Progressive Supranuclear Palsy Home care Gurgaon

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Clinical Case Study

Progressive Supranuclear Palsy (PSP) Home Care in Gurgaon: Home Nursing, Patient Attendant and Home Healthcare

A documented clinical case study illustrating how coordinated home healthcare supported safety, mobility, and quality of life for a 70-year-old patient with Progressive Supranuclear Palsy (Richardson Syndrome) living in Golf Course Road, Gurgaon.

February 2025

12-Week Programme

Reviewed by Dr. Ekta Fageriya

Gurgaon, Haryana

Educational Disclaimer: This case study is entirely fictional and has been created for educational purposes only. The patient details, medical history, treatment, and recovery timeline are imaginary but reflect common home healthcare approaches for individuals living with Progressive Supranuclear Palsy (PSP). It should not be considered a substitute for professional medical advice, diagnosis, or treatment.

Progressive Supranuclear Palsy, commonly called PSP, is a rare neurodegenerative disorder that gradually affects balance, walking, eye movements, speech, swallowing, and cognitive function. It occurs due to the abnormal accumulation of tau protein within specific regions of the brain, leading to progressive deterioration of nerve cells. PSP is frequently misdiagnosed as Parkinson’s disease in its early stages because both conditions involve slowed movement and stiffness. However, PSP typically causes early and prominent balance problems and frequent backward falls, which is an important distinguishing feature that affects treatment planning and safety measures.

Although there is currently no cure for PSP, comprehensive supportive care including physiotherapy, speech therapy, nutritional management, skilled Home Nursing Services in Gurgaon, trained Patient Attendant Services, and coordinated home rehabilitation can significantly improve safety, maintain functional independence for as long as possible, and enhance quality of life.

Patient Background

Patient NameMr. Rajiv Khanna (Fictional)

Age70 Years

GenderMale

CityGurgaon, Haryana

ResidenceGolf Course Road, Gurgaon

OccupationRetired Bank Manager

Marital StatusMarried

Living WithWife and Younger Son

Primary CaregiverWife (67 Years)

Secondary CaregiverSon (39 Years)

Mr. Khanna had been a bank manager in Delhi NCR before retiring to Golf Course Road in Gurgaon. His symptoms began approximately eighteen months before the events described in this case study. Initially, his balance started becoming unreliable and he experienced unexplained falls. His walking had slowed noticeably. He found it increasingly difficult to look downward, which created problems with reading, eating, and navigating stairs safely. His family noticed stiffness in his movements and a gradual reduction in facial expression.

These symptoms initially led to a suspicion of Parkinsonism. However, after detailed neurological evaluation including brain MRI and specialist assessment, the clinical findings pointed toward Progressive Supanuclear Palsy, specifically the Richardson syndrome variant, which is the most common form of the condition. This diagnostic journey, from initial misdiagnosis to accurate identification, is something many PSP families experience and contributes to delayed access to appropriate care.

His wife, at 67 years, became his primary caregiver. His son, who works near DLF Cyber City, was available during evenings and weekends. Before the hospitalization described below, the family had been managing his care with limited professional support, which had become increasingly challenging as his balance deteriorated and falls became more frequent.

Clinical Diagnosis

Primary Diagnosis

Progressive Supranuclear Palsy (Richardson Syndrome Variant). PSP is a neurodegenerative condition caused by the abnormal accumulation of tau protein in the basal ganglia, brainstem, and cerebellum. Unlike Parkinson’s disease, PSP characteristically causes early and severe balance impairment, frequent backward falls, and specific eye movement abnormalities. Mr. Khanna’s symptoms aligned with the Richardson syndrome variant, which involves the classic triad of balance difficulty, vertical gaze palsy, and axial rigidity.

Understanding the Difference Between PSP and Parkinson’s Disease

This distinction matters because the treatment approaches, fall prevention priorities, and prognosis differ between the two conditions. In Parkinson’s disease, balance problems typically develop later in the disease course. In PSP, balance problems are often one of the earliest and most disabling features. Backward falls are particularly common and dangerous because patients often cannot protect themselves during a fall, and head injuries are a serious and potentially life-threatening complication. This case study will reference these differences where they influence clinical decisions because understanding why PSP requires different care priorities than Parkinson’s disease helps explain many of the specific choices made by the treating team.

