Physical therapy after stroke: Rebuilding strength, balance and mobility

Physical therapy plays a vital role for people experiencing physical changes following stroke.

A stroke could affect someone’s mobility in different ways depending on the type and severity of stroke and the area of the brain in which the stroke occurred. Physical effects represent just one of the ways a stroke can impact individuals. Read about the causes, symptoms, risk factors and treatment of stroke to learn more.

When patients have trouble walking or moving around after a stroke because of strength, balance or coordination issues, physical therapy can help address those issues as part of an overall stroke rehabilitation plan.

As with other aspects of stroke rehabilitation, physical therapy focuses on patients’ needs and goals for recovery following stroke, accounting for their specific challenges and abilities.

In this article, you will learn about the role of physical therapy in stroke rehabilitation, what physical therapy can involve and what it may address to help support greater function and independence following a stroke.

How can a stroke affect movement and mobility?

Strokes affect the brain’s ability to control movement. The nature and extent of physical challenges patients experience following a stroke can vary differently from one individual to another.

• Patients may experience muscle weakness or paralysis in upper or lower extremities (i.e., arms, hands, legs and feet), especially on one side of the body depending on the location of the stroke within their brain.
• Patients may experience spasticity, which is a condition that creates involuntary muscle spasms due to a disruption in messages from the brain to muscle groups that cause muscles to stay tight or contracted. Other forms of muscle stiffness or changes in muscle tone are also possible following a stroke.
• Spasticity and/or muscle weakness or an inability to move one side of the body following a stroke, known as hemiparesis, can impact posture and body control.[1]
• Following a stroke, patients may experience fatigue or reduced physical endurance. That fatigue can occur regardless of sleep habits and without warning.[2]
• Patients may have difficulty with balance and coordination following a stroke. On their own or combined with other challenges, these symptoms can affect the ability to stand up, walk or change positions, and they increase fall risk after a stroke.[3]

Physical effects of stroke can impact someone’s everyday life. Patients may find it harder to get out of bed, climb stairs or navigate safely within the home. These challenges can also appear outside of the home environment.

Because strokes affect everyone differently, patients may experience these impacts to different degrees or potentially not experience them at all. For that reason, patients should communicate with their medical and rehabilitation teams their specific physical effects.

How does physical therapy support stroke recovery?

Physical therapists work with patients to build strength and improve their overall movement as part of stroke recovery efforts. Patients should seek out certified physical therapists who are experienced and/or specialize in stroke rehabilitation.

The first step in physical therapy for stroke patients usually involves an evaluation that assesses existing mobility and strength level. Typically, a physical therapist will assess leg strength, walking ability and gait, overall balance and coordination, range of motion, ability to change positions or transfer between surfaces, fall risk and overall stamina. Therapists also ask patients about their pre-stroke level of function and home environment.

This information enables physical therapists to develop goals for their physical therapy that account for deficits patients may experience following their stroke, as well as patients’ existing abilities and their current needs.

Rehabilitation often involves helping patients practice movements and tasks that correlate with everyday activities like navigating their home, bathing and getting dressed. In particular, physical therapy focuses on helping patients build the strength, balance and mobility they need to perform those activities.

Inpatient vs. Outpatient

Typically, inpatient physical therapy focuses on helping stroke patients return home, depending on the available level of support. Meanwhile, outpatient physical therapy tends to focus on helping patients build upon their initial progress and increase their long-term independence.

Because stroke impacts patients differently, no two stroke patients will have identical goals or treatment plans. Some patients may focus on improving their gait or walking longer distances independently. Patients who are unable to walk following stroke may instead focus on transferring safely or increasing their mobility using a wheelchair and improve positioning in bed to reduce the risk for skin breakdown.

Physical therapists in inpatient and outpatient settings will work with patients’ doctors and other members of the rehabilitation team to determine the exact type, amount and intensity of therapy to best address each patient’s needs and goals. For some patients, rehabilitation technology may also support their treatment plan.

Physical therapy (PT) represents one component of a multidisciplinary stroke rehabilitation program, alongside occupational therapy, speech therapy, vision therapy and other services.

What does physical therapy after a stroke involve?

Through their evaluation, physical therapists will tailor specific activities and treatment to what stage of stroke recovery patients are in, what their goals and abilities are and what challenges they face at that time.

Depending on their deficits, activities may include:

• Exercises that strengthen the side of the body affected by the stroke
• Balance exercises to reduce fall risk
• Gait training
• Practicing transfers to different surfaces
• Range of motion exercises and stretching
• Weight bearing through the affected side to encourage recovery

While specific exercises vary, stroke rehabilitation focuses on neuroplasticity, or the ability to retrain the brain’s neural pathways to re-learn old tasks or learn new ways to perform tasks. Learn more about how neuroplasticity aids stroke recovery.

Physical therapists may use rehabilitation technology to supplement exercises. Gait trainers, standing frames and body weight-support systems can help patients further develop their standing and upright tolerance, arm and leg strength, balance and walking ability. Read more about how Good Shepherd incorporates technology into its rehabilitation services.

In cases where stroke has left patients unable to walk independently, physical therapy teams develop strategies and exercises to help patients compensate for lost function. For example, patients may work on transferring in and out of a wheelchair. Additionally, physical therapists and physical therapy assistants (PTA) may also identify assistive devices or orthotics such as walkers, canes, braces or transfer aides to help patients.

