In short: The stroke recovery timeline isn't just "wait and see" — it's a map of what to train this week, how much to dose next month, and when to switch from mobilization to true gait training. Kwakkel (Lancet 2004), Veerbeek (PLoS ONE 2014), and AVERT (Lancet 2015) provide clear guidance for each phase.

Phase 1 — Acute (24 hours – 7 days): Don't lie still, don't overdo it

The AVERT trial (Bernhardt, Lancet 2015, n=2,104) showed very early mobilization (<24 h) at very high dose (>3 sessions/day) produced worse outcomes than starting at 24–48 h with moderate dose.

Planning rule: Start out-of-bed activity on day 2, 3–4 short sessions/day. Focus on sitting balance and transfers — not immediate gait.

Phase 2 — Early Subacute (Week 2 – Month 3): The most productive window

Cortex-driven neuroplasticity peaks here. Zeiler & Krakauer (Curr Opin Neurol 2013) call it the "sensitive period": one hour of training here is worth 3–5 hours in the chronic phase.

≥2–3 PT sessions/day (task-specific, high-repetition)
Body-weight-supported treadmill as soon as supported standing is possible (LEAPS, NEJM 2011)
Add TMS priming ~20 min before each gait session (Hsu, Stroke 2012)
Track Barthel Index and FAC every 2 weeks and adjust

Phase 3 — Late Subacute (Month 3–6): From "can walk" to "can live"

Kwakkel (Lancet 2004) confirms dose–response remains strong through month 6, but the goal shifts from basic ambulation to community ambulation.

Planning rule: Overground walking >500 m/session, dual-task training (walking while talking or carrying), stair training, outdoor terrain.

Phase 4 — Chronic (Beyond 6 months): Not the end, but change the strategy

EXCITE (Wolf, JAMA 2006) and ICARE (Winstein, JAMA 2016) proved gains continue in the chronic phase — but only with high-intensity task-specific training and adjunct technology (ESWT for spasticity, FES for foot drop, robotic gait).

Planning rule: A 3–4 week bootcamp-style intensive block (30–60 total hours), then home program with reassessment every 3 months.

Why phase-based planning beats "just do more therapy"

Wrong-phase training wastes time — heavy resistance in phase 1 can worsen spasticity.
Under-dosing in phase 2 forfeits neuroplasticity that never fully returns.
Training gait before trunk control is ready produces compensatory patterns that are hard to unlearn.

How Sanpiti plans your timeline

Sanpiti's PM&R physician and PT Kultinee Glinpoon (PT 9032) jointly reassess every 2 weeks to adjust dose, technique, and technology (TMS/PMS/ESWT) to match the current phase. Average inpatient stay is 2.6 months — covering phases 1–3 in full.

References

Bernhardt J et al. AVERT. Lancet 2015;386:46–55.
Zeiler SR, Krakauer JW. Curr Opin Neurol 2013;26:609–16.
Kwakkel G et al. Lancet Neurol 2004.
Veerbeek JM et al. PLoS ONE 2014.
Duncan PW et al. LEAPS. NEJM 2011.
Wolf SL et al. EXCITE. JAMA 2006.
Winstein CJ et al. ICARE. JAMA 2016.

How the Stroke Recovery Timeline Affects Rehab Planning (Educational)