The rehabilitation process throughout the first several months of stroke recovery can be confusing and often daunting, with peaks and valleys that either encourage or slow the healing process. Varying levels of paralysis are common, and adjusting to ongoing therapy requires a shift in mindset and a complete lifestyle overhaul.
Yet, some of the most significant improvements often occur during these early days, reflecting the initial plasticity of the brain. Therefore, gaining momentum during this neurologically progressive time is key to facing the often-frustrating period ahead—a stage known as a plateau. During this stage, it may feel as if the initial spike in progress was the end of successful rehabilitation and that no further improvement is possible. But for some, the plateauing phase is quite common and even to be expected, and understanding this will help both the patient and caregivers to avoid losing hope, motivation, and persistence during this difficult time.
Are plateaus real?
Over the past two decades, research has reaffirmed the frequency and common intricacies of plateauing in newer stroke patients. In the past, it was more likely for doctors to assume that patients only regained motor function in the first few months after a stroke, and that once the plateau occurred, ongoing exercises and therapy were ineffective.
However, recently published reports now show that patients can regain motor recovery and function up to 23 years after a stroke. Medical professionals are now finding that this complex recovery period often continues to occur for months and even years after a patient has left rehab—and primarily resumes only if patients and caretakers build a recovery planand have access to evidence-based technology to prevent the plateau phase after leaving traditional rehabilitation. Designing a home-exercise program, often by upgrading the previous inpatient therapeutic regimen, is the key to maintaining progress or restarting growth if the plateau phase has begun.
What causes a plateau?
When a stroke occurs, a specific area of the brain suffers an infarction, obstructing the blood supply and killing the functionality of a section of the brain. Though this specific area is not recoverable, the area directly surrounding the infarction-impacted region still holds potential for rehabilitation. In the moments directly after the stroke, however, the area simply does not work.
During the initial healing phase known as the subacute phase, which is usually the first three to six months after the stroke, the most consistent and encouraging signs of progress occur in these regions. This natural healing stage often takes place when patients are being coached along in rehab; but if the plateau stage occurs towards the end of the natural healing phase, it’s common for patients to be sent home for a shift in care.
For this group of patients, this is a difficult transition for several reasons: familiar exercises must be altered and adjusted, the home routine requires greater adaptability, and patients face the discouragement of no longer seeing an uptick in progress, often deterring patients and caretakers from pushing on. Progressing through the discouragement is more easily accomplished when patients and caretakers understand the plateau stage. A solid plan of ongoing, managed care is necessary for continuing to bolster the still-developing parts of the mind.
It’s not the patients that have plateaued, rather treatment options have plateaued them.
It is important to keep in mind that traditional therapy that isn’t evidence-based can be ineffective and can actually cause a plateau. Sometimes a patient’s recovery is only as good as the therapist, and if the therapist isn’t modifying the treatment to the patient’s specific needs and incorporating the latest proven interventions because they haven’t been trained or educated, the patient will most likely plateau. If the therapist is well educated on the latest advances and interventions in stroke recovery the patient has a much better chance of avoiding the plateau phase. So, a plateau phase may not be an absolute, it’s a possibility.
How can you overcome a plateau?
After reassuring research, the medical community confirms that working with a managed care professional with a series of ongoing exercises does promote improvement in a stroke patient’s long-term recovery. When signs of recovery seem to stall altogether, here are a few common practices for jumpstarting at-home care.
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