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5 Steps to Advancing Physical Therapy for Stroke Patients at Home

By J.J. Mowder-Tinney, PT, PhD, NCS, C/NDT, CSRS, CEEAA and Angie Reimer, OTD, MOT, OTR, CBIST

on August 5, 2023

Categories: Nursing, Occupational Therapy, Physical Therapy, Speech Pathology

For many clinicians, developing and progressing physical therapy for stroke patients at home can feel like a daunting task. But having a process to work from can help increase your efficiency, boost your confidence, and improve outcomes. In this article, we’ll provide a step-by-step process for advancing home exercise programs (HEPs) specifically tailored for stroke recovery.

Understanding the Needs of Post-Stroke Patients

When working with post-stroke patients, it is essential to recognize their unique rehabilitation needs. Physical therapy for stroke patients at home focuses on restoring mobility, strength, and function lost due to stroke. The exercises and strategies outlined here are designed to address the specific challenges faced by these patients, helping them regain independence in their daily activities. Tailoring HEPs to post-stroke patients ensures that therapy is not only effective but also manageable for both patients and their caregivers.

Step 1: Gather Information

First, it’s important to gather information that will assist you in developing a suitable physical therapy for stroke patients at home program that won’t overwhelm your patient or their caregiver. You’ll want to:

Ask your patient and the primary caregiver(s) what two functional activities are most frustrating to them daily and would make the biggest impact if the patient were able to complete them with less difficulty. (These may change continually as the patient improves, but stay focused.)
Determine what barriers are impacting performance or completion of these tasks.
Decide on the two most important areas for the patient to improve while performing the functional task. You’ll want to be task specific and allow as many repetitions as possible while addressing those primary limitations.
Identify the primary impairments (for example, isolated active movement of the arm or lack of gluteus medius strength) impacting the patient’s ability to perform daily activities such as standing up and pulling up their pants, putting on their shirt, and maintaining their balance standing in the bathroom.

Step 2: Assess

Imagine that your patient requires moderate assistance with turning in the bathroom during activities-of-daily-living (ADL) tasks. Observation is key! Take a look at the following:

What does your patient look like when they’re turning? Are they stable in the pelvis to allow shifting of the weight? Possible assessment: gluteus medius weakness.
Are their eyes moving appropriately during movement? Possible assessment: eye tracking issue.
Are they collapsing in the trunk? Possible assessment: proximal weakness in the trunk.
Are they flexed over and relying heavily on their upper extremities to stay upright? Possible assessment: gluteus maximus weakness.
Do they lose balance instantly if their eyes are closed? Possible assessment: decreased somatosensory function.

Step 3: Intervene

When working on functional tasks in the clinic, make adjustments that will target the impairments in your hypotheses above.

Addressing Gluteus Medius Weakness

Add a resistance band around the legs during sit-to-stand or standing activities to increase gluteus medius activation.

Addressing Eye Tracking Issues

Do prepping with visual tracking activity or smooth pursuits to prepare the visual motor and/or vestibular systems.

Addressing Trunk Weakness

Add sustained pushing to increase trunk activation for proximal weakness.

Addressing Decreased Somatosensory Function

Perform standing balance tasks at the counter with eyes closed to improve somatosensory function.

Step 4: Develop Your HEPs

Adjust your home program to address any one of these impairments or limitations. This will allow you to provide increased challenge during therapy sessions without overwhelming your patient.

Step 5: Follow Up

Regularly perform informal reassessments to modify the HEP as the patient progresses. It’s essential to remove older tasks and introduce higher-level ones to keep the patient from feeling overwhelmed with too many exercises, ensuring the effectiveness of physical therapy for stroke patients at home.

Empowering Recovery Through Structured Home Programs

Advancing physical therapy for stroke patients at home requires a thoughtful and individualized approach. By following these five steps—gathering information, assessing patient needs, implementing targeted interventions, developing tailored home exercise programs, and regularly following up—you can enhance the recovery process for your post-stroke patients. These strategies not only address specific impairments but also empower patients and their caregivers to actively participate in the rehabilitation journey. With a well-structured plan, you can provide effective, manageable, and impactful home programs that foster independence and improve quality of life for stroke survivors.

J.J. Mowder-Tinney, PT, PhD, NCS, C/NDT, CSRS, CEEAA

J.J. Mowder-Tinney received her Bachelor of Science in psychology from the University of Colorado, Boulder, and her Master of Science in physical therapy from the University of Miami in Florida. She completed her doctorate in physical therapy at NOVA Southeastern University. She has almost 20 years of experience in a multitude of clinical settings, with the majority of her experience being with people with neuromuscular deficits.

She is certified as a clinical specialist in neurologic physical therapy by the American Board of Physical Therapy Specialties (ABPTS). She has extensive training and is certified in Neuro-Developmental Treatment (NDT), and she received her Certified Stroke Rehabilitation Specialist (CSRS) from the American Stroke Association.

She is currently an associate professor at Nazareth College in the physical therapy department. She teaches the neuromuscular series that incorporates the onsite pro-bono clinic. In addition, she teaches an advanced neuromuscular elective.

She has served on many professional committees related specifically to neurology, spinal cord injury rehabilitation, wound care, and adaptive seating. She has also conducted nationwide seminars on the treatment of patients with neurological deficits, spinal cord injuries, balance challenges, and Parkinson's disease.

Angie Reimer, OTD, MOT, OTR, CBIST

Dr. Reimer received both her Bachelor of Science degree in health sciences and master's degree in occupational therapy from the University of Findlay and her doctorate in occupational therapy from Indiana University. She boasts more than 20 years of clinical experience with geriatric and neurologically impaired populations, including serving as a regional manager and educator for several rehabilitation organizations. Additionally, Dr. Reimer codeveloped and teaches the CSRS certification, which is the only certification in stroke rehabilitation. She is a member of the American Society of Neurorehabilitation, the American Congress of Rehabilitation Medicine, the Indiana Occupational Therapy Association, and the American Occupational Therapy Association (AOTA), and she is a member of several regional and national practice committees, such as the AOTA's national credentialing committee. Dr. Reimer has presented courses across North America on kinesiology taping and stroke rehabilitation and has lectured extensively for PT and OT programs across the United States.

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5 Steps to Advancing Physical Therapy for Stroke Patients at Home