How we treat stroke

The strongest predictor of motor recovery after stroke is not which method is used but how much therapy is delivered. That is why our programme is specified in hours per day rather than in a list of techniques: four to six hours of active therapy, five to six days a week.

This is deliberately demanding. The first three days are the hardest part of the stay, and we tell families that before admission rather than after.

Physiotherapy works on standing, balance and walking. Occupational therapy works on the arm, the hand and the tasks of daily life. Speech and language therapy works on communication and swallowing where these are affected. A rehabilitation physician reviews progress daily and adjusts the plan.

The disciplines share one written plan and one set of goals. Without that, therapies compete for the same hours and the patient is the one who loses.

Robotic gait training lets us deliver a high volume of guided steps in a session, more than a therapist can sustain manually. Robotic arm support does the same for reaching and grasping. The evidence points to a benefit from combining robotic and conventional therapy, not from replacing one with the other.

A device is a way of increasing dose. If a patient can already perform the movement, the device adds nothing and the hour is better spent elsewhere.