A combination of exercises, technology and strategies helps physical therapists work with patients on building the strength necessary to maximize long-term independence and improve their quality of life.

How can physical therapy help with walking, balance and mobility after a stroke?

Physical therapy may help patients improve walking and balance after a stroke in several ways. It can also help patients who are unable to walk because of their stroke learn to use assistive devices that support mobility.

Walking and functional mobility

Because strokes can result in muscle weakness or paralysis, impaired balance and coordination or other physical deficits, physical therapy commonly focuses on helping patients safely increase their mobility. Exercises will focus on improving patients’ neuroplasticity and retraining their neural pathways.

At Good Shepherd, physical therapists may also incorporate high-intensity gait training – particularly in outpatient rehabilitation – when appropriate for a patient. In this training, patients use weights, wear a heartrate monitor and increase their exertion level during gait training. Research has shown this can improve recovery.

Meanwhile, equipment like gait trainers, parallel bars, robotics and body-weight support systems can also help patients improve walking and mobility skills.

In their evaluation, physical therapists may determine patients will benefit from an assistive device, such as a walker, cane or wheelchair, or orthotics, such as braces, to improve their mobility. Read more about how Good Shepherd’s Brace Clinic supports patient mobility.

Mobility goals will differ for everyone depending on the stroke’s impact. Some patients may focus on walking independently while others may prioritize safely transferring from a bed to a chair. Physical therapists will work with patients to establish safe, achievable and appropriate goals.

Balance and fall prevention

Stroke patients may find it harder to move safely because of the effects stroke can have on balance, strength, coordination, sensation or vision. These effects can also increase their fall risk.

The initial evaluation will assess patients for fall risk and measure their balance. Balance tests will depend on the patient’s level of independence and mobility.

During treatment in both inpatient and outpatient settings, physical therapists may challenge patients’ balance to help them improve and gain confidence in it. Therapists may also educate patients on safe practices for walking, sitting or standing to reduce their fall risk. In some cases, assistive devices can help patients feel more stable.

Physical therapists will also collaborate with other members of the rehabilitation team. If patients have cognitive or motor-skill deficits that increase their fall risk, physical therapy can coordinate with occupational and speech therapy teams to incorporate those skills into physical therapy as a way of helping patients build functional mobility.

Improving functional mobility becomes particularly important as patients prepare to return home after inpatient stroke rehabilitation.

Supporting progress outside of physical therapy

While physical therapy sessions play a key role in a patient’s stroke rehabilitation, progress can occur outside of those sessions.

During inpatient stroke rehabilitation, physical therapists can involve families in the sessions, training them on safe and appropriate exercises they can do with patients independently.

Families and caregivers receive training during the inpatient discharge process to provide patients with appropriate mobility support. Therapists also review patients’ home exercises. For patients who are unable to walk independently, families and caregivers receive training on bed positioning to prevent skin breakdowns and safe transfers. Meanwhile, care managers ensure families and caregivers have the appropriate training, equipment and information to assist patients safely.

In outpatient rehabilitation, physical therapists can also provide safe, appropriate exercises for patients to continue independently at home.

Throughout stroke rehabilitation, families and caregivers can encourage patients and maintain a positive outlook that supports recovery.

Patients, families and caregivers should regularly communicate physical changes or changes in their needs or goals to their physical therapist and entire rehabilitation team. See our guide to learn more about how family members and caregivers can support someone’s stroke recovery.

Stroke rehabilitation is an ongoing process. Patients can make progress months, or even years, after a stroke.

Physical therapy and stroke rehabilitation at Good Shepherd

Everyone’s physical recovery looks different following stroke. Your therapy and treatment plan should reflect your specific needs and change as you progress through your stroke rehabilitation.

At Good Shepherd Rehabilitation, physical therapy works alongside a multidisciplinary team to help you maximize your function and independence after a stroke.

Good Shepherd Rehabilitation Hospital in Center Valley, Pa., offers a CARF-accredited inpatient stroke rehabilitation program. Physical medicine and rehabilitation physicians lead a team of certified rehabilitation registered nurses and therapists who specialize in stroke rehabilitation. Learn more about choosing an inpatient stroke rehabilitation facility.

Once home, you can continue therapy through outpatient stroke rehabilitation. We have 20 outpatient locations across eight counties in eastern Pennsylvania that can help you continue to work on your strength, balance and mobility.

During both inpatient and outpatient rehabilitation, Good Shepherd also supports patients with leading-edge technology. Through The Fleming Center for Robotics in Rehabilitation, patients have access to robotic and wearable devices, such as Wandercraft exoskeleton technology.

In addition, our 3D print lab inside the Empower+ Makerspace in Center Valley can help custom-produce tools that help patients participate in everyday activities. Meanwhile, our Wheelchair Seating and Mobility Clinic can help patients identify appropriate mobility devices to maximize their independence.

Life may not look the same after stroke, but rehabilitation can improve your quality of life.

Visit our stroke rehabilitation page to learn more about our program.

You can also call 1-888-447-3422 (44-REHAB) or contact us online.

[1] Hemiparesis | American Stroke Association

[2] Fighting Through Fatigue | American Stroke Association

[3] Restoring Your Balance | American Stroke Association