What it covers is the part no discharge letter explains: why movement is needed, why "let them rest" causes harm, how to support someone safely, what never to do, and which signs tell you to stop in time. It is written for families.

The information in this article does not replace a doctor's consultation and is not a programme of exercises. Safe physical load is decided by the treating doctor; the specific tasks, by a physical therapist after an assessment.

Why there is no exercise list here

Work at home genuinely matters: without daily repetitions, two sessions a week will not deliver what a family hopes for. But "work at home" and "exercises off the internet" differ, for three reasons.

Conditions differ. Weakness, reduced sensation, problems with balance and vision, neglect of the affected side of space (objects, and the person's own arm, go unnoticed on one side), swallowing problems, rapid fatigue — any of these changes what is safe today, and can only be judged at an assessment.

Risks that are invisible from outside. The affected arm is vulnerable: the muscles holding the shoulder joint are weakened, and one awkward movement leads to subluxation and lasting pain. Increased muscle tone builds up precisely when someone is forced to overcome resistance by strength. And separately, the heart and blood pressure: the safe load is set by a doctor.

Repetitions. "How many times" has no universal answer: it depends on endurance, tone, blood pressure and which movement is being trained. Any figure given sight unseen is an invention.

So the programme is built by a physical therapist after an assessment, and the family gets tasks tailored to one person, plus technique shown hands-on. This article is not a substitute for sessions with a therapist: see physical therapy and stroke rehabilitation.

Why movement is needed and rest causes harm

The commonest mistake of the first weeks at home is protecting the person: something frightening happened, let them lie down. But immobility after a stroke is not neutral — it works against recovery:

muscles and the cardiovascular system decondition in weeks, not months;
joints lose range, and shortened muscles restrict movement even where strength returned;
balance is untrained, so the first attempt to stand becomes riskier;
the nervous system gets no repetitions, and relearning a movement is built on them;
the affected arm drops out of daily life: everything is done with the stronger hand.

The mirror-image mistake is doing too much for the person. When relatives lovingly dress, lift and move someone, they lose dozens of daily repetitions and, with them, their confidence. The rule: better to let someone do it slowly themselves than to do it quickly for them. Help should be the minimum that keeps the action safe.

The third extreme is pushing for results. Fatigue after a stroke arrives faster than families expect, so the work alternates short active stretches with real rest: stop before exhaustion rather than "push through and finish". On the pace of recovery, see how long stroke rehabilitation takes.

Principles of safe support

The frame inside which any home programme lives, whatever the therapist has set.

Support, do not pull. Your role is to safeguard balance, not move the person by force. If an action only works because you pull, it is too big for today.

Stand on the affected side. That is where balance is most often lost. Support goes around the trunk — never the hand, forearm or armpit.

Prepare every transfer in advance. Most falls at home are not a movement error but an unprepared room.

One technique, every day. If one relative helps someone stand one way and another does it differently, the person learns neither.

Movement in daily life beats "exercises". Walking to the kitchen, reaching for a cup, holding bread with the weaker hand — repetitions with a purpose, done far more willingly than a formal routine.

What never to do

Never pull or lift by the affected arm

The single most important "do not" here. After a stroke the muscles holding the shoulder joint together are weakened, and the arm is heavy. Pulling on it, lifting by the hand, or hooking under the armpit while helping someone stand leads to shoulder subluxation and months of pain that block all further work with that arm. The affected arm is not pulled, not tugged, and never left hanging without support.

Do not "work through the pain"

The idea that a joint must be forced open by enduring pain belongs to another era. Sharp pain during movement is a signal to stop: it drives up protective muscle guarding, and the next day the range is worse. The cause of pain is assessed by a doctor or therapist, not by the family through trial and error.

Do not rush, and do not leave the person alone at the risky spots

Hurry is the commonest companion of a fall: "quickly, I'm late" makes someone shift their weight before they have stabilised. And the bathroom, stairs and balcony are where a fall is most damaging: agree how the person calls for help, and do not let doors be bolted.

Do not add anything on your own

A neighbour's advice, a video on a phone, "a bit more, because it's going well" — changes are discussed with the therapist, who sees whether tone, blood pressure and that shoulder will tolerate them.

Falls: the main risk at home

Falls after a stroke are dangerous twice over. Directly — fractures and head injuries, and on blood thinners, hidden bleeding as well. Indirectly — through fear: after a first fall people often forbid themselves to move, and that harms more than the bruises.

What makes a fall more likely: leg weakness, altered sensation, dizziness when standing up quickly, neglect of the affected side of space, end-of-day fatigue, night-time trips in the dark, hurry — and small things like backless slippers.

What is worth doing in the home:

clear rugs, cables, thresholds and surplus furniture from daily routes;
provide light at night, from the bed to the toilet;
put stable support beside the bed and in the bathroom: a grab rail fixed into the wall, not a wobbly cabinet;
deal with slippery bathroom surfaces, and add a shower seat if standing is hard;
choose shoes with a closed heel and non-slip sole — indoors too;
keep everyday items between waist and shoulder height;
leave the phone where it could be reached from the floor after a fall.

