Never plan the therapeutic management based on the diagnosis or cause of stroke, but based on sign and symptoms and the patients’ occupational demands.

All students and the therapists who are treating patients with stroke must have thought or heard this kind of question in their practice.

What is the therapeutic management of frontal lobe bleed/infarction?

What is the therapeutic management of occipital bleed /infarction?

What is the therapeutic management of parietal bleed /infarction?

What is the therapeutic management of thalamic bleed?

Instead of answering these questions, we need to ask different questions

What are the sign & symptoms of these patients? What are the physical & perceptual impairments of patients?

What are the activity the patient is able to do and not able to do?

What impairments are limiting the activity? What are the contextual factors & personal and environmental factors are restricting his participation?

Neurologist does the medical or neurological diagnosis of patient’s i. e. Stroke due to infarction or bleed. Bleed or infraction internal capsule, thalamus, basal ganglion, MCA territory etc. This different level of injury and severity will helps us in finding out the prognosis and planning of treatment according to level of lesion and severity of it.


But for us as a physiotherapist we need to look at the movement dysfunction. We need to find the physiotherapeutic diagnosis of movement dysfunction. Such as hemiplegia, henianesthesia, cognitive and perceptual disorders, unilateral neglect, heminomus hemianopia, shoulder dislocation, genu recurvatum, hemiplegic hand, claw hand, fixed flexion deformity,

Stoke is Medical diagnosis, Hemilplegia is a Physical diagnosis ….!”

We treat hemiplegia neurologist treats stroke.

We need to keep in mind that we as therapists don’t treat the cause of the stroke like the medical management. We don’t plan treatment directly with the causative factors of the stroke.

We treat physical & functional dysfunction –  “MOVEMENT DYSFUNCTION”.

We plan our management according to

What are activities limitations?

What impairments (signs and symptoms) of patients causing activity limitation

What is the need of the patients according to their lifestyle, age and occupational demands (personal & environmental factors, contextual factors)?

To get the right answer for the management you need to ask the right question….!

If you ask a right question you will get the right answer for it.

Published by GajananBhalerao

DR. GAJANAN BHALERAO (PT) MPTh Neuro, NDT Adult (USA), Motor relearning (Australia), Aquatic therapist (Switzerland). Associate professor at Sancheti Institute College of physiotherapy, Shivajinagar, Pune. Founder Director of "School of neuro rehab and aquatic therapy" , speciality centre for neuro rehabilitation of stroke, brain and spinal cord injury. Mobile : 9822623701,

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