Stroke physiotherapy,
relearning to walk after time in bed

Earlier and higher-dose is not always better. The large AVERT trial found that very early, high-dose mobilisation within 24 hours of stroke onset led to a lower proportion of good outcomes at 3 months. A better approach is to have a therapist assess the patient as soon as the condition is stable, and to use the weeks to months when neuroplasticity is strongest for enough repetitive and meaningful training. The most important point is to individualise the programme and avoid pushing every patient hard in the same way.

Physiotherapy costs HK$1,000 for 1 hour and HK$1,300 for 1.5 hours. There is no minimum charge, and a single session can be booked as needed. Travel is included in the main areas of Hong Kong Island, Kowloon and the New Territories, and remote areas (such as outlying islands, Ma On Shan and Sai Kung) may carry a $100–200 travel surcharge. See the fees page for details.

Some patients are assessed as unable to stand or walk, for example because the trunk leans far forward, the core is very weak, or one leg has no strength at all, and this kind of assessment is usually based on help from one person. With help from two or three people, some patients are able to stand or walk, but this varies from person to person. When two people help, both support the patient’s body weight; one keeps the knee straight and the other controls the patient’s balance. In weaker cases, a third person may be needed just to stabilise the knee and pelvis. As the patient slowly improves through neuroplasticity, the number of people needed to help may go down. We offer a two-person mode, in which a physiotherapist and a physiotherapy assistant visit together, at HK$1,300 for 1 hour. When you enquire, you can ask the therapist whether this mode suits the patient, and at the first assessment the therapist brings an extra assistant. A family member can also take the assistant’s place, and the therapist shows them how to help during the session.

Patients are mainly grouped by their current level of function. Severe means bedbound or able to sit up only with help. Moderate means able to stand but with difficulty walking. Mild means able to walk with assistance and needing gait correction. The arm and the leg of the same patient may also differ in severity, so they are assessed separately. The first home assessment places the patient accurately, and then the most suitable direction of training is chosen.

The biggest difference is the training environment. Home treatment lets the patient practise real movements using their own furniture and belongings, such as getting up from their own bed and walking along the corridor of their own home, so the benefit carries over more easily to daily life. The therapist can also identify and change hazardous areas of the home on the spot. One-to-one sessions also make sure the training is enough, continuing and individualised.

Home physiotherapy suits every stage of stroke rehabilitation, from continuing rehabilitation after discharge and maintaining function in the chronic phase, to problems such as limb weakness, poor balance, abnormal gait, high muscle tone (spasticity) or the risk of joint contracture. The assessment and training are matched to the patient’s severity and affected limb.

Physiotherapy focuses on physical mobility (such as muscle strength, balance, walking and limb control). Occupational therapy focuses on turning those abilities into the ability to complete daily activities, such as dressing, cooking and bathing independently. The two often complement each other in stroke rehabilitation and can be done together.