Paralysis Physiotherapy at Home: What Treatment Involves and How Recovery Works
The short version
- Paralysis physiotherapy is not massage, and it is not waiting for movement to return. It is structured retraining of movement, plus active prevention of the complications that do the second round of damage.
- Dose is the part Indian families most often get wrong. NICE recommends needs-based rehabilitation of at least 3 hours a day, on at least 5 days a week, across physiotherapy, occupational therapy and speech therapy.1 Two visits a week is maintenance, not rehabilitation.
- But more is not better in the first 24 hours. NICE specifically advises against high-intensity mobilisation in the first 24 hours after stroke symptoms begin for people who need help to sit, stand or walk.2
- Most damage after the first week is preventable. Contractures, pressure sores, a subluxed shoulder, chest infection and clots are what turn a recoverable patient into a permanently dependent one.
- The family is part of the treatment. A therapist visits for an hour. Positioning, turning and safe transfers happen the other twenty-three.
- Recovery is fastest in the first months and does not stop there. Progress slows, but it continues, and there is no age or time limit on starting.
When someone in an Indian family is paralysed — by a stroke, a spinal injury, a road accident — the hospital phase is intense and then it simply stops. The family is sent home with a discharge summary, a bag of medicines and a person who cannot move one side of their body, and told to "do physiotherapy". Nobody explains what that means, how much of it is needed, or what will go wrong if it does not happen. This page explains all three.
What is paralysis physiotherapy?
It is neurological rehabilitation delivered by a physiotherapist with training in brain and spinal cord conditions. The work has two halves that run at the same time: retraining movement — getting the nervous system to recruit whatever muscle it still can, in useful patterns — and preventing secondary damage to joints, skin, lungs and circulation while that happens.
The second half is the part families underestimate, and it is where most avoidable harm occurs. A limb that is never moved stiffens into a fixed position within weeks. Skin under constant pressure breaks down in hours. A weak shoulder pulled by a well-meaning relative can be injured permanently. None of that is caused by the original stroke or injury. All of it is caused by what happened afterwards.
Retraining movement
Repeated, task-specific practice of the movements the person actually needs — rolling, sitting, standing, stepping, reaching.
Protecting joints
Daily passive range of movement and correct positioning so joints do not stiffen into positions that cannot be undone.
Protecting skin
Turning schedules and pressure-redistributing surfaces, because a pressure injury can start within hours of unrelieved pressure.4
Protecting the chest
Breathing exercises, upright positioning and assisted coughing, since chest infection is a common cause of readmission.
Managing tone
Spasticity is assessed and managed with the wider team — stretching, positioning, splinting and medical treatment where needed.1
Teaching the family
Transfers, positioning and a home programme, so the twenty-three hours without a therapist are not wasted.
Types of paralysis, and why the plan differs
The label matters because it tells you what is still working and what the realistic goal is. One-sided weakness after a stroke and a complete spinal cord injury need almost opposite programmes: one is mostly about re-recruiting a side that still has connections, the other is mostly about maximising what remains above the injury level and building independence around it.
| Pattern | What is affected | Typical causes and focus |
|---|---|---|
| Hemiplegia / hemiparesis | One side of the body, arm and leg together, often with facial involvement | Usually stroke or brain injury. Focus on re-recruiting the weak side, balance, and preventing shoulder and hand problems |
| Paraplegia | Both legs and often the trunk, depending on level | Spinal cord injury, tumour, infection. Focus on trunk control, transfers, wheelchair skills and independence |
| Quadriplegia / tetraplegia | All four limbs and the trunk; breathing may be affected at high levels | High spinal cord injury. Focus on respiratory care, positioning, assisted function and preventing complications |
| Monoplegia | One limb | Nerve injury, localised brain lesion. Focus on that limb's function and on not neglecting it |
| Facial palsy | One side of the face | Bell's palsy, stroke. Focus on facial retraining, eye protection and eating safely |
| Flaccid vs spastic | Limp and floppy, versus stiff and resistant to movement | Many patients pass from one to the other. The handling, splinting and exercise change completely between the two |
If the paralysis followed a stroke specifically, the wider recovery picture — including speech, swallowing and cognition — is covered in stroke recovery at home. For someone who is largely confined to bed, the daily positioning and skin routine is in bedridden patient care at home.
How much therapy is actually enough?
