Physical Therapy in the Hospital After a Stroke

A cerebrovscular accident (CVA), also known as a stroke, is a significant medical event that may cause serious functional impairments. If you have had a stroke, then you understand how this can limit your ability to move around and perform your normal work and recreational activities.

Care for a stroke begins immediately in the hospital. You must be stabilized and continually assessed to ensure an optimal outcome. In the hospital, you will encounter several different healthcare professionals who will work with you and your family to help you recover to the greatest extent possible.

Physical therapy in the hospital after a stroke is essential. After a stroke, you may have difficulty moving your body normally, and your ability to walk, move in bed, or sit in a chair may be impaired. Working with a physical therapist in the hospital after a stroke can help you regain motion and improve your ability to move around safely.

What Is a Stroke?

A stroke occurs when a portion of your brain is deprived of oxygen. This causes damage to that area of the brain, and it may result in serious problems with the way you move. There are different ways in which your brain may be deprived of blood, nutrients, and oxygen. The main types of stroke are:

• Ischemic: This type of stroke occurs when a blood vessel becomes blocked, usually by a clot. This type of stroke accounts for about 87% of all strokes.
• Hemorrhagic. This type of stroke occurs when a weakened blood vessel ruptures, causing bleeding in the brain.
• Transient ischemic attack (TIA). This "mini stroke" occurs when a blood vessel is temporarily occluded or injured. It doesn't cause permanent injury to the brain, but can be a strong warning signal of a future stroke.

Another type of stroke is called a cryptogenic stroke. This occurs when it is unknown what has caused your stroke.

Different areas of your body may be affected by a stroke. This depends on which area of the brain is injured during the stroke. Signs and symptoms of a stroke may vary widely. Common symptoms of a stroke include:

• Sudden onset of double vision or trouble seeing in one or both eyes
• Sudden onset of difficulty speaking or forming words
• Sudden onset of numbness, weakness, or spasm on one side of your face, arm, or leg.
• Loss of coordination and balance
• Sudden loss of walking ability
• Severe headache

When you are admitted to the hospital with a suspected stroke, your physician will perform various tests and studies to determine the cause of your symptoms. You may have a clinical examination of your movements, and diagnostic tests like a magnetic resonance image (MRI) or a computed tomography (CT) scan may be taken. These can show your physician where your brain has been injured and how to best treat your stroke.

If you are admitted to the hospital after a stroke, several professionals will care for you. These may include:

• Physicians
• Nurses
• Physical therapists (PT)
• Occupational therapists (OT)
• Speech-language pathologists (SLP)
• Social workers
• Nursing aides

All of these professionals will work together to help you fully recover to the maximum degree possible.

Physical Therapy Examination

A physical therapist is a healthcare professional who will come to you in the hospital and work with you to help you recover functional mobility after your stroke. Physical therapists are movement experts who will work with other rehab professionals to help you recover basic functional movements.

Physical therapy in the hospital after stroke usually begins within one to two days of admission. Your first session with your PT will be an initial evaluation. During this session, your therapist will review your medical history and get a sense of your functional status prior to your stroke. They will likely ask questions about your work and recreational activities, your home setup, and your social and family structure.

Various tests and measures will be performed by your PT after a stroke. These may include:

• Bed mobility function
• Transfer ability
• Walking ability
• Measure of range of motion
• Spasm assessment
• Strength assessment

Since there are so many varied impairments after a stroke, your PT may focus on only a few areas. You may be having difficulty moving in bed and walking, but your ability to reach and lift things may be maintained. Or, your arm may be weak and in spasm, while your legs are functioning fine.

Once your PT completes your initial evaluation, they will work with you to develop initial rehab goals and a plan of care. You may wish to include your family in your rehab plan of care. Your family members may need to learn and understand your functional limitations, and they may need to help you move around during the initial days and weeks following your stroke.

Hospital-Based Physical Therapy Treatments for Stroke

Often, in the hospital, patients who have had a stroke meet with their PT once or twice a day. There may be multiple medical issues occurring after your stroke, and your PT will likely visit you in your hospital room. Medication lines, catheters, and monitoring machines may prevent you from moving around easily. Some hospitals have a separate therapy room where you will work with your PT.

Your PT will tailor your rehab program to your specific needs. In the hospital, the main goal is to maximize your mobility so you can go home as soon as possible. Therefore, three main areas of function are typically the focus of hospital-based PT after stroke: bed mobility, transfers, and ambulation.

Bed Mobility

Bed mobility is your ability to move around in bed. Can you move up and down in bed, roll over, and get up from a lying down position? Your PT will work with you with specific techniques to help you maximize your mobility in bed. Exercises for bed mobility may include:

• Rolling
• Bridges
• Quad sets and glute squeezes
• Straight leg raises

Your PT may also work with you and the nursing staff to implement positioning techniques. This is especially important if you are having difficulty moving in bed. Positioning techniques may help reduce the risk of skin breakdown and ulcers while in the hospital.

Transfers

Transferring is your ability to move from one position and surface to another. Can you transfer from your bed to a chair? Can you transfer from a sitting position to standing and safely sit back down again? Your PT will work with you to improve your ability to transfer. Sometimes, specialized tools like a slide board are used to assist with transferring from your bed to a chair.

Your therapist may have you perform specific exercises to improve your transfer ability. These may include:

• Seated leg extensions
• Seated heel raises and toe raises
• Mini squats with upper extremity assistance

Your physical therapist may also prescribe exercises for you to do throughout the day when you are not in therapy. They should write down your hospital exercise program, and your family members may be asked to help with the exercises.

Ambulation

Your PT will work with you in the hospital after a stroke to help you walk safely. They may provide some level of assistance to you while walking. The different levels of assistance include:

• Dependent
• Maximal assist
• Moderate assist
• Minimal assist
• Contact guard assist
• Stand-by assist

You may also use an assistive device to walk in the hospital after your stroke. Your PT can choose the best device for you. These may include:

• Standard walker
• Wheeled walker
• Lofstrand crutches
• Cane

The ultimate goal of ambulation training is to ensure that you can safely walk well enough to move on to the next venue in your care after a stroke. Your PT can work with you to maximize your walking ability and ensure that you can get around safely.

Exercises that may be done to improve walking ability include:

• Standing hip flexion
• Standing hip abduction
• Standing knee flexion
• Mini squats

Before doing any exercise after a stroke, you must check in with your physician or physical therapist to ensure that it is safe for you to do.

A stroke may affect various body parts in different ways. Your PT may work with you in concert with other healthcare professionals. It is common for a PT and OT to treat a patient together after a stroke. That way, your PT may work on transferring and walking while your OT works with you to improve activities of daily living.

When Can You Go Home?

After a stroke, one common question is, "When can I go home?" Each and every person is different, and a stroke may affect you differently than someone else. The ultimate goal of rehab after a stroke is to help you return to your previous level of function quickly. The typical care map after a stroke may include:

• Acute care hospital
• Rehabilitation or skilled nursing facility (SNF)
• Home care therapy
• Outpatient rehab

Depending on your course of treatment and the severity of your condition, you may be able to leave the hospital and be discharged directly home. Other times, you may need a few weeks of rehab at a dedicated facility prior to returning home. Speak with your physician, discharge planner, and rehab team to understand your specific course of care.

A Word From Verywell

A stroke is a serious medical event that may cause difficulty with functional mobility like moving in bed or walking. Working with a physical therapist in the hospital after a stroke may be helpful in regaining safe mobility. That way, you can get back to your normal work and recreational activities.