Acute Stroke Recovery at Home
Case Study: Acute Stroke Recovery at Home
How AtHomeCare’s Rapid Neurorehabilitation Program Transformed Recovery for a 68-Year-Old Stroke Patient in Delhi
Executive Summary
This case study examines how AtHomeCare’s comprehensive home-based neurorehabilitation program enabled a 68-year-old male patient to achieve remarkable recovery following a hemorrhagic stroke. By implementing rapid physiotherapy, remote vitals monitoring, and caregiver training within the comfort of the patient’s home, AtHomeCare’s intervention resulted in a 42% improvement in functional independence, 100% prevention of hospital readmissions, and significant cost savings compared to traditional rehabilitation approaches. This case demonstrates AtHomeCare’s expertise in delivering evidence-based stroke rehabilitation in home settings, achieving outcomes that exceed national averages while prioritizing patient comfort and family involvement.
Key Finding: AtHomeCare’s home-based neurorehabilitation program with telemonitoring resulted in superior clinical outcomes, 100% prevention of hospital readmissions, and approximately $24,000 in healthcare cost savings compared to traditional inpatient rehabilitation.
Patient Background
Mr. Sharma, a 68-year-old retired accountant, was admitted to a Delhi hospital with sudden onset of left-sided weakness and slurred speech. His medical history included hypertension (poorly controlled), type 2 diabetes mellitus, and hyperlipidemia. He lived with his wife in a two-story home and was independent in all activities of daily living prior to the stroke. His medications included metformin 500mg twice daily, amlodipine 5mg daily, and atorvastatin 20mg at bedtime, with reported adherence of approximately 60%.
Initial examination revealed left-sided hemiparesis (3/5 strength in upper extremity, 4/5 in lower extremity), facial droop, dysarthria, and neglect of his left visual field. His National Institutes of Health Stroke Scale (NIHSS) score was 9, indicating moderate stroke severity. CT scan confirmed a right basal ganglia hemorrhage measuring approximately 15 mL. After 72 hours of inpatient stabilization, Mr. Sharma was medically stable but required significant rehabilitation.
At this critical juncture, the hospital recommended inpatient rehabilitation, but Mr. Sharma and his family expressed a strong preference for home-based care. The hospital’s stroke specialist recommended AtHomeCare’s stroke rehabilitation program, noting their expertise in home-based neurorehabilitation and telemonitoring. AtHomeCare conducted an evaluation within 24 hours of referral and confirmed that Mr. Sharma was an appropriate candidate for their home-based stroke rehabilitation program.
AtHomeCare’s Assessment and Intervention
AtHomeCare’s specialized stroke rehabilitation team conducted a comprehensive assessment at Mr. Sharma’s home within 72 hours of hospital discharge. The assessment followed American Stroke Association guidelines for post-stroke evaluation and included:
- Neurological Examination: Using the NIHSS, which was 7 at the time of assessment, indicating moderate stroke severity.
- Functional Assessment: Barthel Index score of 40/100, indicating moderate dependence in activities of daily living.
- Mobility Assessment: Functional Ambulation Category (FAC) score of 1 (non-ambulatory), requiring maximal assistance for any weight-bearing.
- Cognitive Assessment: Montreal Cognitive Assessment (MoCA) score of 18/30, indicating mild cognitive impairment.
- Home Environment Evaluation: Assessment of the home environment for safety, accessibility, and suitability for rehabilitation.
- Family Support Assessment: Evaluation of Mrs. Sharma’s ability and willingness to participate in the caregiving process.
Based on this comprehensive assessment, AtHomeCare developed a personalized rehabilitation program that would be delivered in Mr. Sharma’s home over a 12-week period. The program was designed to meet international standards of stroke rehabilitation while leveraging the benefits of home-based care.
Baseline Functional Measures
- NIHSS Score: 7/42
- Barthel Index: 40/100
- Functional Ambulation Category: 1/5
- Berg Balance Scale: 8/56
- Fugl-Meyer Assessment (Upper Extremity): 28/66
- MoCA Score: 18/30
AtHomeCare’s Initial Assessment
- Medical Stability: Confirmed
- Home Environment: Suitable with modifications
- Family Support: Strong (wife motivated) >Risk Factors: Hypertension, diabetes, poor medication adherence
- Rehabilitation Potential: Good
- Home Care Needs: High
AtHomeCare’s Comprehensive Home-Based Rehabilitation Program
AtHomeCare implemented a comprehensive home-based neurorehabilitation program that combined evidence-based rehabilitation techniques with advanced telemonitoring technology. The program was designed to maximize recovery potential while ensuring patient safety and preventing complications.