Far more than most Indian families are arranging. NICE recommends needs-based rehabilitation of at least 3 hours a day, on at least 5 days of the week, covering physiotherapy, occupational therapy and speech and language therapy together.1 Within that, the guideline increased the physiotherapy component to one to two hours a day, five days a week.1
Set that against what usually happens: a physiotherapist visits two or three times a week for forty minutes, and the rest of the week the patient lies in bed. That is not a small shortfall. It is a different treatment altogether, and it is the single biggest reason recovery in Indian homes underperforms what the same patient could achieve.
The practical answer is not to hire a therapist for three hours a day, which almost nobody can afford. It is to understand that the therapist's job includes setting up what happens between visits. A good home programme, taught properly to a family member or attendant and actually done, is what closes the gap. NICE itself allows for this: where a person cannot or does not wish to do three hours a day, therapy should still be offered on a minimum of five days a week.1
The one situation where more is worse
In the first 24 hours after stroke symptoms begin, for someone who needs help to sit out of bed, stand or walk, NICE advises against high-intensity mobilisation.2 This follows the AVERT trial, in which very early, higher-dose out-of-bed activity reduced the odds of a good outcome at three months compared with usual care.3 Early movement is right; forcing a lot of it in the first day is not. In hospital this is the treating team's call, not the family's.
Not sure whether the current programme is enough?
An assessment establishes what the patient can do now, what the realistic goal is, and what the family should be doing daily between visits. Healthy Jeena Sikho arranges neuro physiotherapy at home across Chandigarh, Mohali, Panchkula and Kharar.
What a session actually involves
Not one technique but a sequence, chosen for where the patient is: positioning and passive movement at the dependent end, progressing through rolling, sitting balance, transfers, standing and stepping, with task-specific practice of real daily activities throughout. Strengthening and tone management run alongside.
| Component | What it involves | Why it matters |
|---|---|---|
| Positioning | How the patient is placed in bed and in the chair, changed on a schedule | Prevents contractures, pressure injury and shoulder damage. The cheapest intervention with the biggest return |
| Passive range of movement | The therapist or a trained family member moves each joint through its range daily | A joint that is not moved stiffens. Once a contracture forms, it is far harder to reverse than to prevent |
| Bed mobility | Rolling, bridging, moving up the bed, coming to sitting | The foundation for everything else, and it reduces how much the family has to lift |
| Sitting balance | Sitting unsupported, reaching in different directions, tolerating being upright | Without trunk control, standing and walking cannot be built |
| Transfers | Bed to chair, chair to commode, with or without a board or hoist | Decides whether the person leaves the bed at all, and protects the carer's back |
| Standing and weight-bearing | Supported standing, standing frame or tilt table where indicated | Helps bone, circulation, bowel function and tone, even before walking is realistic |
| Gait retraining | Stepping, walking with aids, stairs, outdoor surfaces | Built in stages rather than attempted early with two people holding the patient up |
| Task-specific practice | Repeated practice of the actual task — reaching for a glass, standing from a chair | The nervous system learns what it repeats. Practising the real task beats generic exercises |
| Strengthening | Progressive work on whatever muscle is recruitable, weak side and strong side | Weakness, not just tone, limits function. The unaffected side also deconditions |
| Chest physiotherapy | Breathing exercises, positioning, assisted cough where the cough is weak | Chest infection is one of the commonest reasons a stable patient deteriorates |
| Splinting and orthotics | Resting splints, ankle-foot orthosis, arm support, as assessed | Holds joints in useful positions between sessions and helps walking mechanics |
| Family training | Teaching the daily programme, handling and transfers to whoever is there | Turns one hour of therapy into a whole day of it |
Never pull on a weak arm
After a stroke the shoulder on the weak side often loses the muscle support that holds the joint together, and the arm can partially slip out of the socket. Lifting or pulling the patient by that arm — to move them up the bed, to turn them, to help them stand — can injure the joint permanently and cause pain that lasts for years. Move the person by supporting the trunk, never by the weak arm, and make sure every relative and attendant in the house knows this.
How recovery works, stage by stage
Recovery is fastest in the early months and slower but not finished afterwards. The intensive evidence for therapy is strongest in the first six months, but improvement continues with continued work, and starting late is far better than not starting. What follows is a general shape, not a prediction — the actual course depends on the cause, the severity and the individual.
