The subacute stroke phase refers to a key post-stroke period where major improvements in function and ability can occur. This phase can also pose health risks.
Stroke is one of the leading causes of death and disability globally. It is a medical emergency that occurs when the brain receives inadequate blood flow and cells become damaged or die.
While some stroke damage is irreversible, many people can regain skills through subacute phase rehabilitation.
This article looks at the subacute stroke phase, why it is important for rehabilitation, and what people can expect during recovery.
When is the subacute phase after a stroke?
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The subacute phase refers to 7 days to 6 months post-stroke.
Doctors divide the subacute phase further:
- Early subacute phase: first 3 months post-stroke
- Late subacute phase: 4–6 months post-stroke
Risks during this phase
Stroke may happen in the brain, but it can pose health risks throughout the body for weeks or months.
A 2022 review explains that, immediately after a stroke, the brain initiates a body-wide state of immune activation and inflammation.
By the time the subacute stroke phase occurs, however, immune activation has switched to a state of immunosuppression. This increases vulnerability to infections, particularly pneumonia and urinary tract infections (UTIs).
Persistent inflammation can also aggravate preexisting conditions, such as cardiovascular disorders, increasing the risk of secondary vascular events, including:
- recurrent stroke
- heart attack
- progression of atherosclerosis
Why is the subacute phase important?
The subacute phase is a pivotal time when the brain begins to reorganize or regain plasticity.
A 2021 study found that the brain is actively reorienting its functions during the subacute phase. Between 60–90 days, it is also primed for developing motor skills.
Monitoring during the subacute phase
During the subacute phase, a rehabilitation team continually monitors a person’s progress and assesses motor function. The team also evaluates how well the person performs everyday tasks.
In a joint statement from 2021, the American Heart Association and American Stroke Association recommended the following tests throughout the subacute phase:
- diagnostic imaging of the carotid artery
- electrocardiogram
- CT scan or MRI of the brain
- blood work, including complete blood count and glucose check
- blood pressure monitoring
Preventing complications
Post-stroke complications can be physical and psychological. Depression is common in the first 3 months after a stroke. It can continue to affect as many as 25%Trusted Source of stroke survivors for up to 2 years.
The following sections describe other common complications and how professionals prevent them.
Venous thromboembolism (VTE)
VTE occurs when a blood clot forms in a vein. It is common when a person has limited movement for long periods.
Doctors use low dose anticoagulants to prevent VTE, though some care facilities may also use compression devices on the legs where clots regularly form.
Pressure sores
Pressure sores, or bedsores, develop when prolonged pressure from bed rest damages the skin and creates an ulcer.
Regularly changing positions may reduce the risk of bedsores. If that is not possible, special foam mattresses and sheepskin mattress covers may disperse pressure and provide relief.
Infection
Managing infection is challenging during the subacute stroke phase.
A review from 2018 concluded that long-term antibiotic use offers minimal benefits for preventing infection.
Instead, current preventive measures involve managing factors contributing to pneumonia, such as difficulty swallowing, which can increase the chances of aspirating food or liquid into the lungs.
Delirium
Delirium is a type of cognitive impairment. It is a state of confusion that involves a lack of situational awareness. Up to 25% of people experience delirium after a stroke.
Common delirium prevention methods include:
- early access to functional therapies, such as physical therapy
- eliminating disturbing background noises
- playing soft, soothing music
- using pleasant fragrances
- providing calendars, clocks, and a view of daylight to keep a sense of time
- using corrective lenses and hearing aids
- offering delirium-recognition education
Restorative treatments
A stroke can be debilitating. Recovery often requires a multidisciplinary approach involving the following therapies:
Nutritional therapy
Around 80% of strokes are preventable. Diet is key in managing preventable risk factors, such as high blood pressure, diabetes, and overweight and obesity.
Nutritional therapy can guide goals such as weight management and reducing sodium intake.
Physical therapy
Physical therapy is part of post-stroke rehabilitation during the subacute stroke phase. A physical therapist works to restore and maintain functions necessary for everyday life through targeted exercises and movements.
Common goals include:
- sitting
- standing
- walking
- lying down
- switching between movements
Speech and language therapy
“Aphasia” is the term used to describe difficulty communicating. It is a language disorder that can affect up to 30% of people post-stroke.
It is possible to regain most communication skills through speech and language therapy. However, people who have experienced the most severe strokes are the least likely to see improvement.
Outlook
The effects of a stroke vary, as does the path to recovery.
While functional and neurological recovery typically occurs within 3–6 months during the subacute phase, it may take years to regain most abilities.
Sometimes brain damage is irreversible. As many as 50% of stroke survivors experience chronic disability post-stroke.
Summary
The subacute stroke phase occurs 7 days to 6 months post-stroke. It is an important time for the brain to restructure its functions, adjusting to the damage from the stroke.
The subacute phase is a prime time for rehabilitation. However, people are also vulnerable due to suppressed immune function and chronic inflammation.
Regular medical tests and preventive treatments can help limit post-stroke complications. Under a multidisciplinary therapy program, it is possible to regain motor skills, communication, and everyday life function.
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