Physiotherapy after stroke

Many stroke survivors face a range of difficulties from movement problems, to not being able to do their everyday activities. These problems can, however, improve with rehabilitation therapy.

How can physiotherapy help after a stroke?

If you have lost movement in part of your body, physiotherapy can help you learn to move so that you can get around and be more independent. For example, it can help you learn to use your arm and hand in everyday activities as much as possible.

Physiotherapists often work with other professionals to help you with the range of problems that stroke can cause. You may be helped by occupational therapists, speech and language therapists, doctors, nurses and social workers. This is called the multidisciplinary team (MDT), or stroke team.

Some physiotherapists specialise in conditions caused by changes in the brain, such as stroke and other neurological conditions such as brain injury. They are known as neurological physiotherapists, or neuro physios.

What does physiotherapy involve?

From 24 hours after a stroke, if it’s safe to do so, you will be encouraged to move around as much as you are able to. Depending on how your stroke has affected you, this may be on the bed, sitting in a chair, walking or continuing with your previous activities.

In the early stages, physiotherapy may focus on preventing complications and helping your recovery. Later, it can help you find ways to enable you to do things that are important to you, such as getting in and out of bed, or doing sports.

You might use equipment or find different movement patterns to complete a task. A physiotherapist can also help you adapt an activity or task so you can do it more independently.

Your therapist will work with you to set goals, or priorities for things you want to be able to do. Larger goals such as walking may be broken down into smaller steps, starting with sitting and standing independently.

This gives you shorter-term targets to work towards with your rehabilitation team. Your goals will depend on how your stroke has affected you as well as your abilities and interests before the stroke. Your treatment is focused on the things that are important to you.

You can find out where local physiotherapy services are located in England via the NHS website.

What is occupational therapy?

Occupational therapy is an important part of your recovery and rehabilitation. It involves relearning everyday activities to enable you to lead a full and independent life. It helps you regain the skills you need for day-to-day activities and other things you want to do.

It may be that you need to regain skills for daily tasks such as getting out of bed, washing yourself or making a hot drink.

Perhaps you would like to continue with a hobby that you had before your stroke, like painting or playing a musical instrument. If you worked before your stroke, occupational therapy can help you return to employment.

Occupational therapists (OTs) are qualified, registered, healthcare professionals. They often work with other members of the stroke team to help with the full range of problems that stroke can cause.

The team may include physiotherapists, speech and language therapists, doctors, nurses and social workers, plus other specialists. This is often called the multidisciplinary stroke team.

You may see occupational therapists at different times following your stroke, depending on your needs. Occupational therapy may happen in hospital, or you might be offered it when your needs change at a later stage in your recovery.

Therapists can be based in different settings and locations. These include hospitals, community rehabilitation services, social services departments, wheelchair services, housing and mental health teams.

What does occupational therapy involve?

First, your occupational therapist (OT) will assess your strengths and abilities, and any difficulties you have following your stroke.

This is likely to cover how you can manage daily activities, your ability to move, and any problems with sensation, vision and perception. OTs may assess your thinking skills and explore how this affects how you do things.

An important part of occupational therapy in this early stage is understanding your routines, hobbies and home environment. During an assessment you will usually be observed doing everyday tasks such as washing or dressing, or making a hot drink in the kitchen.

Your therapist may also use questionnaires or assessment packs to learn more about your abilities.

Your OT should work with you to agree a rehabilitation plan tailored to your individual needs. Together, you will set your goals for success.

They can also help you deal with any setbacks that arise. The therapist can help you measure your success, for example by breaking down each activity into stages that you can achieve one at a time.

Your therapist or other team members, such as assistants, will also teach you, your family or carers how to look after your health. They should also make sure any help that is needed to do this is in place.

Moving again

The more therapy you have and the more active you are after a stroke, the better. Guidelines recommend that you should receive at least 45 minutes of each type of therapy you need per day for as long as you need it.

How can my family or carer help?

In most cases, if you wish, it’s possible for members of your family, friends or carers to attend rehabilitation sessions with you.

