Operating Guides for In-Hospital and Community-Based Stroke Rehabilitation in LMICS

Stroke is a leading cause of long-term disability worldwide, with a disproportionate burden in low- and middle-income countries (LMICs). Effective rehabilitation is essential for improving functional outcomes, reducing dependency, and enabling community reintegration for stroke survivors. This chapter outlines practical operating guides and standard operating procedures (SOPs) for implementing stroke rehabilitation across hospital and community settings in LMICs, with particular relevance to India. The chapter describes structured approaches to in-hospital stroke rehabilitation, beginning with early referral, multidisciplinary team (MDT) coordination, and rehabilitation assessment within 24–48 h of medical stabilization. Emphasis is placed on ICF-based multidimensional assessment, early task-specific therapy, goal-oriented rehabilitation planning, and structured caregiver training. In settings with a limited workforce, task-sharing and family-led rehabilitation models are highlighted as pragmatic strategies to extend rehabilitation coverage. Standardized discharge planning, including home exercise programs, patient education, and referral to community resources, is recommended to ensure continuity of care. This chapter also presents community- and home-based rehabilitation models, which are critical in LMIC contexts where institutional rehabilitation capacity is limited. Home assessments, individualized rehabilitation plans, and integration with primary care and community-based rehabilitation (CBR) systems are emphasized. Training community health workers and linking stroke rehabilitation with non-communicable disease services can enhance long-term care and prevention. Structured follow-up schedules and simple quality indicators are proposed to monitor outcomes and strengthen rehabilitation systems. Overall, the chapter provides practical, scalable guidance for integrating stroke rehabilitation into health systems across hospital and community levels. By combining evidence-based practices with context-appropriate adaptations, these SOPs aim to support the expansion of accessible, effective stroke rehabilitation services in LMICs.