Occupational Therapy and Stroke Rehab: Subacute Phase

The subacute phase of stroke recovery typically spans from the first week to the first several months post-stroke, a period where the brain is highly adaptable and responsive to therapy. This page covers the early, intensive interventions frequently used in occupational therapy to help patients regain lost skills, adapt to physical changes, and return home safely. 

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 subacute stroke rehab

During the subacute phase, your brain is uniquely primed for recovery, so a comprehensive evaluation to identify target goals is a vital next step. As you can see below, OT assessment covers a lot of ground. That’s because a stroke can change how you navigate your daily life in a variety of ways. Therapists assess a variety of factors to gain a big picture of how you are doing and where we can help you improve.

An accurate and thorough baseline also allows your therapist (and you!) to discern how much the interventions are helping. 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.

Core Occupational Therapy Outcome Measures

In occupational therapy, one of our core outcome measures is your self-report on your quality of life. At the end of the day, this is the most important outcome for us. We want our treatments to have a significant impact on your day-to-day life. 

• Quality of Life Patient Reported Outcome Measure – The PROMIS Global 10

Possible Assessments for Subacute 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
• Allen Cognitive Level Screen
• Assessment of Life Habits
• Assessment of Motor and Processing
• Barthel Index for ADLs
• Canadian Occupational Performance Measure
• Cognitive Performance Test
• Executive Function Performance Test
• Frenchay Activities Index
• Kettle Test
• Kohlman Evaluation of Living Skills
• Lawton Instrumental Activities of Daily Living
• Menu Task
• Multiple Errands Test
• Stroke Impact Scale
• Weekly Calendar Planning Activity

Motor Function

• Chedoke-McMaster Stroke Assessment Scale
• Fugl Meyer Assessment
• Grip Strength
• Manual Muscle Test
• Motor Assessment Scale
• Motricity Index for Motor Impairment After Stroke
• Pinch Strength
• Rivermead Motor Assessment
• Stroke Rehabilitation Assessment of Movement

Mobility

• Berg Balance Scale
• 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
• Arm Motor Ability Test
• Box and Blocks
• Chedoke Arm and Hand Activity Inventory
• Motor Activity Log
• Nine Hole Peg Test
• TEMPA

Mood and Cognition

• Addenbrooke’s Cognitive Examination
• Beck Depression Inventory
• Cognistat Cognitive Assessment
• 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
• Saint Louis University Mental Status Exam
• Trail Making Test

Visual Perception and Neglect

• Behavioral Inattention Test
• Line Bisection Test
• Motor-Free Visual Perception Test

Spasticity

• Disability Assessment Scale
• Modified Ashworth Scale
• Modified Tardieu Scale

Stroke Severity

• Arnadottir Occupational Therapy Neurobehavioral Evaluation
• Glasgow Coma Scale
• Orpington Prognostic Scale

Setting occupational therapy goals for subacute stroke rehab

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

• Functional Capacity and ADLs/iADLs
  • Upper body dressing, meal preparation, personal hygiene
• Motor Function
  • Transitions, walking, navigating stairs
• Mobility
  • Balance, transfers, wheelchair navigation
• Upper Extremity
  • Grasping, reaching, manipulating objects
• Mood & Cognition
  • Problem solving, memory, safety awareness
• Visual Perception & Neglect
  • Visual scanning, neglect, spatial orientation
• Spasticity
  • Stretching, positioning, functional use of limb

Occupational therapy treatment interventions for subacute stroke patients

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)
• 🟡 Cognitive Behavioral Therapy (CBT) Interventions in Group or Individual Sessions ¹⁸
• 🟡 Home-Based ADL Training Before Discharge from Inpatient Rehabilitation ²⁰
• 🟡 Home-Based ADL Training and Education ²¹
• 🟡 OT-Provided ADL Training Strategies ²²
• 🟡 Sensory Retraining²⁶

Instrumental Activities of Daily Living Interventions

• 🟢 Constraint-Induced Movement Therapy (CIMT) or CIMT in Combination with Other Interventions ^28,29,20,31

Social Participation Interventions

• 🟡 Health Empowerment Group with Individual Follow-Up ²²
• 🟡 Home-Based Long-Term Support and Education⁴⁸
• 🟡 Inpatient, Home, and Telephone Follow-Up Intervention Focusing on Preparation for Discharge, Social Functioning, and Quality of Life ^49,50
• 🟡 Medication Adherence Via Text Reminders and Environmental Cues ^20,21
• 🟡 Long-Term Walking, Strength, and Balance Group Intervention ³⁶
• 🟡 Multimodal Long-Term Intervention (individual or group) for Education, Coping, Problem Solving, and Stress Management ^51,52
• 🟡 Multimodal Stroke Education with Supportive Follow-Up ^37,38
• 🟡 Problem Solving Without Additional Interventions ^53,54
• 🟡 Telephone Education and Support Group with Individual Stress Reduction Techniques⁵⁷

Discharge suggestions

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

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.

