Post-stroke - Timely rehab key to regain full mobility
NEW DELHI: Arvind Sagar, 58, who had a history of hypertension and diabetes, suffered an ischemic stroke last July. The stroke affected the right side of his brain, impairing motor and cognitive functions on the left side of his body. Fortunately, his family acted quickly, and he was rushed to the hospital. Doctors performed an emergency thrombectomy within four hours of the stroke’s onset.
The procedure was successful, and imaging confirmed the complete removal of the blood clot. Arvind began showing signs of recovery within 48 hours as he regained partial movement in his left arm and leg, giving his family hope that he would recover fully. After a week in the hospital, he was discharged with a detailed rehabilitation plan that included physical therapy, occupational therapy, and speech therapy.
The doctors also emphasised the importance of lifestyle changes such as a balanced diet, regular exercise, and stress management to support his recovery and reduce the risk of another stroke. However, despite the medical team’s guidance, Arvind and his family underestimated the importance of rehabilitation. They believed the surgery had addressed the primary issue and assumed that time would naturally heal the rest.
With busy schedules and no immediate or visible improvement from the initial therapy sessions, they gradually discontinued his rehabilitation routine. As the months passed, the consequences of this decision became evident. By January, six months after his stroke, Arvind’s condition had deteriorated significantly. His left side grew weaker, and he could no longer walk without assistance.
His muscles became stiff, and he developed contractures that severely limited his range of motion. This stiffness was so severe that it required additional surgical intervention. The physical decline was only part of the story. Emotionally, Arvind struggled with frustration and depression as he became increasingly dependent on his family for daily activities. His social life suffered as well—he withdrew from friends and relatives, ashamed of his inability to function independently.
In desperation, Arvind returned to rehabilitation six months after his initial discharge. But by then, the damage caused by the delay was irreversible. The therapy sessions were challenging, and his progress was slow compared to those who had started their recovery journey immediately after surgery. While he did see some improvement, he could never fully regain the mobility and independence that might have been possible with timely rehabilitation.
Arvind’s story is a poignant reminder of the critical role post-stroke rehabilitation plays in recovery, according to doctors. “Patients always think that medicines are the cure. They are, but rehabilitation plays a critical role,” said Dr Madhukar Bharadwaj, director & HOD of neurology, Aakash Healthcare, Delhi. “Many stroke patients miss out on good stroke rehabilitation, which is extremely essential for stroke recovery, as recovery continues for weeks to months after an acute stroke.
For stroke survivors, recovery is a journey that demands both medical intervention and a steadfast commitment to rehabilitation,” he added. “We talk a lot about preventing a stroke and about early treatment, once somebody has had a stroke, especially if they’re within the four-and-a-half hour treatment window, where we try to maintain the blood supply to the brain. But sometimes this is not possible, or this is unsuccessful, leading to permanent injury to the brain.
To recover from the deficits caused by a stroke, in the form of either weakness, loss of sensation or loss of balance, rehabilitation is one of the important tools,” said Dr UM Sreenivas, consultant, neurologist, MGM Healthcare Hospital, Chennai. According to Bharadwaj, there are five types of disabilities that strokes can cause.
“Paralysis or movement control problems, difficulty in sensing pain, temperature or position disturbances, language difficulties (both spoken and understanding), memory problems, and emotional liability - where a person loses control over their emotions,” he explained. How rehabilitation works Rehabilitation for stroke survivors is a multidisciplinary process aimed at minimising disabilities and enhancing physical, emotional, and social well-being.
It typically begins as soon as the patient’s condition stabilises, often within 24-48 hours after the event. “Stroke rehabilitation works by a concept called neuroplasticity where other unaffected areas of the brain take over the function of the affected areas and hence the person is able to regain the function which was lost lost due the stroke,” said Dr Sreenivas.
