Understanding Chronic Stroke: What It Means & How to Recover

Generally speaking, “chronic stroke” refers to the period of recovery that takes place at least six months after the initial stroke event. When a patient enters this stage of recovery, their progress may appear slower than it did in the acute stage. However, improvements are still possible, even decades after a stroke.

In this article, you will learn why recovery may slow down in the chronic stages of stroke recovery and how you can encourage your brain to continue its healing process.

Why Chronic Stroke Recovery Seems Slower

The most rapid part of stroke recovery often occurs within the first three months. During this period, stroke survivors are often heavily involved in different therapies (typically at an inpatient rehab center, or at home).

Also during this time, the brain enters a heightened state of neuroplasticity, and a phenomenon known as spontaneous recovery typically occurs.

Spontaneous recovery refers to the brain’s innate ability to repair and salvage the parts of the brain that have been damaged but not destroyed. When this occurs, some functions might naturally return without any intervention.

Spontaneous recovery typically occurs during the acute stages of stroke rehabilitation, which usually lasts around six months. After this point, spontaneous recovery ceases, and patients usually enter their first stroke recovery plateau. It’s important to understand that, although recovery may slow, it will not stop unless the patient stops participating in rehabilitation.

Recent research shows that plateaus are not permanent. Stroke recovery can, in fact, continue during the chronic stages. For examples of this, see our stroke recovery timeline where we show videos of survivors continuing with recovery even past the 10 year mark.

Therefore, if you feel like your gains have slowed or ceased, do not give up. You can still make progress in your recovery, as long as you take the correct steps.

How to Improve During the Chronic Stage of Stroke Recovery

The best way to encourage recovery from stroke, even in the chronic stage, is to engage your brain’s natural neuroplasticity.

Neuroplasticity refers to the brain’s ability to reorganize itself in response to repetitive stimulation. This allows the brain to transfer functions that were once held in damaged parts to new, healthy areas.

To activate neuroplasticity, you must engage in intense, repetitious exercise that targets the skill you wish to improve. For example, to improve your speech, you will need to focus on practicing speech therapy activities several times per day.

In the following sections, we will show you some of the best therapy interventions that can help you activate neuroplasticity during the chronic stages of stroke:

1. Constraint-Induced Movement Therapy

For stroke patients with hemiparesis (muscle weakness on one side of the body), constraint-induced movement therapy is one of the most effective ways to restore arm function.

Constraint-induced movement therapy is a challenging form of rehabilitation where the non-affected side is “constrained” from participating.

This forces use of the affected side of the body. Stroke patients will need at least minimal movement on their affected side in order to participate in this therapy. (If your muscles are completely paralyzed, use the methods for stroke paralysis recovery instead.)

Constraint-induced movement therapy typically involves 3 steps:

1. Restraining the unaffected limb
2. Forcing use of the affected limb
3. Massed practice

Massed practice simply means high repetition and frequent practice. This provides the brain with the stimulation it needs to rewire itself through neuroplasticity and improve motor control.

Studies on constraint-induced movement therapy in chronic stroke patients have shown tremendous results, with patients regaining significant arm function after only 10 weeks of therapy.

2. Mental Practice

Mental practice is a treatment that involves rehearsing a movement mentally. Sometimes, the person will listen to a pre-recorded audio that describes a task in detail. The details can include the exact movements needed to complete the task and how the movements might feel. Mental practice can also be done in a less formal way by having the patient simply think about the task they want to do, including the movements necessary, without the pre-recorded audio.

Mental practice activates neuroplasticity in similar ways that physical practice does. In fact, studies show that combining mental practice with physical practice or passive range-of-motion exercise helps improve mobility in stroke patients.

Therefore, if the effects of a stroke severely limit your mobility, you can still visualize performing the exercises, which initiates the rewiring process.

3. Mirror Box Therapy

This therapy may help you recover from weakened or absent hand movements that can be caused by stroke.

To practice mirror therapy, place a mirror over your affected hand and then perform some hand therapy exercises with your non-paralyzed hand. This activates mirror neurons in the premotor cortex, the part of the brain that controls movement.

Essentially, mirror therapy tricks the brain into thinking it is moving your paralyzed hand, which activates neuroplasticity. Surprisingly, you may notice your affected hand starting to twitch or move in response. If this does not happen at first, it may come with time.

This therapy is only effective if you have one strong side, however. If stroke paralysis affects both sides of your body, the other treatments may be more appropriate.

4. Electrical Stimulation

Electrical stimulation is another way to encourage your brain to rewire itself and improve muscle movement after stroke.

It works by sending an electrical impulse directly to your affected muscles, causing them to contract. This stimulates the brain and activates neuroplasticity.

According to research from the American Heart Association, combining electrical stimulation with physical therapy is more effective for stroke patients than just exercise alone. In addition, attempting to activate your muscles when you feel the electric pulse can increase the benefits.

While you can do e-stim from the comfort of your own home, we recommend trying it under your therapist’s supervision first. They can show you the best areas to place the electrodes and how to safely operate the machine.

5. Home Therapy Devices

Home therapy devices such as FitMi are great ways to motivate you to progress in your stroke recovery.

FitMi combines elements of gaming with stroke rehab techniques. These minigames stimulate the brain and make therapy more engaging. In fact, the average patient accomplishes 23x more reps with FitMi than with traditional therapy. That’s because FitMi is designed to motivate players to beat their high scores and complete more and more exercises.

The more exercises you complete, the more you will activate neuroplasticity, which will help you overcome secondary stroke effects much sooner.

Recovering During the Chronic Stages of Stroke

Stroke can affect many major abilities, such as movement and communication. Although recovery can feel slow at times, the brain is capable of repairing itself even during the chronic stages.

To regain abilities, patients must engage in rigorous therapy. This can allow your brain to rebuild neural pathways and regain function again.