What can still change in the months and years after a stroke?
Many people hear that “most recovery happens in the first months” after a stroke. This is partly true: the brain’s capacity to reorganise (neuroplasticity) is usually greatest early on. But it does not mean that nothing can change later.
What research shows about the later phase
Studies of people in the chronic phase, months or years after a stroke, show that some functions can still change with targeted, intensive practice:
- Arm and hand: in a programme of intensive upper-limb NeuroRehabilitation (90 hours over three weeks) for people a median of 18 months after stroke, median scores of arm impairment and activity were higher six months after the programme than at admission [1].
- Speech and language: in a randomised trial, three weeks of intensive speech and language therapy improved verbal communication in people aged 70 or younger with chronic aphasia after stroke [2].
- Overall care: the American Heart Association/American Stroke Association guideline describes comprehensive NeuroRehabilitation with adequate resources, dose and duration as an essential part of stroke care [3].
What this means in practice
Change in the later phase is usually slower and depends on the specific problem, its severity, general health, and how much focused practice is possible. Areas that are often reassessed include walking and balance, arm and hand use, spasticity and pain, speech and swallowing, attention and memory, mood, fatigue and independence in daily activities.
A useful first step is a detailed assessment that sets realistic, measurable goals. The programme may combine classical physiotherapy and NeuroRehabilitation with technology-supported methods such as robotic physiotherapy, and is reviewed at intervals.
Frequently asked questions
Is it too late to start NeuroRehabilitation years after a stroke? Not necessarily. Research shows that some functions can still change in the chronic phase with intensive, targeted therapy, but each situation is different and needs an individual assessment.
Will improvements last? In the programme described above, scores were measured again six months after treatment [1]. Maintaining gains usually requires continued practice at home.
See also: Stroke guide · Walking after stroke
Please note: NeuroRehabilitation results vary from person to person. What is possible for an individual depends on their condition, and any plan requires an individual medical assessment.
Assessment and contact
This page is general health information and does not replace an in-person examination. In an emergency, call your local emergency number.
Sources
- Ward NS, et al. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square programme. J Neurol Neurosurg Psychiatry. 2019. PMID: 30770457
- Breitenstein C, et al. Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting. Lancet. 2017. PMID: 28256356
- Winstein CJ, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016. PMID: 27145936