Sunday, June 15, 2014

Recovery is done in four phases.


[Note the timing of all phases are highly variable based on the individual survivor.] 

1. The hyperacute phase (the first 6 hours ). Time is brain. Get to the hospital, asap. The most important reason is outlined here.

2.  The acute phase (~day 1 to day 7 [note all time periods are highly variable]). This is usually done in the hospital. In terms of recovery your main responsibility is to keep yourself healthy. Therapists will typically focus on helping you do what you can do. This is a time for convalescence.

3. The subacute phase (~day 7 to 3 months). This is usually done with some help from therapists. You will experience the most recovery during this phase. This is the time that rehabilitation should "put the pedal to the metal." This is where the hard work begins. During the subacute phase the brain is "primed" to recover. Make the most of this phase because it is a window of opportunity to reach the highest level of recovery.Squander it and squander the highest level of potential recovery.

4. The chronic phase (~3 months to the end of life). Typically the survivor has very little contact with rehabilitation professionals during the chronic phase. This is the time to implement a "do-it-yourself" plan for recovery. Recovery comes at fits and starts and is much more difficult than during the subacute phase. Still, important gains can be made during this phase. Up to very recently it was thought that no recovery could be made during the chronic phase. We now know that essential progress can be made during the chronic phase.


Tamara said...

In the subacute stage they didn't encourage me to "put the pedal to the metal", but only tried to discourage me by saying I had to accept being disabled. Which horrified me, because my mind made the connection: disabled -> not sexy -> redundant. But now after 5 years, I feel the pitbull inside of me keeps hitting a wall. I'm stuck in fight or flight, which makes my muscles in my affected arm and leg tense. They relax when I take psychological support though. Than I let go of over thinking how I walk. I had a bleed (subarachnoid) and I remember your blog about bleeds averaging better recovery than blocks. And that bleeds often write statements like "and then my spirit kicked in", which is BS according to you, because there is less overall brain damage. I've been waiting for years now for my spirit to kick in, but it still hasn't happened yet.

oc1dean said...

This is where I think a large part of the problem of stroke recovery exists. There is nothing in there that your doctor is doing to help your recovery. It's all either therapists or the survivor. And I know that right now there is nothing in the standard of care for doctors to be doing.

Peter G Levine said...

What can they do? In some ways I think therapy is the final prescription...what do we do now? I dunno...send 'em to therapy.

oc1dean said...

Ah Peter, The 31 things I'm going to demand my doctor does for me after my next stroke. And I don't care if they haven't been clinically tested. I want the kitchen sink thrown at stopping the neuronal cascade of death.
And yes Peter, I'm damned arrogant to think I might know more than my doctor.

Linda said...

Thanks for such a nice clear way of describing the stages.

I have a few ideas about what a physician can do and I think some could do a lot more than they currently do.

If they took more of a wellness approach they would make sure patients got ongoing services. They would work on making sure drug side effects were not adding to problems. They could make sure people at risk get to see a Psychologist/ dietician (etc.) to learn how to improve their health so they are able to make the best use of their physical therapy efforts.

As new issues crop up they could be proactive about ordering a new set of therapy or even just a quick therapy assessment to encourage people to keep moving in the right direction.

An encouraging "Good for you for working hard on your recovery." could go a long way toward keeping people engaged in their rehabilitation.. self designed or otherwise.

Kadima said...

Chronic stroke people can get 'community based' speech therapy such as aphasia groups, participate in research, and pay for PT/OT. I'm still wondering if a physiatrist or neurologist is useful in this stage?

Unknown said...

It's true, it's always possible to get better. I had a stroke 5 years ago, and I never stoppes trying to insist and never give up, because, after all, I'm still alive and I want to have the best I can get!

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