Returning Home After a Stroke

How soon can you go home after being in the hospital or rehab facility? What condition can you realistically expect to be in? The answers depend on the severity of your stroke, the areas of the brain it affected, and other factors.   Some people who've had a stroke can return home after a few days in the hospital. Others will not get home for many weeks if they need treatment in a rehabilitation facility. A few stroke survivors require long-term nursing care. For most people who have had a stroke, living at home is possible only if they can manage activities of daily living, such as dressing, eating, and using the toilet. You also have to follow medical advice and take prescribed medications. But you will probably need help even if you can perform activities of daily living. Don't try to do it alone, at least not right away. Plan on having a relative, friend, or home-health aide stay with you for at least the first night you're home and possibly longer. If you've been in a rehabilitation facility, chances are that someone in charge of discharge planning will visit your home ahead of time to evaluate what equipment and assistance you will need.   Before returning home permanently, it's a good idea for you to visit for a day or a weekend so that relatives or caregivers will have a chance to identify and correct potential problems. If you have trouble getting around the house, for instance, furniture may need to be rearranged, throw rugs removed, and handrails built. If you need a wheelchair, doorways may have to be widened and ramps or lifts installed.

Advice for Caregivers

If a relative, spouse, or a close friend has had a stroke, you are affected, too. You miss the person's companionship and worry about his or her well-being. But you have a vital role to play in the person's recovery. You may need to offer practical help with the person's care, and you will certainly need to be supportive when your loved one's spirits fall. Your encouragement can make the crucial difference between rehabilitation results that are mediocre and results that are successful. When you step in to help, keep the following hints in mind:

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.

Make everyone's life easier by learning about and using assistive devices that will help your loved one do as much alone as possible.

Take advantage of support groups and other resources for caregivers. Learn as much as you can about stroke and rehabilitation. Support your loved one's efforts to participate in decisions about rehabilitation. If your loved one has trouble communicating, ask your doctor or a speech therapist for

advice. For example, speaking slowly and allowing plenty of time for a response can help. So can using pictures, photographs, gestures, and sounds or computerized communication devices.

Ask to attend some of the rehabilitation sessions to learn how the program works. Make sure the staff suggests activities that fit your loved one's needs and interests.

Encourage and help your loved one practice the skills learned in rehabilitation.

Find out what your loved one can do on his or her own, what he or she needs help with, and what he or she can't do at all. Then try not to do tasks that you know your loved one can do without your help.

Consider adult day care. A local adult day care program can be a good option if your loved one is living at home but has some degree of mental impairment. Adult day care can help give a few hours respite to a relative who is caring for a stroke patient at home. It would not be suitable for someone who is relatively self-sufficient.

Physical Therapy After a StrokePhysical therapy retrains your muscles to do what they did before your stroke — but the process may require plenty of time and patience.After a stroke, muscles may not remember how to perform actions that were once simple, like sitting and walking. A stroke patient will need to relearn these skills with the help of physical therapy. Physical therapy retrains muscles and reminds them how to work together again.

Physical Therapy: Regaining Mobility

Physical therapy focuses on getting the stroke patient to use limbs that have been weakened or paralyzed by the stroke.

While occupational therapy concentrates on helping patients learn to feed themselves, chew and swallow, and get dressed, the main goal of physical therapy is mobility. A physical therapist wants to teach the stroke patient how to walk, sit, stand, and get in and out of bed, a chair, and a car all on their own.

"Physical therapists evaluate and treat the deficits that stroke patients are left with, the musculoskeletal deficits. We will start in acute care, with early mobilization of the patient and exercises," says Mary Ann Owsley, PT, supervisor of the physical therapy stroke team for inpatient rehab at the Frazier Rehab Institute, a service of Jewish Hospital and St. Mary's HealthCare in Louisville, Ky.

