• In the same hospital where you were initially treated for your stroke
• In a special rehabilitation hospital or facility
• By visiting a rehabilitation hospital or facility or a private clinic (i.e., as an out-patient)
• From a rehabilitation specialist who may come to where you are living

• Because every stroke is different there is no single or main treatment. Each person and each stroke requires a different approach.
• If a person is medically stable they will be able to start rehabilitation within 24 hours after a stroke (the sooner the better). Some people will need more rest and medical treatment before they begin specific treatment such as exercises.
• Each person will progress at a different rate, and faster at some times than others.

• Designed in consultation with the person with a stroke and their family
• Adjusted over time to meet changing needs
• Aimed at helping the person with stroke to overcome the problems associated with their particular stroke.
• Created so the stroke person is an active participant in their own rehabilitation

• Doctor. One doctor will be your main doctor or attending physician. In hospital, this doctor may be a neurologist (a doctor who specializes in the brain or nervous system), neurosurgeon, internal medicine specialist, a rehabilitation specialist or geriatrician. Once back at home, your own family doctor will be the main doctor with occasional help from these others. Doctors provide supervision and care for medical problems related to the stroke.
• Nurse. Nurses work closely with you, your family, and the healthcare team during the initial stages following a stroke. Until you can do more for yourself, nurses will help you with daily care such as taking medications, bathing, dressing and toileting. They can also help organise community services you may need after you go home.
• Pharmacist. Your pharmacist fills your prescriptions and can answer any questions you might have about your medications.
• Physiotherapist. If you are having difficulty moving around, using an arm or leg, getting your balance or coordinating your movements, you will be helped by a physiotherapist. He or she will teach you special exercises and techniques to improve muscle control, balance, mobility and walking.
• Occupational Therapist. An occupational therapist can help you relearn to perform daily tasks on your own and learn new practical skills for everyday life. He or she can help you to work towards your personal goals and to make the best use of your physical and mental abilities.
• Speech-Language Therapist or Pathologist. If you have trouble speaking, understanding speech, reading or writing, a speech-language pathologist will work with you. He or she will help you improve your speech or learn other ways to communicate. The speech-language therapist will also help you if you have problems swallowing.
• Psychologist. If you are having problems with thinking or memory skills, or are having emotional issues, a psychologist may help you.
• Social Worker.A social worker can help you and your family deal with feelings of anger, sadness, depression, confusion and anxiety that are common after a stroke. Social workers also help with arranging community services, family finances, work, and discharge plans.
• Recreational Therapist. A recreational therapist can help you plan new hobbies and interests, or learn new or different ways to resume old ones.
• Dietician. The dietician can help you and your caregiver plan healthy meals to help with weight control, cholesterol levels, other dietary needs, or any problems you might have swallowing or eating.

The other key people in your rehabilitation team are you, your caregiver, family and friends. Your active participation is essential. Practicing what you have learnt with the therapists is a very important part of rehabilitation. This can carry on long after the therapists have stopped seeing you. Your caregiver, family or friends can also help you continue your rehabilitation at home and can provide important emotional support.

Even when you have finished your rehabilitation program, health professionals may continue to monitor your progress for some time. Some health professionals may make home visits. Others may arrange for office visits. Rehabilitation services may also be available in the community through hospitals, nursing homes, public health or social service agencies, or support groups. Ask your rehabilitation team about services in your community

Complementary Therapies
Complementary therapies include such things as acupuncture, various types of massage, manipulation or body work, and herbal remedies. There is little or no research to tell us whether complementary therapies are helpful in recovering from stroke. Before using complementary therapies, speak with your doctor or stroke rehabilitation team. Some complementary therapies may not be appropriate or safe for you. For example, some herbal remedies can interact with prescription medications.

