Both researchers and clinicians have suspected for some time that stroke victims benefit from medically directed home care. But until recently there hasn’t been substantial evidence to support specific measures.

The pandemic has accelerated acceptance of telehealth as a core component of healthcare delivery, and because of this we believe there is an opportunity to rethink previous approaches to stroke recovery.

This article examines recent shifts in thinking on the topic – and explores how medically directed home care can help facilitate the execution of a post-stroke care plan.

The advent and efficacy of telerehabilitation

A 2019 literature review of randomized control trials (RCTs) brought to light several areas where telerehabilitation – the use of interactive devices to support rehabilitation programs - can be effective in post stroke care.

  • Arm motor function. Establishing basic movement, constraint-induced movement, and task-specific movement.
  • Occupational health. Telerehabilitation has been shown to improve multiple ADLs.
  • Patient satisfaction and quality of life. Patients were generally satisfied with telerehabilitation and felt it improved their lives.

NOTE: The literature review mentioned above cautioned against overstating the impact of telerehabilitation, and noted specifically its limitations in helping patients restore balance and gait. In these cases, traditional in-person therapy may be more appropriate; a visit from a professional can address in-home safety issues and provide direct physical assistance.

More recently, a 2020 study by The American Academy of Neurology validated the role of telerehabilitation for home-based motor training, concluding that “it is feasible, safe, and efficacious for patients with stroke to receive professional rehabilitation training at home,” using technology-supported techniques including live video consultations.

“We help carry out the rehabilitation plan almost no matter what it involves,” said SeniorBridge Director of Clinical Services Deb Hess. “If it’s telerehab, we can help with technology and videoconferencing, setting up monitors and audio, and preparing a safe practice area. It’s all about continuing to push neural growth and build new pathways.”

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people who experience apathy 6 months after a stroke

Human icon with thought bubble

The American Heart Association made this point regarding post-stroke apathy: “Apathy has a strong effect on participation in meaningful activities and life’s roles,” it stated, “likely explaining in part why 50% of people 6 months post stroke lack meaningful activity. Apathy post stroke is under-studied, poorly measured, and largely ignored in the rehabilitation process.”

Stroke rehab at home: Providing context and continuity

“Stroke Rehabilitation at Home” is a research review published by the American Heart Association. A 2016 edition summed up the advantages of at-home rehabilitation by saying “providing therapy in the home environment supports continuity of care, establishes a relationship that the therapist and patient are making a journey together, provides an authentic environment for the experiences of functioning, and encourages patients to develop problem-solving skill.”

The research mentioned above pointed out that one shortcoming of stroke care at home is motivation. Whereas in an outpatient facility a patient may experience a sense of collective purpose and energy, this is not always the case at home. For this reason, home care professionals should provide active encouragement to keep therapy moving forward.

We have the ability to keep them engaged. Writing letters to loved ones. Going on Facebook. Gardening. Going to restaurants on Wednesdays. It’s all about keeping them motivated and moving forward.

Deb Hess

SeniorBridge Director of Clinical Services

Not to be forgotten: Caregiver support

Another aspect of rehabilitation at home concerns the people most often forgotten in this equation: Family caregivers. Ironically, they are positioned to benefit from medically directed home care as much as the patient.

Research done by the biomedical journal Acta Clinica Croatica in 2019 proved what home care providers have known for many years: In-home support of caregivers has a powerful impact on their ability to cope: “home care for stroke patients coupled with education of caregivers decreased the caregiver burden and increased their quality of life,” the study reported.

The lesson of both research and direct experience is this: Telerehabilitation can extend the reach of therapy into the home of the stroke survivor, and medically directed home care can help ensure the patient is engaged in their recovery.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on hypertension home care support services, contact SeniorBridge.

Sources consulted:
PLOS ONE (2019)
National Library of Medicine /NIH/Neurology (2020)
American Heart Association/Stroke (2016)
National Library of Medicine /Acta Clinica Croatica (2019)

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