"We get them up and moving around as soon as possible, even if all they are able to do initially is sit up on the side of the bed and work on sitting balance. Then we progress to being more independent with all of their basic mobility — from getting in and out of the bed to the wheelchair, to walking with different types of assistive devices, like canes and walkers," says Owsley.

Physical Therapy: Success Through Strength

Physical therapy involves using and strengthening the muscles, even before the patient can do this on their own. Therapists use both active and passive range-of-motion and strengthening exercises. Active exercises are ones the patient performs unassisted; passive exercises are performed or aided by the physical therapist. Both types help strengthen muscles.

The physical therapist will create an exercise program for the patient to follow so that muscle strength can be maintained and new skills won't be lost.

Physical Therapy: Family Education

Physical therapy also involves working with family members and caregivers. "We start working with the families as soon as we can to follow through with any of these techniques for positioning and range of motion," says Owsley. "We do a lot of education with the stroke victim and their families as far as the limitations that they may be left with."

Physical Therapy: Following Through With a Plan

Physical therapy often starts while the stroke patient is still in the hospital, so you can continue to work with the same physical therapist once you return home or move to the inpatient stroke rehab center. However, if your initial treatment was not at a primary stroke center with health providers specifically trained in stroke, you may want to find a physical therapist to help with your stroke recovery at a certified stroke rehabilitation center.

Physical Therapy: Managing the Costs

Often, private health insurance plans will cover either a percentage of the costs or a set number of physical therapy sessions. Medicare usually pays for physical therapy after a stroke. Find out about your coverage before physical therapy begins so you understand what costs, if any, you will be responsible for.

Physical therapy works best when it is started early and is continued regularly, usually a few times each week. Slowly but surely, your body will start to remember and respond, and repair the damage done by stroke.

The Importance of Exercise After a Stroke Excess weight, high blood pressure and cholesterol, depression — exercise can help deal with all of these issues. And there are even more good reasons to exercise after you've had a stroke.

After a stroke, you’re probably not anxious to put on your running shoes and go jogging. You’re facing other concerns — but you should know that exercise is very important for stroke recovery and for preventing another stroke.

Only slightly more than half (57 percent) of stroke survivors are getting regular exercise, according to a survey of 11,862 men and women who had survived at least one stroke.

Stroke survivors need their doctor’s advice — or the guidance of another health professional — to get moving. If your doctor has not talked to you about the importance of exercise in preventing stroke, make a point of bringing it up.

Evidence That Exercise Helps After a Stroke

“Sitting around after a stroke is not helpful. It’s better to get exercise,” says Argye Beth Hillis, MD, executive vice chair of the department of neurology and co-director of the cerebrovascular division at Johns Hopkins University School of Medicine in Baltimore.

“Any kind of aerobic exercise is helpful — things like swimming, jogging, anything that gets the heart rate up and helps you to lose weight, says Dr. Hillis.

In fact, such exercise may mean less damage from future strokes. A recent Danish study of 265 adults who had survived a stroke found that those who exercised the most, before and after the stroke, experienced less severe strokes and recovered better.

Why Exercise Improves Stroke Recovery

Being physically active will help with your stroke recovery, and help prevent a second one, because it:

Controls cholesterol levels. Keeping your cholesterol level low is very important if you want to prevent another stroke. Exercise increases “good” cholesterol.

Fights high blood pressure. By keeping your blood vessels working well, you can fight high blood pressure.

Controls weight. Many stroke survivors need to lose weight to reduce their risk of another stroke. Even if you’re already at a healthy weight, exercise will help with weight management.

Fights depression. Depression is common after a stroke and can make it hard for you to find the motivation to do anything, let alone get moving. But did you know that being physically active fights stress and depression, which in turn reduces your additional heart disease and stroke risk?

Easing Into Exercise

There are two possible scenarios for stroke survivors. The first is that your stroke left you with no physical disability. In this case, when your doctor says you can begin exercising again, you’re ready to develop a post-stroke recovery routine. Go slow and check in with your doctor to make sure you’re not overdoing it.

