A stroke can affect you physically in many ways, including paralysis or weakness down one side. It can affect muscles and joints, leading to painful muscle spasms or dislocations. A stroke can affect your balance and posture. Your coordination can be damaged, making it hard to walk or use your hands.

Physiotherapy can help you get back as much movement as possible after a stroke. It can help you re-learn to use your arms and hands to complete everyday tasks, like dressing. Physiotherapy can help you regain movement and strength in your legs to improve movement and balance.

Neurophysiotherapy is a specialism of physiotherapy. A neurophysiotherapist is trained to understand the impact of changes caused by damage to the brain and nervous system as in stroke.

The aims of physiotherapy

In the early stages after a stroke, physiotherapy will focus on looking for any problems and preventing complications like muscle tightness. Your physiotherapist will work with you on restoring your ability to move and be active again.

As time goes on, physiotherapy focuses on helping you to become more independent and do what is important to you. This can include tasks for looking after yourself such as dressing and cooking, or getting back to your usual activities such as walking, work and leisure.  

When can physiotherapy begin?

From 24 hours after a stroke, you will be encouraged to get up and about as much as you are able to. This could mean walking around, or sitting up in a chair, depending on you and the effects of your stroke.

You should be assessed by a physiotherapist soon after your stroke. Guidelines recommend that while undergoing rehabilitation in hospital, you should receive 45 minutes of each type of therapy you need per day.

What happens?

Setting goals with you
Your therapist will work with you to set your goals. This will take into account your priorities, hopes and plans. Your goals will depend on how severe your stroke is, your previous abilities, and the life you hope to lead in the future. Your goals may be small to start with and involve a simple task, such as reaching for and grasping an object.

Getting up
Your physiotherapy will begin in hospital with exercises in bed and moving around on the ward. Once you are ready, you should progress to more active sessions, which you will probably receive in a rehabilitation area or special physiotherapy gym.

Doing therapeutic activities
The physiotherapist will suggest activities to help you practise specific skills that you need to improve. So if you are having difficulty keeping your balance when standing, you may be asked to practise standing up a lot. If you have difficulty lifting your arm you need to focus on doing activities that make you lift your arm. If you are having difficulty walking you need lots of walking practice.

Who will support you
There are many ways to work on improving. You may work on a one-to-one basis with a physiotherapist, particularly on the tasks and the movements you are learning to do. You may also work with a physiotherapy assistant, in a group, or have tasks and activities for you to practise on your own outside of therapy sessions.

Strength and balance
One of the main physical problems facing stroke survivors is weakness in the arms and legs. This can be improved with strengthening exercises. Exercises to build up your stamina and stretching exercises to prevent muscle and joint stiffness are also beneficial. 

There are different ways that you can do these exercises. You may exercise under the supervision of the physiotherapist and/or an assistant, attend a group exercise or circuit training class, or work individually in a gym. You can also practise independently in your own time outside a formal therapy session. Talk to your physiotherapist about what is suitable for you. 

Help from an interdisciplinary team
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. 

When will my therapy end?

The quickest recovery is usually in the first few month after a stroke, but recovery can carry on for months and years. After this time, improvements usually happen because you have become fitter, stronger and more able to use your body, rather than due to recovery from the damage caused by the stroke itself. Your brain will be able to change by being challenged in a similar way to when we all learn new skills.

If you have ongoing difficulties resulting from your stroke, you should continue to have rehabilitation (including physiotherapy) for as long as you need. This means for as long as you have clear goals and the therapy is helping you make progress towards them. If your therapist thinks that you are no longer benefiting from therapy, they will talk to you about ending the sessions.

Physiotherapy outside hospital

You might leave hospital while you’re still receiving therapy, and this should carry on at home. You should get support from the stroke team, and get the same amount of therapy that you were getting in hospital.

If you did not stay in hospital, or you didn’t get any therapy while you were in hospital, you might still need physiotherapy to help with any problems you have. If you have new problems some time after a stroke you might also need some therapy. Ask your GP to refer you for physiotherapy. This might be with a hospital stroke team or community rehabilitation team. You may also be able to refer yourself.

Equipment you might need
Your physiotherapist or occupational therapist will assess your needs. They can arrange for any equipment you may need such as a wheelchair, a hoist to help you get in and out of a chair or bed. You may need adaptations to the house when you go home, such as a ramp or wider doors.

Physiotherapists can provide other equipment to help you get about more easily such as walking frames, rollators (walking frames with wheels) and sticks.

Review at six months
You should also be reassessed six months after your stroke to see if you need further treatment or a change to your treatment plan. At any time, if new problems arise or old ones resurface, you can ask your GP or consultant to refer you to a physiotherapist.

Many services now operate 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.

Private therapy

You may wish to consult a private physiotherapist, for instance if you feel you could benefit from further therapy, or if you want to supplement any NHS treatment. This is allowed under current guidelines. Let your NHS therapist know you plan to do this, both as a courtesy and to ensure you continue your treatment and goals. 

Check that the private therapist has substantial experience of stroke rehabilitation and the appropriate qualifications. Look for the initials MCSP (Member of the Chartered Society of Physiotherapy) and SRP (State Registered Physiotherapist) after their name. Also ensure that you understand their fee structure, how many sessions are likely to be involved and whether you can be treated at home. You can read our guide to finding private treatment.

Physiotherapy and your brain

One way that physiotherapy helps you after a stroke is through a process called neuroplasticity. This process can be guided by the rehabilitation you receive following your stroke. Physiotherapy encourages neuroplasticity to take place by doing physical activities that help your brain to relearn those skills.

What is neuroplasticity?
A stroke damages brain cells, and these can’t re-grow. But the brain can re-organise itself, by getting other brain cells to take over the work of the damaged cells. This means you can sometimes regain skills and abilities damaged by stroke, like movement and coordination. This is called neuroplasticity.

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