Understanding Chronic Stroke and Stroke Recovery

Stroke is one of the main causes of death in the U.S. It’s also the leading cause of disability among adults.

Recovering from a stroke can take a long time. If you or someone you love has had a stroke, here’s what you need to know about chronic stroke and recovery.

What Is Chronic Stroke?

Each year an estimated 610,000 people in the U.S. have a stroke for the first time, according to a report from the American Heart Association. And 185,000 people have a recurrent stroke. That means they have had a stroke before.

For many people, problems from stroke can turn into chronic, or ongoing health problems.

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Long-Term Effects of Stroke

The long-term effects of stroke depend on which part of the brain the stroke attacked. What happens on one side of your brain affects body function and activities controlled by the opposite side, for most of the upper part of the brain. A stroke can also happen in your brainstem or cerebellum, in the base of your brain.

Right-side stroke

If your stroke happens in the right side of your brain, you may experience:

  • Paralysis on the left side of your body.
  • Vision problems.
  • Memory loss.

Left-side stroke

If your stroke happens on your left side, you may experience:

  • Paralysis on the right side of your body.
  • Vision problems
  • Speech and language problems.
  • Memory loss.
  • Slower, more cautious reactions.

Brainstem stroke

Your brainstem controls basic central nervous system activities, including consciousness, breathing, and blood pressure. A stroke in your brain stem can affect these activities.

Paralysis isn’t common with brainstem strokes. If you have a brainstem stroke, you may experience:

  • Dizziness, vertigo, or severe imbalance.
  • Double vision.
  • Slurred speech.
  • Decreased consciousness. That means you aren’t as alert or aware.
  • Locked-in syndrome. If this condition happens, you can move only your eyes.

General stroke symptoms

Some of the problems you may experience from a stroke depend on the type of stroke you’ve had. But other problems can happen no matter what type of stroke you’ve had. If you’ve had a stroke, you may experience one or more of the following:

  • Fatigue or tiredness.
  • Seizures.
  • Muscle weakness.
  • Pain.
  • Difficulty swallowing.
  • Incontinence.
  • Stiffness or tightness in the muscles and tendons in your arms or legs. The medical term is spasticity. Left untreated, your muscles can freeze into an abnormal and painful position.

Stroke can affect how you communicate and think. Communication and cognitive changes include:

  • Aphasia. Difficulty speaking or understanding what others are saying.
  • Apraxia of speech. You know what you want to say but can’t get the words out.
  • Anomia. Trouble finding the words you want to say.
  • Dysarthria. Problems moving your lips and tongue to make sound.
  • Short-term and long-term memory problems.
  • Trouble with reading, writing, or numbers.
  • Auditory overload. This means your brain gets overwhelmed by sound or noise.

You may experience mood and behavioral changes after a stroke. Emotional and personality changes include:

  • Depression. Up to two-thirds of all stroke survivors experience depression at some point. According to the ASA, untreated depression can lead to longer hospital stays and can get in the way of stroke recovery.
  • Anxiety.
  • Uncontrolled laughing or crying. The medical term is pseudobulbar affect or PBA.

How Long Does Stroke Recovery Take?

Each stroke is different, and each person who has a stroke is different. Your stroke recovery will depend on several things:

  • What part of the brain was affected.
  • The severity of your stroke.
  • How quickly you received treatment for your stroke. The faster blood flow returns to normal, the better your chances of recovery.
  • Your other health or medical issues.
  • Your support system.

Where to receive stroke rehab treatment

To recover from a stroke, you may need rehabilitation services. Your rehab team will decide what kind of physical therapy, speech therapy, or occupational therapy you need.

In stroke rehab, you will work on regaining function and strength. You will also learn ways to manage deficits, such as loss of movement, speech, or vision, that you may not recover.

Rehab may feel challenging or overwhelming at times. But ultimately, stroke rehab can help you regain your strength and confidence — and help undo some of the damage caused by the stroke.

Hospital-based rehab

Most people who’ve had a stroke spend about six days in the hospital receiving acute care. The goal is to get you well enough to go to rehab or home. You’ll typically receive some rehab services during this time.

Inpatient rehab

Up to 55% of stroke survivors need more inpatient care after their acute hospital stay.

One option is an in-patient rehab facility (IRF). IRFs are acute-care or freestanding hospitals that specialize in intensive rehab care for various conditions, including stroke. The care should include at least three hours of therapy, five days per week.

Most stroke survivors who qualify for an IRF stay an average of 15 days. That’s according to the American Academy of Physical Medicine and Rehabilitation. About 70% of them are well enough to go home after their IRF stay.

Another option is inpatient care through a skilled nursing facility. You may need this type of inpatient care if you have complex medical issues, such as needing a ventilator or dialysis treatments.

Outpatient rehab

Starting your rehab care in an IRF or skilled nursing facility can ensure that you’re safe to go home. But you may still need more rehab once you’re home. You can get this through an outpatient clinic or through in-home nursing or therapists.

Stroke recovery timeline

Everyone’s recovery timeline is different. In general, it takes three to 12 months to recover from a stroke. Many people need even more time to recover. The ways in which the body recovers from stroke are still active areas of research

Here are some common recovery milestones.

First three months after stroke

The first three months after a stroke are when recovery appears to be the fastest. During this time, your brain may be more able to make new connections and learn new things. This ability is called neuroplasticity.

After about three months after a stroke the brain’s ability to change appears to more or less return to normal. That’s why it’s so important to begin needed therapies as soon as possible after you have a stroke. After three months, your brain will continue to make new connections, but it may take longer to see improvements in function.

Several weeks after stroke, vertigo and double vision from brainstem strokes often go away.

Several months after stroke

Most people start to have less fatigue a few months after stroke. For some people who had a stroke, fatigue can last for several years.

Longer-term outcomes of stroke

About one-third of stroke survivors develop poststroke depression (PSD). This is major depression that lasts two weeks or more. Most cases of PSD happen in the first year after stroke.

While older age is a risk factor for stroke, younger people can also have stroke. Up to 10% of strokes happen in people ages 18 to 45, according to the AHA report. Thirteen years after their stroke, about 45% of younger patients had poor functional outcomes.

Get Help Right Away

Recovery from stroke begins with getting care as fast as possible. UPMC’s BE FAST helps you spot the warning signs:

Balance – Sudden loss of balance

Eyes – Sudden double vision or vision loss

Face – One side drooping

Arms – One arm weak or numb

Speech – Slurred

Time – BE FAST: CALL 911!

Editor's Note: This article was originally published on , and was last reviewed on .

About Stroke. American Stroke Association. Link.

Effects of Stroke. American Stroke Association. Link.

Brain Stem Stroke. American Stroke Association. Link.

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association. January 2023. Circulation. Link.

Life After Stroke. American Stroke Association. Link.

Life After Stroke: Patient Guide. American Stroke Association. Link.

The Post-Acute Continuum for Stroke Care. American Academy of Physical Medicine and Rehabilitation. Link.

Post-stroke Care. Practical Neurology. 2019. Link.

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