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As a general rule of thumb, the earlier patients show recovery after stroke the better the outcome at 6 months. Spontaneous recovery is strongest within the first 4 weeks and then tapers off over the next five to six months. Traditionally, rehabilitation during this time period is more effective than after six months. A number of methods currently are used to facilitate movement in affected extremities (arms/legs) and teach compensatory techniques to perform activities of daily living (ADL).

Traditional Methods

• Conventional - range of motion/strengthening exercises, training in mobility for functional independence
• Neurodevelopmental Training (NDT) - also known as the Bobath technique. This technique was developed in the 1940s and the principle is to reduce muscle spasticity by focusing on normal patterns of movement.
• Proprioceptive neuromuscular facilitation (Knott & Voss) - relies on quick stretching and manual resistance of muscle activation of the limbs in functional directions, which often are spiral and diagonal in direction.
• Brunnstrom technique - facilitates synergistic patterns of movement that develop during recovery from hemiplegia (paralysis of one side of the body). Development of flexor and extensor synergies is encouraged during early recovery with the hope that synergic activation of muscles will transition into voluntary activation of movements
• Rood technique - modifies movement with cutaneous sensory stimulation

When these approaches to stroke recovery are compared to each other, no one method appears to be more effective than another. However, NDT alone may require prolonged periods of time to produce functional results which may be accomplished faster in conjunction with other methods. Some rehabilitation facilities also incorporate biofeedback into their program to complement other types of therapy.

Approaches Based on Motor Learning Theory

Many approaches to motor recovery after stroke are goal oriented, task specific approaches which developed from the application of motor learning theory. This stresses structured practice of goal oriented tasks with specific feedback patterns for successful transfer and retention of a new skill. Stroke survivors practice changing motor behavior rather than normalizing movement patterns. Because of impairments in motor or sensory systems, transfers, activities of daily living (ADL) and ambulation become new skills, and must be taught and performed in different ways.

• Constraint Induced Movement Therapy (CIMT) - the unaffected limb is immobilized in a splint inside a sling for 90% of waking hours over 2-week period, except weekends. The affected limb is used repeatedly in a number of exercises for a period of 6 to 7 hours per day, for 10 weekdays. The most recent studies have demonstrated improvements in the amount and quality of movement by at least 100% in both laboratory and "real-world" settings. However, constraint-induced movement therapy requires movement of at least 10 degrees of finger extension and 20 degrees of wrist extension in the affected limb. Furthermore, the endurance to tolerate the intensity of training significantly limits the number of stroke survivors who can participate in this protocol.
• Partial weight support treadmill training - stroke survivors are trained to ambulate in a harness system which decreases the amount of weight-bearing required to walk. The efficacy of this technique appears to increase with treadmill speed. Training in the support system may significantly improve balance, motor recovery, overground walking speed, and possibly overground walking endurance. It is not clear whether training with body-weight support decreases the length of inpatient rehabilitation.