5 Steps to Advancing Home Programs for Post-Stroke Patients

For many clinicians, developing and progressing your patients’ home exercise programs (HEPs) 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 HEPs for post-stroke patients.

Step 1: Gather Information

First, it’s important to gather some information to assist you in developing an appropriate program that won’t overwhelm your patient or the patient’s 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

Perform informal reassessment of the patient regularly to upgrade the HEP as the patient improves. Don’t forget to take away older items as you add higher-level ones to prevent the patient from becoming overwhelmed with the number of tasks they have been given.