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Understanding Massive Stroke: Secondary Effects & Methods for Recovery

therapist working on what to expect after a massive stroke

A massive stroke is a significant medical event that affects the brain. It can be fatal or lead to significant secondary effects such as coma or paralysis. While the prognosis can be grim, there is hope for massive stroke recovery.

This post will explain the potential secondary effects of a massive stroke and steps you can take for rehabilitation. The journey may be long, but with the right approach, many massive stroke survivors can recover.

Use the links below to jump straight to any section:

What Is a Massive Stroke?

A stroke occurs when the supply of blood in the brain is compromised. When blood flow in the brain is interrupted by a clot, it’s called an ischemic stroke. When an artery in the brain bursts, causing uncontrollable bleeding, it’s called a hemorrhagic stroke.

When the brain does not receive enough blood supply, brain tissue damage can occur. After a massive stroke, many areas of the brain can be substantially affected or die. While you cannot revive dead brain cells, the healthy areas of the brain can step in to pick up some slack.

Before we dig into that process, it helps to understand the prognosis for a massive stroke.

Massive Stroke Recovery Prognosis

Medical experts often use the NIH Stroke Scale to determine the severity of a stroke. Patients that score between 21 and 42 (the highest possible score) are considered to have suffered a massive stroke.

When asking your medical team what to expect after a massive stroke, they may use your score to provide a rough prognosis. However, every stroke is different and every recovery will be different. This makes it almost impossible for doctors to provide an accurate prognosis for all patients who suffer a massive stroke.

Therefore, it’s important to follow through with rehabilitation to see what type of recovery is achievable. While one specialist may claim that recovery plateaus after 1-2 years, you might prove that you can see gains up to 5 years later.

In order to get the most from rehabilitation, it helps to understand how the brain recovers from damage like a massive stroke.

How the Brain Recovers After a Stroke

illustration of brain showing neural networks

Massive stroke recovery revolves around healing the brain to restore function in the body. Fortunately, the brain has an innate ability to heal itself after injury, even large injuries like a massive stroke.

Through the phenomenon of neuroplasticity, healthy areas of the brain can take over the functions damaged by stroke. While the recovery process takes time and hard work, there is hope for recovery.

Neuroplasticity occurs based on experience. Whatever you are repeatedly exposed to, or whatever you repeatedly practice, are the skills that your brain becomes more efficient with.

This is why stroke survivors often start rehabilitation before they are even discharged from the hospital. The medical team needs to expose the brain to therapeutic experiences to get the recovery process started as soon as possible.

After discharge from the hospital and inpatient therapy, stroke survivors can maximize recovery from a massive stroke by continuing rehabilitation at home. It often takes years to recover from the effects of a massive stroke, but long-term rehabilitation is the best-known way to recover.

Up next, you’ll discover what side effects commonly occur after a massive stroke. Then, you’ll learn over a dozen rehabilitation methods you can use to keep recovery going.

Potential Secondary Effects of Massive Stroke

The location of the stroke has a substantial impact on the side effects experienced. For example, a left-hemisphere stroke is more likely to lead to language difficulties than a right-hemisphere stroke; because the language center of the brain resides in the left hemisphere.

Talk to your neurologist to understand where your stroke occurred. This will help you better understand what to expect after a massive stroke.

Here are the most common side effects of a massive stroke:

  • Post-stroke paralysis. Loss of motor function is one of the most common stroke side effects. For a mild stroke survivor, the motor loss might manifest as weakness on the affected side (hemiparesis). For a massive stroke survivor, motor loss could mean paralysis on the affected side (hemiplegia).
  • Coma after stroke. Falling into coma after stroke is more common after a massive stroke or brain stem stroke. It’s possible that someone in a coma can still hear you, so talk to your loved one and speak words of encouragement.
  • Severe speech difficulties. Difficulty with speech after a stroke is a condition called aphasia. Sometimes, it makes speech more difficult, and in some cases, massive stroke survivors cannot talk at all. But remember: there is hope for recovery.
  • Difficulty swallowing. A condition called dysphagia can make it difficult for stroke survivors to swallow. They may require a feeding tube while in the hospital until swallowing abilities are regained.
  • Difficulty breathing. Some massive stroke patients cannot breath on their own and require a ventilator. These patients require intensive care in a long-term acute hospital.
  • Cognitive difficulties. Sometimes a stroke can impair a person’s critical thinking or memory skills. Generally speaking, a severe stroke may lead to more severe cognitive difficulties.
  • One sided neglect. A condition called hemineglect can make it hard for a stroke patient to notice things in the environment on their affected side. They may eat only half of their plate because they do not recognize that there’s food on the other half.
  • Sensory loss. If the areas of the brain that contribute to sensory loss are compromised, it can lead to sensory disorders after stroke. A common example is numbness after stroke. It can also include tingling sensations, difficulty feeling hot/cold, and more.
  • Vision problems. Vision is also processed by the brain. If the visual cortex has been damaged, it can cause vision problems like partial blindness.
  • Spasticity and contractures. Spasticity is characterized by muscle stiffness that occurs when a stroke interferes with the signals sent between the brain and body. When spasticity is severe, it can result in contractures where the joints become extremely stiff (as seen with clenched hands after stroke).

This is not a complete list because some massive strokes will differ from others. However, these are the most common side effects reported.

Next, we’ll discuss methods for recovery.

Methods for Massive Stroke Recovery

Stroke rehabilitation focuses on harnessing the brain’s natural ability to heal itself after injury by exposing the brain to therapeutic experiences. The best results occur when rehabilitation is pursued consistently and long-term.

