by Damon .M
(Long beach, ca)

Question: Hello, my mom is 73 years old and this is her second stroke. Her first stroke was in 2011. The doctor called it a speech stroke. h]Her mobility was not affected but her focus, cognition, memory, thinking and comprehension were affected. This 2015 stroke first affected her right leg only. She had minor weakness for the first week and no right arm problem at first, but after the first week in the hospital her right arm got really weak. After her blood pressure was stable she was transferred to the rehab center. When she was there, her balance was slightly off but she sat up on her own for about 30 mins. She needed about 50% assistance standing and walking. She would have done better but her focus was not there when it came to rehab instruction or commands. Also, she became apathetic and slightly depressed and didn't want to participate willfully. So the insurance dropped her down from acute rehab to SNF. When she was transferred to SNF, her progress went down for the first week she was there, and I got scared. I thought it was another stroke but I couldn't tell if was. The week after she started to progress again but slower than she was at the acute rehab center. It has been one month and her balance is improving, her standing is 30%, she has good days and bad. Her left arm and leg is really strong. Doctors have told me she will walk again since she had a minor stroke, but give it 3 to 9 months. Right now I can't see that. Is this normal for stroke patients to do good for two weeks and don't do that good the next two weeks?

Answer: It is not unusual to have fluctuations in rehab performance after stroke. Many factors can contribute to this including fatigue, lack of sleep, dehydration, becoming accustom to a new environment, brain changes and healing, effects of medicine, etc. Also, when an individual changes from one facility to another, the new staff have to get to know the patient. They may be more cautious and not be aware of the patient's capabilities so it may seem that the patient has declined, but in reality it could just be the new caregivers doing less complicated tasks until they know how well the patient can balance and transfer. Give it time, your mother should continue to improve, and there will be day to day fluctuations in her performance. If you noticeable a considerable change such as new paralysis or a significant change in mental status, bring it to the attention of the doctor as this could be a new stroke or other medical problem.

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