AtHomeCare’s Rapid Physiotherapy Protocol
AtHomeCare’s specialized neurorehabilitation physical therapists delivered intensive, evidence-based physiotherapy 5 days per week for the first 4 weeks, then 3 days per week for weeks 5-12. The protocol was based on principles of neuroplasticity and functional recovery, with progressive intensity based on Mr. Sharma’s tolerance and response.
Key components of AtHomeCare’s physiotherapy protocol included:
- Early Mobilization: Beginning with bed mobility exercises and progressing to sitting balance, standing balance, and ambulation as tolerated.
- Constraint-Induced Movement Therapy (CIMT):strong> Modified CIMT for the upper extremity to promote neuroplasticity and functional recovery.
- Body Weight-Supported Treadmill Training: Using AtHomeCare’s specialized home-based harness system to facilitate early ambulation.
- Functional Electrical Stimulation (FES):strong> Applied to the wrist and finger extensors to improve motor control and reduce spasticity.
- Balance and Coordination Training: Progressive exercises to improve balance and reduce fall risk.
- Task-Specific Training: Practice of functional tasks relevant to Mr. Sharma’s daily life and goals.
AtHomeCare’s Remote Vitals Monitoring System
AtHomeCare implemented a comprehensive telemonitoring system to ensure Mr. Sharma’s safety and enable early intervention for potential complications. The system included:
- Vital Signs Monitoring: Bluetooth-enabled devices for blood pressure, heart rate, oxygen saturation, and temperature, with measurements transmitted automatically to AtHomeCare’s clinical team.
- Activity Monitoring: Wearable accelerometer to track step count, activity levels, and sleep patterns.
- Blood Glucose Monitoring: Connected glucometer with automatic transmission of readings to monitor glycemic control.
- Medication Adherence Tracking: Smart pill dispenser with reminders and monitoring to ensure consistent medication administration.
- Video Consultations: Twice-weekly video sessions with AtHomeCare’s rehabilitation team for assessment and progress evaluation.
- Alert System: Automated alerts for vital signs outside of predetermined parameters, with immediate notification to AtHomeCare’s clinical team.
AtHomeCare’s Telemonitoring Equipment
- Bluetooth Blood Pressure Monitor
- Pulse Oximeter
- Smart Thermometer
- Activity Tracker
- Connected Glucometer
- Smart Pill Dispenser
- Tablet for Video Consultations
AtHomeCare’s Alert Parameters
- Systolic BP >180 or <100 mmHg
- Diastolic BP >110 mmHg
- Heart Rate >100 or <50 bpm
- Oxygen Saturation <92%
- Blood Glucose >250 mg/dL
- Fever >100.4°F (38°C)
- Inactivity >24 hours
AtHomeCare’s Caregiver Training Program
AtHomeCare provided comprehensive training for Mrs. Sharma to ensure she could safely and effectively support her husband’s recovery. The program included:
- Stroke Education: Comprehensive education about stroke, recovery process, and potential complications.
- Assistance with Activities of Daily Living: Hands-on training in safe techniques for transfers, dressing, and mobility assistance.
- Exercise Supervision: Training on supervising and assisting with home exercise programs.
- Medication Management: Education about medications, side effects, and administration.
- Monitoring Skills: Training on recognizing signs of complications and using monitoring equipment.
- Communication Strategies: Techniques for effective communication with Mr. Sharma.
- Self-Care Training: Education on caregiver self-care and stress management.
Implementation and Progression
AtHomeCare’s program was implemented over 12 weeks, with regular assessments and adjustments based on Mr. Sharma’s progress and tolerance. The program followed a structured progression designed to maximize recovery while ensuring patient safety.
AtHomeCare’s team focused on bed mobility, sitting balance, and prevention of complications. Physiotherapy sessions of 30 minutes, 5 days/week. Remote vitals monitoring 4 times daily. Mrs. Sharma received training on basic assistance and monitoring. Mr. Sharma progressed from requiring maximal assistance for sitting to minimal assistance.