With that said, here are the best rehabilitation methods for massive stroke survivors:

1. Range of motion exercises

physical therapist adjusting arm mobility for massive stroke recovery

After a massive stroke, it’s important to keep the limbs moving and stretch them with ROM exercises. This will help prevent spasticity from worsening and help prevent bedsores.

See more ROM exercises »

2. Physical therapy exercises

If you ask your doctor what to expect after a massive stroke, they will often mention physical therapy. It’s a critical component for recovering movement after a massive stroke.

Your physical therapist will help guide you through therapeutic exercises that will help retrain the brain to control your muscles. After discharge from inpatient therapy, it’s important to continue with PT at home.

See all physical therapy stroke exercises »

3. Passive exercise

If you struggle with paralysis after a massive stroke, then physical therapy exercises might not be accessible on your own yet. Fortunately, you can start with passive exercise. This is the starting point for many patients during massive stroke recovery.

Passive exercise involves moving your body parts without exerting effort. For example, you can move your affected arm with your non-affected arm. Although you aren’t “doing it yourself,” this movement still helps spark neuroplasticity.

Learn more about passive exercise »

4. Electrical stimulation

therapist applying electrical stimulation to massive stroke patient

Massive stroke survivors that struggle with paralysis can greatly benefit from electrical stimulation. When electrical currents are applied to the affected muscles, it supplies the brain with a large amount of stimulation. This helps spark the rewiring process. When electrical stimulation is paired with physical therapy exercises, it’s even more effective.

Learn more about electrical stimulation »

5. Constraint-Induced Movement Therapy

Constraint-induced movement therapy can help when arm paralysis occurs after a massive stroke. It involves restricting the non-affected arm while forcing use of the affected arm. This type of rehabilitation therapy is difficult, which can be frustrating for the patient, but it’s clinically proven to be effective.

Learn more about CIMT »

6. Mirror therapy

what to expect after a stroke with hand paralysis

When you ask your medical team what to expect after a massive stroke, and you suffer from hand paralysis, they will likely suggest participating in mirror therapy.

Mirror therapy can help patients recover hand paralysis by tricking the brain into thinking you’re moving your affected hand. It’s likely that your inpatient rehabilitation center will use this therapy, as it’s growing in popularity due to its effectiveness.

Learn more about mirror therapy »

7. Mental practice

Another great way to spark neuroplasticity is by visualizing your affected limbs moving. In the stroke rehabilitation field, this is referred to as mental practice or motor imagery. Best of all, it’s clinically proven to help improve motor deficits after stroke.

It can be tempting to skip simple rehabilitation techniques like mental practice because of its simplicity. Don’t underestimate it, though. During massive stroke recovery, multiple approaches to rehabilitation can help boost results.

Learn more about mental practice »

8. Botox (for motor improvement)

Massive stroke survivors that struggle with severe spasticity may benefit from botox injections. This drug helps temporarily reduce spasticity. Although the results are temporary, patients can use the improved mobility to practice rehab exercises. That will address the root cause of the spasticity, leading to long-term results.

Learn more about botox »

9. Electroacupuncture

acupuncturist applying needles to stroke patient

Electroacupuncture is a treatment that combines electrical stimulation with acupuncture. When combined with physical therapy, it has been found to help improve spasticity in patients during massive stroke recovery.

Alternative treatments are making their way into the stroke rehabilitation field. Don’t be surprised if you ask your therapist what to expect after a massive stroke and they mention some form of electrical stimulation.

Learn more about acupuncture for stroke recovery »

10. Speech therapy

speech language pathologist work with massive stroke patient

If you have some ability to speak, but you need help improving your speech and cognitive abilities, then speech therapy can help. Working with the experts (Speech-Language Pathologists) can also help you regain the ability to swallow, too.

There can be a great need for speech therapy during massive stroke recovery. Many patients will receive help from an SLP for several months after stroke, and then need to continue with therapy at home to continue rehabilitation. Apps like the CT Speech & Cognitive Therapy App can help with this.

Learn more about speech therapy »

11. Singing therapy

If a stroke patient cannot talk at all, they might be able to sing their words. That’s because singing is controlled by the right hemisphere while talking is a left hemispheric function. Singing therapy takes hard work, but it provides hope for getting your voice back.

Learn more about singing therapy »

12. Sensory reeducation

If you struggle with changes in sensation after massive stroke, like numbness or tingling, then sensory reeducation exercises can help. They retrain the brain how to process sensory input, which may help improve sensory issues like numbness.

Learn more about sensory reeducation »

13. Vision restoration therapy

Vision restoration therapy can help improve vision problems in some stroke survivors. These programs utilize eye exercises to help retrain the brain how to process visual input.

Learn more about vision restoration therapy »

Understanding Massive Stroke

A massive stroke is a significant medical event that can alter major abilities, such as movement and communication. Although the side effects can be severe, the brain is capable of recovering from the damage through therapy.

Patients who survive a massive stroke should participate in rigorous rehabilitation programs to recover as much movement as possible. Other therapies recommended by the medical team, such as speech therapy, should also be pursued.

The road to recovery will look different for each massive stroke survivor. Patients can find hope in neuroplasticity: the brain’s innate ability to rewire itself and bounce back from injury.

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Monica & Jerry’s review of FitMi home therapy

What are these “WOO HOOs” about?

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In Jerry’s photo below, you can see him with the FitMi pucks below his feet for one of the leg exercises:

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