Hemorrhagic Stroke: Five Tips for Rehabilitation

A stroke occurs when the flow of blood to part of the brain is cut off or significantly reduced. Without the oxygen carried by the blood, brain cells can die quickly, which can cause permanent brain damage. Strokes can be major or minor and the consequences can range from complete recovery to fatality.

There are two types of strokes: ischemic and hemorrhagic. An ischemic stroke is caused by lack of blood flow to brain tissue. This can happen when the arteries in the brain narrow due to a condition such as atherosclerosis. A blood clot can form in the narrow arteries and block blood flow. This is called a thrombosis. Another cause of ischemic strokes is an embolism. This occurs when a blood clot forms somewhere in the body and then travels to the brain and blocks blood flow.

About 13 percent of strokes are hemorrhagic. These are strokes that are caused by a rupture in a blood vessel in the brain. The majority of strokes are ischemic.

A hemorrhagic stroke is also called an intracerebral hemorrhage, or an ICH. An ICH occurs when a blood vessel ruptures and blood accumulates in the tissue around the rupture. This puts pressure on the brain and causes a loss of blood to the surrounding areas.

Immediate medical treatment is important for the best odds of recovery. Prevention is also important. If you control your risk factors, you can greatly reduce your odds of having any type of stroke.


A hemorrhagic stroke that occurs inside your brain is also called an intracerebral hemorrhage. Symptoms of an ICH can vary from person to person, but they’re almost always present immediately after the stroke occurs.

Symptoms may include:

  • total or limited loss of consciousness
  • nausea
  • vomiting
  • sudden and severe headache
  • weakness or numbness in the face, leg, or arm on one side of the body
  • seizures
  • dizziness
  • loss of balance
  • problems with speech or swallowing
  • confusion or disorientation

A stroke is a medical emergency. Call emergency medical services or have someone drive you to the hospital if you think you’re having a stroke.

There are two possible causes of a ruptured blood vessel in the brain. The most common cause is an aneurysm. An aneurysm occurs when a section of a blood vessel becomes enlarged from chronic and dangerously high blood pressure or when a blood vessel wall is weak, which is usually congenital. This ballooning leads to thinning of the vessel wall, and ultimately to a rupture.

A rarer cause of an ICH is an arteriovenous malformation (AVM). This occurs when arteries and veins are connected abnormally without capillaries between them. AVMs are congenital. This means they’re present at birth, but they’re not hereditary. It’s unknown exactly why they occur in some people.

Immediate emergency care is crucial for a hemorrhagic stroke. This treatment focuses on controlling the bleeding in your brain and reducing the pressure caused by the bleeding.

Drugs can be used to reduce blood pressure or slow down the bleeding. If you experience a hemorrhagic stroke while on blood thinners, you’re at particular risk for excessive bleeding. Drugs to counteract the effect of the blood thinners are usually given right away during emergency treatment.

Surgical treatment

Once a hemorrhagic stroke is brought under control with emergency care, further treatment measures can be taken. If the rupture is small and produces only a small amount of bleeding and pressure, supportive care may be the only other form of care you need. This may include:

  • IV fluids
  • rest
  • management of other medical problems
  • speech, physical, or occupational therapy

For more serious strokes, surgery may be needed to repair the ruptured blood vessel and stop the bleeding. If the stroke is caused by an AVM, surgery may be used to remove it. This is not always possible, however, and depends on the location of the AVM. Surgery may also be required to relieve the pressure caused by the bleeding and brain swelling.

The duration of recovery and rehabilitation depends on the severity of the stroke and the amount of tissue damage that occurred. Different types of therapy may be involved, depending on your needs. Options include physical therapy, occupational therapy, or speech therapy. The primary goal of therapy is to restore as much function as possible.

Your outlook for recovery depends on the severity of the stroke, the amount of tissue damage, and how soon you were able to get treatment. The recovery period is long for many people, lasting for months or even years. However, most people with small strokes and no additional complications during the hospital stay are able to function well enough to live at home within weeks.

There are certain risk factors for a hemorrhagic stroke. If you can avoid these factors, you reduce your odds of experiencing one. High blood pressure is the most likely cause of an ICH. Keeping your blood pressure under control is the best way to control your risk. Talk to your doctor about how to lower your blood pressure if it’s too high.

Alcohol and drug use are also controllable risk factors. Consider drinking in moderation and avoid any type of drug abuse. Blood thinners help prevent ischemic strokes but can also increase your odds of having an ICH. If you are on blood thinners, be sure to speak to your doctor about the risks.