AtHomeCare introduced standing balance, pre-gait activities, and upper extremity functional tasks. Physiotherapy sessions increased to 45 minutes, 5 days/week. Modified CIMT was initiated. Remote vitals monitoring 3 times daily. Mr. Sharma achieved standing balance with minimal assistance and began weight-bearing activities.
AtHomeCare focused on ambulation, advanced balance activities, and fine motor skills. Physiotherapy sessions of 60 minutes, 5 days/week. Body weight-supported treadmill training was initiated. Remote vitals monitoring 2 times daily. Mr. Sharma progressed to ambulation with a walker (FAC 3) and improved hand function.
AtHomeCare emphasized community ambulation, advanced ADLs, and cognitive-communication tasks. Physiotherapy sessions of 60 minutes, 3 days/week. Community integration activities were initiated. Remote vitals monitoring 1 time daily. Mr. Sharma achieved independent ambulation with a cane (FAC 4) and independence in basic ADLs.
Outcomes and Results
Under AtHomeCare’s comprehensive program, Mr. Sharma demonstrated significant improvements across all measured domains, exceeding typical recovery trajectories for hemorrhagic stroke:
Functional Outcomes
| Measure | Baseline | 12 Weeks | Improvement | National Average |
|---|---|---|---|---|
| Barthel Index | 40/100 | 82/100 | 42% | 25-30% |
| Functional Ambulation Category | 1/5 | 4/5 | 3 levels | 1-2 levels |
| Berg Balance Scale | 8/56 | 48/56 | 40 points | 15-20 points |
| Fugl-Meyer (Upper Extremity) | 28/66 | 52/66 | 24 points | 10-15 points |
| NIHSS | 7/42 | 2/42 | 5 points | 3-4 points |
Medical Outcomes
AtHomeCare’s telemonitoring system enabled early intervention for medical issues, resulting in excellent medical outcomes:
- Blood Pressure Control: Average systolic BP decreased from 160/95 mmHg to 130/80 mmHg, with no hypertensive urgencies.
- Glycemic Control: Average blood glucose decreased from 156 mg/dL to 126 mg/dL, with no hypoglycemic events.
- Medication Adherence: Improved from 60% to 85% through AtHomeCare’s smart pill dispenser and monitoring system.
- Complications: No hospital readmissions, infections, falls, or other complications during the 12-week program.
- Swallowing Function: Normalized with no episodes of aspiration or pneumonia.
Quality of Life and Patient-Reported Outcomes
Mr. Sharma reported significant improvements in quality of life and psychological well-being:
- Stroke Impact Scale (SIS):strong> Improved from 65/100 to 32/100, indicating substantially reduced impact of stroke on daily life.
- Depression: PHQ-9 score improved from 8 to 2, indicating resolution of depressive symptoms.
- Anxiety: GAD-7 score improved from 10 to 3, indicating minimal anxiety.
- Quality of Life: EQ-5D-5L score improved from 0.52 to 0.78, indicating significantly enhanced quality of life.
- Return to Activities: Mr. Sharma resumed playing chess with friends and helping with household finances, activities he enjoyed prior to the stroke.
“We were worried when my husband had the stroke. The hospital wanted to send him to a rehabilitation facility, but we wanted him at home. AtHomeCare made it possible. Their team was professional, knowledgeable, and compassionate. The telemonitoring system gave us peace of mind, and the therapists were incredible. My husband recovered much faster than we expected, and we avoided the stress and cost of a rehabilitation facility. We’re forever grateful to AtHomeCare for giving us our lives back.”
Comparative Analysis: Compared to national averages for similar stroke cases, Mr. Sharma’s outcomes under AtHomeCare’s program exceeded typical results: functional improvement 35% higher than average, hospital readmission rate 100% lower (national average 15-20%), and medication adherence 25% higher than average. The home-based approach resulted in approximately $24,000 in healthcare cost savings compared to traditional inpatient rehabilitation.
How AtHomeCare Made the Difference
AtHomeCare’s unique approach was instrumental in Mr. Sharma’s recovery, providing several key advantages over traditional rehabilitation models:
Early Intervention in a Familiar Environment
AtHomeCare initiated rehabilitation within 72 hours of hospital discharge, capitalizing on the window of heightened neuroplasticity in the acute phase of recovery. The home environment provided a comfortable, familiar setting that reduced stress and anxiety, factors known to inhibit recovery. By avoiding the disruption and stress of transitioning to a rehabilitation facility, Mr. Sharma was able to focus energy on recovery rather than adapting to a new environment.
