Can you explain a stroke? After brain injury, usually due to interrupted blood supply, there follows a loss of information about 'how to'. It might be a loss of how to move, how to balance, or how to speak, even how to recognise things or faces.

How does a stroke affect me? Uniquely! Each stroke affects each individual person uniquely, depending upon what information processing is affected, and that individual person’s response to the loss.

Can you help recovery? Yes! Just having someone willing to listen and able to recognise the difficulties you are experiencing, someone who can identify your situation is likely to help recovery. The way in which you respond to the stroke may help or hinder your recovery: what you do determines how you recover! Having a guide to the recovery territory can be invaluable.

How long after a stroke can you help? For as long as you are breathing! The recovery process can get into a rut, and ruts can take some getting out of. Sometimes people who have had a stroke reach a ‘plateau’ in treatment. Either way, change and the help to change continues to be possible.

What will it cost? It will cost time and energy on your part, and on that of the therapist, and it may be time and energy that more than repays the initial expenditure.

How do I avoid having a stroke? It may not be possible to avoid having a stroke if the risk factors are there, and at the same time it may be possible to gain some insight into possible risk factors and so take action to reduce them.

What treatment might work for stroke? Within hours of having a stroke there exists a window in which some medicines are highly effective. In order to benefit from these you will need immediate specialist medical treatment. Not all general hospitals offer this specialist treatment yet. After the initial window of pharmacological opportunity the treatment of choice will be therapeutic care tailored to your specific needs. Such care will seek to identify your potential for ever widening patterns of activity, to keep the window for that potential open, and actively realise that potential through carefully graded exposure. To the extent that recovery patterns are defined by nonreciprocal strategies, for example spasticity, the treatment will seek to create more choice, ultimately with a view to recovering reciprocal strategies.

What other therapies might help? It is not inconceivable that all other therapies might help. There is much evidence to suggest that the nature of the client-therapist relationship is important in being able to predict a positive outcome. There is evidence to suggest that the client’s ability to feel what is happening in their body as a bodily felt sense is a predictive factor for positive outcome. Any therapeutic intervention that leaves you feeling more human is going to translate into a release of holding strategies, any therapy that leaves your body feeling more your own is providing some of the missing information that characterises stroke. Specific expertise i.e. specific to stroke is likely to be of especial value where it coincides with specific loss. For example occupational therapists working with stroke are often particularly expert in difficulties to do with sequencing and recognition. Speech and language therapists specialising in stroke are often particularly knowledgeable about and skilled in treating difficulties with eating and swallowing. Neurophysiotherapists are particularly skilled in facilitating more efficient and effective postural control.

How do I choose a therapist? Within the NHS you will probably be allocated to an appropriate therapist. Probably the most important factor in choosing a therapist is the sense that the therapist is on your side, that you sense an alliance between you. This is the basis for trust and confidence in the treatment process, and such confidence is critical to a therapeutic outcome, in my view. Establish through asking and discussion that the therapist has the expertise and experience that you need, and if you don’t know what you need ask about that.