Phase 1 — Protect and position
Goal: no avoidable damage while the situation stabilises.
- Positioning schedule and turning established from day one, with a pressure-redistributing mattress where the patient cannot shift their own weight.4
- Daily passive range of movement to every joint on the affected side, taught to the family.
- Chest care — upright positioning, breathing exercises, assisted cough if needed.
- Clot prevention as prescribed by the treating team, and watching for a hot, swollen, painful calf.5
- Shoulder protection on the weak side, and the no-pulling rule explained to everyone.
Phase 2 — Get upright
Goal: out of bed, sitting, and tolerating being vertical.
- Bed mobility — rolling and coming to sitting with decreasing help.
- Sitting balance built up from supported to unsupported, then reaching while seated.
- Sitting out of bed daily, in a proper chair rather than propped in bed.
- Transfers taught to the family, with the right technique and the right equipment.
- Supported standing introduced when trunk control allows.
Phase 3 — Build function
Goal: useful movement in real tasks, not just on the mat.
- Standing tolerance and weight shift, progressing to stepping.
- Gait retraining with an appropriate aid, then on different surfaces and stairs.
- Upper limb work — reaching, grasping, releasing, and using the hand in tasks.
- Task-specific practice of the things the patient actually wants to do.
- Spasticity managed as it emerges, with the wider team where medical treatment is needed.1
Phase 4 — Independence and maintenance
Goal: as much independence as possible, and keeping it.
- Household and community mobility, including outdoor surfaces and transport.
- Self-care retraining with occupational therapy input — dressing, washing, eating.
- Home modifications — grab bars, ramps, bathroom changes, furniture heights.
- A long-term programme the person keeps doing, because gains are lost when work stops.
- Periodic review rather than discharge and forget.
Indicative only. Patients move through these at very different speeds, and some do not reach every stage. The stages are a sequence, not a schedule.
The complications that cause the second injury
Most of what disables a paralysed patient in the first year is not the original event. It is contractures, pressure sores, shoulder injury, chest infection, clots and falls — all of which are largely preventable, and all of which are prevented by the same boring daily routine.
| Complication | How it develops | What prevents it |
|---|---|---|
| Contractures | A joint held in one position shortens the surrounding tissue until the position becomes fixed | Daily passive range of movement to every joint, correct positioning, splinting where assessed |
| Pressure injury | Unrelieved pressure over the tailbone, heels, hips or shoulder blades damages skin and the tissue beneath | Regular repositioning, a pressure-redistributing mattress, keeping skin dry, daily skin checks4 |
| Shoulder subluxation and pain | The weak shoulder loses muscular support and the joint partially separates, often worsened by pulling on the arm | Correct positioning and support, never lifting by the weak arm, training everyone in the house |
| Chest infection | Lying flat, a weak cough and unsafe swallowing let secretions and food enter the lungs | Upright positioning, breathing exercises, assisted cough, safe feeding as advised by the team |
| Deep vein thrombosis | Immobility slows blood flow in the leg veins | Early mobilisation, prescribed preventive measures, and reporting a swollen, warm or painful calf immediately5 |
| Spasticity | Muscle tone increases over weeks, pulling limbs into tight positions | Assessed and managed with the multidisciplinary team — stretching, positioning, splinting, medical treatment1 |
| Falls | Usually as the patient starts moving again and overestimates what they can do | Supervised transfers, clear floors, correct aids, and not progressing faster than balance allows |
| Deconditioning of the good side | Weeks in bed weaken everything, not only the affected side | Whole-body activity, sitting out, and strengthening the unaffected limbs too |
| Low mood and withdrawal | Loss of function, role and independence, often unaddressed | Raise it with the doctor. It is common, treatable, and it directly affects how much therapy gets done |
At home or at a centre?
Both work. The deciding factors are usually how hard the patient is to transport, how much equipment the programme needs, and whether the goals are about the home environment. Many families end up with a mix — home sessions early, centre sessions once the patient can travel.
| Consideration | At home | At a centre |
|---|---|---|
| Early, dependent stage | Usually better — no transfer into a vehicle, no travel fatigue | Difficult and exhausting when the patient cannot sit safely |
| Relevance of practice | Training happens on the actual bed, actual chair, actual bathroom, actual doorways | Excellent facilities, but the skills still have to transfer home |
| Equipment | Limited to what can be brought or rented | Parallel bars, tilt tables, gym equipment available |
| Family involvement | Strong — the family is present and can be taught directly | Depends on who accompanies the patient |
| Cost and time | No travel cost or attendant time lost to transport | Session cost may be lower, but add travel and time |
| Later stage | Good for home and community goals | Often better once higher-intensity or equipment-based work is appropriate |
Patients in the Tricity can combine both — physiotherapy at home during the dependent phase, and the physiotherapy centre in Sector 71, Mohali once travelling becomes practical.
