d.edu.