Physiotherapists bridge service gaps in stroke rehabilitation

Australian stroke survivors face significant barriers to rehabilitation, particularly more than six months after stroke, when access to therapy sharply declines (Scrivener et al 2022). 

Public rehabilitation services are typically time-limited and their abrupt cessation after six months leaves many without the support needed for long-term recovery (Scrivener et al 2022). 

Access is especially limited in rural and remote areas, where specialised services are scarce (Stroke Foundation 2024). 

For those with suitable private health cover, private hospitals remain one of the few settings where ongoing rehabilitation is available.

Some access gaps are filled through private practice, supported by NDIS funding and chronic disease management plans.

However, these schemes do not account for the frequency or intensity needed. Community support groups and clinical trials are other potential avenues to further rehabilitation treatment.

Physiotherapists can play a key role in bridging service gaps. 

An awareness of the available options allows for bespoke treatment plans that leverage access to multiple schemes to better meet the rehabilitation needs of stroke survivors. 

Physiotherapists and their clients who have survived stroke can visit here for more information on enrolling in clinical trials, here for stroke support groups and here to find out more about chronic disease management plans.

Physiotherapy supports secondary stroke prevention

The prevention of secondary strokes is an important component of post-stroke rehabilitation. 

Modifiable risk factors account for 82–92 per cent of stroke risk, including diet, blood pressure, obesity, smoking and physical activity (O’Donnell et al 2010). 

Physical activity guidelines for stroke survivors recommend moderate-intensity activity for at least 10 minutes on most (if not all) days or 20 minutes, twice per week, at a vigorous intensity (Kleindorfer et al 2021). 

Per day, 6500–8500 steps are recommended (Tudor-Locke et al 2011).

Stroke survivors could exercise independently or a structured program may be more suitable. 

For those who are able, one option is high-intensity interval training, with emerging evidence showing safe and positive outcomes (Moncion et al 2024, Baricich et al 2024, Boyne et al 2023). 

Keeping active throughout the day and reducing sedentary time is also crucial and can be successfully achieved via social and community activities (Espernberger et al 2025). 

Depending on ability, these can include structured exercise, community groups, social activities, work or volunteering, personal roles and responsibilities, and hobbies.

Resources to consider include the i-REBOUND After Stroke website, the Stroke Foundation’s Living Well After Stroke program here and any secondary stroke prevention programs that operate in your area.

Falls prevention is important after stroke

Falls are a common complication of stroke within the hospital setting and even more so within the community.

It has been reported that up to 73 per cent of community-dwelling stroke survivors experience at least one fall annually (Dennison et al 2019). 

When compared to the general population, stroke survivors who fall are at greater risk of injury, including fractures (Yang et al 2021).

Falls can place a significant psychological burden on stroke survivors as well as an economic burden on the community.

It is important for physiotherapists to deliver effective, evidence-based interventions to prevent falls from occurring. 

However, there is limited evidence on effective falls prevention in stroke survivors and physiotherapists should follow the recommended principles for preventing falls in the general older population. 

Stroke survivors who are assessed as being at risk of falling should be provided with an individually prescribed exercise program and advice on safety. 

Stroke-related impairments that can contribute to falls include muscle weakness, sensory loss, reduced attention and visuospatial issues. 

Physiotherapists should also be aware that ‘non-serious’ falls in stroke survivors are predictive of future falls, which may limit the stroke survivor’s confidence and subsequent activity levels (Dennison et al 2019).

Post-stroke deficits may be invisible

Stroke can have a profound impact that extends beyond physical limitations. 

For example, pain, fatigue and depression may begin to develop soon after acute care finishes (Chohan et al 2019). 

Within the multidisciplinary team, physiotherapists play a key role in identifying, assessing and treating these complications while supporting patients and their families through the rehabilitation process.

Pain is common after stroke and affects stroke survivors’ quality of life, yet it is often under-recognised and masked by impaired cognition (Delpont et al 2018). 

Common pain syndromes for stroke survivors include shoulder pain, central post-stroke pain and headache. 

Despite a lack of strong, evidence-based recommendations, physiotherapy is reported to be effective in managing chronic pain following stroke (Haslam et al 2021). 

Fatigue is another complication frequently reported by stroke survivors that can negatively affect their functional recovery. 

Graded activity training with cognitive therapy was found to significantly reduce post-stroke fatigue and improve endurance (Alahmari et al 2025). 

Post-stroke depression is associated with poorer functional independence in activities of daily living (Ezema et al 2019). 

For stroke survivors who have depression or are displaying depressive symptoms, a structured exercise program that involves resistance training is recommended (Saunders et al 2020).

Physiotherapists can help address upper limb deficits

Weakness in the upper limb affects almost half of all stroke survivors (Dalton et al 2024). 

However, upper limb rehabilitation is often overlooked in the early period after a stroke, leaving most stroke survivors with ongoing impairment (Nakayama et al 1994). 

Although upper limb function is more closely linked to independent living and quality of life than lower limb function (Lang et al 2013), this vital aspect of post-stroke recovery is frequently deprioritised when the push for faster discharge forces clinicians to prioritise mobility. 

Resistance from healthcare providers to adopting the technology and equipment required to support high-quality upper limb rehabilitation continues to compound this deprioritisation (Wodu et al 2025).

The best evidence for upper limb recovery after stroke supports high dose therapy (Schneider et al 2016) and the patient is agnostic to which allied health discipline provides such therapy (Kelly et al 2020). 

Gone are the days of thinking of the upper limb as the occupational therapist’s problem. 

If stroke survivors are to regain meaningful upper limb function, physiotherapists must take a leading role in the management of the post-stroke upper limb.

>>Dr Tamina Levy APAM is an advanced practitioner neurological physiotherapist at Flinders Medical Centre and a senior lecturer at Flinders University, Adelaide. Tamina explored exercise adherence in survivors of stroke in her PhD and continues to develop related resources. She is a member of the Clinical Council of the Stroke Foundation and the APA Neurology group.

>>Matt Wingfield APAM is a senior physiotherapist in neurological rehabilitation at Epworth HealthCare. Matt is a lecturer in physiotherapy and a PhD candidate at the University of Melbourne, exploring motor recovery of the upper limb. He is a member and past chair of the Victorian branch of the Neurology group.

>>Yinn Ting (Alex) Ho MACP is an APA Titled Gerontological Physiotherapist and the regional manager at United Physiotherapy Group. Alex has a keen interest in assisting older adults to reach their potential and maximise their quality of life. He is the vice chair of the Victorian branch of the APA Gerontology group.

>>Neha Awasthi APAM is a clinical supervisor (residential and homecare) at Vivir Healthcare and an experienced allied health
professional with a strong focus on aged care and community-based rehabilitation. Neha is a committee member of the Victorian branch of the Gerontology group and a member of the Neurology group.

>>Karl (Charlie) Espernberger APAM (he/him) is a senior physiotherapist and neurological and NDIS team lead at Donvale Rehabilitation Hospital. Charlie is a PhD candidate with a broad interest in neurology; his research focuses on physical activity in stroke survivors. He is a member of the Neurology group.

COURSE OF INTEREST: Post-stroke lateropulsion—pushing for greater understanding of rehabilitation and recovery 

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