Stroke Recovery Plateau: Why Progress Slows Down & How to Keep Going

You may hear a lot of different phrases regarding rehabilitation after a stroke, but what is a stroke recovery plateau? During the early stages of stroke rehabilitation, survivors often make rapid gains in function. After a few months, however, progress may slow or stall, which can lead to discouragement or frustration during the rehabilitation journey. Therapists call this slowing of progress a plateau phase.

While this can be a difficult hurdle during the rehab process, a stroke recovery plateau is a common phase that many survivors experience. Contrary to how this slowing of progress may feel, a plateau after stroke does not mean your recovery has ended. It is possible to push through a stroke recovery plateau and continue working toward your goals.

To help you understand more about a stroke recovery plateau, this article will explain the possible causes of a plateau as well as a general timeline for this slowing of progress. Additionally, we will review tips and tricks to help you overcome a stroke recovery plateau if it occurs.

What Is a Stroke Recovery Plateau?

A stroke recovery plateau is a period of little or no gains in function after a period of rapid progress. These plateaus are frustrating and can make you feel as though you will make no further progress toward your rehabilitation goals.

Most commonly, a stroke recovery plateau occurs around 3-6 months post-stroke. This is roughly the same time that spontaneous recovery slows down, too (more on this soon). During a plateau period, survivors may notice that their speech is not improving as quickly as it once was or that their walking seems to stop progressing. Additionally, survivors may even notice regression of post-stroke symptoms.

In the past, it was commonly believed that recovery ended once a survivor hit their first plateau after stroke. As a result, stroke rehab programs would discourage therapy after six months, citing that improvements in function would no longer be made.   

Today we know this is not true as recent research has shown that plateaus are not permanent. Stroke recovery can continue much later after a plateau, as demonstrated by studies investigating rehab interventions in chronic cases of stroke. For example, a recently published report described one man who finally recovered movement in his hand 23 years after his stroke.

Therefore, if you experience a plateau after your stroke, do not give up. Survivors can experience improvement after a stroke recovery plateau, even later than 6 months post-stroke. To help you understand why a stall in progress can occur, we will review the causes of a stroke recovery plateau in the next section.

Causes of Plateaus After Stroke

Before you can learn how to move forward from a stroke recovery plateau, it helps to understand what causes this slowing of progress to begin with. To answer this question, let’s review neuroplasticity; the brain’s natural repair mechanism.

After a stroke, the brain enters a heightened state of plasticity as it heals from injury. This means that it becomes easier for the brain to reorganize itself and recover lost function. When an area of the brain is affected by stroke, neuroplasticity can help rewire functions lost in that area of the brain to other healthy areas.

Heightened plasticity is responsible for most of the spontaneous recovery that occurs after a stroke. It also plays a role in the functional recovery that takes place with consistent rehabilitation post-stroke. Unfortunately, this heightened state of plasticity cannot last forever will and eventually slow.

When neuroplasticity in the brain slows, physical progress will also slow down. This decreased plasticity and slowing of progress is what contributes to a stroke recovery plateau. However, even though neuroplasticity is at a lower level, it is still present. This means you can still make progress, but it may take more work and time.

How to Get Past Stroke Recovery Plateaus

High repetition of task-specific exercise engages the brain’s neuroplasticity, even during a stroke recovery plateau. Therefore, the best way to push through a plateau is to continue with an intentional and consistent therapy regimen. It is important to work closely with your therapy team to develop a plan that addresses your specific secondary effects after stroke and helps you reach your unique goals.

There is a wide variety of exercises for stroke recovery available, but the most important factor in a good recovery program is consistency. However, this can be hard to maintain when it feels like you are not making progress. To help with this, the following are a few ways to boost your motivation and push through the plateau:

1. Add Variety to Your Regimen

Creating a daily routine is a valuable piece of the stroke recovery process. However, a stroke recovery plateau can make your routine feel as if it is no longer as effective as it should be.

While it is important to continue with your daily therapy regimen, changing up your routine can help break up the monotony and increase your motivation level. Some examples of how to add variety to your therapy regimen during a stroke recovery plateau include:

• Trying different exercises. It is important to find exercises that are engaging and fun to help you reach your goals after stroke. For example, try adding in some new balance exercises or tai chi to your home exercise program. Or, if it is safe for you, take your exercise routine outside for a change of scenery. Your physical or occupational therapist can also be a great resource for finding new exercises.
• Finding a hobby. Pick a new skill you want to learn, such as gardening, painting, or learning a new game, and substitute that for an activity you are feeling burnt out on. Using your mental and physical skills for fun hobbies or projects after stroke can help you improve in ways you might not expect. For example, learning a new board game can improve your fine motor function and sharpen your cognitive skills. 
• Setting a new goal. Use the acronym SMART to set new goals for stroke recovery. The goal should be Specific, Measurable, Achievable, Relevant, and Time-bound. For example, maybe you will want to increase the amount of time you can stand unsupported from 30 seconds to one minute. Setting new goals can help you break out of a stroke recovery plateau by showing that you are still progressing, even if this progress is slower than it used to be.

These simple changes can add the variety your brain craves during rehabilitation and give you a boost of motivation during a stroke recovery plateau. Talk with your family, friends, and therapy team to come up with more ideas to add variety to your daily routine.

2. Seek Accountability

Another good way to push through a stroke recovery plateau is to find an accountability partner. This could be your physical therapist, a family member, or a close friend. A stroke can cause major changes to daily life and the recovery process is a long journey for most survivors. Finding someone to help you stay motivated as you navigate life after stroke can make a huge difference in your recovery.

For instance, if you experience memory difficulties after stroke, your accountability partner could check in to remind you to do your exercises every day. Or perhaps a friend would like to join you for your exercises or take you to a new fitness class. Having someone to support you and encourage you to exercise can help you overcome this plateau.

3. Try Interactive Home Therapy Equipment

Interactive home therapy devices such as FitMi can be a great addition to your rehabilitation routine and can help you push through a stroke recovery plateau. FitMi combines elements of gaming with therapist-approved stroke recovery exercises, motivating you to perform the high repetition of exercise needed to see improvement in function.

This helps turn therapy into an immersive experience and can prevent boredom during exercise sessions. As a result, survivors can accomplish hundreds of repetitions per half-hour session, which helps to maximize neuroplasticity and push through a recovery plateau after stroke.

Overcoming the Stroke Recovery Plateau

While a stroke recovery plateau is a common aspect of the recovery journey, this can be frustrating for survivors as they see a slowing of functional improvement. However, we know that this stall in progress is likely temporary and that survivors can continue to regain function even decades after their stroke.

Overcoming a recovery plateau is difficult, but not impossible. Discovering new hobbies, finding an accountability partner, and adding variety into your exercise routine are all great ways to help you boost your progress. Most importantly, staying consistent with your stroke recovery exercises is the best way to ensure that you continue progressing toward your goals.