Occupational Therapy and Stroke Rehab

If you are considering occupational therapy as a treatment for stroke rehabilitation recovery, we want you to be as informed as possible—so we, as OTs, can truly partner to create the best course of treatment for YOU.

 In occupational therapy, we tend to work from “menus” of evidence-based assessments and treatments. This gives us the flexibility to meet the specific needs of each patient. Below, you’ll find the assessment and treatment options your therapist may use, along with the evidence supporting them.

You will also find stroke rehab therapists near you.

Please note that this page is for educational purposes and does not substitute advice from your medical provider.

Why pursue occupational therapy after a stroke?

This article focuses on therapy treatment for stroke rehabilitation.

When providing stroke rehabilitation treatment, your occupational therapist will help you modify or adapt your activities of daily living—such as your sleep routine, meal preparation, social participation, bathing, dressing, and home management—in addition to helping you return to the activities that are meaningful to you. These interventions are tailored to you as an individual, with consideration of your specific interests, wants, and needs. Through therapy, lifestyle adjustments, and healthy habits, you may reduce your risk of having a second stroke.

Investing in therapy early is important, because occupational therapy can help decrease the overall cost of stroke treatment by improving patient independence, reducing hospital readmissions, and potentially decreasing the need for long-term care.¹

The average lifetime cost of stroke per person ranges from $90,981–$228,030 depending on the type of stroke.² Averaged across all individuals and types of stroke, the lifetime cost per person is about $103,576. Research indicates that approximately 11% of individuals will experience an additional stroke within a year of their first, and this number rises to 26% within 5 years.³

By contrast, based on this study out of Europe, early occupational therapy costs around $5,813 per person for inpatient stroke rehab and $2,061 for outpatient stroke rehab. In addition to potentially reducing your risk of having a second stroke in the future, this treatment route also focuses on helping you return to the activities that are meaningful to you—making it an important option for many people.

From Canadian Stroke Best Practices and Pedretti’s Occupational Therapy.

Therapy works best when there is buy-in from the patient. It is important that you work with your therapist to set treatment goals that truly reflect what’s important to you. Goals in stroke rehabilitation often fall under these categories: Functional Capacity and ADLs/iADLs; Motor Function; Mobility; Upper Extremity; Mood & Cognition; Visual Perception & Neglect; and Spasticity.

After a thorough evaluation and goal-setting process, it is time to start making progress. Below are treatment interventions that can be implemented as part of a holistic therapy program.

🟢 = Strong support in evidence
🟡 = Moderate support in evidence
Based on: Occupational Therapy Practice Guidelines for Adults with Stroke

Activities of Daily Living (ADL) and Functional Mobility Interventions

• 🟢 Balance Training as Intervention to Support Occupation ^5,6,7

• 🟢 Mental Imagery with Task-Oriented Training ^8,9

• 🟢 Mirror Therapy with Task-Oriented Training ^10,11,12

• 🟢 Stroke Self-Management Interventions ^13,14

• 🟡 Action Observation with Task-Oriented Training ¹⁵

• 🟡 Activity-Based Interventions ¹⁶ (such as computer-based training for visual scanning training and optokinetic stimulation, mental practice, mirror therapy, voluntary trunk rotation, and vestibular rehabilitation)

• 🟡 Aquatic / Hydrotherapy Activity ¹⁷

• 🟡 Cognitive Behavioral Therapy (CBT) Interventions in Group or Individual Sessions ¹⁸

• 🟡 Early Mobilization ¹⁹

• 🟡 Home-Based ADL Training Before Discharge from Inpatient Rehabilitation ²⁰

• 🟡 Home-Based ADL Training and Education ²¹

• 🟡 OT-Provided ADL Training Strategies ²²

• 🟡 Recreational Interventions ^23,24,25 (such as music, horse riding, or creative arts activities)

• 🟡 Sensory Retraining ²⁶

• 🟡Upper Extremity Passive Range of Motion (PROM) ²⁷

Instrumental Activities of Daily Living Interventions

• 🟢 Constraint-Induced Movement Therapy (CIMT) or CIMT in Combination with Other Interventions ^28,29,20,31 (self-regulation, trunk restraint, robotic therapy, shaping, adaptive, and repetitive practice of functional tasks)

