Stroke

A stroke interrupts the blood supply to part of the brain. The functions that part controlled — moving an arm, keeping balance, forming words, swallowing — can be lost or weakened. Which abilities are affected depends on where in the brain the stroke happened, not on how severe it felt at the time.

The brain can reorganise itself and take over lost functions through neighbouring areas. This is called neuroplasticity, and it is the mechanism rehabilitation works with. It is strongest in the first months after the stroke, which is why the timing of rehabilitation matters as much as its content 2.

The signs appear suddenly. The face droops on one side, one arm drifts down when both are raised, and speech becomes slurred or muddled. Any one of the three is enough to call an ambulance — waiting to see whether it passes is the most common and most costly mistake families make 1.

Less familiar signs are missed more often: sudden loss or blurring of vision in one eye, sudden severe headache with no cause, sudden dizziness with loss of balance, or numbness down one side. Symptoms that resolve within minutes still matter — a transient ischaemic attack often precedes a larger stroke 1.

There are two mechanisms with the same name. In an ischaemic stroke — the large majority — a clot blocks an artery supplying the brain. In a haemorrhagic stroke a vessel bursts and blood presses on the tissue around it. The distinction is not academic: it decides the emergency treatment, and it shapes what the first weeks of recovery look like.

The risks that matter most are the ones that can be changed: high blood pressure above all, then atrial fibrillation, diabetes, smoking, high cholesterol, physical inactivity and excess weight. Age and family history add to the picture but cannot be altered. Someone who has had one stroke is at higher risk of another, which is why secondary prevention runs alongside rehabilitation rather than after it 3.

Brain imaging comes first and comes fast. A CT scan is usually done within minutes of arrival because it separates a bleed from a clot, and the two are treated in opposite ways. MRI shows the damaged area in more detail and is often added later, particularly when the stroke is small or the timing is unclear 1.

Alongside imaging, the cause is investigated: blood pressure, blood glucose and cholesterol, an ECG and often longer heart-rhythm monitoring to look for atrial fibrillation, and ultrasound of the neck arteries. For rehabilitation the imaging matters less than the functional assessment — what the person can and cannot do now — but the discharge summary and the scans are what let a rehabilitation physician judge a case from abroad.

As soon as the person is medically stable. International stroke guidelines recommend beginning rehabilitation in the acute hospital and continuing it without a gap 4. In practice, the gap between discharge and the start of intensive rehabilitation is where recovery is most often lost — not because the treatment is wrong, but because the waiting time is long.

This is the single reason most international patients contact us. If you are currently waiting for an inpatient place, it is worth asking two questions of any provider, including us: when can you actually start, and how many hours of therapy will there be each day.

Recovery is fastest in the first three to six months, continues more slowly for the next two to three years, and further gains remain possible after that 5. The early period is a window in which the same effort produces more change — not a deadline after which nothing can be gained.

Progress is rarely even. The leg usually recovers ahead of the arm, because walking can be retrained with body weight and repetition while hand function needs finer control. Fatigue, low mood and difficulty concentrating are common and are part of the condition rather than a lack of effort. What predicts outcome most reliably is the starting severity and how early intensive therapy begins 2.

A typical inpatient day runs from morning assessment through to late afternoon, with four to six hours of active therapy split into sessions of 30 to 45 minutes. Sessions alternate between physiotherapy, robotic gait training, occupational therapy for arm and hand function, and where needed speech and swallowing therapy.

A companion can stay with the patient throughout. For families travelling from abroad this is not a comfort detail: the person who will support recovery at home learns the exercises alongside the therapist during the stay.