Occupational Therapy and Stroke Rehab: Acute Phase

After a cerebrovascular accident (CVA) happens, the recovery clock starts ticking immediately. The acute phase of stroke rehabilitation covers the first few hours and days after the event, when the main focus is medical stabilization. This page covers the immediate hospital treatments occupational therapists routinely use to promote prevention, safety, and early engagement, often within the first 48 hours after a stroke event. 

Because if you or a loved one are receiving occupational therapy as a treatment for stroke, 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.

At the bottom of this page, you’ll find occupational therapy professionals near you who can support you in your stroke recovery and rehabilitation.

Therapist-recommended assessments for acute stroke rehab

During the acute phase immediately following a stroke, your brain is in a critical, highly dynamic window of initial recovery. A prompt and focused evaluation to identify immediate functional needs is an important first step. As you can see below, OT assessment covers a lot of ground right at the bedside. That’s because a stroke can abruptly change how your body and brain interact in a variety of ways. Therapists assess a variety of factors to gain a big picture of how you are doing and figure out the best way to help you start recovering.

An accurate and thorough baseline also allows your therapist (and you!) to track your progress from day one, adapt therapies as your medical status stabilizes, and help determine the safest next step for your rehabilitation journey. Your therapist may perform certain assessments at various intervals over the course of therapy.

Members of the OT Potential Club can log in to see stroke-related assessments broken down by acute, subacute, and chronic phases. They’ll also find additional information about how to access each assessment.

Possible Assessments for Acute Stroke Rehabilitation

Gathered from Canadian Stroke Best Practices and Pedretti’s Occupational Therapy.

Functional Capacity and Activities of Daily Living

  • 10 Meter Walk Test
  • 6 Minute Walk Test
  • AlphaFIM
  • Barthel Index for ADLs
  • Frenchay Activities Index

Motor Function

  • Fugl Meyer Assessment
  • Manual Muscle Test
  • Motor Assessment Scale
  • Motricity Index for Motor Impairment After Stroke
  • Stroke Rehabilitation Assessment of Movement

Mobility

  • Berg Balance Scale
  • Clinical Outcome Variables
  • Functional Ambulation Categories
  • Functional Reach Test
  • Postural Assessment Scale for Stroke
  • Range of Motion
  • Rivermead Mobility Index
  • Timed “Up and Go” Test
  • Tinetti Performance Oriented Mobility Test
  • Trunk Control Test

Upper Extremity

  • Action Research Arm Test
  • Box and Blocks
  • Weber Two Point Discrimination Test

Mood and Cognition

  • Cognitive Log
  • General Health Questionnaire
  • Geriatric Depression Scale
  • Hospital Anxiety and Depression Scale
  • Medical Outcomes Study Short-Form Health Survey
  • Mini-Mental State Examination
  • Montreal Cognitive Assessment
  • Patient Health Questionnaire-9

Visual Perception and Neglect

  • Clock Drawing Test
  • Line Bisection Test
  • Motor-Free Visual Perception Test

Spasticity

  • Disability Assessment Scale
  • Modified Ashworth Scale

Stroke Severity

  • Canadian Neurological Scale
  • Glasgow Coma Scale
  • NIH Stroke Scale
  • Orpington Prognostic Scale
  • Sickness Impact Profile

Setting occupational therapy goals for acute stroke rehab

Occupational therapy goals in acute stroke rehabilitation often fall under these categories: 

  • Functional Capacity and ADLs/iADLs
    • Upper body dressing, self-feeding, personal hygiene
  • Motor Function
    • Supine to sit, dynamic balance, strength
  • Mobility
    • Home functional mobility, squat pivot transfer, lateral scooting
  • Upper Extremity
    • Grasping, reaching, dexterity
  • Mood & Cognition
    • Decision making, emotional regulation, pain awareness/ metacognition
  • Visual Perception & Neglect
    • Visual scanning, neglect, spatial orientation
  • Spasticity
    • Weight bearing, transcutaneous electrical stimulation, low load prolonged stretch

Occupational therapy treatment interventions for acute stroke patients

Following an initial evaluation, the focus shifts to immediate, specialized care. In this acute phase of stroke recovery, active treatment interventions are often fewer and more focused as the focus remains on medical stabilization. Occupational therapy at this stage centers on preventing secondary complications and safely preparing you for the next phase of your recovery. Below are the targeted interventions that can be used at the bedside to protect your progress and set the stage for the next phase of rehabilitation.

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

Interventions to Support Occupations (preparatory activities)

  • 🟡 Early Mobilization 19
  • 🟡 Upper Extremity Passive Range of Motion (PROM) 27

Functional Mobility

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

Activities of Daily Living (ADL) and Functional Mobility Interventions

  • 🟡 Action Observation with Task-Oriented Training 15

Discharge suggestions

As you finish your initial stay in acute care, you may transition to a rehab center or skilled nursing facility to continue your progress in the subacute phase of recovery. Because a stroke can affect everything from movement to speech, most people need additional, focused therapy to regain strength, balance, and daily living skills.

Learn more about what to expect next in our guide to Occupational Therapy and Stroke Rehab: Subacute Phase

Choosing a therapist near you for stroke rehab

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 for continued recovery in the chronic phase, 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.

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Conclusion

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

This article is updated regularly based on newly released research. If you have any research you would like us to consider, please drop it in the comments. 

Therapists who would like more detailed information on stroke rehabilitation best practices can join us as members of the OT Potential Club.

Research by

Ella Vanderpool, B.S., is a class of 2025 EL-OTD student with aspirations to work in the inpatient neuro rehabilitation setting. She completed one of her clinical fieldwork rotations working with stroke and spinal cord patients at the Mayo Clinic in 2024. This article was completed as part of her doctoral capstone experience.

See related stroke treatment guides

https://otpotential.com/blog/stroke-rehab-chronic-phase
Occupational Therapy and Stroke Rehab: Subacute Phase

See related courses on stroke

  • The Vagus Nerve and Stroke
  • Neuro Recovery After Stroke
  • Chronic Stroke Rehab
  • OT for Spasticity in Adults

References

Here’s the science that backs the assessment and treatment outlined above. 

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  27. Kim, H. J., Lee, Y., & Sohng, K. Y. Effects of bilateral passive range of motion exercise on the function of upper extremities and activities of daily living in patients with acute stroke. Journal of Physical Therapy Science. 2014.
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  30. Hsieh, Y. W., Liing, R. J., Lin, K. C., Wu, C. Y., Liou, T. H., Lin, J. C., & Hung, J. W. Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke. Journal of Neuroengineering and Rehabilitation. 2016.
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  33. Sit, J. W., Chair, S. Y., Choi, K. C., Chan, C. W., Lee, D. T., Chan, A.W., … Taylor-Piliae, R.E. Do empowered stroke patients perform better at self-management and functional recovery after a stroke? A randomized controlled trial. Clinical Interventions in Aging. 2016.
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Additional References

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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