Stroke Rehabilitation
Concise, clinical overview of acute treatments, rehabilitation pathways, therapy intensity, common interventions and red flags.
Acute treatment (first hours–days)
Rapid evaluation and acute treatment determine early outcomes. Key acute treatments include:
✦ Ischaemic stroke reperfusion: intravenous thrombolysis (alteplase) for eligible patients within the recommended time window and mechanical thrombectomy for large-vessel occlusion when indicated.
✦ General supportive care: airway, breathing, circulation, blood pressure and glucose management, temperature control, and early aspiration/swallow screening.
✦ Inpatient stroke unit care: organised stroke unit treatment improves survival and independence.
These acute decisions are made by the stroke/ED team and determine the earliest timing for starting formal rehabilitation.
Therapy intensity & scheduling
High-quality guidelines recommend offering frequent, goal-directed therapy to people who can participate:
▫️Offer initially at least 45 minutes of each relevant therapy (PT/OT/SLT) on a minimum of 5 days per week for people who can participate and when functional goals can be achieved.
▫️Where possible, inpatient stroke services should aim for people to receive ~3 hours of rehabilitation per day (combined therapies) when clinically appropriate.
Common rehabilitation treatments
Rehab techniques commonly used (selected examples):
𖥔 Task-specific training: repetitive practice of meaningful tasks (sit-to-stand, reaching, walking).
𖥔 Gait training & balance: treadmill training (with/without body-weight support), overground gait practice, balance exercises.
𖥔 Upper-limb therapy: constraint-induced movement therapy (when eligible), task practice, robotics and electrical stimulation adjuncts.
𖥔 Speech, language & swallowing therapy: early dysphagia screening and tailored SLT for aphasia and dysphagia.
𖥔 Spasticity & tone management: stretching, positioning, botulinum toxin when indicated and guided by specialist clinicians.
𖥔 Cognitive & emotional rehabilitation: attention, memory, executive function training and mood support (psychological therapies/medication as needed).