What percentage of stroke patients make a full recovery?

In an ideal world, stroke prevention would be the goal.  As every day we are hearing stories of our NHS in crisis, we don’t really want to be in a position where we need urgent treatment. No one, after all, sets out to be a stroke patient. We should all take individual steps to understand how to reduce our personal risk and recognise stroke symptoms. Do we know our blood pressure, get regular exercise and pay attention to our diet and lifestyle? This is certainly better than becoming a stroke survivor and facing the challenge of making a recovery.

Stroke can be a devastating and life-altering condition that affects a significant number of individuals each year. It can cause permanent damage to the brain, leading to long-term health consequences for patients, their families, and caregivers. As healthcare professionals, it's important for us to understand the recovery rate for stroke patients so that we can educate patients and their families on the outcomes they may expect. In this blog, we'll explore what percentage of stroke patients make a full recovery, what factors affect recovery, and what healthcare professionals can do to help patients achieve the best possible outcomes.

Spontaneous recovery?

Stroke recovery is complex and can vary substantially from person to person. The extent of recovery depends on the severity of the stroke and the location of the brain where the stroke occurred. According to the American Stroke Association, around 10% of people who have a stroke will have a “complete recovery” within the first 30 days. So the natural question that arises is what about the remaining 90%?

Studies suggest that less than 20% of stroke survivors will recover completely even after a prolonged recovery. Many others may have some permanent disability but this is not necessarily a “natural law”.  Many people continue to recover over a period of time and often with intensive targeted rehabilitation, functional recovery can be possible even years after the event. It is always difficult to be certain about recovery though as there is still much to learn.

What influences stroke recovery?

Although we use the general term “stroke” it manifests in very individual ways.  The percentage of stroke patients who make a full recovery can vary depending on the severity of the stroke, the patient's age and overall health, and the timeliness and effectiveness of therapy.  As with other vascular diseases, stroke prevalence and incidence are strongly age-related as these folks can often have elevated blood pressure and less elastic blood vessels that can compromise blood flow to the brain.  In Europe and the USA, the average age of all stroke patients is presently around 70 to 75  years. The well-known demographic shift to an older population is significant here and we recognise the challenges to society that are ahead as stroke patients become older on average.

A stroke occurs whenever blood flow to the brain is interrupted. For example, a blood clot or a broken blood vessel can stop the blood supply to an area of the brain resulting in damage to brain cells. This can result in significant impairment; for example in speech and language, cognition (such as memory, attention and concentration and other skills), limb movement, muscle tone and sensory skills amonst others. This is why stroke is considered to be a leading cause of serious long-term disability.

In general, the earlier treatment is received, the better the chances of stroke recovery. Recovering from a stroke - stroke rehabilitation can be a lengthy process that requires patience, hard work, and commitment. It may take years to recover.

Recovery can often begin quickly after doctors have stabilised the patient's condition. This of course includes restoring blood flow to the brain and reducing any pressure in the surrounding area. It also includes reducing any risk factors for a second stroke. Because of this, rehabilitation may start during an initial hospital stay. Beginning the recovery process as early as possible can increase the chances of motor recovery and regaining affected brain and body functions.

The stroke timeline

The time after a stroke is often divided into descriptive phases. In the past, the terms acute stroke and chronic stroke may have been used but recently more descriptive terms have emerged. The Stroke Roundtable Consortium proposed to describe the first 24 hours as the hyperacute phase, the first 7 days as the acute phase, the first 3 months as the early sub-acute phase, the months 4–6 as the late sub-acute phase, and from 6 months on as the chronic phase.

The idea behind these more detailed phase descriptions is that recovery-related processes after a stroke are time-dependent.

The body will try to “self-repair” within hours of a stroke. The most significant improvements occur in the first few weeks post-stroke, often reaching a relative plateau after 3 months with less significant recovery taking place subsequently, especially concerning any motor control symptoms. After 6 months, spontaneous recovery is usually at its limit, leading to what seems to be a stable situation but with the person experiencing one or more chronic deficits. Nevertheless, with training or other interventions, improvements of some stroke-induced deficits can be achieved in the chronic phase.

