Stroke rehabilitation at home: recovery and support

1. Ask whether early supported discharge is suitable

Some people can leave a stroke unit earlier when a specialist team can safely continue coordinated rehabilitation at home. This is called early supported discharge. It is not simply a faster discharge: the team should assess what support is needed, explain what visits or therapies will be provided and communicate with hospital staff. Availability and eligibility vary locally. If this option is not offered, ask what community stroke or neuro-rehabilitation service will take over, when contact should happen, and who to call if no appointment or visit is arranged.

2. Get a written plan for the first days at home

Confirm the medicines list, equipment, safe transfer instructions, food and drink advice, follow-up appointments and emergency contacts before leaving hospital. Ask who will review changes to medicines and who to contact if a dose is missed or a new side effect appears. If there are stairs, toileting difficulties, a communication barrier or limited family support, raise it before discharge rather than trying to improvise. The guide to hospital discharge and reablement explains practical questions to ask. Keep the plan somewhere visible and share it only with people the person wants involved.

3. Know what rehabilitation can involve

Physiotherapy can work on strength, balance, transfers and walking; occupational therapy can help with daily activities and adapting routines; and speech and language therapy can support communication, speech, cognition or swallowing. Some people also need help with vision, continence, memory, mood, fatigue or returning to meaningful roles. Therapy should be linked to goals that matter to the person, such as getting dressed, preparing a drink or returning to a social activity. Ask the therapist to explain how to practise safely, what to do when tired and how progress will be reviewed. Do not add strenuous exercises without advice.

4. Expect fatigue and emotional changes to need attention

Post-stroke fatigue can feel different from ordinary tiredness and may interfere with concentration, conversation and daily tasks. Plan demanding activities for the person’s better time of day, leave recovery time, and discuss a sudden or worsening change with the stroke team or GP. Low mood, frustration, anxiety, tearfulness or changes in confidence can affect the person and family. These experiences deserve attention; they are not a failure to try hard enough. Ask the GP or stroke team about emotional support and what is available locally. For communication difficulty, reduce background noise, allow time, offer choices and check understanding rather than speaking over the person.

5. Use the six-month review to raise unresolved needs

NICE recommends that information needs are reviewed at the six-month and annual stroke reviews and that fatigue is considered at the six-month review. A review is a chance to describe what remains difficult, including movement, pain, memory, communication, mood, fatigue, work, relationships, equipment and carer strain. Prepare examples and questions; ask how to request a review if no invitation arrives. Needs can emerge after discharge or become clearer when everyday routines resume. A review does not guarantee a particular treatment, but it should help identify whether assessment, advice or a referral is appropriate.

6. Reduce future risk with the clinical team

A stroke team or GP can explain the individual plan for reducing the chance of another stroke. This may include taking prescribed medicines as directed, attending checks and discussing blood pressure, heart rhythm, cholesterol, diabetes, smoking, alcohol or activity where relevant. Do not stop or change medicines based on general advice or a home reading. Help the person keep an accurate list and know who to contact about side effects or supply problems. FAST remains useful for recognising a possible stroke: face weakness, arm weakness or speech problems need an emergency response. Sudden symptoms that resolve can still be urgent.

7. Follow DVLA rules and support the people providing care

After a stroke or transient ischaemic attack, drivers must stop straight away. GOV.UK says car and motorcycle drivers must stop for at least one month and can restart only when a doctor or healthcare professional says it is safe. If symptoms affecting driving remain after that month, or other specified circumstances apply, the driver must tell DVLA. Bus, coach and lorry rules are different and include a longer stop period. Confirm the current rule for the person’s licence category and condition before driving. Family carers can ask for an assessment of their own needs, training for transfers or communication, and support from the stroke team or local carers service.

Common questions