Conclusion

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 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.

See related stroke treatment guides

See related courses on stroke

References

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

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5. Cabanas-Valdés, R., Bagur-Calafat, C., Girabent-Farrés, M., Caballero-Gomez, F. M., Hernández-Valiño, M., & Urrutia Cuchí,G. The effect of additional core stability exercises on improving dynamic sitting balance and trunk control for subacute stroke patients: A randomized controlled trial. Clinical Rehabilitation. 2016. 
6. Cabanas-Valdés, R., Bagur-Calafat, C., Girabent-Farrés, M., Caballero-Gomez, F. M., du Port de Pontcharra-Serra, H., German-Romero, A., & Urrutia, G. Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients. Clinical Rehabilitation. 2017. 
7. van Duijnhoven, H. J., Heeren, A., Peters, M. A., Veerbeek, J. M., Kwakkel, G., Geurts, A. C., & Weerdesteyn, V. Effects of exercise therapy on balance capacity in chronic stroke: Systematic review and meta-analysis. Stroke. 2016. 
8. Guerra, Z. F., Lucchetti, A. L. G., & Lucchetti, G. Motor imagery training after stroke: A systematic review and metaanalysis of randomized controlled trials. Journal of Neurologic Physical Therapy. 2017. 
9. Li, R., Li, Z., Tan, J., Chen, G., & Lin, W. Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials. Complementary Therapies in Clinical Practice. 2017.
10. Hsieh Y wei, Chang K chou, Hung J wen, Wu C yi, Fu M hui, Chen C chi. Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial. Archives of Physical Medicine and Rehabilitation. 2018.
11. Louie DR, Lim SB, Eng JJ. The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis. Journal of Stroke and Cerebrovascular Diseases. 2019.
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16. Liu TW, Ng GYF, Chung RCK, Ng SSM. Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training. Stroke. 2019.
17. Chae CS, Jun JH, Im S, Jang Y, Park GY. Effectiveness of Hydrotherapy on Balance and Paretic Knee Strength in Patients With Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. American Journal of Physical Medicine & Rehabilitation. 2020.
18. Wang SB, Wang YY, Zhang QE, et al. Cognitive behavioral therapy for post-stroke depression: A meta-analysis. Journal of Affective Disorders. 2018.
19. Chippala, P., & Sharma, R. Effect of very early mobilisation on functional status in patients with acute stroke: a single-blind, randomized controlled trial. Clinical Rehabilitation. 2016.
20. Rasmussen, R. S., Ostergaard, A., Kjaer, P., Skerris, A., Skou, C., Christoffersen, J., et al. Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: A randomised controlled trial. Clinical Rehabilitation. 2016.
21. Sahelbalzamani, M., Aliloo, L., & Shakibi, A. The efficacy of self-care education on rehabilitation of stroke patients. Saudi Medical Journal, 30, 550–554. 2009.
22. Legg, L. A., Lewis, S. R., Schofield-Robinson, O. J., Drummond, A., & Langhorne, P. Occupational therapy for adults with problems in activities of daily living after stroke. Stroke. 2017. 
23. Bunketorp-Käll L, Lundgren-Nilsson Å, Samuelsson H, et al. Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke. Stroke. 2017.
24. Bunketorp-Käll L, Pekna M, Pekny M, Blomstrand C, Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation. 2019.
25. Kongkasuwan R, Voraakhom K, Pisolayabutra P, Maneechai P, Boonin J, Kuptniratsaikul V. Creative art therapy to enhance rehabilitation for stroke patients: a randomized controlled trial. Clin Rehabil. 2016.
26. Chia, F. S., Kuys, S., & Low Choy, N. Sensory retraining of the leg after stroke: Systematic review and meta-analysis. Clinical Rehabilitation. 2019. 
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.
28. Liu, K. P. Y., Balderi, K., Leung, T.L.F., Yue, A. S. Y., Lam, N. C. W., Cheung, J.T.Y., et al.  A randomized controlled trial of self-regulated modified constraint-induced movement therapy in sub-acute stroke patients. European Journal of Neurology. 2016.
29. Wu, C. Y., Chen, Y. A., Lin, K. C., Chao, C. P., & Chen, Y. T. Constraint-induced therapy with trunk restraint for improving functional outcomes and trunk–arm control after stroke: A randomized controlled trial. Physical Therapy. 2012. 
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.
31. Lin, K. C., Wu, C. Y., Liu, J. S., Chen, Y. T., & Hsu, C. J. Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabilitation and Neural Repair. 2009.