• 🟡 Driving Simulations ³²

• 🟡 Health Empowerment Group with Individual Follow-Up ³³

• 🟡Medication Adherence via Text Reminders and Environmental Cues ^34,35

Social Participation Interventions

• 🟡 Balance Interventions: Group CBT Interventions for Balance Self-Efficacy and Task-Oriented Balance Training ¹⁶

• 🟡 Long-Term Walking, Strength, and Balance Group Intervention ³⁶

• 🟡 Multimodal Stroke Education with Supportive Follow-Up ^37,38

Stroke Rehab Interventions Involving the Caregiver

• 🟢 Family Support Organizer: Tailored Long-Term Support (before and after discharge) ^39,40,41

• 🟢 Problem Solving and Cognitive Behavioral Therapy Techniques (in-person and with telephone follow-up) ^42,43

• 🟢 Problem-Solving Skills Training with Stroke Education ^44,45,46,47

• 🟡 Home-Based Long-Term Support and Education ⁴⁸ (for ADL training, problem solving, identification of caregiver supports, coping, and stress management)

• 🟡 Inpatient, Home, and Telephone Follow-Up Intervention Focusing on Preparation for Discharge, Social Functioning, and Quality of Life ^49,50

• 🟡 Multimodal Long-Term Intervention (individual or group) for Education, Coping, Problem Solving, and Stress Management ^51,52

• 🟡 Problem Solving Without Additional Interventions ^53,54

• 🟡 Skills Training ^55,56 (such as ADLs, pressure ulcer prevention, transfers, and oral health care—before and after discharge in-home follow-up and postdischarge in-home training with telephone follow-up)

• 🟡 Two-Month Telephone Education and Support Group with Individual Stress Reduction Techniques⁵⁷

New Stroke Rehab Interventions

Our list above was derived from a specific set of clinical practice guidelines, but research and treatment options continue to advance. We want to share new interventions that are gaining traction as we come across them:

• Paired Vagus Nerve Stimulation (VNS): Utilizing the FDA-approved Vivistim® system paired with intensive task-oriented training can significantly increase upper extremity motor recovery in chronic ischemic stroke survivors.⁵⁸

Every person is unique, so your individual response to therapy will also be unique. We recommend that you:

• Follow your therapist’s discharge recommendations to maintain progress made in therapy.

• Continue to use self-management and empowerment strategies to control any remaining symptoms.

• Follow a home exercise program to help establish good habits for body mechanics, even if you feel like you’re back to 100% function.

• Consult your therapist immediately if your condition worsens, or if you continue to have difficulty with your daily activities after 3 months.

• Follow the Stroke Discharge Checklist (stroke.org).

• Make an emergency action plan.

• Adhere to self-management strategies.

  • Includes physical activity, healthy diet, sleep hygiene, well-being, and leisure

• Know how to recognize a second stroke (think FAST):

  • F: face drooping

  • A: arm weakness

  • S: speech difficulties

  • T: time to call 911

Occupational therapists, physical therapists, and speech language pathologists are critical care providers in the realm of stroke rehabilitation. The initial phases of stroke rehabilitation are typically delivered in an acute care setting, so you will be working with the rehab team in your hospital.

As you transition into rehab in the outpatient setting, you will likely have a wider variety of choices for therapists to work with.

Below, you can find occupational therapy professionals who have tagged “stroke” as a focus area.

Hopefully this article helped you understand what therapy for stroke rehabilitation entails.

This article is updated once per month based on newly released research. If you have any research you would like us to consider, please contact us.

OT Potential does not endorse any treatments, procedures, products, or therapists referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking medical advice should consult their medical provider.

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Additional References

• American Stroke Association. (2025). American Stroke Association. Stroke.org.

  • Types of Stroke & Treatment

  • Activities of Daily Living

  • Preventing Another Stroke

  • Financial Information

  • Recurrent Stroke Risks and Prevention

  • Stroke Recovery Treatment

• Hildebrand, M., Geller, D., & Proffitt, R. (2023). Occupational Therapy Practice Guidelines for Adults With Stroke. PubMed.

• Heart and Stroke Foundation of Canada. (2019). Rehabilitation and Recovery following Stroke. Canadian Stroke Best Practices.

• Pendleton, H. M., & Schultz-Krohn, W. (2018). Pedretti’s Occupational Therapy: Practice Skills for Physical Dysfunction (8th ed.). Elsevier.