Another possibility is that your stroke affected your ability to move. If that is the case, you will go through rehabilitation before you can develop a traditional exercise plan. Physical and occupational therapists will help you with your rehab, which also counts as exercise. The best course of rehabilitation is:

Training for basic functions, focusing on muscle control, strength, coordination, and range of motion

Skill training

Building endurance

Although you might think strength is one of the greatest concerns you have in stroke recovery, a review of 151 studies showed that focusing only on developing strength does improve function, but not to the degree that a comprehensive skills-building program can.

Your Post-Stroke Exercise Goals

When you’re ready, you should shoot for:

At least 30 minutes of exercise three to four times a week — more is better Being active as often as possible — for example, parking a little further from your destination to

build in some walking time

Bucking gravity: Try chair aerobics or water sports

Using your cane or walker as part of your routine. A physical therapist can show you how to build an assistive device into a healthy exercise program.

How Music Therapy Can Help With Stroke RecoveryMusic therapy helps stroke patients relearn old skills, like walking and talking, and reconnect with life.

Music therapy is an excellent way to help patients heal and recover after a stroke. It can help stroke patients regain movement, communicate, and lift their mood at the same time.

What Is Music Therapy?

Music therapy is the therapeutic use of music to help patients physically and psychologically recover from a variety of medical conditions, including stroke. Often, a patient will receive music therapy because a doctor has recommended it along with other therapies, including physical therapy and occupational therapy.

Music therapy has been around for thousands of years in various forms, but it wasn’t until 1950 that it was recognized in the United States with the formation of the American Music Therapy Association (AMTA).

"There is a pretty strong research foundation for music therapy," says Al Bumanis, MT-BC, director of communications for the AMTA, and a long-time music therapist.

Music therapy can help stroke patients recover by using music, specifically rhythm, to relearn gait, and singing techniques can be used to help improve speech, says Bumanis, adding that music therapy also lets stroke victims feel like they belong. "People can't feed themselves, but they can sing songs and remember the lyrics,” he says.

Music Therapy and Communication

If stroke patients are having trouble communicating clearly, or struggling to express themselves, music can help them communicate their mood and ease feelings of frustration.

Drums are particularly effective in helping stroke patients communicate, says Bumanis. “They can learn patterns through music to help them communicate."

And music helps stroke patients better communicate with their caregivers. “It's a great thing to share. It helps them reconnect — dancing, singing, listening to music," adds Bumanis.

Music Therapy and Movement

Besides helping with communication skills, music therapy can help a stroke patient regain control over their muscles and regain lost skills, like walking. “It can energize people,” he explains.

"To get stroke victims moving, we can match the tempo to where the client is," Bumanis says. "We then can gradually increase it, with the eventual goal of dropping the music and having the person move on their own."

Music Therapy and Mood

Depression and anxiety are common after a stroke. “Relaxing to music, learning to breathe to music, almost meditating to music are powerful [healing] tools,” says Bumanis. Just participating in musical activities can lower blood pressure and other anxiety-related markers.

Music Therapy and its Cost

According to the AMTA, your health insurance coverage may reimburse you for music therapy; Medicare has recognized it as a reimbursable service since 1994. To be reimbursable, the therapy must be:

Prescribed by your doctor An important part of your therapy

Documented in a treatment plan

Music Therapy: Getting Started

Anyone who is interested in music therapy as part of stroke rehabilitation should contact the American Music Therapy Association to find a music therapist in their area.

If you’re struggling with depression or finding it difficult to learn again after your stroke, music therapy can offer many of the same benefits as other types of post-stroke therapy, but in a more enjoyable, relaxed environment.

Occupational Therapy: Get Back to Life After StrokeOccupational therapy can help stroke patients regain their independence.

After a stroke, survivors want to return to a full, normal, and happy life. Unfortunately, many stroke survivors are left with disabilities that make that goal difficult.

