To know up to what point can a person recover after a stroke or a cerebrovascular accident, is one of the first questions that demand an answer.

Unfortunately, it is a question that even the professionals have some difficulty answering.

I will try to answer it although it is not simple. In fact, this is one of the articles that has given me more problems.

In this article, I will also try to answer the other two closely connected questions to “up to what point can you recover”, which are:

– How long after the stroke, can he recover?

– Does it make sense to think about rehabilitation after “X” years?

These are the questions that I frequently have to answer in the daily emails that I receive.

Up to what point can you recover after a stroke?

As you may know, in the hours after a CVA, sometimes you are not even sure that the unfortunate patient, can even survive.

Consequently, the professional also prepares the family for the most dramatic outcome, thus the first answer to this question is: he is very grave.

On the successive days after the cerebrovascular accident, and in most positive cases, the clinical situation stabilizes and the family makes the question again, and the professional generally disguises the situation saying that his condition is grave, and that he is lucky because he survived.

Each stroke is a world on its own, and  each situation is exclusively individual, so what I am saying has to be taken intelligently.

Later on, the professional will say that if there is a quick recovery within the first weeks, the situation will be more favorable but if the paralysis persists for a longer time the chances of recovering the autonomous  movement will be minimal.

In these situations, you hear phrases like: “the arm is dead, there is no hope, and the hand is also dead”. For the leg and when walking, on the other hand, the diagnosis is generally more favorable,  but  again on this argument some specifications will have to be done..

Personally I do not agree with my patients when they use the term “dead”. I sadly think, that in these circumstances, the only “dead” thing is the desire to want to change things.

If the recovery post stroke turns out to be very difficult, it is our fault, since we study it every day, and we should find more efficient solutions in order to offer more hope to whom, on one hand has been blessed receiving the miracle of surviving a cerebrovascular accident, and on the other, has been unfortunate receiving it.

When my patients tell me that they have heard people say: “the arm is dead”, I show them this picture that I have on my cell phone. It is Berardo´s picture, one of my patients, that in a well known clinic in Berlin, aside from telling him that his arm was half  “dead”,  they also told him that his life expectation was less than a year and a half.

The hand that is writing my name is the hand that was supposedly dead. Nowadays, three years have passed since the stroke, and he is 81 years old. He always tells me that he wants to go back to Berlin to show his hand to that medic…

Now please pay attention. I am telling you this anecdote about Berardo not to say  that all situations can have this outcome. I am sure that Berardo´s case is special, I have had the pleasure of personally working with him for a long time . Probably his injury was positively milder and there are a lot of other factors that must be put on the scale.

I write about Berardo, because he was also told that his arm was dead, that he should have stayed on his wheelchair, but now he does some things with his hand and he walks, although (I am not completely satisfied with his walking), but he keeps getting better and working with a lot of enthusiasm.

Up to what point can he recover?

Each situation should be considered separately, and there are some evaluations that must be done:

– Each stroke injures the recipient´s brain in a different manner.
– Each person who suffers a stroke is different.

Therefore, the professional faced with a patient´s reports, is not always able to offer a coherent prevision. Right now, I have two patients, one with a cerebral injury the size of a  pinhead, just a few millimeters, while the other one has a vast injury that takes almost half the brain.

He is recovering quicker than the patient with the larger injury. Therefore, to make a sound comment is really difficult.

What I often tell my patients, especially the ones whom  I am not closely related to, and which synthesizes my thoughts about this topic: “I cannot tell you an exact amount of recovery, nature has provided for you, but what I can really tell you is what to do in order to achieve the most possible”.

Hence, after an injury, we have a potential recovery which nature provides us with, but in order to achieve the most, it is necessary to take the correct decisions.

Thus, it is not a matter of HOW MUCH physiotherapy has to be done, but rather WHICH physiotherapy has to be done in order to gather the amount that nature has provided us.

For example, I will not reach the same recovery, if I do one hour of hippotherapy per day, instead of doing one hour of neurocognitive rehabilitation, (Perfetti method) per day. The results will undoubtedly be different.

I will not reach the same available recovery doing one hour of muscle reinforcement  per day that I could get with one hour of neurocognitive rehabilitation, (Perfetti method).

Consequently, please remember that NOBODY could exactly tell you how much you can recover after a stroke, and on the other hand, what is really necessary in order to reach the potential recovery that each one deserves, VERY FEW will know what to tell you.

Unfortunately, there is not a unique solution that could work for all. We sail in a confused sea. Thus, the solution should be chosen in a conscious manner, and should be based on how reasonable is what they are offering.

All the recovery that you will get, will be the result of the remodeling of your brain. What I mean is, that the stroke has damaged some areas of your brain, and other cognitive functions interwoven. In order to recover them, it is necessary to do exercises to reorganize the altered functions.

Luckily the brain is a plastic organ, in other words, an organ that has the ability of modifying itself based on the experiences that it lives.

If you think about it, when you want to learn how to play the piano, would it be easier if the professor teaches you the keys, the music, the sounds, and the techniques?. or do you think that you can learn by just doing the fingers´ reinforcement exercises?

In this case, we are talking about learning, It should be just the same when we talk about recovery!

How long after the stroke, can he recover?, Does it make sense to think about rehabilitation after a certain number of years?

Certainly, in the first two-three years after the stroke, the improvements will be more evident (always based on what has been done…) while in the successive periods the improvements will be more gradual. But remember Berardo, he is 81 years old, and three years after the stroke, we still enjoy the little improvements which make the quality of life always better.

However, I think the point here is another one. We have said that the brain is plastic, and that it can always learn and improve in a gradual manner, even as time goes by. Thus, and without a doubt, it is always opportune, to try to improve the quality of life, and get closer to that recovery that nature has placed at our disposal.

I hope I have been clear in this so delicate argument.


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