A stroke causes damage to the body and brain, and recovery is a gradual process that looks different for each individual. Healthcare professionals use stages to measure stroke recovery.

Physical therapist Signe Brunnstrom developed a tool for charting a person’s progress to recovery. It breaks the recovery process into six stages with clear identifying factors.

Stroke recovery is a complicated process that can take months or years. Typically, the most significant improvements occur in the first 3–6 months.

Read on to learn about a person’s outlook after having a stroke and the possible setbacks.

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Physical therapist Signe Brunnstrom developed the Brunnstrom Stages of Stroke Recovery in the 1960s.

The Brunnstrom stages describe the development of the ability to move and the reorganization of the brain after a stroke. This approach allows people who have had a stroke and their doctors to check the progress of their recovery.

The six stages are as follows:

Stage 1: Flaccidity

During the first stage, a person is unable to move their muscles, and they may feel limp and floppy.

Stage 2: Onset of spasticity

A person’s muscles may now tighten involuntarily in response to a stimulus, such as a prod with a finger. However, the person may also have difficulty relaxing their muscles.

Stage 3: Increased spasticity

Some of the person’s muscles begin to tighten. It may be even harder to relax the muscles.

However, a person may now have voluntary control over some of the basic muscle groups to manage limb movement, known as limb synergies.

Stage 4: Decreased spasticity

During this stage, involuntary muscle tightening decreases. The brain gets better at sending signals to specific muscles to move them voluntarily.

Stage 5: Increased complex voluntary movements

With involuntary muscle tightening now at a minimum, a person becomes more capable of performing complex muscle movements voluntarily.

Stage 6: Spasticity disappears, and coordination returns

A person’s control of their movements almost fully returns to typical function. Involuntary muscle tightening disappears, and the person’s movements become more coordinated.

Stroke recovery can happen quickly, or it may take some time. It depends on the individual’s unique condition and circumstances.

A person who has had a stroke usually experiences the most significant improvements in their condition within the first 3–6 months. However, the authors of a 2019 study in the Journal of Neurophysiology found that people could see improvements even beyond 12 months.

On this basis, they recommend the revision of clinical guidelines for stroke rehabilitation.

Factors that can affect a person’s recovery include:

  • the part of the brain the stroke affected
  • how much of the brain the stroke affected
  • the person’s motivation
  • the level of support a person has
  • the quantity and quality of their rehabilitation
  • the person’s health before the stroke

Various factors can affect the success of a person’s rehabilitation from a stroke. Complications that may slow this progress include:

  • swelling of the brain
  • pneumonia due to difficulty moving or swallowing
  • a urinary tract infection due to having a catheter fitted following the loss of bladder control
  • abnormal electrical activity in the brain causing seizures
  • clinical depression
  • bed sores
  • shortening of arm or leg muscles due to a reduced ability to move the limbs
  • shoulder pain due to the corresponding arm pulling on the shoulder because of weakness or paralysis
  • blood clots that form in the leg veins due to immobility from the stroke, known as deep vein thrombosis

A person who has had a stroke is also at increased risk of having another one. According to the Centers for Disease Control and Prevention (CDC), a person who has had a stroke has a 25% chance of having another stroke within 5 years.

Some people also have what is known as a mini-stroke. This is called a transient ischemic attack (TIA), and it is a temporary disruption of the blood flow to a part of the brain.

A person who has had a TIA may have as much as a 17% chance of having a stroke within 90 days. Their risk is highest during the first week.

The brain is an amazing organ that can reorganize its cells, molecules, and systems to help it recover from a stroke. This part of a person’s rehabilitation is known as “spontaneous recovery.”

Spontaneous recovery will vary from person to person, but it is not usually enough to return to pre-stroke wellness. However, in combination with available stroke rehabilitation therapies, spontaneous recovery is an important factor in restoring the function of injured but surviving brain tissue.

Although full recovery from a stroke is possible, some people develop long-term disabilities. The type of disability depends on which part of the brain the stroke affected.

There are five main types of disability following a stroke:

  • Problems controlling movement: Paralysis or weakness, usually on one side of the body, can cause problems with swallowing, posture, walking, and balance. Doctors may refer to one-sided paralysis as hemiplegia and one-sided weakness as hemiparesis.
  • Sensory problems: A person may lose the ability to feel things such as touch, pain, and temperature. People may also lose bladder or bowel control and experience chronic pain due to being unable to move a joint properly.
  • Problems with language: People may have difficulty speaking, writing, or understanding.
  • Thinking and memory problems: The possible symptoms include a shortened attention span, short-term memory deficits, and the loss of the ability to plan, learn new tasks, or perform complex mental activities.
  • Emotional disturbances: People may experience fear, anxiety, frustration, anger, sadness, or grief due to the loss of physical and mental function. Alongside the physical effects of brain injury, this can lead to clinical depression and personality changes.

The CDC says that if a person arrives at the emergency room within 3 hours of their first stroke symptom, they often have less disability after the stroke than people who did not receive care until later. For this reason, it is essential to seek prompt medical attention.

In 1966, physical therapist Signe Brunnstrom developed the Brunnstrom Stages of Stroke Recovery. This approach helps people who have had a stroke and their doctors chart the likely progression to recovery and decide on the best treatment.

Potential setbacks to recovery include pneumonia, clinical depression, and the shortening of muscles due to immobility. Full recovery is possible, but some people develop long-term disabilities. Getting treatment within a few hours significantly increases the chance of a positive outlook.