• Explaining what is involved in physical rehabilitation
• Designing a programme of exercise to help the particular physical difficulties resulting from the person's stroke and giving ongoing instruction and help with exercises
• Re-evaluating the exercises over time in light of the progress being made
• Preventing physical problems that may occur later because of immobility, too-tight muscles or the over use of the good side
• Deciding whether aids (eg. a walking frame) will be helpful and arranging for these to be provided
• Advising caregivers how to physically help the person (eg. how to lift them safely or get them comfortable when lying or sitting)

Occupational therapy: occupational therapy aims to help the person regain abilities in their day-day tasks and return to social or work roles. This includes:

• Self care (eg. washing, dressing, toileting, feeding)
• Household tasks (eg. cooking, cleaning, looking after children)
• Interests and hobbies (eg. playing a musical instrument, using a computer)
• Overcoming barriers for returning to employment (eg. writing, driving, using specific tools)

Speech language therapy: aims to manage swallowing and /or communication difficulties. This includes:

• Assessing and advising on the management of a swallowing difficulties
• Assessment of altered communication to determine whether it is a language difficulty or confusion
• Finding out the type and extent of any communication problem
• Advising the family/whanau how to communicate in the best way possible for the person
• Preparing and carrying out a programme of therapy to encourage the return of communication
• Recommending the use of alternative methods of communication where appropriate

Having a stroke doesn’t necessarily mean hobbies or leisure activities need to be given up – or that new ones can’t be learned. An occupational therapist or recreational therapist may work with the survivor to help adapt the leisure activities enjoyed before a stroke.

Where to start

• Cards - Card holders can help you handle small objects (visit a games store)
• Reading - Book holders, large-print books and books on tape can make reading fun again
• Photography - Most cameras can be operated with one hand.
• Needlework - Many specialty devices can help you work with needle and thread, or spring clamps can help hold things in place.

Being physically active is good for both mental and physical health. It is a great way to maintain a healthy weight, reduce blood pressure, lower cholesterol levels, manage stress and cut risk of heart disease and stroke. Talk to the health care team before starting or resuming any physical activity. It is a good idea to begin gently and slowly. This allows you to gradually build up your fitness level.

• Bowling, lawn bowling, croquet, horseshoes or shuffleboard. These activities can all be played with one hand.
• Golf. Special equipment is available to make it easier for people with disabilities to enjoy this sport.
• Walking. This is an inexpensive and versatile form of activity. When the weather’s bad, just move walks indoors - many shopping malls are open early.
• Yoga, Pilates or Tai chi. These gentle practices are ideal because they focus on going at your own pace and comfort level. Some clubs even offer classes for people with disabilities.
• Gardening Digging and planting offer a great opportunity to get outdoors and be active.

A stroke can cause a lack of sensation or movement in one or both hands. Fluids may pool in a hand through lack of use, which can cause swelling, pain and skin problems.

What to do

• Support the arm on a lap tray with the hand in front, fingers opened and wrist supported.
• Place foam wedges or arm supports to elevate hand to reduce swelling.
• Use other hand to gently bend and open fingers. But if the hand is extremely contracted tight or spastic, don’t force it open. Gently stroke the back of hand and wrist until fingers start to open.
• Do not squeeze soft balls. This causes the muscles of the hand and fingers to tighten and close

Caring for your feet

A stroke often affects how the survivor walks, which can
lead to problems with the feet.

What to do

• Check feet daily for cracks, blisters, sores, swelling or changes in skin colour.
• Tell doctor or chiropodist if signs of infection appear such as redness, swelling or discharge.
• Always wear socks made of natural fibres (cotton or wool) to help absorb sweat and keep feet cool and dry.
• Make sure shoes fit properly. They should be wide and deep enough but fit snugly at the heel. Shop for shoes at the end of the day, when feet are naturally swollen, and be sure to have both feet measured.
• Ideal shoes for anyone who has had a stroke have low heels, shock absorbing soles, laces or Velcro®, deep rounded toe boxes and leather or canvas uppers.

