Supporting Recovery and Preventing Recurrence After Stroke

For patients navigating life after a stroke, leaving the hospital marks the beginning of another critical phase of care. Successful post-stroke management requires a coordinated approach focused on two primary goals: helping patients regain as much function as possible and addressing the factors that could lead to another stroke.

AHN Department of Neurology’s comprehensive stroke network connects patients with the expertise and resources they need throughout their recovery. The department’s addition of a vascular neurologist specializing in stroke recovery and secondary prevention further strengthens a multidisciplinary approach that brings together neurology, rehabilitation, cardiology, primary care, and other specialties based on each patient’s needs.

Maximize function during the critical recovery period

Recovery varies by patient, but the first three months after stroke offer an important opportunity to rebuild strength and skills through rehabilitation. Meaningful improvement can continue for up to six months, with many patients establishing a new functional baseline by approximately nine months.

“The goal is to help patients get as close to 100% of their previous function as possible,” said Narendra Kala, MD, a fellowship-trained vascular neurologist who specializes in stroke care at AHN. “Repetition through rehabilitation is really important because that’s how the brain forms new neural connections and helps patients regain function.”

Depending on their deficits, patients may benefit from rehabilitation services including:

• Physical therapy to improve mobility, strength, balance, and coordination
• Occupational therapy to regain daily living skills
• Speech-language therapy to address communication, swallowing, or cognitive challenges

Referring providers can help patients make the most of this critical recovery period by ensuring recommended therapies continue after discharge and reassessing therapy needs as recovery progresses.

Reduce recurrent stroke risk through long-term care

Preventing another stroke starts with understanding why the initial event occurred. At AHN, vascular neurologists like Dr. Kala work to identify the likely stroke mechanism and develop a secondary prevention plan that may include medications, management of risk factors such as high blood pressure, and follow-up with specialists as needed.

As patients transition from the hospital, responsibility for their long-term care increasingly shifts back to their primary care providers (PCPs). To guide longer-term care, PCPs should:

• Review the discharge summary for the identified or suspected stroke mechanism and corresponding recommendations.
• Understand why a medication was prescribed and how long it should continue, instead of continuing the regimen indefinitely.
• Reinforce modifiable risk-factor management, including regular exercise, a nutritious diet, smoking cessation, and appropriate evaluation and treatment of sleep apnea.

Long-term care should also account for factors that can affect a patient’s ability to follow their plan — including cognitive or emotional changes, health literacy, social isolation, medication affordability, and access to mental health or social work resources. Recognizing these challenges can help providers connect patients with the resources they need to maintain their progress.

“Providers should ask not only whether patients are taking their medications and attending appointments, but whether they understand their plan and have the resources and support to follow it,” said Dr. Kala.

Know when to reconnect with vascular neurology

Post-stroke recovery should generally move forward. Any regression in a patient's existing neurological deficits or the appearance of new symptoms warrants further evaluation by the vascular neurologist who most recently evaluated the patient.

Dr. Kala emphasizes that is better to investigate why something is happening, rather than have a patient wait several months while a problem progresses. Reasons to reconnect with the stroke team sooner than a patient's next scheduled follow-up include:

• Worsening deficits
• New deficits or neurological complaints
• Any abnormal movements including but not limited to seizure like activity

By recognizing these changes and working together across specialties, providers can help patients adapt to their new baseline, preserve the progress they have made, and reduce their risk of another stroke.

How to refer

Depending on the urgency of the concern, providers can connect with the stroke team through the following channels so they can help determine the appropriate next step:

• Nonurgent: Send a secure chat through Epic or call the office at 412-359-8850.
• Urgent: Contact Dr. Kala directly at 878-208-2036.
• Emergent or after hours: Reach the on-call stroke physician at 412-359-3131.