Prognosis

The physical rehabilitation after stroke varies, obviously as to what damage is being done and how the person is in themselves. Going to the rehab gym - you might be on a bench and they see if you can sit, if you can hold your body up, sit properly. You need your core stability to be quite strong to sit. If you can't sit, you're not going to be able to stand. So those are the things that they have to go through. If you are in a position where you are able to walk, then you would be standing to see how long you could stand, and then if the physio felt that you could go further, then that would be their call. It's entirely down to the therapist as to how they approach that. There are people that are never going to be able to walk due to the severity of their stroke.

I never knew how complicated walking was until I was in that position, where I was helping the physio, and it breaks down so much. So it's not an easy task.  You have to take it a day at a time and the physio, being the expert, would look and see what that person can do. Occupational therapists usually deal with upper limb, and with the upper limb, it could be that they do make sure that you can open and close your hand, or have a range of movement in your arm-  it might be that you haven't. There is a thing called subluxation, which is where the ball and socket joint is stretched and that's extremely painful. So you have to be very, very careful how you treat that shoulder, and it has to be done by qualified staff.

Therapy can also be for the upper limb. It could be, and it sounds very strange, but it could be tasks like picking things out of rice. Have you got the grip, have you got the sensation of knowing where that thing is? There are lots and lots of things that the occupational therapist does, they can see whether you have got any ‘neglect’. Neglect can be where you don't see to the right-hand side, so somebody could be talking to you from there and you wouldn't know that they were there. For example, somebody with a right or left-handed neglect can have a dinner placed in front of them, and they will eat half the dinner but not realise that the other half is there.

They can do tests to with drawing a clock. They draw half a clock but they don't do the full clock because they just haven't got that vision, and it's quite strange to see. There are a lot of problems that people have that are not visual. For example, people bumping into doors, and you think, "Why are they bumping into a door?". It’s because they don't see the left or the right-hand side, so that doesn't exist, that just does not exist. It is so complicated, which is why the occupational therapist and the physiotherapists are trained to be able to gradually find out what the symptoms are and how they can overcome it. It's about discovering what your abilities are and how the stroke has affected you. Anybody who says, "Oh, you will have to go make a cup of tea today," the reasons behind it is because then they can find out so much about the patient and what difficulties they are experiencing.

The first three months after a stroke is a big time for recovery. You're never going get everything back, but that is when quite a lot of the recovery is made. Recovery never stops, it never, ever stops. You are continually recovering from the time you've had your stroke, to whenever. Your recovery is down to you to move forward. It's about a determination. Not everybody is going to get back what they want because that is just not going happen. And my experience is, nobody gets 100% back after a stroke. There is always a deficit somewhere. The deficit can depend on where the injury is in the brain, how bad the stroke was.

There is never a concrete answer to anything as regards to recovery, because I've seen people after two or three years, and they have improved. It may not be a big improvement, but they have improved. But then you get people that are not going to improve because of the way they are. They don't want to put the work in or for whatever reason. So recovery is really individual, but it never stops. I don't think it ever stops. It takes longer, but people do improve.

When you've had your stroke, obviously there's an element of risk that you could have another one. That is never taken away. If you are in hospital, they have looked at the causes of the first stroke, they have medicated you and told you all the things that you need to follow. If you can try and adhere to that advice, then it will reduce your risk. It will never take it away. Just because somebody has put you on medication that doesn't mean you are never going to have a stroke again. That sounds very harsh, but unfortunately, it's true. And I've worked with people that have had two or three strokes. That does not mean to say that everybody's going to do that, because the majority of people, once they have had the examination and the assessment as to what caused the stroke and they are on the proper medication, that really greatly reduces the risk. But there is always going to be a risk. I think it would be wrong for anyone to say, "No, you're never going to have another stroke," because we don't know.