Associated Medical Conditions

Hypertension, requiring ongoing medication management
Osteoarthritis of both knees, complicating mobility rehabilitation
Mild Vitamin D deficiency, which can affect bone health and increase fall risk
Chronic constipation, common in PSP due to reduced physical activity and medication side effects

No history of stroke, dementia, Parkinson’s disease, diabetes mellitus, or chronic kidney disease was documented. These conditions were relevant because hypertension required careful management alongside PSP medications, knee arthritis influenced the physiotherapy approach, and constipation needed proactive management to prevent complications.

Hospital Treatment

Reason for Admission

Presentation	Details
Recurrent backward falls	Multiple falls in the weeks before admission, including one that led to the current hospitalization
Generalized weakness	Progressive physical decline reducing overall functional capacity
Dehydration	Inadequate fluid intake resulting from reduced self-care capacity
Reduced oral intake	Difficulty eating and drinking without assistance
Increased gait instability	Worsening balance making even indoor movement unsafe without supervision
Difficulty performing daily activities	Could no longer manage basic tasks independently
High caregiver burden	The family was struggling to manage safely without professional support

Mr. Khanna was hospitalized for 8 days. Unlike the COPD case where the admission was for respiratory failure, this hospitalization was primarily for stabilization after a fall, followed by rehabilitation planning.

Preparing the family for the long-term caregiving demands of PSP

Hospital Treatment Component	Purpose
Neurology consultation	Comprehensive reassessment of neurological status and PSP progression since initial diagnosis
MRI brain review	Comparison with previous imaging to assess disease progression
Intravenous fluid therapy	Correcting dehydration resulting from reduced oral intake
Medication optimization	Adjusting symptomatic medications for PSP including considerations for associated conditions
Fall risk assessment	Identifying specific fall patterns and environmental hazards
Physiotherapy evaluation	Assessing current mobility, balance, and fall risk to guide home rehabilitation planning
Speech and swallowing assessment	Evaluating communication and swallowing function, both commonly affected by PSP
Nutritional consultation	Addressing reduced intake and planning nutritional support for recovery
Occupational therapy assessment	Evaluating what the patient could realistically manage independently versus what required assistance
Caregiver counselling
Home healthcare planning	Structuring the discharge plan with specific home healthcare services and equipment recommendations

Following stabilization, the neurologist recommended long-term Home Nursing Services in Gurgaon, home physiotherapy, Patient Attendant Services in Gurgaon, and speech therapy to support safe community-based care. Notably, the discharge plan did not include a Home ICU setup because Mr. Khanna did not require respiratory support, invasive monitoring, or critical care interventions. This distinction is important because it reflects the reality that most PSP patients do not need Home ICU-level equipment.

Condition After Discharge

At discharge, Mr. Khanna remained medically stable but continued to experience symptoms that significantly affected his independence. The symptoms of PSP do not improve with time. They gradually worsen. The goal of home healthcare is not to reverse the disease but to slow functional decline and maintain safety for as long as possible.

Frequent loss of balance, particularly when turning or changing direction
Slow, stiff walking with a broad-based gait pattern
Muscle stiffness, particularly in the neck and trunk, making posture increasingly rigid
Fatigue that developed more quickly than expected during physical or mental tasks
Difficulty initiating movement after sitting for prolonged periods
Impaired downward eye movements affecting safe walking, reading, and eating
Mild slurring of speech, though communication remained possible
Delayed reaction time when processing information or making decisions
Mild difficulty swallowing liquids, with occasional coughing while drinking water
Reduced confidence during mobility due to fear of falling
Increased dependence for outdoor activities and medical appointments
Anxiety about future falls and loss of independence

Functional Assessment at Discharge

Neurological Assessment

Slowed voluntary movements (bradykinesia) affecting all activities
Increased muscle rigidity, particularly in the neck and trunk, causing a stiff, upright posture
Difficulty initiating movement after prolonged sitting, a characteristic feature of PSP
Impaired downward eye movements affecting safe walking and reading
Mild slurring of speech with reduced volume
Delayed reaction time during conversations and daily tasks
Preserved memory and decision-making ability

Mobility Assessment

Independent standing only with close supervision due to balance impairment
Walking limited to approximately 70 metres before requiring rest
Broad-based, slow gait with a tendency to fall backward
Frequent loss of balance while turning, a specific and dangerous feature of PSP
Difficulty negotiating uneven surfaces, thresholds, and changes in flooring
High risk of backward falls, particularly when distracted or fatigued
Dependence on a front-wheel walker for all outdoor mobility
Reduced confidence while walking even with the walker

