Stroke Rehabilitation at Home in Deccan Gymkhana, Pune

A stroke changes a household overnight. In Deccan Gymkhana the patient is often a retired teacher, engineer or doctor who lived independently in a bungalow-turned-flat until the day of the attack, and the person now helping is a spouse of similar age or a son or daughter who has taken leave from work. After a hospital stay, the questions become practical: how do we get him to the bathroom, what should she practise, and how do we keep the arm from stiffening?

This page describes how stroke rehabilitation is carried out in the home for families around the Gymkhana, with the family included as part of the treatment team.

Turning an ordinary flat into a practice space

The physiotherapist begins by walking through the rooms the patient actually uses. The ground floor of an older house and the third floor of a walk-up present quite different problems, and so do a wide hall and a narrow passage between a cupboard and a bed. Typical points to look at:

• Bed height and side. Getting out of bed towards the stronger side is usually safer, and the position of the bed against the wall decides which side that is.
• The route to the bathroom. Door width, threshold lips, a wet floor and the height of the toilet seat all affect whether the patient can go without help.
• Chair and dining seat. A firm chair with arms makes standing practice easier than a soft sofa or a low floor cushion.
• Stairs. If the flat is above ground level and has no lift, the family needs a clear plan for the first outing, including who stands where on the steps.
• Lighting and clutter. Rugs, cables and low tables are removed from the path before walking practice begins.

What a home stroke session works on

The programme depends on which abilities the stroke affected. Common focus areas are sitting and standing balance, moving the weaker arm and leg, relearning to transfer between bed, chair and toilet, walking with or without an aid, and protecting the shoulder from pain and the hand from stiffness. The physiotherapist repeats movements many times and breaks tasks into small parts, since this repetition is what retrains the brain and body.

Families are taught how to position the weak arm, how to help without pulling on it, and how to guard the patient during a transfer. Speech, swallowing and thinking difficulties are handled by other professionals, and we say so openly and work with your doctor and therapists where needed. If the patient also has weakness after an operation, see post-surgery rehabilitation in Deccan Gymkhana; for older people who are becoming frail, elderly physiotherapy in Deccan Gymkhana may help too.

Going out again: appointments and parks

Follow-up visits to a neurologist or physician usually involve a car or auto-rickshaw, a kerb and perhaps a lift. Practise that route at home first: stepping into a vehicle, using a stick or walker, and resting on arrival. Once the physiotherapist agrees, short outings to a nearby garden can make walking practice more interesting, but start with a flat path, a family member beside the patient and a place to sit.

Warning signs after a stroke

A second stroke or a complication needs emergency care. Take the patient to a hospital without delay if there is new weakness, a drooping face, slurred speech, sudden confusion, a severe headache, vision loss, a fit, chest pain or breathlessness. A swollen, painful calf, or a fall with a blow to the head, also needs urgent medical review. Do not start or continue exercises until a doctor has assessed these.

To start a programme, book a home visit. Our guide to home physiotherapy in Deccan Gymkhana lists the roads and neighbourhoods we reach.