Equipment that supports the programme
Equipment does not replace therapy, but the wrong setup makes the therapy impossible. The list is decided by how much the patient can move, not by the diagnosis — and most of it should be rented, because requirements change as function returns.
| Item | What it does for the programme | When it is needed |
|---|---|---|
| Adjustable hospital bed | Backrest elevation for sitting up and chest care; height adjustment that protects the carer's back during transfers | From the start, for anyone who cannot get in and out of bed unaided |
| Air or alpha mattress | Redistributes pressure between turns | Whenever the patient cannot shift their own weight |
| Wheelchair | Gets the patient out of the bedroom, which affects mood as much as mobility | Once sitting tolerance allows; headrest and trunk support if control is poor |
| Commode chair | Removes the hardest and most frequent transfer of the day | Early, and often the item families most regret not arranging sooner |
| Walker, stick or quadripod | Supports gait retraining at the right stage | When standing and stepping begin, chosen by the physiotherapist |
| Splints and ankle-foot orthosis | Holds joints in useful positions and improves walking mechanics | As assessed; these are fitted, not bought off a shelf |
| Transfer board or belt | Makes bed-to-chair transfers safer for both people | Wherever the patient needs help to transfer |
| Suction machine | Clears secretions where the cough is weak | Where advised, particularly after high spinal injury or with swallowing problems |
| Grab bars and bathroom setup | Makes the highest-risk room usable and safer | Before the first attempt at bathing, not after the first slip |
The full rental range and how to time delivery around a discharge is in home care after hospital discharge, and bathroom changes specifically in the bathroom safety guide.
What the family actually has to do
The therapist is present for an hour. Positioning, turning, passive movement, transfers and encouragement happen the other twenty-three, and they are what determine the outcome. This is not a request to be helpful. It is the larger half of the treatment.
- Learn the transfer technique properly from the physiotherapist, and have everyone who helps learn it. Improvised lifting injures both people.
- Keep the turning schedule, day and night, and check the skin over the tailbone, heels, hips and shoulder blades every single day.
- Do the passive movements daily to every joint on the affected side. Ten minutes a day prevents a problem that takes months to treat.
- Never pull on the weak arm — and correct anyone who does.
- Get the patient out of bed and sitting up every day once it is safe. Bed is where deterioration happens.
- Let them do what they can, slowly, rather than doing it for them. Speed is not the goal; independence is.
- Keep a simple daily log — what was done, what was new, what was harder. It changes the therapist's plan more than any description from memory.
- Arrange relief for yourself. Caregiver exhaustion is the commonest reason home rehabilitation quietly stops in month two.
When to call the doctor
Seek urgent medical care for any of these
- Sudden new weakness, facial droop, slurred speech or vision loss — treat as a new stroke and call an ambulance.
- Pain, swelling, warmth or redness in one calf, or sudden breathlessness or chest pain.5
- Fever with breathlessness, fast breathing or a falling oxygen reading.
- Broken skin, or a red area over a pressure point that does not fade when pressure is relieved.4
- New confusion or drowsiness, or a patient who cannot be woken properly.
- Severe headache, or vomiting with headache.
- Inability to pass urine, or a blocked catheter.
- A fall, particularly with a head injury or in a patient on blood thinners, even if they seem fine afterwards.
- Choking, coughing during meals or a wet voice after eating — stop feeding and get the swallow reassessed.
- A rapid increase in stiffness or new severe pain in a limb.
