Stroke recovery at home: therapy, safety, mood and the signs of another stroke

More than 795,000 people in the United States have a stroke each year, and nearly 1 in 4 of those strokes happen to someone who has had one before.¹ That second number is why the weeks at home matter. The routines that support recovery, like therapy, medicines and a safe house, are the same ones that help prevent the next stroke. This note covers therapy at home, safety, eating, medicines, mood and the signs that mean call 911.

The short answer

• Call 911 if any of these come on suddenly: numbness or weakness of the face, arm or leg, blurry vision, trouble speaking or understanding, dizziness or loss of balance, or a severe headache.²
• Take blood thinners, blood pressure medicines and cholesterol medicines as prescribed, and don’t stop them on your own. They help prevent another stroke.²
• Choking or coughing when eating can mean a swallowing problem. Tell the provider.²
• Depression after a stroke is common. Talk about it with family and with the provider.²
• For people who qualify for home health, Medicare covers physical, occupational and speech therapy at home.³

Why the weeks at home matter

Stroke is a leading cause of serious long-term disability, and it limits how well more than half of survivors 65 and older can get around.¹ Many people go home still relearning how to walk, dress, eat or talk, and much of that relearning happens in the house, in the middle of ordinary days. The family sees more of it than anyone on the care team does.

Therapy at home

Medicare covers physical therapy, occupational therapy and speech-language pathology at home when the person qualifies for home health.³ Each works on a different part of recovery:

• Physical therapy works on walking, balance, strength and moving safely between the bed, a chair and the toilet.
• Occupational therapy works on dressing, bathing and eating, and on setting up the home so those tasks are easier and safer.
• Speech-language pathology works on speaking, understanding language, thinking skills and swallowing.

Progress doesn’t have to be fast for therapy to continue. Medicare coverage of skilled therapy doesn’t depend on whether the person can improve, and skilled therapy to keep abilities or slow a decline can be covered too.⁴ Ask each therapist to leave written exercises for the days between visits, and to show the family how to help without doing the work for the person.

Safety at home

• Make the home safe, and ask the provider or therapist about changes that make daily tasks easier.²
• If the person uses a wheelchair, check the skin every day for pressure sores and shift position several times an hour.²
• Don’t drive without the provider’s permission.²
• Preventing falls at home has a room-by-room checklist.

Dressing and daily tasks

Many people need help with tasks they once did on their own, and physical or occupational therapy may help them get those back.² Clothes can make mornings easier: Velcro in place of buttons and zippers, any buttons and zippers on the front, pullover tops and slip-on shoes.²

Eating and swallowing

A stroke can affect swallowing. Choking or coughing when eating are signs of a swallowing problem.² Tell the provider, and ask about safer ways to eat and drink. A speech-language pathologist can test swallowing at home and teach the family what to watch for.

Medicines that help prevent another stroke

Blood thinners, blood pressure medicines and cholesterol medicines help prevent another stroke, and MedlinePlus is direct about it: don’t stop taking any of them.² Fill every prescription before going home, take each one as directed, and ask before starting any supplement or herb. Some blood thinners, like warfarin, need extra blood tests.² Keeping medicines straight after the hospital explains how to get to one correct list.

Mood

Depression after a stroke is common as people learn to live with the changes.² If the person seems sad or down, say so, and tell the provider. Caregivers can wear down too, and the same goes for them.

Staying well

Get a flu shot every year, and ask the provider about pneumococcal and COVID-19 vaccines.² Try to stay away from stressful situations, and if the stress doesn’t let up, tell the provider.²

When to call

Call the provider for trouble moving or getting around, skin sores, a recent fall, pain that’s getting worse, or choking when eating.²

Call 911 if any of these come on suddenly: numbness or weakness of the face, arm or leg; blurry vision; trouble speaking or understanding; dizziness or loss of balance; or a severe headache.² Note the time the symptoms started, and tell the paramedics.