Just as every individual is unique, stroke severity and recovery timelines vary. However, there are similarities in how stroke affects people and recovery stages.
Understanding stroke recovery stages
Stroke recovery is often measured in stages. One method used to evaluate motor skills during stroke recovery is the Brunnström approach. Developed in the 1960s by Signe Brunnström, a Swedish physical therapist, this method provides a general guideline for understanding stroke recovery stages.
Because the Brunnström method relies heavily on observation, scientists are also working to develop new ways to measure stroke recovery. Emerging technologies include wearable sensors that assess gait and mobility.
It is important to note that not all stroke survivors experience every stage outlined in the Brunnström approach. Those with a mild or moderate stroke may start at a higher stage, while others may not progress through all stages.
Brunnström’s seven stages of stroke recovery
Stage 1: Flaccidity
Muscles on the affected side are weak, unable to move and lack tone. They may appear loose or floppy. Because active movement is not possible, a therapist or caregiver should perform passive range-of-motion exercises. These exercises help prevent muscle atrophy, stimulate the brain and encourage neuroplasticity.
Stage 2: Spasticity
Involuntary muscle stiffness begins as the brain starts forming new connections to the muscles. Although uncomfortable, spasticity can be a positive sign that recovery has started. Movement is not coordinated, and limbs may contract or jerk, making exercises difficult.
Stage 3: Increased spasticity
Spasticity becomes more severe and may feel discouraging. Movement, both passive and active, is essential to prevent contractures and continue retraining the brain. Splints, braces and other interventions, including Botox injections, may be helpful.
Stage 4: Decreasing spasticity
With rehabilitation and healing, spasticity begins to lessen and voluntary movement returns. Larger movements in the arms and legs usually return first. Muscles remain weak, and movement may be jerky. Therapy focuses on strengthening, repetition and assisted self-care tasks, such as dressing and bathing.
Stage 5: Complex movement returns
Some mild spasticity remains, but movement becomes more controlled. Gross motor skills continue to improve, and therapy begins retraining fine motor skills such as using a comb or holding a pen.
Stage 6: Spasticity disappears
Movement is more coordinated, and fine motor movement improves. Rehabilitation may include more challenging activities such as cooking, cleaning, swimming or hiking.
Stage 7: Return of normal function
Not every stroke survivor will reach this stage. Those who do can function much as they did before the stroke, including returning to work and leisure activities.
Stroke symptoms based on stroke location
The brain controls how the body moves, feels, thinks and behaves. Stroke symptoms depend on which area of the brain is affected.
- Frontal lobe — may affect personality, reasoning, speech and muscle movement
- Temporal lobe — affects speech, hearing and short-term memory
- Parietal lobe — controls speech, touch and sensation
- Occipital lobe — affects vision
Timeline for stroke recovery
Many stroke survivors recover at least some of the abilities lost to stroke. While some improvement may occur naturally, most stroke survivors need rehabilitation to regain function.
Immediately after stroke
Prompt treatment and early rehabilitation have a huge impact on outcomes. According to the American Stroke Association, rehabilitation should begin as soon as a person is medically stable, sometimes within 24 hours after stroke. Recovery timelines vary and are difficult to predict.
Stroke rehabilitation usually begins in the hospital, though most stroke survivors are discharged within one week. A rehabilitation plan should be in place at discharge and tailored to stroke symptoms, abilities, limitations and other health issues.
Why the first 90 days matter most
The first 90 days after a stroke are critical, as the most significant recovery often occurs during this time. Most improvement happens during the first six months, but progress can continue for months or even years with proper rehabilitation.
How to get the most out of recovery
Effective stroke rehabilitation involves a team that may include physicians, nurses, physical therapists, occupational therapists, speech-language pathologists, psychologists, dietitians, case managers, family members and caregivers.
Inpatient rehabilitation delivers the most intensive stroke therapy. The American Stroke Association recommends inpatient stroke rehabilitation for those who can tolerate at least three hours of therapy a day, five days a week.
Managing challenges and setbacks with stroke recovery
Stroke recovery can feel slow, and it is easy to get discouraged. Understanding potential complications can help keep progress on track.
- Post-stroke depression is common and may be caused by biochemical changes in the brain. Persistent feelings of hopelessness, anxiety, worry or fear that last more than two weeks may require professional help.
- Recurrent stroke affects about one in four stroke survivors. Managing risk factors and following a prevention plan may reduce the risk of an additional stroke.
- Sleep apnea affects more than half of stroke survivors and is linked to recurrent stroke. If you experience signs and symptoms of sleep apnea, including snoring, waking frequently, feeling fatigued, morning headache or memory/concentration problems, a sleep study can help diagnose sleep apnea.
- Pneumonia often occurs in the first week after a stroke. It is frequently caused by swallowing difficulties that lead to aspiration (food or liquid being inhaled into the airways or lungs). A speech-language pathologist can evaluate swallowing and recommend exercise and dietary changes.
- Pressure ulcers can develop due to immobility, potentially leading to serious infections. Regular repositioning, good nutrition and special equipment can help prevent skin breakdown.
Maintaining overall health and well-being
Stroke recovery is an opportunity to build healthier habits that support long-term recovery and reduce the risk of another stroke.
- Be physically active every day
- Stop smoking and limit alcohol
- Laugh often
- Get seven to nine hours of sleep each night
- Maintain a healthy weight
- Reduce processed foods and added sugars
- Manage blood sugar, cholesterol, blood pressure and weight
- Take prescribed medications as directed, including blood thinners to prevent clots