Therapy is usually recommended for stroke survivors to help them relearn how to do everyday things like walking. And although independence is a huge factor in quality of life following a stroke, so is getting back to activities and hobbies that were enjoyed before the stroke. That's where occupational therapy comes in.

Occupational Therapy for Stroke Survivors

Physical therapy and occupational therapy are two different disciplines. A physical therapist will work with stroke survivors on things like sitting, standing, walking, and holding objects. Physical therapy focuses on movement of the stroke-impaired limbs. An occupational therapist will help a stroke patient with daily acts of independence, like learning again how to wash, get dressed, and brush their teeth. Occupational therapy focuses on two main things: restoring independence and quality of life.

"Our motto is living life to its fullest. OTs [occupational therapists] try to help clients to get better as a whole person. We want to help them to recover as much functional ability as possible, and address those things that people really want to improve," says Valerie Hill Hermann, MS, OTR/L, an occupational therapist for the University of Cincinnati’s Neuromotor Recovery and Rehabilitation Lab at the Drake Rehabilitation Center in Cincinnati.

Here are some of the key areas occupational therapists focus on: Early therapy. Occupational therapy usually begins right after the stroke, while the

patient is still in the hospital. "We're helping them to cope with the fact that they had a stroke, how their brain has to recover, how their body is responding to this problem in their brain," says Hermann. Occupational therapists focus on helping stroke patients to do the daily basics, like toileting and getting in and out of bed. "All of these really basic daily things that we take for granted, we help them figure out how to do that," she says.

After the hospital. Occupational therapy continues when the patient is transferred to a rehabilitation center or skilled nursing facility. Once these skills — activities of daily living and functional activities — have been re-learned in those environments, it's time to make sure the stroke patient can do these same things at home, as independently as possible. "Eventually, stroke survivors will go to outpatient therapy clinics for continued

work with activities of daily living, functional mobility, and refining the skills still needed, such as gross motor control and fine motor coordination to engage in desired activities," says Hermann.

Individual sessions. It's hard to pin down what a therapy session will consist of, because every session for every person is different. That's because occupational therapists design an individual therapy program for each individual stroke patient. "For every stroke survivor it's different, because everyone has different goals," says Hermann.

Hermann recommends that stroke patients "really put a lot of effort into [occupational therapy or rehabilitation] in the first year, as the likelihood of recovery is better." And while stroke patients will recover better and faster in the first year, the "potential to continue recovering is forever," says Hermann.

Occupational Therapy: Finding a Therapist

To find an occupational therapist, Hermann recommends asking for a referral from the rehabilitation doctor, or a primary care physician. Stroke patients or caregivers can "go online or call their insurance companies and ask what occupational therapists are in their area," she says.

Once the person is physically healthy again, the main goal of stroke rehabilitation and recovery is to maintain the same quality of life that they enjoyed before the stroke. Whatever pleasures you want to have again — being able to cook your favorite meal, plant flowers in your garden, or tinker with tools — occupational therapy can help you get there.

Making Dietary Changes After a StrokeChanging your diet can help with your stroke recovery. Learn how to make smart choices and pick up some new cooking techniques.

If you’ve survived a stroke, you may find that you need to make changes to your diet: To prevent another stroke, you’ll want to eat foods that are healthier for your cardiovascular system and help lower cholesterol and blood pressure . If your doctor doesn’t offer a referral to a nutritional counselor as part of your stroke recovery, ask for one.

A recent study of 11,862 stroke survivors revealed that only 62 percent of those with high blood pressure got professional guidance on changing their diet to prevent a second stroke. A dietitian or nutritionist can help you figure out how many calories you need every day to maintain a healthy weight or lose weight, and lower your cholesterol and blood pressure if necessary.

“The recommendations from the American Heart Association for reducing cardiac risk are the same for reducing stroke risk,” says Argye Beth Hillis, MD, executive vice chair of the department of neurology and co-director of the cerebrovascular division at Johns Hopkins

University School of Medicine in Baltimore. That means a low-fat, low sugar, low cholesterol diet.

