Stroke: Is there one type of physiotherapy that helps people regain more independence?

No one specific style of physiotherapy has been shown to be better than others. However, a mix of physiotherapy treatments that target specific problems like helping people learn to walk again can increase people's independence after a stroke.

A stroke, also called a "brain attack", harms the brain by interrupting its blood flow. This may happen if a blood clot from somewhere else in the body travels to the brain and blocks a blood vessel there. Changes in the wall of an artery can cause a blood vessel to become blocked too. Less commonly, strokes are caused by bleeding in the brain (cerebral haemorrhage). This can happen, for example, if a blood vessel tears.

A stroke can lead to paralysis of some parts of the body or difficulties with various physical functions, such as speaking. About one person out of every 1,000 will have a stroke, usually when they are older. Out of people over the age of 85, 2% (two in 100) will have a stroke.

After a stroke, physiotherapy is an important part of rehabilitation and the long-term management of stroke-related problems. The treatments used by physiotherapists aim to improve mobility and independence. There are individual treatments for specific problems. These include supported treadmill therapy that aims to help people learn to walk again, or specific exercises or machines that aim to help improve people's balance. Another example of a specific physiotherapy treatment is called "constraint-induced movement therapy". That involves making the person use their weaker side by restricting the side of their body that was not affected by the stroke.

As well as having specific treatments that aim to help people restore their physical abilities, there are also other types of physiotherapy approaches or styles for stroke rehabilitation. These styles include the "neurophysiological approach", where the physiotherapist moves the person's limbs in a certain way. A second major approach is called the "motor learning approach". Here a person practices tasks that they find difficult to do. The third major physiotherapy approach is the "orthopaedic approach", where the physiotherapist gets the person to use the unaffected side of their body to compensate for the paralysed side. This means that the kind of treatment or advice people get can vary greatly, depending on the individual therapist who is helping them.

Physiotherapy programmes can use a mix of these approaches or a single approach. Some use a wide variety of different treatments. As well as individual physiotherapists preferring to use certain treatments, there are also differences from country to country. For example, one study shows that stroke rehabilitation programmes in Britain and Belgium might include more exercises than programmes in Germany and Switzerland.

To see if any particular overall approach is more effective than others, researchers from the Cochrane Collaboration looked at 21 clinical trials that used single or mixed physiotherapy treatments for people with strokes. Because the individual trials were small, there is not a lot of evidence about every one of the possible styles of physiotherapy. In considering the trials, the researchers focused on how effectively the treatments restored a person's balance, strength and walking ability, as well as their level of independence.

The trials did not provide information on what the patients or carers thought of the programmes, so we do not know what kind of physiotherapy people preferred. There is also no specific information about whether certain groups of people benefit more from a treatment than others. For example, something may work better in younger or older people with strokes.

The therapies and patients were too different to make it clear what might work best, or whether any of the therapies can cause harm. However, some trials did suggest that physiotherapy that is based on a mixture of various treatments could be more effective at improving people's independence.

Another form of treatment used in stroke rehabilitation is occupational therapy. This aims to help people regain the ability to do everyday tasks. You can read more about this here (URL: index.497.316.en.html).