Navigating Recovery After Stroke: A Physical Therapist’s Perspective

By Liz Fuhrhop, Doctor of Physical Therapy and Clinical Support Specialist for MYOLYN

As a physical therapist who worked for years at the top-ranked rehabilitation hospital in the country, a sizable majority of the patients I’ve treated throughout my career have been affected by stroke. And that’s not surprising since every year more than 795,000 people in the US alone have a stroke, according to the CDC.

What is a stroke?

There are two main types of strokes: ischemic and hemorrhagic. Ischemic strokes are more common and occur when blood flow is blocked to the brain, causing rapid death of brain cells. A hemorrhagic stroke involves bleeding in the brain, also causing damage to brain cells.

After stroke, patients can present with a number of physical challenges, depending on where and how much the brain is impacted. One of the most common presentations after stroke is referred to as hemiparesis or hemiplegia—meaning one side of the body has significant muscle weakness or paralysis. It’s common to also experience issues with coordination, stiffness (spasticity), and changes in sensation in the arm and leg. All of these impairments can lead to difficulty carrying out activities of daily living, including standing, balancing, and walking. 

What happens after a stroke?

After a stroke and once medically stabilized, patients are typically sent for inpatient rehabilitation until they are deemed safe to return home. After discharge, most patients are then referred for outpatient therapy, often consisting of physical, occupational, and sometimes speech therapies. Outpatient services are carried out as long as “medically necessary,” however once a patient demonstrates a plateau in progress, they will likely be discharged. Patients are often frustrated when therapy ends, as they may not be back to their prior level of function.

In terms of physical recovery, we often see the quickest gains within the first 6 months after stroke. This does not mean that further recovery is not possible after 6 months, but improvement tends to be slower and requires a lot of intention. This is why it’s so critical to make sure you are getting the most out of your therapy sessions and work with therapists who are highly proficient in working with the post-stroke population.

How can I best recover after a stroke?

You may be familiar with the concept of neuroplasticity, or the nervous system’s ability to rewire and create new connections. There are 10 principles of neuroplasticity; one especially important principle is intensity– exercise and rehabilitation interventions need to be intense, or demanding in effort, in order to drive neuroplasticity and maximize recovery. Simply put, without intensity, we won’t get optimal results. Along with intensity, it’s also important to understand the role repetition plays in promoting neuroplasticity. It has been suggested that you need many hundreds of repetitions, if not thousands, to relearn various motor skills after stroke. 

This means– inpatient and outpatient therapy sessions– as well as activities at home– need to be performed at an intensity that you find hard (see this article on a commonly used rating scale used by physical therapists) and you need to repeat hundreds of repetitions to relearn motor skills.

What exercises are good for stroke recovery?

Because your recovery requires hundreds to thousands of repetitions, you need to be working diligently at home between therapy appointments. Talk to your physical therapist about developing a customized home exercise program that’s tailored to your specific ability level and the impairments you want to target. Below are some basic physical therapy exercises often prescribed to patients post-stroke– be sure to have a companion standing by to ensure safety if you are at risk for falls.

• Bridges: lying on your back, bend your knees and place your feet flat on the floor. Press through your heels and lift your hips as high as you can and hold for a count of three— try to match your weaker side to your strong side. Slowly return your hips back down. You can also try a single leg variation of this exercise, where your strong side is extended in front of you and only your affected leg is bridging.
• Sit to stand: practice standing from a sitting position with as little use of your arms as possible– the key is scooting forward toward the edge of your seat and leaning forward (“nose over toes!”) to optimize your setup. Make sure your affected leg is working just as much as your strong side to push yourself into standing. To ensure patients aren’t overrelying on the stronger side, PTs will often have you place your stronger side on a small step, making it harder to use. If you try this, again, only do so with direct hands-on supervision.
• Ankle pumps: while seated with feet flat on the floor, try to lift your toes off the floor. If you can’t lift your weaker foot very high, you can use a gait belt or other band to provide a little assistance as needed to lift to move through your full range of motion. Then press through your toes and lift your heels off the floor, thinking about squeezing your calf muscles.