According to experts, a lot depends on the cause of the stroke, where it occurred in the brain, how soon it was detected, and the severity – these factors decide how much recovery or rehabilitation will happen and what type of therapy is used. “This can include daily activities such as feeding, toileting, dressing, walking, transferring from the bed to a chair, communication skills, speech, writing, memory, problem-solving, vocational training, and pain management, which is a very important part of post-stroke care,” said Bharadwaj.
Dr Guruprasad Hosurkar, additional director of neurology, Fortis Hospital, Bannerghatta Road, Bengaluru, said post-stroke pain significantly hinders rehabilitation, as patients often do not participate fully in the rehabilitation process. “It is crucial for maximising recovery. Recovery happens most significantly in the first three months after a stroke. After that, recovery slows down. Both active rehabilitation, where the patient puts in their own effort, and passive rehabilitation, provided by the therapist, are done rigorously during the first three months,” he added.
Bharadwaj said typically, good stroke rehab team consists of various doctors and workers including neurologists, rehab nurses, rehab physical therapists, occupational therapists, speech and language therapists, psychologists, and psychiatrists. Role of nutrition and lifestyle A balanced diet and healthy lifestyle are integral to recovery and reducing the risk of recurrent strokes.
“Foods rich in antioxidants, omega-3 fatty acids, and vitamins can support brain health, reduce inflammation, and promote healing. Maintaining proper hydration is equally important. Patients are also encouraged to adopt healthier lifestyles—such as exercising regularly, quitting smoking, and moderating alcohol consumption—to prevent further strokes and improve overall well-being,” said Hosurkar.
Technological advancements “New technologies for stroke rehabilitation, such as robots for motor rehabilitation, brain-computer interfaces for language rehabilitation, non-invasive brain stimulators for motor rehabilitation, neuroprosthetics for deficits that are not recovering (such as foot drop), and virtual reality wearable devices or tablet PCs, show great promise in improving rehabilitation outcomes,” said Bharadwaj.
AIIMS Delhi and IIT Delhi collaborated with SparshMind Innovation to develop ReMind, an advanced device designed to overcome barriers in neuro-rehabilitation. Rubina Khan, a member of the R&D team (ReMind), said the device addresses the needs of individuals affected by stroke, spinal cord injuries, and traumatic brain injuries. “It is a promising tool for home-based rehabilitation.
This innovative system integrates virtual reality (VR) modules to provide engaging and personalised functional therapy. The device monitors patient progress, offering detailed insights to optimise physiotherapy protocols. It also features a grip trainer for strength measurement and training, along with a single-camera system that accurately assesses body movements. Built on well-established treatment protocols, ReMind has demonstrated a proven ability to expedite patient recovery.
Field trials have confirmed its effectiveness in delivering superior rehabilitation, supported by objective biomechanical analyses,” she said. Another new technique recently introduced is the bio-feedback system where the muscle activity is recorded and the patient is trained to activate muscles. “Since they can actually see they are sending signals to the muscles as their thought process is linked to the muscle, this helps them understand what they can do to actually increase muscle strength,” said Dr Sreenivas.
Crucial role of support systems Family members and caregivers form the backbone of a patient’s recovery journey. Experts said their role extends beyond physical assistance to include emotional support, which is critical for maintaining motivation and adherence to therapy schedule. “Support systems provide emotional encouragement, help patients stay motivated, and assist with daily activities, significantly enhancing the rehabilitation process. The emotional and psychological support offered by loved ones can be just as important as physical care.
Encouraging community engagement and social interaction further helps reduce feelings of isolation, fostering a holistic recovery environment,” said Hosurkar. “Without good caregiver support, it will be extremely hard for anyone who had a disabling stroke to have any sort of meaningful recovery.
Many times, patients who do not have good emotional support and encouragement from their family give up on rehabilitation a few months after the stroke. This can lead to the loss of accrued benefits, as well as worsening of the disability that occurred post-stroke,” Dr Sreenivas said.
(With inputs from Sinduja Jane @ Chennai, Rishita Khanna @ Bengaluru)