Rehabilitation at home after stroke: a descriptive study of an individualized intervention

Objective: To describe the content of a programme involving early hospital discharge and continued rehabilitation at home after stroke. Design: Quantitative and qualitative descriptive study of an intervention w ithin the context of a randomized controlled trial. Setting. Huddinge University Hospital, Stockholm, Sweden. Subjects: Forty-one patients, moderately impaired after stroke, rehabilitat ed by a team of six occupational, physical, and speech and language therapi sts. Results: The average duration of the programme was 14 weeks, the mean numbe r of home visits 12, and the median total time consumption 23 hours and 20 minutes, of which face-to-face contact with the patient constituted 54%. Th e rehabilitation process was pursued by the patient and the therapist in pa rtnership. Supported by the team the therapists incorporated a wider domain of activities than usual and left a considerable amount of the training to self-directed activities. The most common foci of the visits were speech a nd communication, ADL activities and ambulation. When planning the interven tion the therapists paid attention to discrepancies between the desires and abilities of the patient on the one hand and environmental demands on the other - discrepancies detected through observation of the patient in the ho me environment. Conclusions: The home environment offers therapists working in a team oppor tunities to adopt a behaviour that enables patients with moderate neurologi cal impairments after stroke to resume responsibility and influence over th eir rehabilitation process, resulting in an individualized rehabilitation p rogramme that varies in duration, content and frequency of home visits.