The Good News about Longer-Term
Progress after a Stroke

There's a common belief that most improvement happens within 6 months of a stroke, and that further progress becomes significantly less possible after 6 months. However, while much of the improvement does happen within the initial period, our experience with our patients provides the good news that significant improvements can occur after the first 6 months and, occasionally, several years post-stroke. For example, one patient came to us more than six months after his stroke, unable to walk and having been told that he would never be able to walk. After 2 years of intensive work with a heads up! physiotherapist and a personal trainer together with an enormous effort, he has learnt to walk again.		Longer-Term Treatment of Strokes     Click below to listen to Anna Hamer, the Clinical Director of heads up!, talk about longer-term treatment of strokes. (If you don't have broadband, it may take some time to load.)

Even patients who are able to make less progress - for example, who get more movement in their arm or who learn to walk up and down steps - benefit by gaining greater independence and being able to take part in more activities.

Where the belief comes from

There are two main reasons for the belief about the 6 month deadline.

Partly it's rooted in out-of-date theories about how the brain works.

And partly it's come about because many doctors and other health professionals who deal with strokes don't often see the patients who've made longer-term progress.

This is because the NHS does not have the resources to be able to provide long-term treatment for stroke patients, and so treatment tends to be very much focused on the initial period after a stroke.

However, it's a very unhelpful belief because it puts a lot of pressure on patients in hospital who are struggling to come to terms with having had a stroke but who can already hear the clock ticking away.

It also discourages people from reaching their recovery potential because they think that further treatment will bring no benefit.

Progress after a stroke doesn't come easily and always requires hard work and commitment, so it's important not to give false hope.

However we believe that false despair can be just as destructive.

Who we treat

We treat all people who have been affected by a stroke, including:

• those who haven't required in-patient treatment but who have still experienced some reduction in their movement abilities

• those who have just come out of hospital and who want to carry on the rehabilitation they started there

• those who have been getting some out-patient rehabilitation but now want to increase the frequency of treatment

• those who had a stroke many years ago and who need help with problems that are reducing their quality of life.

The treatment benefits you can expect

Our aim is to help our patients lead as full and as satisfying lives as possible.

When we first see patients, we ask them what they want to achieve. Some people want to walk or drive again, some people want to be able to eat or dress independently while others want relief from stiffness and muscle pain.

If the goal seems realistic, that's what we'll work on helping the patient to achieve. Where someone has over-ambitious goals, we'll help them to choose goals they are more likely to reach.

Of course, a patient's progress is dependent on many factors, apart from the amount and quality of rehabilitation treatment, such as:

• the severity of the stroke

• the amount of time that has passed since the stroke happened

• the patient's determination to improve, and their willingness and ability to do home exercises

• the support of their spouse and/or family members.

It's also important to realise that a stroke is a potentially deteriorating condition.

If the stroke has been severe and a person doesn't have continuing treatment, then they may well get stiffer and their movement repertoire is likely to decrease. Elderly people who have had a stroke may also become less mobile as a function of their increasing age.

Advice and support

Our health services often struggle to help patients with long-term conditions like a stroke effectively - which means that people are mostly left on their own without having anyone to ask about day-to-day questions that are troubling them.

One benefit of coming to see a neurological physiotherapist is that you have access to a qualified professional, who always has time to answer your questions, and to provide reassurance and guidance.

Recovering from a stroke can be a long and challenging journey.

The role of a neurological physiotherapist is not just to treat you but also to provide support and encouragement when you are feeling disheartened - and to help keep you focused on your long-term goals.

For a long time, scientists used to be believe that the brain was a fixed structure and that it couldn't change much over time.

This was why there was a belief that recovery could only happen during the period immediately after a stroke.

However, the amazing developments in neuroscience over the past few years have shown that the brain is a much more fluid and flexible structure that we previously believed.

The brain's neuroplasticity means both that previously unused circuits (synapses in neuroscientific terminology) can be brought into use and that new connections can be formed within the brain.

This explains how the brain can re-organise itself to recover at least some of the movement abilities that are lost after a stroke.

However, this re-organisation doesn't happen by magic.

Neurological physiotherapy provides specifically targeted stimulation of the brain through moving and activating limbs and muscles. This directed movement stimulates the brain to re-organise itself in the most efficient and functional way.

What is neuro-physiotherapy treatment like?

If you've ever been to a musculo-skeletal physiotherapist, you'll be surprised at how different a neuro-physiotherapy session is.

Our approach is very much hands on because the physiotherapist has to help the patient's body do things that it has lost the ability to do on its own - and so help re-educate the brain about how to achieve movement.

This involves the physiotherapist activating muscles, and re-aligning muscles and joints by physically moving the patient's body.

It can be hard work both for the patient and the physiotherapist but, by re-educating the brain and the body through actual movement, progress in rehabilitation can be achieved.

How often is treatment needed?

The amount of treatment needed is dependent on the severity of the stroke, the goals of the patient and how motivated they are.

At the end of the assessment, the physiotherapist will make a recommendation about the frequency and length of treatment needed.

Very occasionally a patient won't be able to benefit from physiotherapy, in which case the physiotherapist will advise them of this as soon as it becomes apparent.

Out-patient clinics

The practice operates on an out-patient basis in the South East - we have clinics outside Dorking in Surrey (which is close to the M25) and in Kingston, Roehampton and Sevenoaks.

However some people do regularly travel a considerable distance to come to heads up! when they can't find a neurological physiotherapist with relevant expertise in their area - for example, we have had patients from Bournemouth, Gloucester, Nottingham and Oxford.

Read more

To find out more, you can explore the following pages:

• patient stories - find out more about patients who have been treated by heads up!
• the Bobath concept - we base all our treatment on the Bobath approach
• a typical treatment session - find out what goes on in a typical treatment session at heads up!
• new patient assessment - every new heads up! patient is given a detailed assessment to find out what the most effective approach to treatment will be.

Your next step

If you would like to discuss how we may be able to help you or one of your family members, please contact Sally Watt, our Practice Manager, on (01306) 888171.

If you have any detailed questions about treatment, we can arrange for you to have a chat with one of our physiotherapists.

Unfortunately, we are unable to give specific advice to anyone about their condition without first assessing them, as everyone has different clinical needs and goals.