What to Expect in Stroke Rehab

Following a stroke, about two-thirds of survivors receive some type of rehabilitation. This is a time of both hope and anxiety for stroke families: hope that the survivor will make a good recovery; anxiety or fear about what happens next and what to expect. In this second of our two-part series on rehab, we want to alleviate some of the mystery and hopefully some fear and anxiety around the inpatient rehab part of the stroke recovery journey. We talked to Richard L. Harvey, M.D., section chief for Stroke Rehabilitation at the Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago) and one of the authors of the American Stroke Association rehab guidelines, about what survivors and their families can expect in an inpatient rehab facility (IRF).

Once medically stable, survivors are discharged either to an IRF, a skilled nursing facility (SNF) or home. (For more on the difference between IRFs and SNFs, see our previous article in this series.)

Determining What's Needed

Dr. Richard Harvey

Once admitted to the inpatient rehabilitation facility (IRF), a physiatrist (or a neurologist with rehabilitation experience) does a general assessment of the survivor’s abilities. “The physiatrist determines that, indeed, the person is ready for rehabilitation,” Harvey said. This is when therapy and other medical orders are written.

Sometimes there are medical precautions that must be kept in mind and made clear in the medical orders for staff and therapists to follow. “For example, some patients need to have a fairly high blood pressure after their stroke to maintain good blood flow to the brain. There may be limitations to what the survivor can do because of that, and the physiatrist will want the therapist to monitor blood pressure closely while they’re doing therapy. Medical precaution is important information that would be placed into the medical orders.”

Once the orders are written, actual therapy begins the next day. Each type of therapist seeing the survivor performs his or her own thorough assessment of specific functions such as motor skills and communication. These measure how independently the survivor is able to function using a standard measuring tool, such as the Functional Independence Measure (FIM). It measures a wide variety of activities such as dressing your upper and lower body, going to the toilet, walking, climbing stairs, communication, problem solving and memory. Each category receives a score between 1 (completely unable) to 7 (complete independence); total score possible is 118 points.

“Patient goals are critical to care planning and their thoughts are gathered on admission by the physician and nurse and also on the next day by the individual therapists,” Harvey said.

Results of these assessments and discussions provide a baseline from which to set goals and guide the kind of therapy the survivor receives. “We set goals for what we hope survivors can achieve at discharge and that drives the rehabilitation therapy that we do,” Harvey said. “The therapy will focus on achieving those goals. So, a physical therapist sets goals for walking and mobility. An occupational therapist sets goals for dressing and other ADLs [activities of daily living], and a speech therapist works with communication, swallowing, and memory and cognition. They all have specific goals. Nursing is involved as well and helps with things like bladder and bowel control, skin care and nutrition.”

Working Toward Those Goals

After the assessments are done and goals set, the rehabilitation team meets to discuss the results and the patient’s goals. “Then we will figure out how long it’s going to take to accomplish the goals, and we set the discharge date,” Harvey said.

This is a target date. The team meets weekly to evaluate progress. If the target date no longer seems feasible, a new plan is proposed. If a survivor’s progress seems slow, the team works to determine why and adjusts the plan accordingly. The rehab team works closely with the patient and family to develop a mutually agreeable plan. There is communication all along the way and plenty of opportunities to assess readiness for discharge and come up with next steps.

Patients’ perspectives are sought and considered throughout their stay in an IRF. “Any concern raised by the patient is addressed by the team,” he said. “If one team member cannot address it, that team member will seek out the team member who can. Communication between rehabilitation team members is critical and constant.”

The rehab team meets and reassesses performance every week. At those meetings, any barriers to progress are addressed. “For example, if the patient has muscle spasticity that’s interfering with their ability to walk, we might start a medication to treat that. Or if they need any special splints or braces, we make that determination at that meeting,” he said.

These team meetings are rarely, if ever, attended by survivors or family members. However, family members are welcome at therapy sessions, which should occupy at least three hours a day in an IRF.

“Lots of times we schedule time for the family to come in and learn to assist the patient,” Harvey said. “If the patient needs help when they go home, we want the family to assist them at the right level, to do it safely so that neither the patient nor family member gets injured. We want them to provide the right amount of help. We often work with the family one-on-one to train them on how to do this. But it’s also helpful for caregivers to be around and see what’s going on in therapy. It helps them feel engaged in the whole process. Of course, many families can’t do that because of work, but usually at some point, we need the family to come in and spend some time with us to get an idea what’s going on.” In addition, caregivers can be educated in the fine art of saying no and setting limits.

What to Expect of Therapy

Most IRF stroke programs have many elements to support the many aspects of stroke recovery. These may include:

  • individual therapies
  • group therapies
  • teaching strategies to compensate for functions that aren’t fully recovered
  • psychological, emotional support
  • establishing daily and weekly routines
  • goal setting
  • education on: cause of stroke; preventing another stroke; medications; diet; protection of skin; management of spasticity; stretching; caregiver training; community resources after discharge

Different members of the team handle different aspects. For example, secondary prevention is generally something a physician and member of the nursing staff do more than the therapists. On the other hand, setting functional goals tends to fall more to the therapists than the nurse and physician.

“Our goal is to get survivors ready to be discharged safely to their homes,” Harvey said. “Most of the time that involves individual therapy. Occasionally we give group therapy. We often have an upper-body exercise group for people who need to strengthen their weak arm. Or a speech group where patients communicate with each other under the supervision of a speech therapist, but mostly it’s individual therapy.”

