Stroke Rehabilitation: What to Expect During Your Recovery

Strokes can lead to a wide variety of ongoing symptoms and disabilities. Depending on the part of the brain that was affected, these can include anything from weakness of one half of the body to difficulty speaking or processing information. But stroke rehabilitation (rehab) can help. 

A stroke rehab is a facility designed to provide a customized approach to recovery. There, people work with specialists who are specifically trained in treating the physical and mental challenges that can happen after a stroke. If you or someone you know has had a stroke, here’s what to know and expect at these facilities. 

What does stroke rehab entail?

When you’re admitted to the hospital for a stroke, many times you’ll go from the hospital to a stroke rehab before you return home. This is because these facilities offer the best chance for a full and fast recovery. Stroke rehabs can be located within a hospital, or they can be their own facility. Either way, both are known as an “inpatient rehabilitation facility” (IRF). 

When you first arrive

When you’re admitted to an IRF for stroke rehabilitation, a specialist — usually a physical medicine and rehabilitation (PM&R) physician — will do a careful assessment to create an individualized recovery plan. These are some of the important things that the rehabilitation provider will do:

• Physical exam: When you arrive, they’ll perform a careful assessment of your physical and mental strengths and weaknesses to create your treatment plan. To assess your progress, they’ll do this at regular intervals.

• Medication review: Your provider will carefully review your current medications. This lets them identify side effects and figure out if you can stop or reduce any of them. They can also determine if you need new medications to help with pain, bowel and bladder function, concentration, or mood.

• Condition review: Rehab providers consider the entire picture of your physical and mental health, not just your stroke symptoms. They make sure your other medical conditions are addressed and treated. They also consider your frame of mind and address any signs of depression, anxiety, or challenges adjusting.

• Recovery goals: Your provider will want to know what your life was like before the stroke. And they will work with you to identify your personal goals for your recovery — and specifically what you want to be able to do after discharge.

While you are there

After their assessments, your providers will develop a recovery plan that is tailored to your specific needs. This will include a range of activities and specialists. 

Physical exercise

Research shows that early and intensive physical activity (even if it’s challenging) offers the best chance to recover muscle strength and coordination. In the IRF, you’ll likely do at least 3 hours of activities, 5 days a week. 

The IRF has specialized equipment to help you participate as fully as possible. A physical therapist (PT) will create a plan of care for mobility goals such as standing, transferring, walking with a device, or pushing a wheelchair. Rehab nurses work closely with PTs on increasing safe mobility.

Activities of daily living

After a stroke, simple activities may be more challenging — like getting out of bed, bathing, dressing, and toileting. Occupational therapists (OTs) specialize in helping you perform these basic tasks. 

They’ll work with you to find “work-arounds” to get the job done, improve hand-eye coordination, and teach caregivers how to help if needed. OTs (along with recreation therapists) will also focus on skills that will help you return to work or resume your hobbies.

Cognitive, speech, and swallowing activities

Strokes can affect memory, thinking, and concentration. Your speech may be slurred, and swallowing may be difficult due to weakened tongue and throat muscles. Speech and language pathologists (SLPs) specialize in improving these symptoms. They can use special technology to diagnose and treat swallowing difficulties (including a modified barium swallow study or flexible endoscopic evaluation of swallowing study). They also have many tools to help with reasoning and problem-solving skills. 

Bodily function restoration

Strokes can affect things like eating, drinking, urinating, and bowel movements. Your providers will help you get these bodily functions back to normal with the help of medications and routines. 

Skin safety

After a stroke, people generally don’t move around as easily. This can cause prolonged pressure on the skin. The rehabilitation providers will do daily skin checks to make sure that there’s no damage or breakdown. They use special mattresses, creams, and turning techniques to keep the skin healthy.

Before you go 

Throughout your stay, your rehab team will plan your transition to home. This is so you have all the support you need in place before discharge. This includes:

• Durable medical equipment: To help you be as independent as possible, PTs, OTs, and SLPs may recommend assistive devices, like canes, walkers, and wheelchairs. Other equipment may include reachers, lifts, shower chairs, tub benches, and orthotics. 

