Inpatient neurological rehabilitation

Three to five therapy sessions a day, five to six days a week, each 45 to 60 minutes: physiotherapy, occupational therapy, speech and language therapy where needed, and robotic or technology-assisted sessions. Between sessions there is a structured programme of independent practice on the ward rather than unfilled time.

A physician in physical medicine and rehabilitation leads the case and reviews weekly. Nursing is rehabilitation-trained, which matters more than it sounds — how a patient is transferred, positioned and helped to dress on the ward either reinforces or undoes what happened in therapy.

Patients after stroke, traumatic brain injury, spinal cord injury, or in the recovery phase of other neurological conditions, who need daily multidisciplinary therapy and are not yet safe or independent enough to travel to appointments.

It requires medical stability, sufficient endurance to tolerate several sessions a day, and enough alertness to participate. Patients who do not yet meet the endurance requirement start at a lower intensity and build, rather than being turned away.

Goals are agreed with the patient and family in the first week and written down in concrete terms — walking a stated distance, transferring independently, managing a specific daily task. Vague goals produce vague programmes.

Standardised measures are recorded at admission, at review points and at discharge. You receive those numbers, not a narrative. If a goal was not met, the discharge report says so and explains why.

A written home programme, equipment recommendations, and a clear statement of what to continue, for how long, and what should be reassessed. For international patients this includes what can be sourced in your own country and what you should take with you.

Remote follow-up is arranged before you leave rather than offered afterwards. After a moderate to severe brain injury, there is moderate-strength evidence that therapy continued after discharge helps to hold on to the gains of early rehabilitation 2.

For most patients on this programme a companion is required rather than suggested. They are trained in transfers and handling, shown the home programme and asked to practise it under supervision, and taught when not to help — because a person assisted with everything they can nearly do stops being able to do it.

They are not in therapy sessions as a rule; sessions go better without an audience. They are brought in for the parts they need to learn and for the family training blocks.

The plan written before arrival is a proposal based on records. The assessment on day one is what settles it, and where the two differ we say so immediately rather than proceeding with a plan we no longer believe in.

Length can be extended where progress justifies it and shortened where a plateau is genuine. Both are discussed with a reason attached, not presented as a fixed package.

Not automatically. A Cochrane review of 21 trials with 1,412 people after stroke found that adding more time to the same type of rehabilitation made little or no difference to daily activities, with a small benefit for movement impairment; the certainty of that evidence was low to very low 1. Trials in which the extra time was large showed greater benefit, but there is not yet enough evidence to set a minimum daily amount 1.

After moderate to severe brain injury in adults of working age, the picture is clearer: a Cochrane review of 19 studies with 3,480 people found strong evidence that more intensive programmes bring functional gains sooner 2. Hours matter, then, but so does what fills them, which is why the timetable is built around the patient's goals and what they can sustain.