Home physiotherapy after a stroke: a Kenyan caregiver's guide

The first year after a stroke is where most functional recovery happens — and where most of it can be lost if rehabilitation doesn't start early. For Kenyan families, the hardest barrier is getting a stroke survivor to outpatient physio two or three times a week. Home-based physiotherapy removes that barrier entirely.

Why the first 90 days matter most

Neuroplasticity — the brain's ability to rewire itself around the damaged area — is most intense in the first three months and slows after six. Starting structured physiotherapy in the first two weeks after discharge meaningfully improves long-term function. Waiting three months until 'the patient is stronger' is one of the most common, and most costly, mistakes families make.

Setting up the home for rehabilitation

• Clear a 3 m × 3 m floor area with a firm mat or thick blanket.
• Have a sturdy dining chair without arms — most exercises use it.
• Install grab bars in the bathroom and bedside. The physio will advise on placement.
• Remove loose rugs and clear walkways — fall risk is highest in the first 60 days.
• Keep a notebook to record practice sets between visits. Repetition outside sessions drives recovery.

What a typical home physio session looks like

A one-hour session usually combines four elements: range-of-motion work to prevent joint stiffness on the affected side, strength work for the unaffected side and recovering muscles on the affected side, balance training in sitting and standing, and task-specific practice — buttoning a shirt, transferring from bed to wheelchair, walking with a stick. The physiotherapist will leave 15 minutes of homework for the family to repeat daily.

Realistic milestones at 3, 6 and 12 months

At three months, the goal is independent sitting balance, basic transfers (bed to chair, chair to toilet), and beginning supported standing. At six months, most patients are walking with a stick or frame indoors. At twelve months, fine-motor recovery in the hand and arm continues to improve with targeted practice — even after 'the recovery plateau' that some clinicians talk about.

Warning signs to call the physio about immediately

• Sudden new weakness or numbness — could indicate a second stroke.
• Severe headache, vomiting, or sudden confusion.
• A swollen, painful calf on one side — possible deep vein thrombosis.
• Skin breakdown on the heel, sacrum, or hip from prolonged sitting or lying.
• Choking on food or fluids more than occasionally — swallowing assessment needed.