In stroke rehab, there is constant balancing of recovery and compensation. In IRFs, the goal is to work on recovery first — strengthening arms and legs and using whatever strength is regained to help perform functional tasks. “In some cases, that’s impossible, so if a person’s balance is very severely impaired and walking is unsafe, we may shift focus to practice on wheelchair propulsion, which is a compensatory way to move around. But the goal is to help this person be able to do what they need to do as independently as possible. And that either is going to be recovery back toward normal performance or improvement of function based on compensatory strategies with or without devices.”

Stroke Connection. Get the app for free.


- Advertisement -

This link is provided for convenience only and is not an endorsement or recommendation of either the linked-to entity or any product or service.

AD. Amramp Making Life Accessible. 20 years. Be accessible to everyone. Protect your clients & their caregivers from slip and fall accidents. 888-715-7599. Click here for more info.

AD: American Stroke Association-American Heart Association logo. Did you know that about 1 in 4 stroke survivors have a second stroke? Learn more.


Ad: American Heart Association logo. American Diabetes Associaiton logo. Know diabetes by heart logo. Living with diabetes? Inspire others. Submit story button.


AD. American Heart Association logo. Know your blood pressure numbers. And what they mean. Gain Control.  Learn more.


Ad: American Heart Association Support Network. Facing recovery after a stroke or heart disease diagnosis can be overwhelming. You are not alone. Our community is here for you. Join us today. heart.org/SupportNetwork.


Edit ModuleShow Tags

Stroke Rehabilitation

Making the Best Decisions at Discharge After Stroke

The type of rehabilitation and support systems a survivor receives at discharge can strongly influence health outcomes and recovery. In this, the first part of a two-part series on stroke rehab, we offer guidance for the decision-making process required when it’s time to leave the hospital.

What to Expect from Outpatient Rehab

After stroke, about two-thirds of survivors receive some type of rehabilitation. Outpatient therapy may consist of Several types of therapy. Whether a patient is referred to inpatient or outpatient therapy depends on the level of medical care required.

What to Expect in Stroke Rehab

Following a stroke, about two-thirds of survivors receive some type rehabilitation. In this second of our two-part series, we want to alleviate some of the mystery, fear and anxiety around the inpatient rehab part of the stroke recovery journey.
Edit ModuleShow Tags Edit ModuleShow Tags

AHA-ASA Resources

The Support Network

When faced with challenges recovering from heart disease or stroke, it’s important to have emotional support. That is why we created a network to connect patients and loved ones with others during their journey.

Caregiver Guide to Stroke

The Caregiver Guide to Stroke is meant to help caregivers better navigate the recovery process and the financial and social implications of a stroke.

Stroke Support Group Finder

To find a group near you, simply enter your ZIP code and a mile radius. If your initial search does not pull up any groups, try

Tips for Daily Living Library

This volunteer-powered library gathers tips and ideas from stroke survivors, caregivers and healthcare professionals all over the country who’ve created or discovered adaptive and often innovative ways to get things done!

Stroke Family Warmline

The Warmline connects stroke survivors and their families with an ASA team member who can provide support, helpful information or just a listening ear.

Let's Talk About Stroke Patient Information Sheets

Let's Talk About Stroke is a series of downloadable patient information sheets, created by the American Stroke Association, that presents information in a question-and-answer format that's brief, easy to follow and easy to read.

Request Free Stroke Information Packets

Fill out this online form to request free information about a variety of post-stroke topics.
Edit ModuleShow Tags

Stroke & Parts of the Brain

When Stroke Affects the Occipital Lobe

Our occipital lobe, the smallest of the four lobes of the cerebral cortex, controls how we visually interpret our world.

When Stroke Affects the Cerebellum

The cerebellum contains 80 percent of our neurons. Its job seems to be to make things better. We talked with neuroscientist Jeremy Schmahmann about how stroke affects the “little brain.”

When Stroke Affects the Parietal Lobe

The parietal lobe helps us make sense of sensory information, like where our bodies and body parts are in space, our sense of touch, and the part of our vision that deals with the location of objects.

When Stroke Affects the Frontal Lobe

Of the four lobes that make up the cerebral cortex, the frontal lobe is the largest. It plays a huge role in many of the functions that make us human — memory, language, movement, judgment, abstract thinking.

When Stroke Affects the Temporal Lobe

The temporal lobe has several functions, mainly involved with memory, perception and language.

When Stroke Affects the Brain Stem

The brain stem serves as a bridge in the nervous system. It sits at the top of the spinal column in the center of the brain. When a stroke happens there, it can cause a few different deficits and, in the most severe cases, can lead to locked-in syndrome.

When Stroke Affects the Thalamus

The thalamus can be thought of as a "relay station," receiving signals from the brain’s outer regions (cerebral cortex), interpreting them, then sending them to other areas of the brain to complete their job.
Edit ModuleShow Tags


Stroke Notes

Stroke-related news you can use about new scientific findings, public policy, programs and resources.

Readers Room

Articles, poems and art submitted by stroke survivors and their loved ones.

Life Is Why

Everyone has a reason to live a longer, healthier life. These stroke survivors, caregivers and others share their 'whys'. We'd love for you to share yours, too!

Everyday Survival

Practical tips and advice for day-to day living after stroke.

Life At The Curb

A unique perspective on survival by comedian and stroke survivor John Kawie.

Simple Cooking

Cooking at home can be a daunting task, but a rewarding one for your diet and lifestyle (and your wallet). Making small changes in your diet is important to your heart health. Here are simple, healthy and affordable recipes and cooking tips.

Helping Others Understand

Stroke affects people differently and many of the effects of stroke can be complicated. Helping friends and family understand how a stroke is affecting a survivor can help everyone involved.

Support Showcase

Our new department highlighting the good work being done by stroke support groups from around the nation. If you are part of a successful support group we should consider featuring, let us know!