Goal #1: Reducing Saturated Fat Intake

Your basic goal will be to lower the amount of saturated fat in your diet to 8 to 10 percent of your total calories.

You should:

Avoid whole milk; try skim or nonfat instead. No eat fatty cuts of meat; try leaner cuts and fish.

Not eat chicken or turkey with the skin still on.

Goal #2: Cutting Down on Fats Overall

Keep calories from all fats to less than 30 percent of your daily calorie intake.

This may mean:

Learning new ways of cooking, such as baking or broiling, instead of frying Using low-fat or fat-free salad dressings

Avoiding high-fat additions to foods — for instance, butter and sour cream on your potatoes

Using small amounts of spreads such as margarine

Goal #3: Cutting Back on Cholesterol

Keep your cholesterol intake to below 300 milligrams a day. Here’s how:

Cut back on meat and dairy products. Eat more vegetables, fruits, and whole grains.

Avoid egg yolks and liver.

Goal #4: Cutting Back on Salt

High blood pressure is a risk factor for stroke — and salt is directly related to high blood pressure. One way to help reduce your risk of stroke is to keep your salt intake to less than 2,400 milligrams a day. Try using other kinds of salt-free seasonings such as herbs, spices, or fruit juices (lemon or orange) to flavor foods.

Diet Challenges After Stroke

When you’re in stroke recovery, you may not have the energy or desire to cook or even eat. Some people find it hard to chew and swallow after a stroke. These problems require your doctor’s help. You might need to be treated for depression or get a referral to see a professional who can help you relearn how to enjoy eating again.

Here are some ideas that might make it easier to eat a healthy diet during stroke recovery:

Plan to eat your “big” meal at a time when you have energy. Keep bags of washed, cut fruit and veggies for quick, healthy meals.

Try soft foods such as scrambled eggs, cooked whole-grain cereals, yogurt, soup, and applesauce.

With a little effort and some professional help, you will soon enjoy eating again.

Stroke Care: Educating the FamilyAs the caregiver of a loved one who's had a stroke, you'll need to learn all you can about the aftermath of a stroke.

When you become a stroke caregiver, you are faced with the challenge of understanding the stroke and stroke care — and then explaining to friends and family what has happened and what it means. Doing so will make it possible for them to help you carry the caregiver burden, but you may be unsure about how to discuss stroke care.

“The most important aspect for any of this is education and information. With all the emotional turmoil, there is often a sense of being out of control, of not understanding the natural recovery process,” says Paul Newman, PhD, a neuropsychologist and director of behavioral health at the Drake Center at the University of Cincinnati. A neuropsychologist is a psychologist who is trained in how the brain functions.

The first step is for you and your loved one to learn as much as possible. Research has shown that knowledge about stroke can even help reduce the extent of depression in the patient.

The First Few Months Post-Stroke

Caregivers may see a stroke survivor improve rapidly during the first three months, but then become distressed when improvement slows. It’s important to be ready for changes in the patient’s mood and behavior. While in the past doctors believed stroke recovery stopped at about one year, they now know that the brain is always changing. Part of stroke care is learning to do things in new ways. It’s also about accepting the fact that sometimes, you will not have control over the situation.

Educating Others About Stroke

Here are some general rules of thumb for teaching friends and family what you’re learning about stroke:

Set the tone. If you’re open and honest about stroke care, other people in your lives will be more comfortable talking about the situation.

Involve children. Newman believes that children and grandchildren can be the strongest motivators for stroke care success — and also may be the easiest people to talk to. Give them age-appropriate tasks so they can help out.

Accept help. Accepting help is like giving people a gift, says Newman. It allows them to feel good about themselves and useful to you.

Ask for help. Caregivers burn out very quickly if they take all the work on themselves. If you need a break or you just need company, let people know.

