“When will I be able to walk…?”
“When will I be able to speak…?”
These are questions that physical therapists are often asked by patients or their relatives, which are difficult to answer precisely. However, what can be more clearly explained is why we do physical therapy for stroke patients, how much improvement can be expected, and what factors influence the outcome.
Stroke is a condition where the brain lacks blood or oxygen supply, causing brain damage. The severity of the disability depends on the location of the brain tissue that is damaged.
After receiving medication and various medical procedures from doctors until the condition stabilizes—which depends on the pathology and lesions of the patient—most patients still experience loss of control in one side of the body’s limbs, speech, swallowing, and even emotional instability. Some may lose memory and have abnormal thinking processes.
These symptoms result from brain injury, and their severity depends on the extent of brain damage. These problems require physical therapy to correct, restore, and treat early to prevent complications. Early physical therapy leads to less disability, and some patients can return to living and performing daily activities almost normally.
Physical therapists are responsible for caring for, treating, and rehabilitating the physical functions of patients who have lost control or have weakness due to brain injury. They help patients return to work and daily life with better quality of life, reducing the burden on family and society. The focus is on muscle control training, muscle strengthening, reducing spasticity, and analyzing patients’ deficits in activities such as moving in bed, sitting, standing, and walking to plan treatment and rehabilitation. Techniques used include joint mobilization to prevent stiffness, exercise stimulation to increase muscle strength, balance training, gait correction to approximate normal walking, and providing simple, appropriate home exercises tailored to each patient’s condition. Rehabilitation also involves other professionals such as occupational therapists who manage swallowing and complex activities, and speech therapists who assist with speech. Some cases may also involve psychologists, rehabilitation physicians, and social workers.
The appropriate time to start physical therapy is after the patient’s condition stabilizes and the doctor deems it suitable. The first 3-6 months after hemiplegia or paralysis is the period when patients recover the fastest, known as the “golden period of recovery,” resulting from the brain’s own healing combined with learning movement. After this, recovery slows down. When the brain’s self-recovery phase ends, it enters a phase of adaptation of the remaining brain cells. If movement training is done correctly, the brain can continue to develop for up to 7 years before slowing down. Conversely, if patients practice incorrect movement skills, recovery slows not because of the brain but due to changes in body structure and habits that prevent improvement. Movement problems then become increasingly difficult to resolve over time.
Therefore, the success of early physical therapy depends on the extent of injury, the patient’s mental state, cooperation, caregiver understanding, and consistent treatment. These factors cause recovery to vary among individuals. Regarding the question of why physical therapy is done for stroke patients and how much improvement can be expected, the answer depends on these factors.
Rattana Jitwongtrakool, PT
Senior Physical Therapist, Physical Therapy Profession