The journey of stroke recovery in 2021
Stroke is one of the most devastating and most prominent causes of disability around the globe, with 800,000 new cases each year in the US alone. During a stroke, the brain experiences an interruption in blood supply, which prevents the brain tissue from receiving the oxygen it needs to function properly. The most prevalent type of stroke is an ischemic stroke, which happens when a vessel that supplies blood in the brain is blocked and accounts for 87% of all stroke patients. The less common type of stroke is hemorrhagic stroke, which occurs when an artery in the brain ruptures. Many survivors struggle daily with the cognitive, emotional, and physical damage caused by the stroke, and often live with little hope of regaining full independence.
Despite the widespread availability of rehabilitation programs and other interventions, an estimated two-thirds of the seven million stroke survivors living in the US are currently disabled. Daily living activities that people don’t generally think twice about, such as eating, dressing, or holding a conversation, become monumental hurdles that can no longer be accomplished independently.
This is especially true in the time of COVID-19, which poses additional challenges for stroke victims and their families during the recovery process due to lockdowns, changes in healthcare practices, and social distancing.
The link between the mind and body during stroke recovery
Dr. Jill Bolte Tayler, neuroanatomist, internationally recognized inspirational speaker, and stroke survivor, shares her breathtaking story in her book “My Stroke of Insight: A Brain Scientist's Personal Journey” which highlights the feelings of helplessness and terror often experienced by stroke victims. Through relatable and empathetic language, she illustrates the emotions and physical sensations she felt at each stage of the stroke and the following recovery.
Dr. Taylor writes that “for a successful recovery, it was important that we focus on my ability, not my disability”. It was imperative for her recovery that people not regard her as a person with a disability, rather that they focus positive and supportive energy on her progress. Dr. Tayler thrived when she had support and encouragement from her team of medical professionals and loved ones.
Because the brain is involved in managing both our physical and emotional well-being, the damage caused by a stroke can lead to lasting emotional and behavioral changes for stroke victims. Feelings of depression and anxiety are some of the most common emotional side effects experienced by survivors while recovering from a stroke. Depression is often characterized by feelings of hopelessness and the urge to withdraw from social interactions, while anxiety is defined as intense moments of uncontrolled fear. It’s no wonder victims are affected so deeply, as the brain has just experienced severe trauma and while the body is trying to heal, the mind is working to cope with the recent brain trauma and working to understand how to move forward.
Dr. Taylor recounts her own experience of emotional and physical challenges following a hemorrhagic stroke. She was able to study her own recovery from a scientific perspective, years following the event. She stresses in her book that from the initial onset of a stroke and throughout recovery, a person generally loses touch with their sense of self. This is due to the profound control the brain has on the body and the physical and cognitive functions that are injured during a stroke. However, with hard work and perseverance, Dr. Taylor shows how far one can come during the recovery process.
Breaking down stroke recovery
As she describes her recovery story, Dr. Taylor frequently refers to stroke victims as being similar to a newborn baby who needs to relearn everything, from walking, talking, eating, and even individual and complex thought processes. Actions as simple as relearning how to walk outside can be a huge hurdle to overcome. Over time these symptoms improve, especially with the proper rehabilitation processes in place.
Cognitive recovery: The brain’s “files”, mainly memories and learned behaviors, have actually been damaged due to the trauma of a stroke. Damage often leads to challenges remembering basic things, the inability to concentrate, the inability to speak and relay messaging coherently, and the motor memory. The survivor now needs to work very hard to recover the new information or relearn lost information. This information may be the names of everyday items, personal preferences, or even how to walk. Recovery of these files will aid in both physical and emotional recovery, and is part of the rehabilitative process, but can be enhanced with the support of a loved one consistently remaining by the survivor’s side to help stimulate these abilities.
Physical recovery: The brain has been physically harmed by a stroke and is recovering from an injury, which impacts the rest of the person’s body. This impact often causes motor impairment in the limbs which can result in challenges carrying out specific activities such as tying their shoes or making a pot of coffee. This can be a devastating outcome for most people, and can really limit their independence. Recovery is a long hard road, but with hard work and dedication, survivors do see progress.
Emotional recovery: The survivor must learn how to re-balance their emotions since the brain controls the emotions and chemical balance, and a damaged brain can result in imbalance or extreme emotions. Coupled with the challenges of facing physical disability and the need to relearn basic functions, this can be a very challenging time for people to cope with. Constant emotional support from friends or family is often the best solution during this process.
Practical application: Recovery during COVID-19
When a person first has a stroke, the common pathway in the US medical system often involves a visit to the emergency room at the onset of symptoms, followed by a stay in the acute care unit for urgent treatment if needed. Once recovered enough to be discharged, patients usually move to either an inpatient or outpatient rehab facility, a nursing home, or their own homes.
Once discharged, survivors are required to travel back and forth between their homes and the rehab center, often shortly after having the stroke. This can be a challenging pathway to endure for patients as they are still newly recovering from the stroke, and travel can be taxing, not to mention expensive.
The COVID-19 pandemic has altered the nature of this pathway, and the implications aren’t all negative. Due to growing research that states that stroke survivors are at a higher risk of developing serious complications from COVID-19, neurologists are sending stroke patients home to recover in order to decrease their risk of being exposed to potential threats in the hospital or rehab centers. With the onset of the pandemic, the digital health industry boomed and Telehealth solutions tailored for stroke survivors became the new normal. Now patients will receive care remotely from the comfort and safety of their own homes.
While the pandemic has created so many new challenges, we are seeing the long-term benefits from the push to create high-quality Telehealth solutions. The ability to participate in remote support groups or to seamlessly speak with a medical professional has reduced the need for the patient to make the taxing journeys to and from the rehab center, possibly decreasing the emotional and physical toll on survivors.
COVID-19 has redefined healthcare and created a new normal for the medical system, especially for stroke victims. It has essentially reinvented the way HMOs, doctors, and patients all interact. We hope to see a hybrid model put in place in the future, where the patient receives the face-to-face interaction they need but is able to receive care remotely to reduce health risks and improve their overall recovery experience.
Whether you’re a recent stroke survivor, or struggling with long-term side effects, or are close to a survivor, it’s important to educate yourself on the recovery process and learn about all the different options available for rehabilitation and recovery. The American Stroke Association is an excellent source for identifying helpful resources for maximizing your recovery potential.