Involve a stroke care doctor or other professional. If you’re having a hard time explaining why as caregiver you must do things a certain way, involve a health professional who can talk to your family with authority.

Assert yourself. Let your opinions and feelings be known to your family. Getting angry or combative will not help the situation.

Dealing With Changes in the Stroke Patient

Many stroke victims look or behave differently after a stroke. Polite adults may avoid discussing these changes directly, whereas children might mention them immediately and loudly. “There is often an elephant in the room,” observes Newman.

You can set the tone by directly bringing up the stroke-care process. For example, you can talk about the physical therapy your loved one is receiving to improve his walking or you can share some of the speech therapy activities, tools, and techniques you are both learning.

What is harder, says Newman, is talking about the unseen changes. A weak arm is easier to educate family about than a change in your loved one’s ability to think. This creates two troublesome situations for a caregiver:

A stroke survivor may be very persuasive in saying he can do certain things (such as climb a ladder to repair a roof tile) that you know he can’t — but friends and family doubt your advice not to let him.

A stroke survivor may appear “normal” for a visit with family who go away thinking things are not so bad — which then makes you, as a caregiver, feel isolated.

Again, says Newman — educate your loved ones, and be open and honest about what is going on.

Keeping All Informed and Involved

Whether you’re keeping family informed over a long distance or within the same city, Newman advises using Internet tools such as CarePages.com, which make it easy to communicate with a lot of people at once about someone’s condition. Some of these sites include a calendar function that can be very helpful in keeping track of what needs to be done and who’s doing it. There are also plenty of support groups that you can find online, or even through the hospital where your loved one received care.

Top 10 Questions to Ask Your Doctor After a StrokeAs you move ahead with your recovery, you'll have lots of questions about navigating life after stroke

If you’ve had a stroke, you probably have concerns about what lies ahead in the weeks and months of stroke recovery. You may have a limited amount of time with your doctor to get all the stroke recovery information you need.

“We always try to figure out what caused the stroke, but I am not sure that when patients are in the hospital they hear everything their doctors say or understand it,” notes Argye Beth Hillis, MD, professor of neurology, executive vice chair of the department of neurology, and co-director of the cerebrovascular division at Johns Hopkins University School of Medicine, in Baltimore.

Dr. Hillis recommends asking questions until you understand completely what happened with your stroke and what you’re supposed to do to take care of yourself. You may want to use a tape recorder or bring a trusted friend or family member with you when you talk to your doctor — these both can help you remember key pieces of information.

Use this list of questions to guide you in your conversation with your doctor:

Questions to Ask About Stroke Recovery

1. What caused my stroke? Your doctor will probably give you a technical explanation of why you had a stroke, but you also need to know if any preventable factors contributed to your stroke. Once you have this information, you can work on lowering your risk of having another stroke. Smoking, high blood pressure, heart disease, being overweight, stress, drinking a lot of alcohol, and being physically inactive can all contribute to your stroke risk.

2. What can I do to reduce my risk? There are a lot of steps you can take after your first stroke to reduce the risk of a second stroke, including changing your diet, taking your stroke medications, and getting more exercise. Try to set some concrete goals with your health care provider so you know whether you are succeeding.

3. Am I getting the rehabilitation services I will need to achieve my goals? If you feel you need specific assistance after your stroke, but haven't received help with

individualized concerns related to diet or speech, for instance, talk to your doctor about referring you to the appropriate specialist.

4. What are my treatment options? Depending on the underlying cause of your stroke, you may benefit from taking certain medications or even having special surgical procedures to reduce your risk of another stroke. Ask your doctor about which specific stroke treatment options are available to you.

5. What kinds of health specialists are going to be a part of my stroke recovery team? Your stroke recovery team could include a neurologist, a speech pathologist, a physical therapist, an occupational therapist, a social worker, a psychologist, a nutritionist, and other health care providers. Try to get a list of names and contact information that you can refer to later.