• Caregiver training: Toward the end of the rehab stay, you’ll be invited to have your friends, family, or personal-care assistants attend training sessions with your therapists and care team. This way they can learn what kind of help is needed. This training gives you and your caregivers confidence to reproduce the lessons at home.

• Discharge planning: About 80% of people go home or to an assisted-living environment after rehab in an IRF. Case managers (discharge planners) will make sure you have the necessary services and equipment at the time of discharge. They can also help with follow-up appointments and referrals to social workers in the event of financial or social challenges.

How long does stroke rehab last?

Stroke recovery time varies from person to person. It depends on the severity of someone’s stroke as well as their other medical conditions:

• Mild strokes: People with mild strokes can often go home with home health services right after they leave the hospital. Home health nurses and therapists continue care visits at home for as long as necessary, usually a few weeks.

• Moderate to severe strokes: People with these strokes can often transfer to an IRF, where they stay from 1 to 4 weeks. 

• Very severe strokes: Good options for people with these strokes include long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs). This includes people who have severe brain damage and can’t follow simple instructions or tolerate 3 hours of therapy per day.

The general rule of thumb is that 70% of stroke recovery occurs in the first 3 months. Continued recovery will occur at a slower pace for another 1 to 2 years. This is why it’s very important to get intensive rehabilitation as early as possible after a stroke.

About 30% of people who have had a stroke will have some permanent symptoms (usually muscle weakness). But rehab specialists help you find ways to cope with and adapt to those symptoms. 

Caregivers during stroke rehabilitation

The inpatient stroke rehabilitation team can consist of many specialists, most of whom will be involved in your care. You might work with several of each type, including a: 

• Rehabilitation physician

• Rehabilitation nurse

• Physical therapist

• Occupational therapist

• Speech and language pathologist

• Respiratory therapist

• Neuropsychologist

• Psychologist

• Orthotics and prosthetics specialist

• Recreation therapist

• Case manager

• Social worker

Friends, family members, or staff who will help care for you after discharge are encouraged to participate in your therapy. They’ll be offered caregiver training before discharge.

How much does stroke rehabilitation cost?

Health insurance usually covers rehabilitation care. Fee-for-service Medicare plans do not require prior authorization for admission to an IRF and allow the fastest transfers to recovery. 

Private insurance plans and managed Medicare plans require prior authorizations for IRF level of care. This process can take days to weeks, and sometimes the transfer request is denied. Physicians and patients may appeal, but there’s no guarantee of success. These delays in care are under scrutiny but remain an unfortunate barrier to stroke recovery.

In cases where a person is uninsured and does not qualify for Medicaid (there are certain poverty criteria), self-pay stays are a possibility. But they are cost-prohibitive for most people, as inpatient rehabilitation can cost thousands of dollars a day. 

Things to bring to stroke rehab

Most stroke rehab treatment involves simulating your life at home and setting you up to succeed there. So consider asking a caregiver or friend to bring in the following items:

• Photos of your house, inside and out: Seeing details about your home setup and transportation help your therapists anticipate your needs. Are there stairs to enter? How wide are the doors? Will you be getting in and out of a car or truck? 

• Clothes and nonslip shoes: Therapists will help you with dressing techniques and mobility tasks. And they want you to try doing it safely with your usual belongings. You will not be in a hospital gown for very long. Loose fitting clothing may be best at first.

• Equipment you use on a daily basis: Some people use canes, walkers, orthotic devices, and CPAPs daily. Others use pill boxes to organize their medications. Some have smartphones, laptops, or ledgers. Therapists can use these items in your sessions and track your progress.

• Home medication list: Your rehab team will make sure you take everything you need — and nothing you don’t need. If you take medication that the hospital may not have in stock during your stay — like vitamins, supplements, or rare medications  — bring them with you so you don’t miss a dose. 

• Contact list and healthcare forms: Make sure the rehab facility has your emergency contact information in your chart. And bring any relevant legal documents, like your code status or POLST, healthcare power of attorney document, or advance directive. The IRF is considered separate from the hospital (even if it’s in the same building). So your new chart may not have copies of these items, even if you already gave them to the hospital.

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Written by:

Valerie Anne Jones, MD

Val Jones, MD, is a physician who is certified by the American Board of Physical Medicine and Rehabilitation (ABPMR).

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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