If you need help with daily tasks such as getting in and out of bed or using the stairs, your physiotherapist can teach your family or carer how to help, and how to use any equipment you need.

When will my therapy end?

The fastest recovery takes place in the first weeks and months after a stroke. But we know that improvements can and do carry on for years.

You can help your recovery by practising exercises, staying active and using the skills you have re-learned. Improvements can be due in part to you becoming fitter and stronger as time passes, but they are also due to the brain rewiring itself. See ‘Neuroplasticity’ above.

When you start physiotherapy, you set goals and plan exercises with the therapist. Therapy should finish when you reach your goals, such as walking or improving your balance.

It can also end if the therapist assesses that further therapy wouldn’t benefit you, because the therapy isn’t helping you make progress. You should have therapy for as long as you need it, but this is not always the case in all areas of the UK.

At any time, if new problems arise or old ones return, you can ask your GP to refer you to a physiotherapist. In some areas they offer a ‘direct referral’ system, where you can contact the team or department directly to make an appointment without having to go through your doctor.

If you find it hard to get the support you need, call our Helpline for advice and information.

You can find out more about physiotherapy and occupational therapy in the linked PDFs below.

Information guides

Where to get help and information from the Stroke Association

Call us on 0303 3033 100,from a textphone 1800 0303 3033 100
Our Helpline offers information and support for anyone affected by stroke, including family, friends and carers.

Read our information
Call the Helpline to ask for printed copies of our guides.

Other sources of help and information

Chartered Society of Physiotherapy
Phone: 020 7306 6666
Has a register of therapists who are members of the Association of Chartered Physiotherapists interested in Neurology (ACPIN).

The Health and Care Professions Council
Phone: 0845 300 4472 or 020 7582 0866
Holds a register of health, psychological and social work professionals, including occupational therapists, who meet the national standards of training and practice.

Living made easy – mobility and walking
Living made easy mobility and walking section provides information on a range of different mobility equipment available for people with disabilities, including the details of the list of suppliers who sell them.

Royal College of Occupational Therapists
Tel: 020 3141 4600
The professional body for all occupational therapy staff in the UK. They have a number of specialist sections covering areas like stroke and private practice. They offer a list of private therapists and advice on choosing a therapist.

Physio First
Phone: 01640 684 960
Has an online database of qualified physiotherapists, which can be searched by location and specialism.

Age UK
Phone: 0800 169 6565
Provides information on health and wellbeing and has a booklet with exercises to help build strength and balance.

Ataxia UK
Phone: 0845 644 0606
Provides a range of services, including advocacy and local groups, to support people with ataxia.

The British Association of Prosthetists and Orthotists
Phone: 0845 166 8490
The professional body for Prosthetists and Orthotists in the UK.

Phone: 0845 123 2372
Supports children and young people with hemiplegia, and their families.

A.A Mobility Scotland
Phone: 01236 761 596
A leading supplier of a range of mobility products in Scotland. Offers free home visits.

Able2Wear Ltd
Phone: 0141 775 3738
Provider of specialist clothing for people with disabilities including clothes with Velcro fastenings.

Anything Left-Handed
Phone: 01737 888 269
Offers specialist products, including equipment for the kitchen and garden for people who are left-handed.

Independent Living Company
Phone: 020 8931 6000
Has a range of mobility and daily living aids. Some equipment can be hired for short periods or as a trial to help you decide if it is suitable for you before buying it.

OT Stores
Phone: 0845 260 7061
Supplies a wide range of daily living, occupational therapy and physiotherapy aids. Has a specialist showroom and advice centre in Malvern and appointments can be made with an occupational therapist there.

Ottobock UK
Phone: 01784 744 900
Ottobock is a world-leading manufacturer and supplier of orthotic supports - such as for drop foot - and other stroke rehab products, as well as wheelchairs and prosthetics that all promote mobility and personal independence.

Apps from MyTherappy

App recommendations from the NHS for survivors and carers ranging from communication, eating and drinking, healthy lifestyle, vision and more.

Disclaimer: The Stroke Association provides the details of other organisations and apps for information only. Inclusion on My Stroke Guide does not constitute a recommendation or endorsement.