Another powerful exercise option for stroke recovery is Functional Electrical Stimulation (FES) cycling. This innovative intervention uses small, targeted electrical pulses to activate muscles in individuals with paralysis or significant weakness. By stimulating specific muscle groups, FES enables the legs to pedal a stationary cycle—even when voluntary movement is limited. The result is a safe, effective way to promote muscle strengthening, cardiovascular fitness, and improved motor control during rehabilitation.

FES cycles are typically found in neuro-focused PT clinics, as well as most “neuro gyms” or activity-based therapy facilities. But you can also look into getting an FES cycle, like the MyoCycle, for home. This way you’ll have unrestricted access to high-quality therapy at home, helping you get the intensity and repetition you need to help boost your recovery efforts.

Is FES cycling beneficial after a stroke?

Published research on FES cycling has shown improved strength, balance, walking distance and spasticity in participants recovering from stroke. FES cycling is also an effective, intensive workout, activating weakened muscles of the trunk, thigh, and lower leg, without the risk of falling. 

Here are some highlights of recent research:

• In 2019, Shariat et al. provided further evidence that FES cycling improves functional mobility and gait speed, in addition to spasticity and range of motion, when using an interval approach to stimulation in patients with chronic stroke.
• in 2021, Zhang et al. demonstrated that FES cycling can promote motor recovery in the lower limbs after stroke.
• Bao and colleagues (2021) investigated the effects of FES cycling on neuromuscular interactions in individuals with chronic stroke and showed enhanced functional connectivity between the damaged areas of the brain and the affected leg, suggesting bidirectional changes in both descending and ascending sensorimotor pathways. Clinically, the participants showed improvements in lower leg function as well as improved balance and a reduced risk for falls.

Why FES cycling should be included in every stroke recovery plan

Outside of the benefits reported in the research, I’ve seen firsthand how powerful FES cycling can be in stroke rehabilitation. It’s one of my favorite tools because it consistently delivers results.

One patient stands out—she had severe weakness in her affected leg and was so unstable that we began the process of getting her a full leg brace (KAFO) to prevent her knee from buckling. While we waited for the brace, we started intensive FES cycling. Just two weeks later, her quad had strengthened so much that she barely needed the KAFO. We were able to shift to a much simpler ankle brace (AFO), accelerating her mobility and confidence.

FES cycling also works incredibly well as a “neuro-primer”—a way to activate the nervous system and prep the body for functional movement. Even after just 10–20 minutes of cycling, I’ve seen patients gain noticeable control over their affected leg, paving the way for better outcomes through neuroplasticity.

And for those in the chronic stage of stroke recovery (6+ months post-stroke), FES cycling remains a safe, effective form of high-intensity exercise—without the fall risk that comes with walking programs. It also helps reduce spasticity, maintain joint mobility, and prevent contractures—key concerns that can limit progress and quality of life long-term.

How the MyoCycle excels in delivering therapeutic exercise at-home after stroke

The MyoCycle delivers the most advanced FES technology that maximizes therapeutic benefits while maintaining exceptional ease of use. Other features I love about the MyoCycle:

• The user is in control of their level of stimulation at all times– this means that over time, as your body adjusts to the sensation of stimulation, you can continue to increase the intensity to your tolerance to drive stronger contractions. The harder the muscles contract, the better the workout! 
• The MyoCycle detects the user’s output and automatically applies resistance to cycling so that the workout is customized to the specific abilities of the user—if you push hard, the MyoCycle pushes hard back. When you get fatigued, the motor will assist your pedaling.This ensures a dynamic, load-bearing and challenging workout that automatically adjusts to the unique abilities of the user. 
• Foot drop is a common presentation seen after stroke. The MyoCycle V2 Plus systems have a “Walking mode” feature where we can coordinate the stimulation to train the motor pattern of the knee straightening/foot lifting as seen during the swing phase of walking. This may help influence the reorganization of the motor programs in the nervous system and improve function in walking.
• The “symmetry” reading on the MyoCycle allows the user to determine how much work the left leg is doing compared to the right leg. This metric allows the user to see how much the weak side is lagging and work toward narrowing the gap.
• The dynamic power display shows your current workout intensity alongside your personal bests, creating a compelling visual that motivates you to push harder and achieve new records.

If you or your loved one is recovering from a stroke, I would suggest looking into FES cycling to continue therapeutic exercise at home. You can learn more about FES cycling and the MyoCycle by requesting more information or attending one of our webinar events.