32. Devos H, Akinwuntan AE, Nieuwboer A, et al. Comparison of the Effect of Two Driving Retraining Programs on On-Road Performance After Stroke. Neurorehabil Neural Repair. 2009.
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.
34. Kamal AK, Shaikh Q, Pasha O, et al. A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study. BMC Neurology. 2015.
35. O’Carroll RE, Chambers JA, Dennis M, Sudlow C, Johnston M. Improving Adherence to Medication in Stroke Survivors: A Pilot Randomised Controlled Trial. Annals of Behavioral Medicine. 2013.
36. Stuart M, Benvenuti F, Macko R, et al. Community-Based Adaptive Physical Activity Program for Chronic Stroke: Feasibility, Safety, and Efficacy of the Empoli Model. Neurorehabil Neural Repair. 2009.
37. Geng G, He W, Ding L, Klug D, Xiao Y. Impact of transitional care for discharged elderly stroke patients in China: an application of the Integrated Behavioral Model. Topics in Stroke Rehabilitation. 2019.
38. Ru X, Dai H, Jiang B, et al. Community-Based Rehabilitation to Improve Stroke Survivors’ Rehabilitation Participation and Functional Recovery. American Journal of Physical Medicine & Rehabilitation. 2017.
39. Lincoln NB, Francis VM, Lilley SA, Sharma JC, Summerfield M. Evaluation of a Stroke Family Support Organiser. Stroke. 2003.
40. Mant J, Carter J, Wade DT, Winner S. Family support for stroke: a randomised controlled trial. The Lancet. 2000
41. Mant J, Winner S, Roche J, Wade DT. Family support for stroke: one year follow up of a randomised controlled trial. J Neurol Neurosurg Psychiatry. 2005.
42. King RB, Hartke RJ, Houle T, et al. A Problem-Solving Early Intervention for Stroke Caregivers: One Year Follow-Up. Rehabilitation Nursing Journal. 2012.
43. Pfeiffer K, Beische D, Hautzinger M, et al. Telephone-based problem-solving intervention for family caregivers of stroke survivors: A randomized controlled trial. Journal of Consulting and Clinical Psychology. 2014.
44. Bishop D, Miller I, Weiner D, et al. Family Intervention: Telephone Tracking (FITT): a pilot stroke outcome study. Top Stroke Rehabil. 2014.
45. Cheng HY, Chair SY, Chau JPC. Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: A randomised controlled trial. International Journal of Nursing Studies. 2018.
46. Deyhoul N, Vasli P, Rohani C, Shakeri N, Hosseini M. The effect of family-centered empowerment program on the family caregiver burden and the activities of daily living of Iranian patients with stroke: a randomized controlled trial study. Aging Clin Exp Res. 2020.
47. Perrin PB, Johnston A, Vogel B, et al. A culturally sensitive Transition Assistance Program for stroke caregivers Examining caregiver mental health and stroke rehabilitation. Journal of Rehabilitation Research and Development. 2010.
48. Ostwald SK, Godwin KM, Cron SG, Kelley CP, Hersch G, Davis S. Home-based psychoeducational and mailed information programs for stroke-caregiving dyads post-discharge: a randomized trial. Disability and Rehabilitation. 2014.
49. Shyu YIL, Chen MC, Chen ST, Wang HP, Shao JH. A family caregiver-oriented discharge planning program for older stroke patients and their family caregivers. Journal of Clinical Nursing. 2008.
50. Shyu YIL, Kuo LM, Chen MC, Chen ST. A clinical trial of an individualised intervention programme for family caregivers of older stroke victims in Taiwan. Journal of Clinical Nursing. 2010
51. Van den Heuvel, Elisabeth TP, de Witte LP, Nooyen-Haazen I, Sanderman R, Meyboom-de Jong B. Short-term effects of a group support program and an individual support program for caregivers of stroke patients. Patient Education and Counseling. 2000.
52. Wilz G, Barskova T. Evaluation of a cognitive behavioral group intervention program for spouses of stroke patients. Behaviour Research and Therapy. 2007.
53. Grant JS. Social Problem-Solving Partnerships with Family Caregivers. Rehabilitation Nursing Journal. 1999.
54. Grant JS, Elliott TR, Weaver M, Bartolucci AA, Giger JN. Telephone Intervention With Family Caregivers of Stroke Survivors After Rehabilitation. Stroke. 2002.
55. Kalra L, Evans A, Perez I, et al. Training carers of stroke patients: randomised controlled trial. BMJ. 2004.
56. Kuo YW, Yen M, Fetzer S, et al. A home-based training programme improves family caregivers’ oral care practices with stroke survivors: a randomized controlled trial. International Journal of Dental Hygiene. 2016.
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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.

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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