Stages of Stroke Recovery
A stroke can end a life and can change the body and brain in many ways. Knowing the stages of stroke recovery can inform you about the journey towards independence to expect following the event. The level of severity of a stroke varies from brain to brain; so too does the progression of recovery. Individual recovery is related to the amount of damage to the brain, which areas of the brain and body were affected, as well as the overall health of the individual. The progression of rehabilitation includes the steps, or stages, of stroke recovery. Knowing what the stroke recovery stages are allows you to know and expect what is coming.
In this article we will discuss the seven stages of stroke recovery from a stroke, what to expect in each stage, and what an individual and their family should expect from recovery. In addition we will explore some of the MORE frequently asked questions regarding stroke and recovery.
Stage 1: Flaccidity
The first stage of recovery following a stroke is referred to as flaccidity. Most commonly, this stage begins immediately after the stroke has occurred and lasts from hours to weeks. In this stage, the muscles that are affected by the stroke become flaccid (limp) or have little to no movement.
Flaccidity, the lack of muscle tone and active movement, occurs when the signals that the brain sends to the muscles are interrupted, and without the ability to engage the muscle through nerve input, the muscle does not contract. In addition to flaccidity, patients may also be unable to initiate reflexes, as well as have a decrease in the muscle tone.
During the flaccidity stage, medical and rehab professionals will work with their patient to gently introduce range of motion (ROM) exercises to prevent joint stiffness and muscle atrophy. Flaccidity can seem like a step backwards in recovery, but flaccidity is an important step to recovery from a stroke. The rehabilitation and recovery goals during flaccidity are to prevent complications such as the development of pressure sores, joint contractures, and pneumonia.
Stage 2: Spasticity Appears
Spasticity develops within stage 2, which typically occurs within a few weeks after injury. Waking during stage 2 means you have added some increased muscle tone to the flaccidity. At this stage may experience some stiffness or tightness in the muscles, most notably in the arms and legs. Stiffness reduces movement and can impair coordination.
Spasticity happens when the brain’s ability to communicate with the body’s muscles is broken. The connection from brain to muscles becomes over active at times, which can lead to involuntary muscle contractions and involuntary muscle spasms. It will probably not be helpful at times to complete the task you desire, but spasticity is one more part of the recovery continuum because it's a signal that the brain is beginning to stay engaged with the muscles.
Physical therapy and occupational therapy are important during this stage to assist patients in learning how to manage spasticity and prevent it from becoming a chronic lifelong condition. Stretching exercises, deep tissue massage, and medications in some instances will help control spasticity.
Stage 3: Increased Spasticity
As recovery continues, spasticity may increase in Stage 3, which can last anywhere from several weeks to months depending on the severity of the stroke and extent of rehabilitation. In this Stage 3, the patient experiences increased muscle tightness, causing more problems with basic movements such as raising the arm, elongating the leg, or walking.
The increase in spasticity may also lead to the impacted limbs becoming stiff, and, if left unmonitored, the likelihood of joint mobility problems can develop. Patients frequently have concerns over muscle contractions, and stiffened muscles become painful simply because they have been stuck in one position for too long.
While it can be frustrating, this is still the body trying to heal itself, and this experience is normal in the recovery process. The brain will become more efficient in sending signals as the body repairs itself, but this could also be presented as more spasticity before more improvement occurs. The next stage of rehabilitation involves strengthening muscles, improving the range of motion, and retraining the brain to eventually change and control motor function.
Stage 4: Decreased Spasticity
Stage 4 is moving toward a more functional state of recovery, as patients' spasticity is decreasing, and they begin to notice their muscles becoming less stiff and more relaxed. As spasticity learning decreases, movement is easier and coordinating movements is improved.
Stage 4 patients demonstrate some voluntary control over their extremities again. Movements previously difficult, such as bending the arm or walking without a limp, are easier when implemented. Importantly, at this stage, patients are likely still not achieving full control over their affected limbs, and rehabilitation is still important.
