The Basics of Stroke Rehabilitation

  •   October 5, 2017

“A stroke happens when blood stops flowing to any part of your brain, damaging brain cells. The effects of a stroke depend on the part of the brain that was damaged and the amount of damage done.”1

Did you know:

  • Every year nearly 14,000 Canadians die from stroke.2
  • There are over 50,000 new strokes every year in Canada.2
  • 741,800 Canadian adults live with the effects of stroke.3
  • ¼ of Canadians who have had a stroke are under 65.3
  • Stroke prevalence rises significantly after age 55.3

Types of stroke

There are two broad categories of stroke, those caused by a “brain bleed” or hemorrhage and those caused by a clot in a blood vessel carrying blood to the brain. A hemorrhage happens when a blood vessel breaks. This impacts the brain in two ways. First, by interrupting the flow of blood to the brain cells, and second, because blood has a toxic effect on brain cells when the two are in direct contact. A blood clot impacts the brain by stopping the flow of blood to the brain. When the brain cells are deprived of blood flow, oxygen, and nutrients brain cells die. In both types of stroke, the change in circulation ultimately effects the brain’s function and the person’s ability to complete certain tasks or activities.4

A third type of stroke, a transient ischemic attack (TIA), is caused by a temporary blockage of blood flow to the brain, also due to a clot. Unlike other strokes, the symptoms of a TIA are short lived because the clot either becomes dislodged from the blood vessel or dissolves.5 However, a history of having a TIA is a risk factor for a future stroke,6,7 so TIAs should be thought of a warning signs for future strokes and should be taken seriously.

Early recognition is essential

In some circumstances, early recognition can enable treatment directed at the cause of the stroke and significantly improve the person’s long term outcomes. In recent years, media campaigns have focused on raising awareness of the signs of stroke through the acronym FAST:

  • F ace – Is one side drooping?
  • A rm – Can the person raise both?
  • S peech – Is it slurred, jumbled, or incoherent?
  • T ime – Is of the essence. Call 911.8

Common issues following a stroke

No two strokes are the same, just as no two people who experience a stroke are the same; however, some common concerns post stroke include:

  • Weakness of the arm or leg on one side
  • Loss of flexibility
  • Changes to balance
  • Decreased ability to walk
  • Decreased ability to complete usual tasks of daily living
  • Changes in the ability to speak
  • Changes in the ability to swallow and eat
  • Changes in vision or perception
  • Changes in memory, thinking or judgment

Physiotherapy helps: a part of your team

Some of the concerns listed above can be directly addressed by physiotherapists, while others may affect the person’s physiotherapy treatment plans. Physiotherapists work as members of your health-care team, a team which may also include doctors, nurses, occupational therapists, speech-language pathologists, and other health professionals. This team works together to address the patient’s needs, identify the problems the patient is facing due to their stroke, and develop plans to help the person recover their abilities, manage any long-term changes, and achieve their goals.

Physiotherapy helps: in hospital

In the early days after a person has a stroke, care is ideally delivered by a dedicated “stroke team” working in an area dedicated to stroke patient care, such as a stroke unit.9 It has been found that people who receive care in dedicated stroke units start rehabilitation earlier and have better functional outcomes.9 Current stroke best practice guidelines recommend that where this level of care is not available (due to geography or population size), hospitals develop arrangements so that patients can be transferred to stroke units in larger centers.9

In hospital settings, physiotherapists are often involved in assessing the ability of people to balance, move from bed to chair (to transfer), to stand and walk, and the person’s flexibility and strength. People are sometimes surprised by how early physiotherapists start working with people who have had a stroke. However, research has suggested that having people start moving soon after being admitted to hospital increases their likelihood of independence with walking in the future,9,10,11 may reduce other complications,10,11 and may help with the person’s sense of well-being in general.

Physiotherapy helps: preparing to leave hospital

Physiotherapists also help the person to plan for going home or to a stroke rehabilitation centre for further therapy (depending on the person’s needs and what resources are available to help them). In some cases, patients may be sent to dedicated rehabilitation centers to receive ongoing therapy from a team similar to the one seen in hospital. The main difference is that the focus in rehabilitation settings is on therapy and rehabilitation to help the person achieve their goals.

Another increasingly common approach to rehabilitation are Stroke Early Supported Discharge (SESD) programs, in which people who have had a stroke receive physiotherapy and other rehabilitation services in their home environment.12 These programs are designed to address the ongoing rehabilitation needs of people who are able to be in their home environment with additional support.

