Up to what point can you recover after a Cerebrovascular Accident?  

There is not an expiration date.

In the hospital and / or a clinic, after a cerebral stroke or a CVA, it is common to hear that the recovery will be possible in a maximum time of a year. Others speak about a six months time, others eight months, and the most generous ones go for the possibility of a recovery in a year and a half time after the cerebrovascular accident.

Sometimes I ask myself, where is the expiration date label for the recovery of the hemiplegic patients, that allows them to be so precise as to the length of time for the recovery period.  

The reality is that there is no label, much less an expiration date. The answers about the length of time of the recovery a year after the cerebrovascular accident, has precise reasons of biological characteristics on one hand, and are based on the average recovery experience on the other one  “If the arm movement and a good walk are not recovered in a 6 months’ time after the CVA, it will be very difficult for the patient to recover in the future”

This is the typical phrase that days after the dramatic event of a stroke, the patients and their relatives hear when they ask for information about the future development of the recovery, but it could also be changed for this one: “In six months what we could define as an spontaneous recovery generally appears, that is to say, what could be gotten even without our intervention. What happens after, taking into consideration the past recovery experiences which are based on what traditionally is proposed in the rehabilitation, is that he will not recover much”.

What happens biologically a year after a cerebrovascular accident?

The nature of our body functions in perfect harmony and logic in order to allow a better recovery. In that sense, after a cerebrovascular accident, it coordinates our physiological processes in a truly perfect manner, dividing the first year of consvalence in three stages:

Inhibitory Stage

Stimulating Stage

Normal-Stimulating Stage   

The length of these stages is clearly indicative, and they vary from hemiplegic patient to hemiplegic patient, it also depends on the type of injury and the type of rehabilitation experiences proposed.

Inhibitory Stage

In this first stage, which can be identified in the first weeks after the CVA, we are going to have a much graver condition than the real damage. In fact, it is common  that the hemiplegic patient presents an almost total paralysis in half of his body. This is due to a medullar shock that our organism suffers after the stroke, in other  words our organism puts the majority of our nervous transmissions at rest, in the opposite side of the body where the injury took place. It is like if the body would say: “I have suffered a grave injury, I am limiting all my motor abilities because the affected brain region right now, is not able to handle, the information related to the movement”

In this stage, also called “flaccid”, the patient is in bed with much reduced motor abilities. The situation seems difficult to recover and the patient is still at the hospital or in the first weeks of rehabilitation. For more information about the stages after a stroke or a cerebrovascular accident, I recommend to please read the article about diaschisis.

Stimulating Stage

Later on, the body supplies the adequate biological tools in order to speed up the recovery, opening some neuronal circuits again, which were previously inhibited. This reactivation follows very precise rules, the simplest circuits will be reactivated, first the reflexes and the simplest movements, and it will be done increasing the vitality of the nervous conduction. In this stage, the patient shows the first signs of recovery and you can begin to discern the first movements. The stimulating stage lasts around 6 to 8 months, and it is the most delicate since the recovery is more animated but this speed is also valid in the opposite direction.  

What I mean is that the hemiplegic patient is subdued to a rehabilitation only aimed at the muscles and the walking reinforcement, thus the first awakening of the muscles and the reflexes are structured showing that muscular rigidity called spasticity, which limits the most complex neuronal circuits that produce movements of greater quality.

Here the patient is at the end of the foreseen rehabilitation cycle and he is sent home, but a great percentage will have developed an uncertain way of walking very often helped by a cast or a splint for the foot, and a very confusing and poor movement of the arm and hand due to the spasticity, since the rehabilitation energies have been centered on the autonomy of the step.

In this stage and time the patient finds alternatives, like the  botulinum toxin, the transcranial magnetic stimulation (TMS) and other proposals like robotics, but without achieving any important benefits, and again, simply because the work is not aimed at the real problem which is the brain.

Normal-Stimulating Stage   

This is the stage where the organism after switching on the turbo for the recovery goes back to a normal nervous conduction state. Normally at this time, close to a year has passed and if the rehabilitation has not been correctly applied, you will find the patient walking in an unbalanced manner and with an arm that he can barely move. While a smaller percentage of patients were benefited with a more favored spontaneous recovery, even though the base that they started with, has been similar to the most part of the patients who after a year had a smaller recovery.

What happens after a year?

After a year from the CVA, the body is still prepared to improve, since the recovery that should occur at the brain level, will enjoy the plasticity of our central nervous system which does not have an expiration date. The recovery is a learning process that does not have age or time limits.  It is clear that the sooner you begin to work, the greatest the recovery potential will be, and getting to work after a year has gone by, where pathological effects were structured due to the inadequate rehabilitation, will make everything more difficult. There are patients who started to improve even after 10 years. It is obvious that the recovery available by nature will be different than the one you can get the first days after the cerebrovascular accidents or after the first year, however, you can always improve the situation. The most interesting case is one of a lady whom I saw 22 years after her cerebrovascular accident, and that several months later has substantially improved the quality of her walking, and the ability of moving the arm and the hand, even reducing the spasticity. Unfortunately, after so many years of activities aimed at the muscles which have increased their spasticity, the lady has some deformities in her fingers which will be difficult to treat, but generally speaking, her case shows that after a cerebral hemorrhage, there are no expiration dates.