recovery back toward normal performance or improvement
of function based on compensatory strategies with or
Although interesting technology is being used, it is not
widely adopted because scientific evidence to date does not
show that it offers improvement over standard care.
Robots for walking or improving hand use are mostly
available in research or academic medical centers. “Robots
are very expensive,” Harvey said. On the other hand,
electrical stimulation for retraining arms and legs is more
widely accepted and cheaper.
Video game systems with motion-sensitive controls (like
the Nintendo Wii) and computer programs or games are
sometimes used as training tools to incorporate a survivor’s
weak side, improve balance or challenge them cognitively.
Harvey is working with a research fellow who’s
developing a smartphone app for stroke patients to practice
using their weak upper limb. Speech therapists also use
tablets and smartphones for both language recovery as well
as a device to help survivors communicate with others.
For the first three months after a stroke, the brain is
much like a child’s brain, ready to learn, ready to make new
connections. This ability for our brains to adjust is known as
neuroplasticity and it plays a crucial role in recovery.
“It’s a time of really rapid change in the central nervous
system,” Harvey said. “About three months after the stroke,
neuroplasticity is becoming more normalized, sort of the
AM I GETTING APPROPRIATE CARE?
same neuroplasticity that everybody else has.” At that point,
there’s still plenty of recovery available, but Harvey equates
it to learning to play the guitar from scratch: “If I wanted to
learn to play the guitar, I would have to get a guitar and take
lessons and practice and practice and maybe in a year or
two, I’d be able to play some basic songs on the guitar,” he
said. “That’s a skill that I would have to learn. Survivors can
still improve their function, but it requires lots of practice to
Though survivors can continue to improve their function
for a long time, there is only one opportunity to get the
most out of the heightened neuroplasticity during the early
weeks and months of rehab following a stroke. Knowing
that you’re getting appropriate care that is helping you make
progress toward your goals is important.
There are some signs to watch for to be sure you’re
getting appropriate care. According to Harvey, too much
group therapy is something to be wary of, “Acute inpatient
rehabilitation should mostly focus on one-to-one therapy.”
If they’re focusing only on compensatory strategies and
survivors are spending more time in a wheelchair than on
their feet, that’s an issue.
If caregivers or survivors don’t like what they see
happening, Harvey says they should speak to the physician
in charge because they are ultimately responsible for the
care of the patient. There may be a legitimate reason for the
altered therapy, but families should get an explanation.
“Our goal is to get
survivors ready to be
discharged safely to
their homes. Most of
the time that involves