The Truth about the Plateau in Stroke Recovery

 6 min read

As a stroke survivor, you may have heard someone say, “You’ve reached a plateau,” or “You’re plateauing.” A plateau is high flat land, so what does it have to do with your stroke recovery?

Immediately after you have a stroke is when everything is at the very worst. You may be paralyzed, confused, and unable to speak. Each day you get better as your brain heals, recovering from the shock of the stroke. The progress in the first few weeks or months is often rapid— a steadily upward line on the recovery chart.

But then the slope of that line may start to grow more horizontal. The change doesn’t come as fast or as spontaneously. As that line flattens out, you’ll start to hear about a plateau in your progress. After you’ve reached it, it may feel like you’re stuck—unable to climb any higher. Therapists may start to suggest your therapy will end. Doctors might say this is the best you’ll ever be. And you know what? They might be right— if you believe them.

The Myth of the Plateau in Stroke Recovery

Lots of stroke survivors keep improving, years after their stroke. They say the plateau doesn’t exist – it’s a myth! But doctors are saying it’s real – that recovery slows or stops. So is the plateau in stroke recovery true, or is it a myth?

It’s both. While it’s true that spontaneous recovery in the brain does slow down after a period of time post-stroke, the key word there is spontaneous. That means it happens without you even trying. If you’re riding the wave of recovery, thinking each day is going to be better than the last, there will come a point when that stops being true. When you see that you’re not getting better, you may start to feel sad and hopeless. And then things really stop getting better. In fact, they may start to get worse because you’re depressed.

Related Article: The Under-Recognized Connection between Aphasia and Depression

The myth part of the plateau concept is that there’s nothing you can do about it. The brain can and will continue to change and improve if you work at it. Progress is absolutely possible years after stroke with focused exercises toward specific goals. It’s just not as easy as it was early on. You have to set a target, break it down into steps, and work on it repetitively. You may need to work on just one goal at a time. But you can make progress. You have to maintain your hope and motivation, and you’ll start to see change again.

Plateau in stroke recovery means something different than you might think. Focused effortful progress comes after rapid spontaneous recovery.

Ups and Downs in Stroke Recovery

There are always ups and downs in stroke recovery. Some days your skills may take a dip, or even a dive. If you’re tired, sick, overwhelmed, or stressed, your speech or mobility may suffer. These downturns may last a few hours, a few days, or even a few weeks. But over time, they’ll get better. If they don’t, it’s a good signal to go talk to your doctor or therapist to see if something else may be causing the decline. Usually, you’ll return to your best abilities once you’re rested or relaxed.

Plateau means flat. Recovery is always up and down, but generally up.

There are also exciting upturns, like when a full sentence comes out perfectly, or your finger moves in a way it never has before. This spark of recovery may only last a moment, but it’s good news. It often means your brain is ready for the next step.

With all the daily ups and downs, the important thing to focus on is the overall trend of recovery. What can you do today that you couldn’t do a month ago? How much better do you sound now than six months ago? Keeping a journal, a video diary, or weekly recordings of yourself can really help you to see the progress over time that you may not notice day-to-day.

Tactus Therapy apps make it easy to track your progress. You can send detailed reports after each session, then compare when you’re ready. Try our aphasia apps for free to see how you can keep your stroke recovery going. Not sure where to start? Our App Finder can help!

What to Do When You Reach a Plateau in Stroke Recovery

Since we know that progress can stall out, it’s important to understand how to jump-start recovery again. Here are some things you can try to get things moving again:

Set a new functional goal

Learn to set SMART goals: specific, measurable, achievable, relevant, and time-bound. When you’re working systematically toward something that matters to you, your motivation will stay high.

Use a new evidence-based technique

Research tells us what works and for whom. Ask your therapist about techniques that are proven, or start with our How To guides for evidence-based speech therapy treatments and our Language Therapy app that has been proven to help people make progress, years after stroke.

Sign up for a research study

Get the latest cutting-edge treatments by being part of the research studies that will inform therapists. It may not always work, or you may be part of a control/placebo group, but it feels good to help others and you may just luck out with a great new treatment. Find an aphasia research study here.

Try a new therapist

It may not be you who’s stuck— it may be your therapist. Starting therapy with a new clinician can bring fresh eyes and a different bag of tricks to help you solve your problems.

Join a stroke or aphasia group

Support groups can help in so many ways: friendship, inspiration, and exercises. It helps to know you’re not alone in stroke recovery. If there are none in your area, try an online group, like #2 on this list.

Learn a new hobby or skill

Using your mental and physical abilities in fun activities can reap benefits in other areas of your life. Take up the piano and you may see improvement in buttoning your shirt. Join a bridge group to strengthen your math and attention skills you need to manage your finances.


Get out and help others to add purpose to your life. Babysitting, dog walking, or visiting lonely elders can give you more chances to speak without feeling judged. Community gardens and food banks offer a chance to get out of the house and help.

Take a break

Sometimes taking a break from therapy can let your brain recharge and refocus, while giving you time to do things you enjoy. Having fun is therapeutic too, and it can inspire new functional goals.

Don’t get discouraged

Everyone recovers at different rates. Don’t compare your recovery to others. Hope is the most powerful drug there is, so do everything you can to hold onto it.

Stroke recovery isn’t easy, and it isn’t fast, but you can always make progress. Henry Ford famously said, “Whether you think you can, or think you can’t– you’re right.”

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Megan S. Sutton, MS, CCC-SLP is a speech-language pathologist and co-founder of Tactus Therapy. She is an international speaker, writer, and educator on the use of technology in adult medical speech therapy. Megan believes that technology plays a critical role in improving aphasia outcomes and humanizing clinical services.