“The proportional recovery rule” of stroke assessment assumes that stroke patients can improve their condition by 70% in 6 months. Yet recent evidence reports that recovery may continue beyond 6 months into what has historically been called the “chronic” phase.

Since brain neuroplasticity varies from patient to patient, it is impossible to draw an exact roadmap for stroke recovery. The research cited above acknowledged that “Regarding the dynamic changes of a clinical picture of a patient after an ischemic episode…the doctors, physiotherapists, and speech therapists do not have a universal procedure or concept.”

While researchers continue to compile evidence guiding stroke rehabilitation practices, this article presents reasons how medically based home care can make a significant impact in the critical window, and beyond.

The traditional stroke-recovery window: 0-6 months

The accepted thinking about stroke tells us that from the first moments, the clock is ticking. This article in “Neurological Research and Practice” (2020) identifies the timetable as follows:

Hyperacute phase

Acute phase

Early sub-acute phase

Late sub-acute phase

Chronic phase

24 hours

7 days

3 months

4-6 months

6 months +

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It’s well known that in the first hours after an ischemic stroke, recovery is under way. “A cascade of plasticity-enhancing mechanisms leads to dendritic growth, axonal sprouting, and the formation of new synapses,” according to the article. “The most significant improvements occur in the first few weeks…after 6 months, spontaneous recovery is usually at its limit, leading to a more or less stable, i.e., chronic deficit. Nevertheless,” the report concluded, “improvements of some stroke-induced deficits can even be achieved in the chronic phase, primarily for more cognitive domains like language.”

Looking beyond the critical window

There is a growing body of work that indicates stroke patients are often capable of receptivity to therapy that was not previously thought possible.

For example, in a Journal of Neurophysiology article (2019), authors wrote that “We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.”

The Critical Window

illustration of opening window

While new information indicates that recovery gains can be made beyond the “critical window” of stroke recovery (6 months), it also remains true that initial recovery periods are where significant progress is made. The International Journal of Rehabilitation Research (2015) affirms “the importance of the period within 3 months for recovery after stroke, during which most of the recovery occurred, ranging from 48 to 91%.

3 home care contributions

If, as the evidence suggests, stroke recovery is both a marathon and a sprint, then the patient’s progress may need to be supported over time. In our experience, these are among the most critical areas of recovery that home care can affect:

1. Preventing falls. In the first 6 months at home, as many as 70% of stroke patients will fall, and many of them will endure more than one fall. Hip or pelvis fractures and other injuries follow, and a cycle of setbacks can be the result. Home care professionals can work with family caregivers to create and maintain a safe environment.

2. Facilitating treatment – including speech. “Our work with stroke patients often involves carrying out the plan,” said Deb Hess, SeniorBridge Director of Clinical Services. “We do things like manage modified diets, create safe practice areas, report through telehealth, and work on aphasia. Any program a therapist designs, we can help facilitate.”

3. Dealing with depression, maintaining motivation. The American Heart Association (2016) pointed out that as many as one third of stroke survivors suffer from depression – and the degree of depression corresponds to the severity of the stroke. Apathy and anxiety are also common. Home care can help identify these emotional states for assessment, and make a positive intervention. “People who have had a fall or a second stroke or both get knocked back and it’s very hard on them,” said Deb Hess. “We have to overcome the frustration and keep them motivated and moving forward.”

Many factors influence stroke recovery. But the “critical window” can be kept open longer by the ability of medically directed home care to preserve safety, elevate mood, and implement therapy.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on hypertension home care support services, contact SeniorBridge.

Sources consulted:
National Library of Medicine /NIH/Neural Plasticity (2019)
Neurological Research and Practice (2020)
National Library of Medicine /NIH/ Journal of Neurophysiology (2019)
The International Journal of Rehabilitation Research (2015)
American Heart Association (2016)

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