Some people who have had a stroke need special footwear either for support or to fit braces or orthotics (devices that give extra support and help straighten foot inside shoe). Footwear advice and specialty items can be obtained from chiropodists or stroke rehabilitation specialists.

• Learning and remembering new information: Events that happened before the stroke may be remembered, but learning and remembering new information may prove difficult. For example, someone with this problem might remember how to play a card game they played in the past, but be unable to learn new games.
• Applying information to a new setting. Therapists call this “generalizing” the information. For example, a patient may learn how to move from a wheelchair to a bed while in the hospital, but be unable to do the same task at home.
• Doing something without being reminded or prompted. Therapists call this “initiating actions”.
• Becoming confused or lost in what should be a familiar place or losing track of the time or date.
• Problem solving. This involves memory and planning. If a stroke has affected the memory and ability to make decisions, it may be hard to organize thoughts.
• Attention spans. Sometimes attention spans become limited, which means remembering, using or acting upon many pieces of information may be difficult. Multi-tasking- some people with stroke find it hard to do two things at once, such as walking and talking, or working in the kitchen and listening to the radio. This is because they have to focus a lot on one task, that they cannot then add in another task.

Talk to the doctor or specialist about getting help with the memory problem. There are also some techniques the survivor or caregiver can use to help manage memory problems. These include:

• Ask the person to break the message up into smaller pieces.
• Write down or tape-record the message to refer back to.
• Repeat the information to help remember a long list.
• Be patient. Getting angry or frustrated will only make it harder to remember.
• Concentrate on one thing at a time (removing distractions such as the TV or radio).
• Use memory aids such as appointment books, written notes, lists and schedule cards.
• Break tasks into small steps and finishing each step one at a time.
• Avoid rushing into things. Stop and think before starting a new task.
• Allow family, friends or caregiver to help.

• Maintaining close relationships and intimacy is important. Sexual feelings and desire for sexual intercourse are a normal part of life both before and after a stroke. Our recently produced ‘Intimacy After Stroke’ booklet gives some useful suggestions. To obtain a copy, you can either:
• Download it from this website
• Contact your nearest Stroke Foundation Office

• Expressive — knowing what to say, but can’t get the words out.
• Receptive — might not understand what people are saying

Some stroke survivors may have both forms. Aphasia can also make it difficult to read or write. It can be very frustrating for everyone involved. The severity of the aphasia will vary from person to person. In some people, it may be temporary and improve quickly after a stroke. Other people may have permanent language problems. Speech therapy can help recover use of language, or develop new ways of communicating as well as giving friends and family use new strategies to use too.

• Wernicke’s aphasia: speaking without hesitation using incorrect words and difficult to understand. There may also be difficulty understanding what is being said, reading or writing.
• Broca’s aphasia: In severe cases, only able to get out bursts of a few words. Vocabulary may be limited and the affected person may be difficult to understand.
• Anomic or nominal aphasia: patient understands what other people are saying and may be able to read, but has trouble naming objects or people, or coming up with nouns.
• Global aphasia: This is more severe and there may be total, or near total, loss of language, reading or writing. It may be hard to understand other people or to communicate. This type of aphasia is sometimes seen immediately after a stroke has occurred.

Many people who survive a stroke feel fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. These feelings are a natural response to the psychological trauma of stroke. The effects of brain damage can cause some emotional disturbances and personality changes.

Depression is a sense of hopelessness that disrupts an individual's ability to function. It is very common among stroke survivors. In fact, about half of all stroke survivors become depressed at some point during their recovery. Caregivers struggling with new responsibilities and roles are also at risk of becoming depressed. But remember - depression is not a sign that someone is weak or “not trying”, it is not something people can just snap out of.

If someone has two or more of these symptoms for more than two weeks, a doctor or social worker needs to be contacted. Depression can be treated – and the sooner it is treated, the better the outcome. Post-stroke depression can be treated with antidepressant medications and psychological counseling.

Family members can help by encouraging and facilitating leisure and social activities - as well as emotional and spiritual support