For years, neurologists believed that survivors of stroke had a six-month window to recover. After that, they would be stuck with whatever physical and cognitive limitations they had. That view has changed dramatically. “Because of neuroplasticity—the ability of the brain to form new neural pathways after other pathways have been disrupted—patients can keep regaining function,” says Amy Towfighi, MD, associate professor of neurology at the University of Southern California's Keck School of Medicine.

While patients may not regain all abilities they had before the stroke, they can recover. “The single most important predictor of recovery is the severity of the initial stroke,” says Larry B. Goldstein, MD, FAAN, chair of the neurology department at the University of Kentucky. Time is also crucial: “Clot-busting drugs such as tPA and clot-retrieval procedures can dramatically improve stroke-related deficits, but they need to be used as soon as possible after the onset of symptoms,” Dr. Goldstein emphasizes.

Most stroke survivors experience the most rapid recovery during the first few weeks and plateau after about three months, but “individuals can recover over much longer periods, even if rehabilitation is delayed,” says Dr. Goldstein.

Stroke rehabilitation is “the next frontier in the field,” says Ralph L. Sacco, MD, FAAN, chair of neurology at the Miller School of Medicine at the University of Miami. “We've made amazing progress with acute stroke treatment, so much so that the amount of disability is less, and recovery is better,” he says. “And there is clear evidence that physical rehabilitation and speech and cognitive therapy do make a difference.”

Here's what specialists recommend to maximize progress after a stroke.

Start rehab immediately. A 2017 study in the journal Stroke found that patients who started intensive rehabilitation three days after being admitted to the hospital had the best outcomes. “The frequency and intensity can maximize the benefit,” says Dr. Goldstein. “Patients can rewire networks and trails in the brain with the right kind of rehabilitation and practice,” says A.M. Barrett, MD, FAAN, executive director of the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Healthcare System.

Keep up with physical therapy. “In an ideal world, patients would be able to continue with physical, occupational, and speech therapy so they could reach their full potential,” says Dr. Towfighi. “The key to recovery is practicing tasks over and over.” Insurance typically pays for only a limited number of sessions, but doing physical therapy exercises on your own, several times throughout the day, can make a significant difference.

Try telehealth. “Telemedicine works well to guide therapy during the pandemic,” Dr. Goldstein says. A 2018 study in the Journal of Medical Internet Research found no differences in quality of life and improvement between stroke patients who did rehabilitation through video calls and those who did them in person. “The American Stroke Association can help patients and their families navigate the insurance system and craft a plan that is at least partially covered by insurance, whether outpatient or community-based,” says Dr. Barrett.

Incorporate other types of therapy. Experts also recommend gait and balance training to avoid falls, as well as speech and occupational therapy. “Improvement in speech tends to take longer, but I've seen progress years after the initial stroke,” says Dr. Sacco.

Treat depression. A major roadblock to adjusting to life after stroke is depression. A study in JAMA Psychiatry found that depression in stroke patients was three times as high as in the general population. Brain changes brought on by stroke can contribute to depression, as can going from being completely independent to relying on others. “It's important for people to get support, whether they see a therapist or focus on things they want to strive for in the future,” Dr. Barrett says. Some studies suggest that treating all stroke patients—not just those known to be depressed—with antidepressants may improve functional movement and even paralysis, along with their quality of life. “Whether or not every stroke patient should be given antidepressants, it's clear that those who do have depression will benefit from medication,” says Dr. Barrett.

Take the tougher path. The tendency to avoid doing things that are difficult is counterproductive after a stroke. For example, a patient with limited mobility in one hand who uses only the stronger hand will never strengthen the weaker hand. A rehabilitation technique known as constraint-induced movement therapy is designed to isolate the weaker limb. Patients put their strong limb in a splint and intensively use the weaker limb for many hours a day for several weeks. “It's hard work,” Dr. Barrett says, “but we've seen people progress 20 years after a stroke.”

Embrace technology. “There are a variety of novel approaches that can supplement stroke rehabilitation therapy,” says Dr. Goldstein. One option is robotic therapy, which allows for remote rehabilitative treatments—for instance, harnesses and braces that use artificial intelligence to correct gait, which have been helpful during the pandemic and for patients who can't travel.

Reframe expectations. Although life may change after a stroke, patients can continue with favorite activities but do them in a new way. “It means finding the right therapy, the right equipment, and the right kind of support,” says Dr. Barrett.

Set objectives. Establish small and realistic short-term goals, says Dr. Towfighi, co-author of What You Must Know About Strokes. “When we work with patients, we ask them, ‘What has meaning for you? What would give you a sense of accomplishment?’ Motivation can help drive the recovery.”