--- title: "Stroke Rehabilitation: Ischaemic and Haemorrhagic Stroke" description: "A complete guide to recovery after stroke: the two stroke types, what rehabilitation involves, when it starts, how long it lasts and what affects the outcome." date: 2026-10-24 lastmod: 2026-11-02 canonical: https://drmotiva.com/en/articles/stroke-rehabilitation/ lang: en --- # Stroke Rehabilitation: Ischaemic and Haemorrhagic Stroke A stroke happens when part of the brain suddenly loses its blood supply. Stroke is one of the leading causes of death and long-term disability worldwide [3]. Many people think of stroke as a single, severe event. In reality, strokes range from very mild to severe, and most patients can benefit from a well-planned rehabilitation programme. ## The two main types of stroke - **Ischaemic stroke (about 85% of cases):** an artery supplying the brain is blocked by a clot or narrowed vessel. See [Ischaemic stroke: treatment and recovery](https://drmotiva.com/en/articles/ischemic-stroke-recovery/). - **Haemorrhagic stroke (about 15% of cases):** a blood vessel ruptures and bleeds into or around the brain. See [Brain haemorrhage recovery](https://drmotiva.com/en/articles/brain-haemorrhage-recovery/). - **Transient ischaemic attack (TIA):** symptoms resolve, usually within minutes, but they are an urgent warning sign. See [TIA and minor stroke](https://drmotiva.com/en/articles/tia-and-minor-stroke/). Although the cause differs, the consequences (weakness, speech, swallowing, balance and thinking problems) and the principles of rehabilitation are largely the same for both types [1]. Further reading: the [guide “Stroke”](https://drmotiva.com/en/guides/stroke/) and the articles [Partial Paralysis (Hemiparesis): Causes, Treatment and Rehabilitation](https://drmotiva.com/en/articles/partial-paralysis-hemiparesis/) and [Early Rehabilitation After Stroke: Why Timing Matters](https://drmotiva.com/en/articles/early-rehabilitation-after-stroke/). ## What does stroke rehabilitation involve? Rehabilitation is organised, goal-directed and multidisciplinary [1, 2]. Depending on the patient’s needs, the programme may include: - Physiotherapy for movement, balance and walking - Occupational therapy for hand use and daily activities - Speech and language therapy for communication and swallowing - Management of spasticity, shoulder pain and other complications - Cognitive and psychological support - Where suitable, robot-assisted training and non-invasive brain stimulation ## When should it start, and how long does it last? Care in an organised stroke unit improves outcomes [4]. Rehabilitation begins once the patient is medically stable. The fastest gains usually occur in the first three to six months, but meaningful improvement can continue afterwards with targeted therapy. See [Stroke recovery timeline](https://drmotiva.com/en/articles/stroke-recovery-timeline/). ## What affects recovery? The size and location of the stroke, initial severity, age, other illnesses, the intensity and timing of therapy, and family support all play a role. Each patient’s course is different, so goals are set individually after assessment. In an emergency, sudden facial drooping, arm weakness or speech difficulty means calling your local emergency number immediately. Time is brain. ## The rehabilitation team and assessment Stroke rehabilitation is teamwork. The team is usually led by a PM&R physician and may include physiotherapists, occupational therapists (who train daily activities such as dressing and washing), speech and language therapists, rehabilitation nurses, psychologists and social workers. At the start, the team assesses strength, muscle tone (stiffness or floppiness), sensation, balance, walking, arm and hand use, swallowing, communication, thinking and mood. Standardised scales are used to measure progress over time, for example independence in daily activities. Goals are agreed with the patient and family, such as walking to the bathroom safely or eating with the affected hand, and reviewed regularly. ## Treatment options in general terms - **Task-specific training:** practising real activities (standing up, walking, reaching) many times, with gradually increasing difficulty - **Strength, fitness and balance exercise** adapted to the patient’s condition - **Management of spasticity** (involuntary muscle tightness) with stretching, positioning, splints and, where appropriate, medication or injections decided by the physician - **Speech, swallowing and cognitive therapy** (therapy for memory, attention and planning) - **Supportive technologies** such as electrical stimulation, robot-assisted training or brain stimulation, used alongside active therapy, not instead of it, in selected patients ## What families can do at home - Encourage the exercises set by the team every day, little and often - Let the patient do as much as is safely possible instead of doing tasks for them - Remove trip hazards, improve lighting and fit grab rails where needed - Watch for low mood, unusual tiredness and coughing during meals, and report them - Look after your own health and rest as a caregiver ## When to see your physical medicine and rehabilitation specialist After acute hospital care, the rehabilitation process is best led and advised by a physician specialised in physical medicine and rehabilitation (PM&R, also called physiatry). At home, too, it is worth consulting a PM&R specialist, who examines the patient, sets goals and guides therapy and supportive treatments together with the physiotherapist and the wider team. Ask for a review if: - function is getting worse instead of better, or progress has stalled for several weeks - new pain, stiffness, swelling or falls appear - mood, sleep, swallowing or bladder control change - you are wondering whether a robotic or other advanced therapy might be suitable Whether robotic or other advanced therapies are suitable is decided by a PM&R specialist focused on neurorehabilitation. Prof. Dr. Engin Çakar works in this field and can be consulted online or in person; otherwise, consult a PM&R specialist near you. **Call emergency services immediately** for sudden new weakness, facial drooping, difficulty speaking, a severe headache or loss of consciousness: these can be signs of a new stroke. ## Frequently asked questions **Is rehabilitation different for ischaemic and haemorrhagic stroke?** The medical treatment in the first days differs. Rehabilitation principles are largely shared, adapted to each patient’s deficits. **Is it too late to start rehabilitation months after a stroke?** Not necessarily. Many patients in the chronic phase still have goals that can be worked on. **Who leads the programme?** A physician specialised in physical medicine and rehabilitation coordinates the team and plans the therapy. **How many hours of therapy are needed?** There is no single number. In general, more practice of meaningful tasks is associated with better function, but the amount has to match the patient’s tolerance and medical condition and is set individually. **What happens after discharge from the rehabilitation unit?** Rehabilitation usually continues as outpatient or home-based therapy, with periodic reviews by the PM&R specialist to adjust goals, exercises and aids. ## Assessment and contact You can request an appointment or a second-opinion review of existing reports and imaging: [Contact & second opinion (WhatsApp)](https://drmotiva.com/go/wa?l=en&t=&loc=inline_contact&p=%2Fen%2Farticles%2Fstroke-rehabilitation%2F). This page is general health information. Diagnosis and treatment decisions are made individually after examination. ## Sources 1. Winstein CJ, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016. [PMID: 27145936](https://pubmed.ncbi.nlm.nih.gov/27145936/) 2. Langhorne P, et al. Stroke rehabilitation. Lancet. 2011. [PMID: 21571152](https://pubmed.ncbi.nlm.nih.gov/21571152/) 3. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021. [PMID: 34487721](https://pubmed.ncbi.nlm.nih.gov/34487721/) 4. Langhorne P, et al. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev. 2020. [PMID: 32324916](https://pubmed.ncbi.nlm.nih.gov/32324916/)