1.CAN STROKE PATIENTS  RECOVER FULLY?

Around  10%  -15% of  stroke survivors can recover almost fully and  25%  recover with mild impairments .As nature  of  stroke and  patient’s status  are different  in each case so, extent of recovery is highly variable. .But  comprehensive rehabilitation has been proven to maximize the chances of  complete recovery. Certain factors  influencing  stroke recovery have been  identified . Age   , severity  and mechanism of stroke, area and extent of brain damage , functional and mental status , degree  of disability at  presentation, time between onset of stroke and initiation of rehabilitation and it’s consistency ,presence of coma  , seizures , altered  memory  , judgement ,reasoning, or ‘cognition’ , gross speech deficit,  unawareness  of one side of body or ‘Hemineglect’   , psychological problems recurrence  of stroke ,comorbidities  affect  recovery.

Younger patients  having  mild stroke with out much complications  or gross  physical , cognitive and psychological  problems manged by early optimal  medical  and rehabilitative interventions  have fair chance  of complete recovery. Though , with multi-disciplinary approach , technology assisted and evidence based therapy patients with considerable disabilities  are able to achieve  highest level of functional recovery.

2.HOW LONG DOES STROKE RECOVERY TAKE? IS RECOVERY FROM POST STROKE  PARALYSIS POSSIBLE?

 Time line of   stroke  recovery is variable.  Neuroplasticity , a complex  process  of brain  repair, hightens in first  3 months post stroke. Hence  maximum recovery occurs and rehabilitation remains most effective in 3 months.Then recovery slows  down and maintains a plateau upto  six months. Around 60% of stroke survivors    are able to walk by then. After that recovery continues at slower  pace  for years and beyond. Hence continuation of rehabilitation is crucial  in regaining maximum capacity in long-term. Evidence of recovery even 12 to 18 months after stroke are available.

Loss of power  and voluntary control partially or fully in muscles of affected side is  common after  stroke .Initially muscles become flaccid ,then tone returned and  starts increasing ,so that extremities take a particular resting position or ‘Synergy’.,then tone reduces and normal functions are  restored. But  considerable variation occurs in this classic process . Where some patients recover completely ,others are left with mild to marked weakness .

In recent time along with traditional exercise therapy modern techniques like neur-odevelopmental retraining, motor learning, EMG Biofeedback, Constraint induced movement therapy , virtual reality and robotics have optimised the chance of  recovery  from post stroke paralysis.

3.WHY  DO SOME STROKE SURVIVORS  EXPERIENCE SEIZURES?

Stroke is a leading cause of seizure and epilepsy.Around  11.5% patients with stroke are at risk of developing  late onset seizures in next  5 years.Seizure can occur  early , which peaks with in 24 hours .One third cases of early  seizure present with post stroke epilepsy.It has less chance of recurrence. Early seizure occurs due to lack of  blood and oxygen supply in brain ,it’s toxic and metabolic effects and over excitation of brain tissue. Late onset seizure  peaks  with in 6 to 12 months after  stroke , it  has higher recurrence rate .Higher age and intracerebral  haemorrhage that means ,large  bleeding in brain matter are  most important risk factors for developing  seizure. Large blood vessels occlusion hampering  blood supply in  wide  area of brain, damage of  CORTEX  of brain, compromise of  blood supply in certain brain artery (Middle cerebral arteries)are  associated with post stroke epilepsy. Seizures negatively  affects recovery and rehabilitation outcome. So timely interventions with anti epileptic  medication is required.1