Recovery after a stroke usually starts in hospital within days and continues at home for months, sometimes years. A team of therapists works with you on movement, speech, swallowing, thinking and mood. Many people go home early with an early supported discharge team, who continue therapy at home.
In England, NICE says people who need it should be offered at least 3 hours of therapy a day, 5 days a week. A 2023 guideline covering the whole UK and Ireland was written to set the same standards across all five nations. In practice, Irish audit data show staffing gaps across all health and social care professions, and early supported discharge is not yet available from every hospital.
This guide explains what rehabilitation should look like, what the evidence says about early discharge and speech therapy, and where to find support. If you are worried about new symptoms right now, read our page on the FAST signs of stroke and call 112 or 999.
Every stroke is different. The NHS puts it plainly: for some people recovery takes days or weeks, with little lasting impact. For others it takes months or years, and may mean changes at home or at work.
The HSE says stroke survivors are often in hospital for around 3 weeks, depending on severity. The 2024 Irish National Audit of Stroke reported an average acute hospital stay of 17 days.
The HSE lists stroke doctors and nurses, physiotherapists, occupational therapists and speech and language therapists. Psychologists, dietitians, pharmacists and social workers may also be involved. You should set goals with the team that matter to you, and NICE says they should be reviewed regularly.
This is where the guidance changed most recently.
NICE guideline NG236 (October 2023) says to offer needs-based rehabilitation for at least 3 hours a day, at least 5 days a week. That time is shared across physiotherapy, occupational therapy and speech and language therapy. If a person cannot manage that much, or does not want it, therapy should still be offered at least 5 days a week.
The earlier 2013 guideline recommended at least 45 minutes of each relevant therapy, 5 days a week. NICE's committee said more intensive rehabilitation had clinically important benefits. It also said current practice is inconsistent and the higher target may need more resources.
NICE guidance applies to England. The National Clinical Guideline for Stroke for the UK and Ireland (2023) is the first "five nations" stroke guideline. It was developed with Ireland's National Clinical Programme for Stroke. The Royal College of Physicians of Ireland and Scotland's guideline network (SIGN 166) both endorse it.
The Irish National Audit of Stroke covered 6,156 stroke patients in 2024. Its 2025 organisational audit found staffing gaps in every health and social care profession it measured:
The audit recommends that all stroke units be resourced to provide specialist stroke rehabilitation.
If you feel you are not getting enough therapy, it is reasonable to ask the team what your plan is and why.
Early supported discharge (ESD) means leaving hospital sooner and continuing rehabilitation at home with a specialist stroke team.
NICE recommends offering ESD to people who can move from a bed to a chair, alone or with help, if home is safe. Therapy should continue at the same intensity as in hospital. After leaving hospital, people with rehabilitation needs should be followed up by the community stroke team within 72 hours.
A Cochrane review (2017) pooled 17 trials with 2,422 participants, mostly older people with moderate disability. Compared with usual care, ESD:
It made no clear difference to death alone, mood, or carers' outcomes. Benefits were seen with coordinated multidisciplinary teams, and were weaker at one and five years.
In Ireland, 14 hospitals had access to an ESD team in 2025, up from 10 in 2021. In 2024, 680 patients went home with ESD. Nine teams could provide therapy at least 5 days a week. The audit recommends more ESD teams.
In England, NICE acknowledges that access to ESD varies and that some areas do not have dedicated coordinators.
Aphasia is difficulty with language: speaking, understanding, reading or writing. It is different from dysarthria, which is slurred speech caused by weak speech muscles. The Cochrane review of speech and language therapy reports that about one in three people who have a stroke experience aphasia.
NICE recommends screening for communication problems within 72 hours of the stroke. If problems are suspected, a speech and language therapist should assess them. Therapy should be individualised and should coach family and staff in supportive communication.
The 2016 Cochrane review included 57 randomised trials with 3,002 participants. Compared with no therapy, speech and language therapy improved functional communication, reading, writing and expressive language. The effect on functional communication was modest (standardised mean difference 0.28). Based on smaller numbers, the benefits were not clearly evident at later follow-up.
Therapy at higher intensity, higher dose or over a longer period gave better functional communication than less therapy. But more people dropped out of high-intensity programmes, so it does not suit everyone.
NICE also says to consider computer-based programmes or apps for word finding, alongside face-to-face therapy, and communication aids where they would help.
The NHS says most people with aphasia after a stroke improve with treatment, especially in the first few months. Some keep improving months or years later, and some recover fully. If word-finding problems appear without a known stroke, our guide to word-finding difficulty covers other causes.
NICE's 2023 update added or strengthened several checks.
Depression is common. A meta-analysis of 61 studies with 25,488 people estimated that about 31% of people have depression at some point after a stroke. Anxiety and difficulty controlling emotions, such as sudden crying or laughing, also occur.
The HSE says your mood should be assessed before you leave hospital. Talking therapies, such as CBT, and sometimes antidepressants may be offered.
If you or someone you care for has thoughts of suicide or self-harm, get help now. In Ireland or the UK, call Samaritans free on 116 123, day or night. In Ireland you can also text 50808. In an emergency, call 112 or 999.
NICE recommends a review of your needs at 6 months and then every year, covering mood, communication, carers and everyday life. The NHS advises asking your team if the 6-month review does not happen. NICE also says people can self-refer back, usually with help from their GP.
Ireland. The HSE says you usually cannot drive for 1 month after a stroke or TIA, unless your doctor says otherwise. You must tell your insurer. Our guide to driving with a neurological condition in Ireland covers the rules in more depth.
UK. GOV.UK says car drivers must stop for at least 1 month. You must tell the DVLA if problems such as weakness, vision or memory persist after a month. Bus and lorry drivers must tell the DVLA and stop for at least a year.
Work. NICE recommends planning a return to work early, including adjustments and a phased return.
Caring after a stroke can be hard, frustrating and lonely. NICE recommends reviewing carers' training and support needs at the 6-month and annual reviews. In Ireland, Family Carers Ireland offers a freephone line on 1800 24 07 24, according to the HSE. Our guide to Carer's Allowance in Ireland explains the main payment.
This implanted device stimulates a nerve in the neck during arm exercises. The US Food and Drug Administration approved the Vivistim system in August 2021 for moderate to severe arm weakness long after an ischaemic stroke.
The VNS-REHAB trial ran at 19 UK and US centres. It randomised 108 people, at least 9 months after stroke, to active or sham stimulation alongside therapy. Arm impairment scores rose 5.0 points with active stimulation and 2.4 with sham. At 90 days, 47% versus 24% had a clinically meaningful response. The manufacturer funded the trial. The device needs surgery and, as far as we could find, is not part of standard NHS or HSE care.
We have not listed clinical trials here. If you are interested in research, ask your stroke team whether any studies are recruiting locally.
It varies widely. Some people recover within days or weeks. Others are still improving months or years later. Rehabilitation should continue for as long as it is helping you meet your goals.
Most people with aphasia after stroke improve with speech and language therapy, especially in the first few months, according to the NHS. Some keep improving for years, and some recover fully. Others continue to have difficulties and learn other ways to communicate.
In England, NICE recommends at least 3 hours of therapy a day, 5 days a week, for people who need and can manage it. If you get much less, ask why.
Yes, it is common, and it is treatable. About 3 in 10 people experience depression after a stroke. Tell your stroke team or GP. If you have thoughts of suicide, call Samaritans on 116 123.
This article is general information, not medical advice. Talk to your GP or stroke team about your own situation.
Reviewed by: Proco Team
Last updated: November 2026