Myths worth dropping
| Commonly believed | Verdict | What is actually the case |
|---|---|---|
| "Physiotherapy is massage and oil" | Myth | Massage may feel good but does not retrain movement. The treatment is graded, repeated, task-specific practice plus complication prevention. |
| "Wait and see if movement returns first" | Harmful | Waiting is when contractures form and skin breaks down. Positioning and passive movement start immediately. |
| "Two sessions a week is enough" | Myth | NICE recommends at least 3 hours a day across therapies, 5 days a week. Two sessions a week is maintenance, and the gap is filled by the home programme.1 |
| "Complete bed rest helps healing" | Harmful | Immobility causes pressure sores, clots, chest infection, stiffness and deconditioning. Being upright is part of the treatment. |
| "After six months nothing more will improve" | Myth | Recovery is fastest early, but improvement continues with continued work. Starting late is far better than not starting. |
| "Any physiotherapist can treat paralysis" | Partly | Neurological rehabilitation is a distinct skill set. NICE specifies treatment by physiotherapists with relevant training in this area.1 |
| "Electrical machines do the work" | Myth | Some modalities have a role as an adjunct, but nothing replaces repeated active practice of the task. |
| "Pull the arm to help them sit up" | Harmful | Pulling a weak shoulder can injure the joint permanently. Support the trunk instead. |
Paralysis physiotherapy at home with Healthy Jeena Sikho
- Assessment before any programme. What the patient can do now, what is realistic, and what the family should be doing daily — written down rather than described once.
- The family is trained, not just instructed. Transfers, positioning, passive movement and the home programme taught to whoever is actually there, because that is where most of the therapy happens.
- Practical, in your own home. Getting out of your actual bed, using your actual bathroom, and managing your actual doorways and thresholds.
- Equipment arranged alongside the therapy. Hospital bed, air mattress, wheelchair, commode and walking aids on rental, so the setup can change as function returns rather than being bought once.
- Progressed and reviewed. A staged plan with review points, not the same session repeated for six months.
- Across Chandigarh, Mohali, Panchkula and Kharar, with a physiotherapy centre in Sector 71, Mohali for when travelling becomes practical.
- Trusted since 2015. ISO 9001:2015 certified home healthcare, operating across North India.
Related guides: stroke recovery at home, bedridden patient care at home, home care after hospital discharge, bathroom safety after surgery or stroke and the recovering at home hub. Equipment is on the hospital bed on rent and mobility aids pages.
Neuro physiotherapy at home across Chandigarh, Mohali, Panchkula and Kharar. Call +91 98769 78488 or WhatsApp +91 98759 15278.
Frequently Asked Questions About Paralysis Physiotherapy at Home
What does paralysis physiotherapy at home involve?
Two things running together: retraining movement through graded, repeated, task-specific practice — rolling, sitting, transfers, standing, stepping, reaching — and preventing secondary damage through positioning, daily passive range of movement, skin care, chest care and tone management. The family is taught the daily programme so the work continues between visits.
How much physiotherapy does a paralysed patient need?
NICE recommends needs-based rehabilitation of at least three hours a day, on at least five days a week, covering physiotherapy, occupational therapy and speech and language therapy, with the physiotherapy component at one to two hours a day. Where that is not possible, therapy should still be offered on a minimum of five days a week. In practice most Indian families arrange far less, and the gap is closed by a properly taught home programme.
When should physiotherapy start after a stroke or spinal injury?
Positioning, passive movement and chest care start immediately. Getting out of bed begins as soon as the clinical condition permits. The one exception is that NICE advises against high-intensity mobilisation in the first 24 hours after stroke symptoms begin for people who need help to sit, stand or walk, following trial evidence that very early high-dose out-of-bed activity reduced the odds of a good outcome at three months. That decision sits with the treating team.
Can paralysis be cured with physiotherapy?
Physiotherapy does not repair the original damage. What it does is help the nervous system recruit and reorganise whatever pathways remain, build strength and control around them, and prevent the complications that would otherwise cause further disability. Outcomes range from full functional recovery to substantial independence with aids, depending on the cause and severity. Anyone guaranteeing a cure is selling, not treating.
How long does recovery from paralysis take?
Recovery is fastest in the early months, and the evidence for intensive therapy is strongest in roughly the first six. But improvement continues with continued work, and there is no point at which starting becomes pointless. Plan in months, review progress against goals set at the start, and expect the rate to slow rather than stop.
What happens if physiotherapy is delayed?
Joints that are not moved stiffen into fixed positions that are far harder to reverse than to prevent. Skin under unrelieved pressure breaks down. The chest accumulates secretions, and immobility raises clot risk. Much of the disability seen a year after a stroke or spinal injury comes from these secondary problems rather than the original event.
Why must you never pull on the weak arm?