Personalized, High-Intensity Rehabilitation
AtHomeCare delivered higher intensity rehabilitation than typical outpatient therapy, with 5 days/week of therapy for the first 4 weeks. The home setting allowed for personalized, one-on-one therapy sessions that could be precisely tailored to Mr. Sharma’s needs and progress, unlike the more standardized approaches often used in institutional settings.
Continuous Monitoring and Early Intervention
AtHomeCare’s telemonitoring system enabled continuous monitoring of vital signs and medication adherence, allowing for early intervention before complications developed. This was particularly crucial for Mr. Sharma, given his history of poorly controlled hypertension and diabetes. The system detected and addressed potential issues before they became serious, preventing hospital readmissions—a common problem in stroke recovery.
Enhanced Medication Management
AtHomeCare’s smart pill dispenser and remote monitoring improved medication adherence from 60% to 85%, a critical factor in secondary stroke prevention. Poor medication adherence is associated with a 4-fold increased risk of recurrent stroke. The home-based approach allowed for daily medication management that would be impossible in traditional rehabilitation settings, significantly reducing Mr. Sharma’s risk of recurrent stroke.
Family Integration and Support
AtHomeCare leveraged family support as a therapeutic resource. Mrs. Sharma’s involvement in the rehabilitation process provided emotional support and motivation that enhanced Mr. Sharma’s engagement in therapy. The structured caregiver training ensured that family support was provided safely and effectively, without risking injury to either person.
Cost-Effectiveness and Resource Optimization
AtHomeCare’s approach resulted in significant cost savings while achieving superior outcomes. By avoiding extended hospitalization and rehabilitation facility stays, the program saved approximately $24,000 in healthcare costs. These savings were achieved not by cutting corners but by optimizing resource allocation—delivering intensive rehabilitation where it was most effective and preventing costly complications through proactive monitoring and intervention.
Cost-Effectiveness Analysis
AtHomeCare’s home-based approach demonstrated significant cost-effectiveness compared to traditional inpatient rehabilitation:
| Cost Component | AtHomeCare Program | Traditional Inpatient Rehab | Savings |
|---|---|---|---|
| Initial Hospital Stay | $12,000 | $12,000 | $0 |
| Rehabilitation Facility Stay | $0 | $20,000 | $20,000 |
| Home-Based Rehabilitation | $8,000 | $0 | -$8,000 |
| Telemonitoring Equipment | $2,000 | $0 | -$2,000 |
| Readmission Costs (Average) | $0 | $12,000 | $12,000 |
| Total | $22,000 | $46,000 | $24,000 |
Beyond direct costs, AtHomeCare’s approach resulted in indirect savings through:
- Reduced caregiver burden and associated costs
- Earlier return to household and community activities
- Reduced transportation costs for therapy sessions
- Prevention of complications requiring expensive interventions
Conclusion
AtHomeCare’s comprehensive home-based neurorehabilitation program with telemonitoring enabled Mr. Sharma to achieve remarkable recovery following a hemorrhagic stroke. The combination of rapid physiotherapy, remote vitals monitoring, and caregiver training resulted in significant functional improvements, excellent medical outcomes, and enhanced quality of life.
AtHomeCare’s approach demonstrated that home-based rehabilitation can deliver outcomes that meet or exceed those of traditional rehabilitation approaches while offering the added benefits of patient comfort, family involvement, and cost savings. The success of this case highlights AtHomeCare’s expertise in delivering evidence-based stroke rehabilitation in home settings and their ability to achieve superior outcomes through personalized, technology-enhanced care.
As healthcare continues to evolve toward value-based models, AtHomeCare’s approach represents the future of stroke rehabilitation—delivering high-quality, patient-centered care that maximizes recovery while optimizing resource utilization. For Mr. Sharma and his family, AtHomeCare not only restored function but also restored hope and quality of life, demonstrating the transformative power of home-based rehabilitation when delivered with expertise and compassion.
This case study serves as a testament to AtHomeCare’s commitment to excellence in stroke rehabilitation and their ability to achieve superior outcomes through innovative, patient-centered care. It also highlights the potential of home-based rehabilitation to transform recovery for stroke survivors in Delhi and beyond.
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