Neuroplasticity, or the ability of the brain to change, is the key principle that guides how therapists design and deliver rehabilitation

Restoring a person’s health through training and therapy. programs for patients. Typically, the first goal of rehabilitation is to help the patients get back to the way they were before the stroke. Unfortunately this is not always possible, so for some stroke survivors, the goal of therapy is to find a new way of doing things.

Below are five important tips about neuroplasticity that therapists must consider when treating a patient (based on the article by Kleim and Jones).

Tip 1—“Use It or Lose It”

A healthy brain maintains connections that are used frequently and “cleans away” connections that are not used for a period of time. Just like a muscle, if you do not use it enough the cells will weaken. Based on this rule, therapists encourage patients to keep moving the impaired limb to prevent connections in the brain from being lost.

Tip 2—“Use It and Improve It”

When you perform a task and practice it over and over again, the same network of connections in the brain is activated over and over again. Repeated activation of that network causes it to be strengthened and work more efficiently, which ultimately leads to improved performance of the task. For example, when you practice playing an instrument, your performance gets better with practice as the network of connections in your brain that you use to play your instrument is strengthened. Therapists encourage patients to keep practicing their exercises and using their impaired side, as this will lead to positive changes in those specific brain networks.

Tip 3—“Practice Specific”

Rehabilitation exercises should be specific to the task or function that the patient wants to improve. If you want to change the area of the brain that controls the arm, you need to practice doing tasks with the arm. If you want to improve function of the left leg, do exercises with the left leg. If the patient is having problems with holding a fork, then the therapist will give specific exercises that mimic the position of the hand while it is holding a fork.

Tip 4—“Practice Repeatedly”

To enable the brain to change, many repetitions of a task need to be performed. For example, if you were learning how to juggle, would your ability to juggle be better if you practiced three times or if you practiced 30 times? The same is true for therapy after stroke, the more repetitions the better! Therapists encourage patients to practice repeatedly and continue practicing their exercises at home. The more repetitions the patient can practice each day, the quicker the brain will adapt and learn.

Tip 5—“Practice Intensely”

It is also important that when the patient practices, he or she practices intensely. This may be achieved by doing many repetitions or doing tasks that are challenging. Just like training for a long-distance race, you might start with short distances at first, but to get better, you have to push your muscles to work harder and run longer than you did before. This is the same in the brain. To encourage the networks in the brain to change, therapists challenge the patient to work harder and achieve a little more each time.


A stroke occurs when an area of the brain is starved of oxygen, caused by a blockage or a bleed in the brain. The after-effects of a stroke depend on which area of the brain was affected. Neuroplasticity is the process that allows the brain to recover from a stroke. Therapists design rehabilitation programs based on what is known about neuroplasticity, with the goal of returning the patient back to normal. The five tips explained above are essential principles for stroke rehabilitation.


Stroke: ↑ When an area of the brain is damaged from a lack of oxygen. Ischemic stroke is when there is a blockage, whereas hemorrhagic stroke is when there is a bleed in the brain.

Blood Vessel: ↑ Carries blood throughout the body. There are different types of blood vessels, such as arteries, which carry blood full of oxygen to the brain, or veins, which carry blood from the brain to the lungs to be reloaded with oxygen.

Neuron: ↑ Specialized brain cell that computes and communicates information through its many connections. Neurons make connections with other neurons to form networks that control specific functions.

Neuroplasticity: ↑ The ability of the brain to adapt and change.

Rehabilitation: ↑ Restoring a person’s health through training and therapy.


The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


[1] ↑ Blausen.com, S. 2014. Medical gallery of Blausen Medical 2014. WikiJ. Med. 1. doi: 10.15347/wjm/2014.010

[2] ↑ Kleim, J. A., and Jones, T. A. 2008. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J. Speech. Lang. Hear. Res. 51:S225–39. doi: 10.1044/1092-4388(2008/018)

Article information


McCambridge A (2019) Recovery After a Stroke—Five Tips for Rehabilitation. Front. Young Minds. 7:21. doi: 10.3389/frym.2019.00021

Dr Rohit Bhaskar, Physio
Dr Rohit Bhaskar, Physio Dr. Rohit Bhaskar, Physio is Founder of Bhaskar Health and Physiotherapy and is also a consulting physiotherapist. He completed his Graduation in Physiotherapy from Uttar Pradesh University of Medical Sciences. His clinical interests are in Chest Physiotherapy, stroke rehab, parkinson’s and head injury rehab. Bhaskar Health is dedicated to readers, doctors, physiotherapists, nurses, paramedics, pharmacists and other healthcare professionals. Bhaskar Health audience is the reason I feel so passionate about this project, so thanks for reading and sharing Bhaskar Health.

Post a Comment

Listen to this article


* indicates required