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Practice Guideline
. 2025 Apr;83(4):1-18.
doi: 10.1055/s-0045-1806924. Epub 2025 Apr 22.

A physiotherapy protocol* for stroke patients in acute hospital settings: expert consensus from the Brazilian early stroke rehabilitation task force

Iara Maso  1   2 , Gustavo José Luvizutto  3 , Jéssica Mariana de Aquino Miranda  3 , Carla Ferreira do Nascimento  1   2 , Luana Aparecida Miranda Bonome  4 , Elen Beatriz Pinto  2 , Fabiane Maria Klitzke  5 , Ricardo Machado Souza  6 , Carla Heloisa Cabral Moro  7 , Rodrigo Bazan  4 , Pedro Antonio Pereira de Jesus  1   8 , Eduardo de Melo Carvalho Rocha  9 , Cesar Minelli  10   11 , Sheila Ouriques Martins  12   13   14   15 , Jussara Almeida de Oliveira Baggio  16
Affiliations
Practice Guideline

A physiotherapy protocol* for stroke patients in acute hospital settings: expert consensus from the Brazilian early stroke rehabilitation task force

Iara Maso et al. Arq Neuropsiquiatr. 2025 Apr.

Abstract

The present protocol provides general recommendations based on the best evidence currently available for physiotherapists to use as a guide for the care of stroke patients during hospitalization. The Brazilian Early Stroke Rehabilitation Task Force, comprising physical therapy experts and researchers from different Brazilian states, was organized to develop this care protocol based on a bibliographical survey, including meta-analyses, systematic reviews, clinical trials, and other more recent and relevant scientific publications. Professionals working in stroke units were also included in the task force to ensure the practicality of the protocol in different contexts. This protocol provides guidance on assessment strategies, safety criteria for the mobilization of patients with stroke, recommendations for mobilization and proper positioning, as well as evidence-based practices for treatment during hospitalization, including preventive measures for shoulder pain and shoulder-hand syndrome. The protocol also provides information on the organization of the physiotherapy service at stroke units, guidelines for hospital discharge, and quality indicators for physiotherapy services. We have included detailed activities that can be performed during mobilization in the supplementary material, such as postural control training, sensory and perceptual stimulation, task-oriented training, and activities involving an enriched environment. The protocol was written in a user-friendly format to facilitate its application in different social and cultural contexts, utilizing resources readily available in most clinical settings.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Structured decision-making process used for in-person and virtual consensus meetings.
Figure 2
Figure 2
Safety criteria codes.
Figure 3
Figure 3
Abbreviation: NIHSS, National Institutes of Health Stroke Scale. Neurological safety considerations.
Figure 4
Figure 4
Abbreviations: BP, blood pressure; mmHg, millimeters of mercury; SBP, systolic blood pressure; HR, heart rate; bpm, beats per minute. Cardiovascular safety considerations.
Figure 5
Figure 5
Abbreviations: SpO2, peripheral capillary oxygen saturation; RR, respiratory rate; °C, degrees Celsius. Respiratory and other safety considerations.
Figure 6
Figure 6
Abbreviation: NIHSS, National Institutes of Health Stroke Scale. Flowchart of patient mobilization after stroke in the hyperacute and acute phases.
Figure 7
Figure 7
Note: Drawings reprinted from the manual Shoulder Pain Syndrome after Stroke , by Associação Brasil AVC, with permission from the authors. Bed positioning.
Figure 8
Figure 8
Note: Drawings reprinted from the manual Shoulder Pain Syndrome after Stroke , by Associação Brasil AVC, with permission from the authors. Preventive measures for shoulder pain and shoulder-hand syndrome.
See this image and copyright information in PMC

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