6. Should I be getting treatment for depression? Depression is very common after stroke, but many stroke survivors do not receive help for this treatable condition. Depression can make it hard for you to return to work and engage in other daily activities that you once enjoyed. If you feel down, don't be afraid to tell your doctor. Treatment for depression can be critical to your overall stroke recovery.

7. What kinds of changes can I make to compensate for the consequences of my stroke? Everyone has different challenges after a stroke. Part of your stroke recovery will be finding creative ways to compensate for the skills you’re trying to relearn. For example, if you’re having problems speaking clearly, you may want to carry a notebook of commonly used phrases and pictures that you can point to in order to help others understand you.

8. What role does my family play in my stroke recovery? Family and friends play an important role in helping your medical team understand your strengths and limitations. Find out how to involve them more actively in your stroke recovery.

9. Should I get help from a stroke recovery center or a stroke support program? Recovering from a stroke is a lifelong process. Community-based stroke recovery centers and support groups allow you to work on stroke recovery after you have been officially discharged from your treatment program.

10. When should I call my doctor? Worrying about possible stroke-related complications or about your risk of another stroke is normal — find out what changes warrant a call to the doctor.

Once you gather the information you need about your stroke recovery plan, you'll feel more confident and better able to move forward on your road to wellness.

Speaking Again After a Stroke

Speech therapy can help a person who's had a stroke recover much, if not all, of what's been lost.

When you’re struggling to speak after a stroke, you may worry that you’ll never be able to communicate effectively again. But by including speech and language therapy as part of your stroke recovery, you’ll set communication goals and even find new ways to get your point across.

Tools to overcome your speech challenges may include:

Working with a trained speech and language therapist Using notebooks or pictures to communicate while you relearn speech

Using computer programs to practice building sentences

Practicing desired “real world” skills, such as socializing, ordering off menus, or sending emails

Taking part in ongoing community-based stroke recovery

Customizing Your Post-Stroke Speech Rehab Plan

Your personal goals, strengths, and weaknesses will shape your speech rehabilitation, says Janet Brown, MA, director of health care services in speech-language pathology at the American Speech-Language-Hearing Association in Rockville, Md.

“Therapy for someone who has had a stroke is a collaboration with a skilled speech language therapist and the patient and family,” says Brown. For example, two people may test with the same speech-language deficit, but if one is a dedicated reader and the other primarily wants to regain her ability to chat with her friends, their speech rehabilitation programs will be different.

Brown emphasizes that speech recovery may take time — years, in some cases — and interventions are progressive, beginning with compensation strategies to make people understood.

“Let’s say they have a lot of difficulty expressing themselves. You may want to compensate by giving them written information, like a notebook that has a lot of commonly written phrases or pictures,” says Brown. This approach can help ease some of the emotional stress, depression, and sense of isolation that accompanies speech problems.

Besides using strategies such as notebooks to communicate while going through speech rehabilitation, some stroke survivors may need “processing prostheses” — computer programs that allow them to visually interact with language so that they can get practice forming complicated sentences. After a brief period of training, stroke survivors can use these programs at home to improve their speech.

Lifelong Stroke Therapy

Brown points out that the understanding of stroke recovery is changing, and with it the approach to speech rehabilitation.

“The thinking now is that recovery from stroke is lifelong, as long as an individual is continuing to work on communication skills,” she says. While medical facilities may not be able to provide lifelong speech rehabilitation programs, many communities have organizations for stroke survivors that help them practice speech in real-world settings, such as eating out or using e-mail. Regaining these everyday functions also goes a long way towards helping stroke survivors feel more normal, says Brown.

Recovering Speech: One Stroke Survivor’s Story

In early October 2003, Tom Harper of Slidell, La., woke up feeling fine, went through his morning routine, and found that when his wife of 52 years greeted him, he couldn’t utter a word. At the hospital Harper was told he had experienced “the perfect example of a TIA,” a transient ischemic attack or mini-stroke that indicates a high future stroke risk.

