Emergency treatment comes first
New facial droop, speech difficulty, arm or leg weakness, severe imbalance or sudden severe headache requires emergency stroke assessment. Rehabilitation starts after acute treatment and medical stability; it never replaces urgent stroke care.
Days: prevent complications and begin safe activity
Early priorities can include swallowing assessment, positioning, pressure protection, breathing, transfers and prevention of another stroke. The team reviews blood pressure, diabetes, cholesterol, heart rhythm, smoking and medicines. Family members should understand safe assistance rather than pulling on a weak shoulder.
Weeks: practise meaningful tasks
Therapy may focus on sitting, standing, walking, arm use, communication, self-care and cognition. Repetition matters, but the task and dose must be safe and appropriate. Fatigue, depression, pain, neglect and communication difficulty can limit participation and deserve assessment.
Months: prepare for home and community
Goals can expand toward stairs, outdoor mobility, cooking, dressing, work discussion, fitness and family roles. Equipment, orthoses or home adaptations may improve independence. Recovery may continue after 90 days; this period is not an expiry date.
Spasticity and shoulder pain
Increased tone is treated when it causes pain, interferes with care or blocks function. Management may include positioning, therapy, splinting, medicine or focal procedures. Shoulder pain should not be accepted as inevitable; handling, alignment and movement require review.
Family questions
How much recovery is guaranteed?
No ethical clinician can guarantee an amount. Prognosis depends on stroke severity, health, complications and participation.
What should we bring to a rehabilitation visit?
Discharge summary, imaging reports, medicines, current therapy plan and the family’s main functional concerns.
Plan the transition between settings
Movement from acute hospital to inpatient rehabilitation, home or outpatient therapy can create gaps. A useful discharge plan lists medicines, prevention targets, swallowing status, mobility assistance, equipment, skin care, therapy goals and emergency contacts. The family should know who is responsible for each follow-up.
Home exercise sheets are not enough when a person cannot understand instructions, has severe neglect or requires physical assistance. Caregiver training and realistic supervision needs should be established before discharge.
Review at the end of the early phase
A review around the first few months can reassess walking, arm use, communication, spasticity, pain, mood, sleep, continence, equipment and return to community roles. Goals may shift from basic safety to endurance, independence or work. The team should also revisit prevention of another stroke.