What Should You Do When Physio Ends After a Stroke in South Africa?

This is general information, not medical advice. Always follow the guidance of your loved one's doctor, physiotherapist or occupational therapist.

The hospital or rehab sessions have ended, Mum or Dad is home, and suddenly the plan is up to you. Many South African families find themselves here, often sooner than they expected. This guide explains what to ask for before therapy stops, how to keep practice going at home, and how to get help again if things change.

What should you do when physio ends after a stroke?

Make sure you leave the last session with a clear home programme, then build a simple daily routine and keep track of progress. Recovery can continue at home, but it needs a plan and regular practice.

The 2026 American Heart Association and American Stroke Association rehabilitation guideline recommends ongoing community or home-based rehabilitation after discharge, where it is possible. It also says caregivers can help with home programmes, and that "teach-back" training, where the carer shows the therapist what they have learnt, can improve outcomes for both patient and carer.

In practice, this means you are not starting from nothing. The goal is to carry the therapist's plan into everyday life.

Why does physio often end sooner than families expect in South Africa?

Therapy time is limited in both the public and private sectors, so formal sessions often stop while your loved one still has a lot to work on. This is common and does not mean recovery has stopped.

A review of South African stroke rehabilitation research by Ntsiea (South African Journal of Physiotherapy, 2019) found that stroke survivors often have limited function when they leave hospital, and that limited rehab facilities mean patients are often discharged to the care of their families. The same review notes barriers such as transport, and strain on caregivers.

The scale of the need is large. The Heart and Stroke Foundation South Africa (2023) reports that about 10 people have a stroke every hour in the country, and that about a quarter of people who have a stroke are left with a life-changing disability.

Medical aid rules also play a part. The Council for Medical Schemes lists stroke as a Prescribed Minimum Benefit condition, covering medical management and surgery. Outpatient therapy after discharge is usually paid from your plan's day-to-day or rehab benefits, so check with your scheme what is left for the year and whether a motivation from the doctor or therapist can extend it.

What should you ask for before the last session?

Ask for a written, personalised home programme and a short handover for you as the carer. A few questions now can save months of guessing later.

Your handover checklist

1. A written home programme. Which exercises, how many repetitions, how many times a day, and what to stop doing. Ask for drawings or photos, or take short videos on your phone with permission.
2. A demonstration you can repeat. Do each exercise with your loved one while the therapist watches and corrects you.
3. Goals for the next 3 months. For example, holding a cup with the weak hand, or walking to the gate with a stick.
4. Safety rules. How to help with transfers, how to support the weak shoulder, and signs that mean "stop and call".
5. Equipment advice. Ask whether a splint, walking aid, shower chair or grab rails would help, and where to get them.
6. A contact and a follow-up date. Who to call with questions, and when the next review should be. Ask how to be re-referred if things change.
7. A copy of the discharge summary. Keep it with your loved one's clinic card or medical aid details, so any new clinician can see what was done.

How do you keep rehab going at home?

Turn the home programme into a short, fixed routine that fits around meals and daily tasks. Little and often usually works better than one long, tiring session.

1. Set a time and a place

Pick two or three short slots a day, for example after breakfast and after lunch, in a chair with good support. Keep the exercise sheet where you can both see it.

2. Use everyday tasks as practice

Ask the therapist which daily activities the weak arm or leg can help with, such as holding a facecloth, stirring tea or folding washing. Real tasks are good practice and often more motivating than exercises alone.

3. Keep a simple log

Write down what was done, how it felt and anything new. Notes make follow-up appointments far more useful, especially when you only see a clinician every few months.

4. Let your loved one lead where possible

Self-management, where the stroke survivor learns to set goals and solve problems, can help confidence. A Cochrane review (Fryer and colleagues, 2016) found self-management programmes may improve quality of life and confidence (self-efficacy) a little, though the evidence was low quality.

5. Keep the weak hand involved

Hands often get left out once therapy stops, because the strong hand takes over. Our guide to hand exercises you can do at home after a stroke explains how to match exercises to the hand's level. Some families also use a rehab glove, such as Mirra, to help with daily repetitions. Check with your therapist first whether it suits your loved one.

Where can you find more support after discharge?

Support is patchier than families would like, but there are usually more options than you first think. Start local and ask every clinician you meet for ideas.

The 2026 American Stroke Association guideline describes telerehabilitation as a reasonable option for people with mild to moderate stroke when in-person therapy is limited, which may help families far from a rehab centre.

When should you ask for therapy again?

Ask for a review whenever progress stalls, something gets worse, or your loved one has a new goal. You do not have to wait for the problem to become serious.

In the UK, NICE (2023) uses a review within about 6 months of hospital discharge as a quality indicator, because reviews can reduce emergency readmissions and improve support for survivors and carers. In South Africa there is no guaranteed schedule, so it is worth asking your doctor or clinic to book one. Our guide to helping a loved one's hand recover at home has more ideas for keeping progress going in between.

When should you call a doctor or therapist?

• Walking, balance or use of the arm is getting worse, not better.
• Falls, or near-falls, at home.
• New or worsening pain, especially in the weak shoulder.
• The hand or arm is getting tighter and harder to open or straighten.
• Swelling, redness or skin breakdown, including under a splint.
• Low mood, withdrawal, or you as the carer are struggling to cope.
• Any sudden facial drooping, arm weakness, slurred speech, confusion, vision loss or severe headache. This could be another stroke and is an emergency: call an ambulance straight away (10177 from a landline, or 112 from a cellphone).

Frequently asked questions

Does recovery stop when physio ends?

No. Formal sessions ending is about the service, not about your loved one's potential. Many people keep making gains with regular home practice, although progress often slows over time. Ask the therapist what to expect for your loved one.

How much should we practise at home?

Follow the amount in the home programme. If none was given, ask the therapist rather than guessing. Short sessions spread through the day are usually easier to keep up than one long session.

Can we go back to the same therapist later?

Often, yes. In the public sector you may need a new referral from your clinic or doctor. In the private sector, check your medical aid benefits first, and ask whether a doctor's motivation can help.

What if we live far from any rehab service?

Ask about video sessions, home-based care through your local clinic, and a detailed written programme you can follow at home. A review every few months, even by phone or video, helps keep the programme up to date.

Sources

• Ntsiea MV. Current stroke rehabilitation services and physiotherapy research in South Africa. South African Journal of Physiotherapy, 2019.
• Heart and Stroke Foundation South Africa. World Stroke Week 2023 press release, 2023.
• American Heart Association and American Stroke Association. Transitions in care and community rehabilitation (Adult Stroke Rehabilitation and Recovery Guideline), 2026.
• NICE. Stroke and ischaemic attack: review 6 months after discharge (IND31), linked to NICE guideline NG236, 2023.
• Cochrane: Fryer CE, Luker JA, McDonnell MN, Hillier SL. Self management programmes for quality of life in people with stroke. Cochrane Database of Systematic Reviews, 2016.
• Council for Medical Schemes. Prescribed Minimum Benefits consumer guide (undated).