If someone has fallen: do not haul them up or pull them by the arms. First ask whether anything hurts, whether the arms and legs move, and whether they hit their head. If there is severe pain, a suspected head injury, or they cannot get up, call for help.

Transfers and positioning in bed

This is the part where text is least useful. Transfer technique is taught hands-on: the therapist needs to see your height and strength, the flat's layout, and what the person can do alone. What follows are principles, not an instruction.

Transfers. The aim is for the person to do as much as possible themselves while you only guide. The destination is prepared in advance and set as close as possible; wheelchair brakes go on. The load goes through their legs, not your back, and pulling by the arms or lifting under the armpits is not an option. If a transfer needs two people, that is not a reason to manage alone.

Positioning in bed. Three things matter: regular changes of position, support for the affected arm, and an aligned body. The arm never hangs off the bed or an armrest — it rests on a pillow as the therapist showed you, and the shoulder is not trapped under the body's weight. Long spells motionless mean both a pressure-sore risk and rising tone.

Furniture height. Often the most effective "home rehabilitation" of the first week is not a session but a changed bed height and a bathroom rail: they cut the help needed more than any exercise.

Signs of overload: when to stop

Work at home has a limit, and the family has to see it — the therapist is not in the room. The rule: stop before things get bad. Stop immediately if any of these appear:

chest pain, a feeling of tightness, an irregular heartbeat;
breathlessness that does not settle once the person sits and rests;
dizziness, vision darkening, sudden pallor or heavy sweating;
new joint pain — especially in the shoulder of the affected arm;
a sharp rise in tone, with the limb cramping up;
confusion or slowed responses, simple requests no longer understood;
a clear drop in movement quality: veering, shuffling, catching a foot.

Signs that show later: fatigue lasting into the next day, worse sleep, refusal of activities once done calmly. That is not laziness — it signals too much volume.

What to do then: sit the person somewhere safe, let them rest, do not leave them alone — then tell the doctor or therapist. One episode you report changes the programme; ten hidden ones wreck it.

When to call a doctor

Call emergency services immediately — in Ukraine, 103 — if these appear:

the face drooping on one side, a fallen corner of the mouth;
sudden slurred speech, or they stop understanding what is said;
sudden weakness or numbness in an arm, a leg or one side of the body;
sudden loss of vision or double vision;
a very severe headache that came on suddenly;
seizures or loss of consciousness;
chest pain, or breathlessness at rest.

These are signs of an acute event, including a second stroke — nobody goes to a session, nobody waits until morning.

Arrange a doctor's appointment if:

the person fell and hit their head — even feeling fine, and especially on blood thinners;
persistent pain has appeared in the shoulder of the affected arm;
one calf swollen, red or painful — a reason to rule out a clot, not to rub it;
a temperature appears, or choking starts on food or drink;
muscle tone is rising and interferes with movement and care;
blood pressure has become unstable, or non-blanching patches of skin appear where the person lies.

A physical therapist works with movement, balance and everyday skills; diagnosis, medication and blood pressure belong to the doctor and neurologist. General information on rehabilitation in Ukraine is published by the Ministry of Health of Ukraine.

Questions and answers

So what do we actually do at home, if there are no exercises here?

Do every day what the therapist set after the assessment. Alongside that, things that need no prescription: a safe space, independence in daily tasks, the affected arm's position, activity alternating with rest. If you have not seen a therapist yet, do not start with movement: ask the doctor what load is allowed, and prepare the flat.

How many times a day should we practise?

Nobody can answer that sight unseen, and any number from the internet was not written about your relative. The volume depends on endurance, tone, blood pressure and goals; it is set after an assessment and revised as things change.

The person is afraid to stand up after a fall. What helps?

Fear of falling is a real problem, not a whim, and it passes not through persuasion but through a returned sense of control: a safe environment, dependable support, simple actions that reliably succeed, someone present. Tell the therapist — the programme is built around it.

If you are in Zaporizhzhia

Rehab Place is an outpatient physical therapy office: the person lives at home and comes in for one-on-one sessions with Oleksandr Kaliuzhnyi, physical therapist, in practice since 2012. Part of every session is teaching the family — support and transfer technique shown hands-on, not in text.

The first consultation takes about 60 minutes and costs UAH 300; for military personnel and veterans, UAH 210. If bringing the person in is not possible yet, a home visit is considered on an individual basis — ask when you call.

To book or ask a question: +380 97 824 48 01.

More: stroke rehabilitation in Zaporizhzhia · physical therapy · how long recovery takes · prices · find the office.

The information in this article does not replace a doctor's consultation and is not a programme of exercises. For diagnosis, investigations, medication and safe physical load, speak to the treating doctor.

Safe Movement at Home After a Stroke: How to Help Without Harm