Physical therapy for stroke recovery

Clinically reviewed by Theresa Beckmann, PT, and Kathy Lovato, PT, DPT

A stroke is a complex condition that can affect both your body and mind. Depending on the severity of the stroke and its effects, physical therapy (PT) is often a key part of recovery. When possible, therapy should start as soon as your condition stabilizes.

"The early days are really critical," said Theresa Beckmann, a physical therapist and neurological clinical specialist at Encompass Health Rehabilitation Hospital of East Valley in Arizona. "Every day you don't do therapy is an opportunity missed. It's not just about recovery. It's also about maintaining what you haven't lost."

A stroke happens when blood flow to the brain is suddenly reduced or blocked. This can damage the areas of the brain responsible for movement, balance and coordination. A physical therapist can help you retrain the brain and body through individualized therapy and exercise plans designed to rebuild those connections.

What is physical therapy for stroke recovery

According to the American Physical Therapy Association, physical therapists are "movement experts who improve quality of life through prescribed exercise, hands-on care and patient education."

Physical therapy includes many specialties, from geriatrics and sports medicine to pediatrics and pain management. For stroke recovery, it is important to work with a physical therapist who has experience treating neurological conditions.

Some therapists hold advanced certification as a Neurological Clinical Specialist (NCS). These licensed physical therapists have completed more than 2,000 hours of clinical practice working with people who have disorders of the nervous system, including stroke.

How physical therapy after stroke treats common side effects

A stroke can cause a wide range of physical and cognitive changes that affect daily life. Physical therapy after stroke can address many common challenges, including:

• Weakness on one side of the body known as hemiparesis
• Muscle tightness or stiffness, also known as spasticity
• Low muscle tone, called flaccidity
• Balance and coordination problems
• Difficulty performing certain movements or gestures, also known as apraxia

While PT focuses on movement, Beckmann said cognition also plays an important role in recovery.

"It's a common misconception that only occupational and speech therapists address cognition," she said. "We have to include cognition in the treatment plan (for physical therapy), or it's not going to be successful. We need to understand where to clarify and when to simplify depending on how the brain is processing."

Addressing both physical and cognitive needs helps prepare patients for the real-world demands of daily life.

Physical therapy technologies and techniques used after stroke

Physical therapists may use a combination of advanced technology and simple tools to support stroke recovery. Treatment plans are customized to each patient’s needs, abilities and goals.

Functional electrical stimulation

Functional electrical stimulation uses noninvasive electrodes placed on the skin to deliver gentle electrical pulses to affected muscles. This can help activate weak or stiff muscles and improve movement. Beckmann added that this therapy is best paired with other functional activities, such as walking and cycling.

Devices such as the Bioness L300 may be used to stimulate muscles in the leg during movement.

Weight bearing and gait training

After a stroke, bearing weight and walking safely can be difficult. Therapists may use a static body-weight support system, such as LiteGait or Vector, to help patients practice standing and walking with less risk of falling.

Low-tech options are also important. "We can use walkers, for example, to help arms bear weight. We want to make sure we are looking for ways to include an affected arm into what we are doing as well." Beckmann said. "We're giving the brain as much input as possible to get the body and brain opportunities to reconnect."

Braces or ankle supports can help support the body while your physical therapist works on the hip. Therapists also use resistance sleds like those used in football practice. "We look for ways to build intensity or increase how many times we can repeat an activity in a session because that just creates more opportunities for the brain to relearn what it has lost." Beckmann said.

Balance and coordination exercises

Even when muscles are active, movements may feel unsteady. Balance and coordination exercises as part of your physical therapy treatment plan can improve control and smoothness after stroke.

These activities may include music and dance, "especially if that's something the patient likes," Beckmann said. A metronome also could be used with your physical therapist having you tap your foot in time with it.

Interactive technologies such as the Bioness Integrated Therapy System (BITS) can help improve hand-eye coordination and reaction times.

When physical therapy should begin after stroke

Physical therapy should start as soon as possible. In many cases, therapy begins at the bedside while a patient is still in the acute care hospital.

"The sooner you start PT, the sooner you can reconnect your brain and muscle function and prevent further loss of muscle mass and stability," said Beckmann.

"There is so much research on earlier interventions to get you moving sooner," she said. "Early interventions could cut days off your recovery. It's hard to give one guideline for every patient, but medically, if you're able to tolerate it, you should have PT daily."

Where does physical therapy for stroke take place

While your initial physical therapy should start at the acute hospital after your condition is stabilized, your care team may recommend continuing physical therapy in an inpatient rehabilitation or other post-acute setting. According to the American Heart Association/American Stroke Association, "Whenever possible, initial rehabilitation should take place in an inpatient rehabilitation facility rather than a nursing home."

At an inpatient rehabilitation hospital, patients typically receive at least three hours of therapy a day, five days a week spread throughout the day to allow for rest. Care may include:

• Physical therapy
• Occupational therapy
• Speech therapy, if needed

Patients also receive frequent physician visits and 24/7 nursing care to support medical needs. Your rehabilitation care team will also include a case manager, dietitian and pharmacist. Together, they work with patients and families to create a personalized plan focused on returning to daily activities and the highest possible level of independence.

"I think that's what we really do differently in inpatient rehabilitation," said Kathy Lovato, physical therapist, DPT, director of therapy operations at Encompass Health East Valley. "We get you ready for the whole task. We're pulling it all together, so when you go home, everything is working all together — walking, cognition, etc."