After a stroke the weak shoulder often loses the muscular support that holds the joint together, and the arm can partially slip out of the socket. Pulling on it to move, turn or lift the patient can injure the joint permanently and cause pain lasting years. Move the person by supporting the trunk, and make sure every relative and attendant knows this rule.
Is home physiotherapy as effective as going to a centre?
Both work, and the choice usually turns on practicalities. Home is generally better in the dependent early stage, when transporting the patient is hard and exhausting, and it lets training happen on the actual bed, chair and bathroom the person uses. A centre offers equipment such as parallel bars and tilt tables. Many families use home sessions first and add centre sessions once travelling is realistic.
What equipment is needed for paralysis care at home?
Usually an adjustable hospital bed, a pressure-redistributing air or alpha mattress, a commode chair and a wheelchair, with walking aids, splints and a transfer board or belt added as function returns. The list is decided by how much the patient can move rather than by the diagnosis, and most of it is better rented because the requirement changes.
How do we prevent bed sores in a paralysed patient?
A regular repositioning schedule day and night, a pressure-redistributing mattress where the patient cannot shift their own weight, keeping skin clean and dry, adequate nutrition, and a daily skin check over the tailbone, heels, hips, elbows and shoulder blades. Redness over a pressure point that does not fade when pressure is relieved needs reporting the same day.
What can the family do between therapy sessions?
Positioning and turning on schedule, daily passive range of movement to every joint on the affected side, safe transfers using the technique the physiotherapist taught, getting the patient sitting out of bed daily, and letting them do whatever they can themselves rather than doing it for them. Keeping a short daily log helps the therapist adjust the plan.
Do you provide paralysis physiotherapy at home in the Tricity?
Yes. Healthy Jeena Sikho provides neuro physiotherapy at home across Chandigarh, Mohali, Panchkula and Kharar, with a physiotherapy centre in Sector 71, Mohali for when travelling becomes practical. Hospital beds, air mattresses, wheelchairs, commodes and walking aids can be arranged alongside on rental. Call +91 98769 78488 or message +91 98759 15278 on WhatsApp.
References and further reading
- National Institute for Health and Care Excellence. Stroke rehabilitation in adults — Recommendations , NICE guideline NG236 — including recommendation 1.2.16 (needs-based rehabilitation of at least 3 hours a day on at least 5 days a week across physiotherapy, occupational therapy and speech and language therapy), 1.2.17 (a minimum of 5 days a week where 3 hours a day is not possible), physiotherapy of 1 to 2 hours a day for 5 days a week, treatment by physiotherapists with relevant skills and training, and assessment and multidisciplinary management of spasticity.
- National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management — Recommendations , NICE guideline NG128 — including recommendation 1.7.2 (help people to sit out of bed, stand or walk as soon as their clinical condition permits) and 1.7.3 (do not offer high-intensity mobilisation in the first 24 hours after symptom onset to people who need help to sit out of bed, stand or walk).
- AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial . The Lancet 2015 — very early, higher-dose out-of-bed activity reduced the odds of a favourable outcome at 3 months compared with usual care.
- National Institute for Health and Care Excellence. Pressure ulcers: prevention and management , NICE clinical guideline CG179.
- National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism , NICE guideline NG89.
Medical disclaimer. This page is general educational information about physiotherapy after paralysis. It is not medical advice and does not replace assessment by a qualified doctor or neuro-physiotherapist. No specific exercise programme is prescribed here deliberately, because what is safe and useful depends on the cause of the paralysis, the level and completeness of any spinal injury, muscle tone, sitting tolerance, skin condition and medical stability — which is what an assessment establishes. Handling, transfers, weight-bearing, splinting and the timing and intensity of mobilisation must be determined by the treating team, and their instructions take precedence over anything here. Do not begin, change or intensify a programme, and do not attempt unsupervised standing or walking practice, without professional guidance. The rehabilitation intensity figures quoted here come from stroke rehabilitation guidance and will not apply unchanged to every cause of paralysis. Seek urgent medical care for new weakness, facial droop or slurred speech, chest pain or sudden breathlessness, pain or swelling in one calf, fever with breathlessness, broken skin over a pressure point, new confusion, a fall, or choking during meals. Healthy Jeena Sikho arranges physiotherapy, nursing and attendant services and supplies home medical equipment, and does not diagnose conditions or independently set clinical parameters.