Stroke rehabilitation at home in Lewisham

We have tried to make this genuinely useful rather than a sales page. The numbers are cited. The prices are real. Where the evidence is uncertain, we say so.

What happens locally after a stroke in Lewisham

There is one thing about the Lewisham pathway that catches almost everybody out, so it is worth saying first.

You will not be taken to University Hospital Lewisham. Hyper-acute stroke care for every Lewisham and Greenwich patient is provided at King's College Hospital, Denmark Hill — fifth floor, Ruskin Wing. That is where the ambulance goes. If a relative is looking for you at Lewisham on day one, they are at the wrong hospital.

Once you are through the hyper-acute phase you transfer back to University Hospital Lewisham for ongoing treatment and rehabilitation. There are two wards involved: Beech Ward on the first floor of the Riverside Building, a purpose-built stroke unit with its own physiotherapy, occupational therapy and speech therapy facilities; and Maple Ward on the second floor, a 24-bed rehabilitation unit with an on-ward gym, kitchen and group areas.

Then you go home — and Lewisham's community offer is structured differently from its neighbours.

There is no separately named Lewisham community stroke team. Instead there is a stroke early discharge pathway inside Lewisham's intermediate care Supported Discharge team, jointly funded by Lewisham and Greenwich NHS Trust and the local authority. It brings together nurses, social workers, physiotherapists, an occupational therapist, therapy assistant practitioners and enablement officers, with speech and language therapy and consultant support.

Two numbers matter here, and one of them is genuinely good. The service runs seven days a week, 8am to 8pm — considerably broader than most London boroughs manage. And it usually sees people for around four weeks, up to six depending on progress.

Four to six weeks is the part worth thinking about. It is a sensible length for getting someone safely established at home. It is a short window if your goal is getting an arm working again.

Where the NHS pathway stops

Nothing above is a criticism of the people delivering it. The constraint is how much therapy is commissioned, not how hard anyone is working.

Here is the gap, in numbers.

National guidance — NICE guideline NG236, updated in October 2023 — recommends at least three hours of therapy a day, on at least five days a week after a stroke. That is the standard the NHS is measured against.

An analysis of 94,905 stroke patients in the UK national stroke audit found that the average therapy actually delivered ranged from two minutes of psychology to fourteen minutes of physiotherapy per day of hospital stay. That figure is averaged across every day of an admission, including days when no therapy happened — so on the days therapy ran, people got more. It is still a long way from three hours.

And in the community, nobody is really measuring. When the national audit added new measures in 2024 to check therapy against the NICE dose, every one of them applied to hospital inpatients only. The single community measure records whether you were seen by a stroke team — not how much therapy you actually got.

What we do differently

We deliver intensive rehabilitation in your home in Lewisham, at a dose closer to what the guideline describes. Up to ten sessions a week if that is what your goals need.

The reason dose matters is not that more hours are automatically better — the evidence is more careful than that, and we would rather tell you so. A Cochrane review in 2021 covering 21 trials and 1,412 people found more time in the same rehabilitation produced only a small gain in limb movement and no significant difference in everyday activities. A randomised trial in 2016 gave people up to 9,600 arm repetitions and found no dose-response effect at all.

What the evidence does support is purposeful, task-specific, high-repetition practice, aimed at the things you actually want to do again. And there the numbers are stark: researchers who sat in on 312 therapy sessions counted an average of 32 arm repetitions per session, while feasibility studies show around 300 in a single hour is achievable when a session is designed for it.

That is the difference we are selling. Not more hours of anything — more purposeful practice per hour, in the room where the movement actually matters.

We measure it, and we show you

Every programme is scored on standard, published measures — the same ones your hospital team used. Depending on your goals, that means the Fugl-Meyer Assessment for arm and leg movement, the Action Research Arm Test for hand function, the Berg Balance Scale, ten-metre walk speed, and the UK FIM+FAM for functional independence.

You get the scores. In writing. Including the ones that have not moved.

What it costs

Published, because you should not have to ask.

Programme	Sessions	Price per session
Guided Recovery	1 a week	£150
Intensive Recovery	3 a week	£110
Immersion Recovery	up to 10 a week	£100

A booster pack of two extra sessions a week is £400.

Every programme begins with a 60–90 minute assessment in your home covering a full clinical assessment, a written rehabilitation plan and a programme recommendation — plus an independent management programme you keep whatever you decide next. We ask you to have a family member, carer or advocate there if at all possible, because rehabilitation rarely works when only the patient understands the plan.

If a programme would put you under real financial strain, we will tell you and recommend a lower-intensity option. That is a promise, not a marketing line.

Common questions

What happens when the six weeks are up?

For many people, that is when the questions start — you are safe at home, but a long way from where you were. Lewisham also runs a neurological physiotherapy outpatient service at Lewisham Hospital, and your GP can refer you. Beyond that, continuing at a meaningful dose is generally something you arrange privately. That is the gap we exist to fill, and we would rather be straight with you about it than pretend the NHS pathway simply stops working.

Is it too late? My stroke was months ago.

Not necessarily. An NHS programme at Queen Square in London ran 90 hours of intensive upper-limb therapy over three weeks with 224 patients who were a median of 18 months past their stroke, and saw a median nine-point gain on the Fugl-Meyer scale that held at six months. That was an uncontrolled study with no control group — the authors say so themselves — so treat it as encouraging rather than proof. But "too late" is said far more often than the evidence supports.

Do you guarantee I will get better?

No. Nobody honest does. Recovery varies between people and always will. We will tell you what we think is realistic after the assessment, and we will show you the measurements either way.

Which areas do you cover?

The whole London Borough of Lewisham — Lewisham, Blackheath, Brockley, Catford, Deptford, Forest Hill, New Cross, Sydenham and the surrounding area.

This page is general information and not a substitute for assessment by your GP, stroke team or physiotherapist. Every recovery is different.