Stroke Recovery at Home: Equipment, Routine and Family Roles

What a stroke does

A stroke happens when blood flow to part of the brain is blocked (ischaemic stroke, the most common type) or a blood vessel bursts (haemorrhagic stroke). Depending on the area affected, effects can include weakness or paralysis on one side, loss of feeling, trouble speaking or understanding (aphasia), slurred speech, difficulty swallowing, vision loss on one side, poor balance, memory and thinking changes, neglect of one side of the body, fatigue, emotional changes, bladder and bowel problems and shoulder pain. Recovery depends on the size and location of the stroke, age, other illnesses, how quickly treatment was received and how much rehabilitation follows.

For the early warning signs and emergency steps, see stroke warning signs and the first hour. For preventing another, see preventing a second stroke. For exercise guidance, see exercise after a stroke at home.

Before and at discharge: what to get from the hospital

• A discharge summary with diagnosis, type of stroke, medicines and follow-up.
• A written therapy plan from the physiotherapist, occupational therapist and speech therapist, with pictures if possible.
• Safe handling training: how to help with transfers, walking, dressing, toileting and feeding; see bed transfer techniques.
• Swallowing advice: diet texture and thickened fluids if needed.
• Equipment recommendations and where to get them.
• Medicine list, including blood thinners and blood pressure medicines; never stop or change them without the doctor.
• Follow-up appointments, tests and who to call; see hospital admission and discharge for seniors.
• Warning signs and emergency numbers.
• Referral to outpatient or home therapy, and a plan for the first weeks.

Preparing the home

A room on the ground floor near a toilet is ideal; see ground floor vs upper floor living. Clear paths, remove rugs, add night lights and handrails; see flooring, rugs and trip hazards and handrails and stair lifts.

Bedroom. A bed at a height where feet are flat when sitting, with a firm edge; a hospital bed with backrest if the person is mostly in bed; position the bed so the person gets out on the stronger side; see hospital bed buying guide and bedroom setup for night safety.

Bathroom. Shower chair, handheld shower, grab bars on the stronger side, raised toilet seat or frame, non-slip floor; see bathroom safety after a stroke, shower chair buying guide and raised toilet seat guide.

Living and dining. A firm chair with arms and a supportive back, at a good height; a table at the right height for eating; see choosing a chair for an older person.

Kitchen. Items within reach on the stronger side; non-slip mats; one-handed tools if needed; see simple gadgets for one-handed living and easy grip cutlery guide.

Communication. A phone, call bell or pendant within reach; picture boards if speech is affected; see panic pendant buying guide.

Equipment commonly needed

• Walking aid: quad stick, walking stick, frame or wheelchair, depending on the therapist's assessment; see walking aids after a stroke, quad stick after a stroke and wheelchair buying guide.
• Transfer belt for carers if advised; see how to use a transfer belt.
• Dressing aids: button hooks, elastic laces, loose front-opening clothes; see dressing after a stroke and dressing aid guide.
• Eating aids: non-slip mat, plate guard, easy-grip cutlery; see eating with tremor or weak grip.
• Positioning pillows and a supportive cushion; see positioning pillows after stroke and positioning a bedridden parent.
• Pressure-relieving mattress or cushion for those who sit or lie long; see choosing an anti-bedsore mattress.
• Blood pressure monitor if the doctor advises; see how to measure blood pressure at home.
• Orthoses or splints only as prescribed.
• Continence products and commode if needed; see commode chair guide.

A daily routine

A predictable routine helps energy, mood and recovery.

Morning: wake gently; allow time; toilet; wash and dress seated, with the weak side first for dressing; breakfast sitting upright; medicines from a pill organiser; see pill organiser guide.

Midmorning: therapy practice, short sessions, with rest. Tasks such as standing from a chair, reaching, stepping, using the weak hand in simple tasks, speech exercises.

Midday: meal, rest, a short walk with help.

Afternoon: second therapy block or activity, social contact, a short outing if safe, rest.

Evening: light meal, medicines, gentle activity, family time, a warm wash, preparation for bed.