Regardless of the setting in which ongoing therapy is delivered, whether home or a rehabilitation center, it’s important to remember that “rehabilitation” refers to the process of working towards the patient’s goals and not to a specific setting or location.13 Rehabilitation tends to be a process that lasts for as long as needed to help the person achieve their best possible recovery. When people graduate from rehabilitation centers or SESD programs they may still benefit from ongoing physiotherapy or treatment from other members of the rehabilitation team to address specific concerns. Meaningful improvements can occur for as long as two years.14

Physiotherapy helps: secondary prevention of stroke

Having a low level of physical activity is known to put people at risk of having a stroke. This is also true for people who have had a previous stroke. What’s more, people who have had a previous stroke tend to be less physically active than those who have not had a prior stroke.15 Long-term studies to measure if increasing the amount of exercise lowers the chance of having a second stroke are underway, and this is a topic of interest for researchers. What we know so far is that people who have had a stroke can improve their physical fitness through exercise programs, decreasing their risk of stroke while also increasing their quality of life.15 Exercise completed under supervision has been shown to be safe and beneficial;15 another reason to contact a physiotherapist for help to be more active after stroke.  

Click here to find a physiotherapist to help you on your stroke recovery journey.


  1. Heart and Stroke Foundation of Canada. Stroke. Available at: http://www.heartandstroke.ca/stroke. Accessed on September 25, 2017.
  2. Public Health Agency of Canada. Stroke in Canada. Available at: https://www.canada.ca/content/dam/canada/public-health/migration/publications/diseases-conditions-maladies-affections/stroke-accident-vasculaire-cerebral/alt/pub-eng.pdf.  Accessed on September 25, 2017.
  3. Ontario Stroke Network. Stroke Stats & Facts. Available at: https://ontariostrokenetwork.ca/information-about-stroke/stroke-stats-and-facts/   Accessed on September 25, 2017.
  4. American Heart and Stroke Association. Types of Stroke. Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/Types-of-Stroke_UCM_308531_SubHomePage.jsp.  Accessed on September 25, 2017.  
  5. American Heart and Stroke Association. TIA (Transient Ischemic Attack). Available at: http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/TIA/Transient-Ischemic-Attack-TIA_UCM_492003_SubHomePage.jsp. Accessed on September 25, 2017.
  6. Khare S. Risk factors of transient ischemic attack: An overview. Journal of Midlife Health. 2016; 7(1):2-7. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832890/. Accessed on September 25, 2017.
  7. Wu CM, McLaughlin K, Lorenzetti DL. Early risk of stroke after transient ischemic attack: A systematic review and meta-analysis. Archives of Internal Medicine 2007; 167(22):2417-2422. Available at: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/770035. Accessed on September 25, 2017.
  8. Heart and Stroke Foundation of Canada. Signs of stroke. Available at: http://www.heartandstroke.ca/stroke/signs-of-stroke. Accessed on September 25, 2017.
  9. Heart and Stroke Foundation of Canada. Canadian Stroke Best Practices: Acute stroke unit care. Available at: http://www.strokebestpractices.ca/acute-stroke-management/stroke-unit-care-2/. Accessed on September 25, 2017.
  10. Craig LE, Bernhardt J, Langhorne P, Wu O. Early mobilization after stroke: An example of an individual patient data meta-analysis of a complex intervention. Stroke 2010; 41:2632-2636.
  11. Bernhardt J, English C, Johnson L, Cumming TB. Early mobilization after stroke: Early adoption but limited evidence. Stroke 2015; 46:1141-1146.
  12. Alberta Health Services. Stroke early supported discharge team. Available at: http://www.albertahealthservices.ca/info/service.aspx?id=1065562.  Accessed on September 25, 2017.
  13. Heart and Stroke Foundation of Canada. Canadian Stroke Best Practices: Rehabilitation. Available at: http://www.strokebestpractices.ca/stroke-rehabilitation/. Accessed on September 25, 2017.
  14. American Heart and Stroke Association. 15 things caregivers should know after a loved one has had a stroke. Available at: http://www.strokeassociation.org/STROKEORG/LifeAfterStroke/ForFamilyCaregivers/CaringforYourLovedOne/15-Things-Caregivers-Should-Know-After-a-Loved-One-Has-Had-a-Stroke_UCM_310762_Article.jsp#.WclcPMiGOUk. Accessed on September 25, 2017.
  15. Darden D, Richardson C, Jackson EA. Physical activity and exercise for secondary prevention among patients with cardiovascular disease. Current Cardiovascular Risk Reports 2013;; 7(6):10. doi:  10.1007/s12170-013-0354-5