Continue to see physical and occupational therapists to improve mobility and fine motor skills. Movement therapies/exercises to increase strength and flexibility are helpful in decreasing muscle tension and enhancing recoveries.
Stage 5: Complex Movement Returns
In Stage 5, the user is developing more sophisticated movement abilities in the body. This stage, very often, marks the return of more complex movement abilities, such as walking, grasping, or using utensils. The patient could also experience the return of the abilities to do activities such as dressing or writing that rely on fine motor movement abilities as well.
Although patients may not yet have full executive function over the limbs or muscles, they begin to perform more complex motions. They could begin to improve coordination and balance and begin to demonstrate independence in participation in activities of daily living.
The return of complex movements is ideally the first indicator that the brain has begun creating new pathways for motor control. However, the return of motor control is gradual and will take time to completely develop. Patients may need reassistance in therapy environments to advance their development and improve their remaining challenges, such as weakness and spasticity.
Stage 6: Spasticity Disappears
During Stage 6, the most intense spasticity is often gone, and patients are experiencing more ease in movement. The individual may have regained most of their muscle function and tone, which allows for better motor control. Stage 6 is often a big milestone for many patients. The muscles are now more relaxed, and movement is smoother. Patients may still have some minor weakness or slight loss of coordination, but the major barriers of spasticity have now minimised their functional limitations. The patient is still rehabilitating but is now fine-tuning motor control and building strength for more complex work.
At Stage 6, patients typically can complete many of their activities of daily living with significantly fewer restrictions. OT, PT, psychotherapy, etc. may be further apart, but in order to maintain and strengthen the gains achieved, it is beneficial for the patient to continue therapy.
Stage 7: Normal Function Returns
Stage 7 is the final stage of stroke recovery, and for many people, it is a return to normal function. Stage 7 consists of the return of movement and coordination, as well as normal muscle tone, but it typically takes place months and even years after the stroke.
For many stroke survivors, they will not reach this stage, but for those who reach Stage 7, they often achieve full or near full recovery. They will now begin to return to most activities of daily living with little or no therapy. There may be minor limitations with fine motor work or other minor tasks still affecting some survivors, but most survivors are able to live independently again at this stage.
The goal of rehabilitation during the previous stroke recovery stages was to reach a stage where the patient is able to function as normally as possible, and stage 7 signifies reaching that goal. For those survivors that reach stage 7, there must be a continued commitment to exercise and maintaining a healthy lifestyle to remain functionally independent.
Stroke Recovery and Geriatric Counselling
Stroke recovery is undoubtedly a difficult process, but it is an incredibly fulfilling one. The seven stages of stroke recovery focus on the progressive return of function, from flaccidity to full return to normal function. The stages provide the healthcare professional with a framework and understanding to realise that the path back to value independence of stroke function may take a very long time, but at each stage of recovery, one individual may become more and more independent.
If you or a loved one is experiencing stroke recovery, the right support, assistance, and degree of professional involvement can make all the difference! Olive Eldercare is a geriatric counselling and stroke recovery role model. If you have questions about stroke recovery, physical therapy options, counselling people if they are experiencing any behavioural or cognitive changes or simply want advice on different stroke recovery stages and/or helping with advice in geriatric patient care, please feel free to not hesitate to contact us directly at Olive Eldercare.
Frequently Asked Questions
The four stages of stroke are the onset (when the stroke occurs), the acute stage (during the first few days of recovery), the subacute stage (the weeks to months post-stroke), and the chronic stage (the stage of recovery over a long period of time).
The 5 levels of stroke ordinarily refer to the severity of the stroke from minor strokes (strokes with little to no damage) to major strokes (and resulting significant disabilities). These levels also correspond with the levels of recovery potential.
Stage 7 is the last stage of stroke recovery, back to normal function. Stage 7 means the person is back controlling motor functions and able to perform daily living activities by oneself.
The four main types of strokes are ischaemic stroke (blockage in vessels), haemorrhagic stroke (bleeding in the brain), transient ischaemic attack (TIA) or temporary blockage, and brain stem stroke (this type of stroke will generate more deficits because it’s in the brain stem).
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