Night: safe route to the toilet, lights, commode or urinal if needed; see night toileting from the bed.

Fatigue after a stroke is profound. Keep sessions short, rest often and plan the hardest tasks for the best time of day.

Therapy practice at home

Practice should be regular, meaningful and safe. Follow the therapists' plan; do not invent programmes. In general terms: repeat everyday movements such as sit-to-stand, stepping, reaching and gripping; support the weak arm, never pull on it; encourage use of the weak side in daily tasks; and keep positions that prevent stiffness. See exercise after a stroke at home for principles and cautions. Speech therapy exercises, swallowing exercises and cognitive tasks may also be given.

Swallowing and eating

Swallowing problems (dysphagia) are common and can cause choking and chest infections. Signs: coughing or choking with food or drink, a wet or gurgly voice after swallowing, food pocketing in the cheek, drooling, weight loss, repeated chest infections. If suspected, tell the doctor, who may arrange a swallowing assessment by a speech therapist. Follow the diet texture and fluid advice exactly. Sit fully upright to eat, with small mouthfuls, slowly, and stay upright for a while afterwards. Check the mouth for food residue. Good mouth care reduces infection; see swallowing problems and dysphagia, aspiration pneumonia prevention, soft and pureed diets and oral care for frail older adults. If eating is not safe or adequate, a feeding tube may be discussed; see tube feeding and supplements basics.

Speech and communication

Aphasia affects finding words, understanding or both, and is not a loss of intelligence. Slurred speech (dysarthria) is a muscle problem. Help by: reducing noise; speaking slowly and simply; giving time; asking yes or no questions; using gestures, pictures and writing; not finishing sentences unless asked; treating the person as an adult; practising speech therapy tasks. See communicating with someone who has dementia for gentle general principles, though aphasia differs from dementia. A speech and language therapist can teach techniques and provide communication aids.

Mood, thinking and emotions

Low mood and anxiety affect a large share of stroke survivors. Emotional lability, with sudden crying or laughing, is also common. Memory, attention and planning may be affected. Support with patience, routine and simple instructions; ask the doctor about low mood, which is treatable; see depression in older adults and anxiety in older adults. Encourage social contact and meaningful activity; see loneliness and isolation in older adults.

Skin, shoulder, bladder and bowel

• Skin: check pressure areas, particularly heels and the tailbone; keep the skin dry; change position; see preventing bedsores at home.
• Shoulder: support the weak arm on a pillow; never pull on it; report shoulder pain.
• Bladder and bowel: timed toileting, fluids and fibre; see bladder training and timed toileting and constipation in older adults.
• Sleep: protect sleep; see sleep problems in older adults.
• Sensation: protect numb skin from heat and injury.

Family roles

Recovery is a team effort. Agree who does what: a primary carer; someone for appointments and paperwork; someone for finances; a night helper; a remote member for coordination. Learn safe handling; see how to lift and transfer safely. Avoid doing everything for your parent; let them do what they can. Share duties to prevent burnout; see caregiver burnout signs and prevention, respite care and taking a break and sharing care among siblings. Consider a trained attendant; see hiring a home attendant checklist. Stroke support groups can help families.

Warning signs

Call 112 at once for any new stroke signs: face drooping, arm or leg weakness, slurred speech, sudden confusion, sudden vision loss, sudden severe headache, loss of balance; also for chest pain, severe breathlessness, a seizure, collapse or choking that does not clear. Call the doctor the same day for fever, new cough, chest infection signs, a swollen red painful calf, very high or low blood pressure readings, new pain, a fall, worsening swallowing, refusal to eat or drink, or sudden mood change.

When to ask a professional

The stroke team should direct recovery. A physiotherapist works on movement; an occupational therapist on daily tasks and the home; a speech and language therapist on speech, understanding and swallowing. A doctor manages blood pressure, medicines and prevention. A dietician, nurse and psychologist help with nutrition, skin and continence, and mood. For senior services, call Elderline 14567. In an emergency, call 112.