Physiotherapy After Stroke: What Happens During Rehabilitation?

The assessment

The first session is mostly assessment. The physiotherapist looks at:

• strength and control in each limb
• muscle tone and spasticity
• sensation and body awareness
• sitting and standing balance
• transfers, such as bed to chair
• walking, if possible
• arm and hand function
• how the person manages daily tasks
• the home environment, for home visits

They also ask about goals. What does the person most want to do again?

Setting goals

Goals are specific and meaningful: walking to the bathroom independently, getting in and out of a car, using the affected hand to hold a cup. Goals guide which exercises are chosen and how progress is measured.

A typical session

Sessions usually combine several elements:

1. Warm-up and range of motion for stiff joints.
2. Strength and control exercises for the affected side.
3. Balance training, sitting or standing.
4. Functional practice, such as sit to stand, transfers or walking.
5. Arm and hand tasks.
6. Updating home exercises.

High repetition matters. Recovery depends on practising movements many times.

Managing specific problems

Spasticity. Stretching, positioning and specific exercises help manage muscle stiffness.

Shoulder pain. Careful handling and positioning protect the weak shoulder.

Foot drop. Exercises and sometimes an ankle splint help with foot clearance during walking.

Training family members

Physiotherapists teach family members how to help safely, which exercises to practise and how to encourage independence.

How the plan changes over time

A plan written in week two looks quite different by month three. Early on, much of the work is about safety and basics: sitting balance, standing with support, transfers that don't put the carer's back at risk. As control improves, the emphasis moves towards walking distance, stairs, arm function and getting back into the community, such as a walk to the local market or a visit to the temple.

Progress is rarely a straight line. Fatigue, low mood, infections and poor sleep can all cause a temporary dip, and families sometimes read a bad week as the end of recovery. It usually isn't. A physiotherapist looks at the trend across weeks, using the same measurements each time, and adjusts the load accordingly.

One question worth asking your physiotherapist at every review: what is the next goal, and how will we know when it's reached? A plan with clear next steps keeps everyone, including the patient, pointed in the same direction.

Measuring progress

Standardised measures, like walking speed or balance scores, show progress objectively and help adjust the plan.

For home-based rehab specifically, see our article on home physiotherapy for stroke recovery.