His stroke recovery plan included visiting a speech therapist for three months.

“They would start out with polysyllables like behavior, valentines, division — things like that, three syllables, then four and five syllables, macaroni, favorable, temperature,” Harper recalls. He also remembers being challenged to read aloud paragraphs of increasing complexity and also to perform other language-skills tasks, like finding individual letters in a text to practice letter recognition.

“We kept working like that until I would be able to read a paragraph and the words got more difficult, but it was amazing. Some of the smaller words were more trouble than the four or five syllables sometimes,” recalls Harper.

Six years later, his speech is nearly perfect and Harper, 73, is back to leading an active life as an avid ping pong player, square dancer, and amateur chess competitor.

With time and effort, you too can soon be back on top of your game.

Going Back to Work After a Stroke Here are some tips on how to ease the transition back to work and what adjustments to make in the workplace after a stroke.

Going back to work after a stroke can be challenging, but in some cases, it may actually enhance stroke recovery. While many people who have had strokes are retired, about one in five people who have strokes is employed. Data suggests that only half of those who had paying jobs before their first stroke return to work.

It’s a good idea to make sure that your stroke recovery program is in place before you return to work. You should become knowledgeable about your stroke medications and aware of how to reduce your risk of another stroke.

Tips for Transitioning Back to Work

Once you’re ready, here are some tips for planning your return to work:

Think about adjustments to your schedule or duties that will make your return to work easier; discuss your needs with your employer.

If you're feeling down or depressed, talk to your doctor and seek treatment.

Tell your employer and coworkers about your stroke if you’re going to need help with certain tasks.

Check in with human resources to find out about benefits, special programs, and workplace modifications for which you may be eligible.

When Depression Keeps You From Returning to Work

Although physical limitations might seem to be the primary obstacles to returning to work, depression appears to be the deciding factor for many people. Those who don’t return to work after a stroke are significantly more likely to be depressed, according to a study of Australian adult stroke survivors. Despite the fact that depression occurs frequently among stroke survivors, mood-related symptoms are often overlooked by patients and doctors alike. If you’re reluctant to return to work, you might be experiencing depression. Don't hesitate to discuss any changes in mood with your doctor.

How Work Can Aid Stroke Recovery

If you feel like going back to work could be challenging, that could actually be good for your stroke recovery, notes Argye Beth Hillis, MD, executive vice chair of the department of neurology and co-director of the cerebrovascular division at Johns Hopkins University School of Medicine in Baltimore. “Recovery from a first stroke is best if you do in fact become involved and active,” says Dr. Hillis. “Sitting around after a stroke is not helpful. It’s better to get exercise and speak and do everything that you [would] normally do — if it’s challenging, it’s actually good.”

Hillis recommends working closely with your employer to make your return easier, especially if your stroke has left you with any physical or speech problems. “Sometimes going back to work is hard and fatigue is common,” she acknowledges. Creative adjustments to your schedule may be necessary until you rebuild your endurance. “I try to get people to go back to work part-time if their employer will allow them to.”

Of course, if there were few physical consequences from your stroke, you may not need to tell anyone about it and you can simply return to work full time.

Having an Emergency Plan in Case of Another Stroke

If you’ve had one stroke, you probably worry about having another one. Roughly 30 percent of people who have had a stroke will have a second one within five years of their first stroke. Here’s how to prepare in the event of a stroke at work:

Give your coworkers information about stroke symptoms. Make sure they know that getting anyone who has symptoms of a stroke to the hospital

within an hour increases the chance of recovering with little disability. Ask them to call 911 immediately if they see you exhibiting signs of a stroke.

Tell them where you keep your emergency information. The list should include the following:

The contact information of at least one family member or close friend

You doctor’s name and phone number

The name and address of the hospital you prefer

Information about medication you’re taking

By working closely with your medical team and your employer, you can successfully return to work after a stroke