Stroke Recovery: A Timeline

Most patients are out of the hospital within a week, after they’ve been stabilized and given treatment to protect them against a subsequent stroke. Some can go straight home, either because they’ve recovered so much that they need no further therapy, or because they can do home health therapy or outpatient therapy.

Patients who can handle at least three hours per day of intense therapy, five times a week, are eligible for inpatient rehabilitation facilities. This is what the American Stroke Association recommends for everyone who qualifies, when possible. At these facilities, which may stand alone or be part of a larger hospital, patients get an individualized rehabilitation plan that might include physical therapy, occupational therapy, speech therapy and psychological support. The average stay is about 15 days, according to the American Academy of Physical Medicine & Rehabilitation.

Some patients are too fragile or unable to participate in that kind of intense therapy and are discharged from the hospital to a long-term acute care hospital or a skilled nursing facility, where they can participate in therapy according to their ability. It’s worth noting that some of these patients do improve enough to handle some therapy and see progress.

Outpatient rehabilitation starts after inpatient rehabilitation ends, or in some cases directly after the hospital stay. Sessions are usually a few times per week. In addition to the kinds of therapies available at an inpatient facility, patients may get vocational rehab, pool therapy, driving evaluations, help with using a wheelchair and the opportunity to use virtual reality or robotic therapy, according to the American Academy of Physical Medicine & Rehabilitation.

Ifejika suggests patients look into day rehab programs in their area, as Nichols did. They are intense programs, five days per week, some with transportation. And if you’re given exercises to do in between appointments, Williams says, it’s important to do that “homework” to maximize your recovery.

Regaining independence

Rehab aims to help people perform activities of daily life. “The most important things are their ability to walk, to speak and to swallow,” Ifejika says.

“Have open discussions with your therapy teams about specific goals you may want to work towards,” Williams advises. If you have a hobby you enjoy and want to continue, make sure your therapy team knows it’s important to you. “It may not always be feasible, but it should at least be discussed,” she says.

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Gains made during rehab are possible because of the brain’s ability to adapt to the losses incurred in the stroke. To some extent that happens because nerve cells can forge new connections, Harvey says. But “the real reason why most people recover is that the brain is very redundant, especially with movement,” he adds. You may use a certain neural pathway, say, to grasp and release objects with your hand, but if that pathway is injured, other pathways are available. At first, they’re weak, but “as you practice performing functional movements, those pathways begin to strengthen,” he says. Other systems, such as language, have fewer backup systems. So function may be harder to regain if those parts of the brain are extensively damaged.

How long will it take for stroke recovery?

“Hard work is your best strategy for maximizing your functional recovery,” Nichols says.

He recovered most of his lost capacity over several years. Some of his progress came eight years after his stroke, when a vagus nerve stimulator implant helped him regain further use of his arm. He is now a peer mentor for stroke survivors at the Shirley Ryan AbilityLab. Nichols tells his fellow survivors to involve their support team — they can be a great source of encouragement — and not to expect instant results.

Doug Nichols heads out for a walk with his dog, Gracie, in August 2023.

Courtesy Douglas Nichols

Be prepared for plateaus and setbacks. “A stroke is one of the most difficult things to experience,” Ifejika says. When frustration sets in and patients lose interest in continuing activities that don’t seem to help, she often has them take a two-week break and then get back to it.

Most progress will happen in the first three to four months. But recovery, albeit at a slower pace, can persist long beyond that. Even if you’re 80 percent recovered, you can continue to work on areas that you need help with, Ifejika says. “Stroke recovery is a marathon, not a sprint,” she says. “I’m a strong advocate for outpatient and home therapy past the year mark.”

Because rehab is so crucial to recovery, Ifejika says it’s important that a survivor — or their family members and support team — advocate early on for all the services and therapies for which they’re eligible. Check your insurance policy to make sure it covers inpatient rehab. An insurer has 72 hours to determine whether an urgent care request such as an inpatient rehab stay is approved or denied. If it’s denied but the care team feels the patient qualifies, file an immediate appeal, she says. Find out, too, whether there’s a cap on outpatient or home health therapy visits. Receiving the appropriate services “really affects the ability to have an optimal, functional recovery.”