Determinants of stroke recovery

It can be difficult to separate spontaneous or “natural” recovery from that brought about by interventions of various types. A “rule of thumb” in stroke recovery is in general that patients with mild deficits are more likely to make a good recovery than patients with initially more severe deficits.  

The Icone upper limb robot

The Icone upper limb robot embodies the continuity of care concept as it allows high performance robotic therapy for the upper limbs to be deployed in a home environment

The so-called ‘proportional recovery rule’ assumes that patients can on average improve around 70% (+/− 15%) of their lost function within 3–6 months after a stroke with the lost function defined as being the difference between normal function (e.g., a full score in a motor test) and the initial deficit of the patient. The proportional recovery rule is an interesting concept which assumes that recovery of function follows some fundamental neuro-biological process that cannot be substantially influenced by whether a patient receives high- or low-intensity therapy. It has, however, been criticised recently as there seems to be a significant number of patients who do not follow the proportional recovery “rule”. 

A strong driver of neural plasticity and hence brain reorganisation after stroke is training interventions. Classical training-based interventions such as physical, occupational, or language therapy as well as novel approaches like, e.g., mirror therapy, robotic support to impaired limbs or music-based therapy, have all been shown to enhance functional recovery,  to varying degrees. 

Brain stimulation

Given the intimate relationship between motor performance and neural activity, a promising alternative for improving stroke-induced deficits is to directly stimulate and manipulate brain activity. Non-invasive brain stimulation techniques like transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (TDCS) can be used to modulate neural plasticity. Importantly, TMS- or TDCS-induced changes of regional activity have been demonstrated to propagate towards interconnected brain regions and these approaches seem to be useful when aiming at correcting pathological network configurations as encountered after stroke.

Intensive rehabilitation

In general terms, it makes sense to strive to recover as much function as possible (restitution) and then compensate with devices or aids that can support the person to manage any remaining deficits. There is some urgency in acting upon rehabilitation after a stroke. Compensating for deficits too soon may limit the possibilities for restitution. The body adapts and “learns” new patterns which may not be functionally useful and can be hard to break. The recognition of neural plasticity has given hope to many people that recovery is possible after a stroke but the journey is likely to be a difficult one. Not everyone understands that neural plasticity can have negative as well as positive effects.

Do I believe that intensive rehabilitation is essential? No one ever complained they received too much therapy, and unfortunately the state healthcare system may not be able to provide necessary and sufficient rehabilitation to meet the needs of an increasing number of stroke survivors. Private providers now offer intensive therapy interventions which may utilise advanced technology. These interventions may be quite expensive and it should be understood that they may need to be pursued for some time. They may not even be able to guarantee a particular level of result but it is almost certainly possible for anyone to make some improvement with effort.

Those of us involved in providing products and services in this area recognise the need to provide continuity of care. This means that increasingly we should recognise that stroke rehabilitation needs to be offered for the long term and not just be hospital based and time limited - we need to strive to provide effective products and services that can be used by patients at home for example.

Conclusion

Stroke can be a devastating condition that affects a significant number of individuals each year. However, research suggests that approximately 10-20% of stroke patients experience a full recovery. Factors that influence recovery include the severity of the stroke, the patient's age and overall health, and pre-existing conditions. Healthcare professionals play a critical role in helping patients achieve the best possible outcomes, including effective rehabilitation programs, education, and support for a healthy lifestyle. Stroke recovery is not a linear process, and patients may experience setbacks throughout their recovery, so patience and encouragement are critical in the journey to recovery.

Further reading

Grefkes, C., Fink, G.R. Recovery from stroke: current concepts and future perspectives. Neurol. Res. Pract. 2, 17 (2020). https://doi.org/10.1186/s42466-020-00060-6

NHS Page on stroke recovery - https://www.nhs.uk/conditions/stroke/recovery/

Mayo Clinic - What to expect as you recover from a stroke - https://www.mayoclinic.org/diseases-conditions/stroke/in-depth/stroke-rehabilitation/art-20045172