Swallowing and Communication Assessment

Swallowing and Communication

Mild dysarthria (slurred speech), though communication remained possible
Reduced voice volume due to reduced respiratory support for speech
Mild delay in swallowing liquids with occasional coughing while drinking water
No evidence of aspiration pneumonia at the time of assessment
Therapist recommended swallowing exercises, posture correction during meals, and supervised eating

Activities of Daily Living

Feeding using adaptive utensils
Basic communication
Personal decision-making
Light reading
Watching television
Bathing
Dressing lower garments
Outdoor walking
Stair climbing
Cooking
Shopping
Housekeeping
Hospital appointments
Medication organization

Why Home Healthcare Was Needed

The neurologist recommended structured home healthcare because PSP is a progressive disorder that gradually increases dependence on caregivers. Without professional support, families often reach a point where continuing to provide safe care at home becomes impossible, leading to premature institutionalization. Home healthcare provides continuous support while allowing the patient to remain in familiar surroundings for as long as possible.

Why Home Nursing Was Required

PSP requires ongoing clinical monitoring even though there is no treatment that slows the disease. The nurse needed to track the rate of functional decline, monitor blood pressure and other associated conditions like hypertension, supervise medication timing and constipation management, assess skin integrity for pressure injury risk, and watch for swallowing changes that could indicate aspiration risk. The nurse also served as the communication link between the family and the neurologist, documenting changes in the patient’s condition and escalating concerns appropriately. Without this clinical oversight, subtle deterioration could be missed until it becomes a crisis.

Why a Patient Attendant Was Needed

Mr. Khanna’s wife, at 67 years, had been managing his care without professional assistance, but the situation had become unsafe. He was falling repeatedly, and each fall carried the risk of head injury, which is particularly dangerous in PSP because patients often cannot protect themselves during a backward fall. A trained Patient Attendant in Gurgaon provided 12-hour daily assistance with transfers, walking supervision, personal care, and meal support. Crucially, the attendant ensured the patient did not attempt to walk unsupervised, positioned him safely during meals to reduce choking risk, and encouraged participation in rehabilitation without allowing overexertion. This addressed both the patient’s safety and the caregiver’s physical and emotional burden.

Why Physiotherapy Was the Cornerstone of PSP Rehabilitation

Balance impairment is typically the earliest and most disabling feature of PSP, making physiotherapy the most important component of the rehabilitation programme. The physiotherapist focused on balance training, safe turning techniques (turning en bloc rather than stepping around), posture correction, strengthening, and gait training adapted to PSP-specific movement patterns. Unlike Parkinson’s disease rehabilitation, PSP physiotherapy must account for the patient’s inability to look down reliably, which affects how they walk, sit, and navigate the environment. Home-based physiotherapy in Gurgaon was essential because traveling to a clinic daily would have been physically demanding and logistically difficult, and the home environment was where the patient actually needed to function.

Why Speech and Swallowing Therapy Was Introduced

As PSP progresses, swallowing difficulties become more common and carry a serious risk of aspiration pneumonia, one of the leading causes of death in PSP. The speech-language therapist worked on voice projection, oral motor exercises, and safe swallowing techniques. Mealtime supervision by the attendant complemented this therapy. This component was scheduled at two sessions per week rather than daily because it addressed a specific aspect of care rather than the constant support that nursing and attendant services provided.

Why Fall Prevention Was the Highest Priority

Backward falls are the complication that most threatens safety in PSP. Unlike most other neurological conditions where falls are a secondary concern, in PSP, falls are often the event that leads to hospitalization, head injury, or premature institutionalization. The home care programme placed fall prevention at the centre of every intervention: the physiotherapy exercises targeted balance, the attendant supervised all mobility, the nurse assessed the home environment for hazards, and the family received extensive education on safe transfer techniques and environmental modifications. The goal was not to eliminate falls entirely, which is not realistic in PSP, but to reduce their frequency and severity through a combination of training, supervision, and environmental adaptation.

Why Caregiver Education Was Emphasized

PSP is a progressive condition. The family needed to understand that the trajectory would continue downward, and their role was to adapt to changing needs over time. The nursing team educated them on recognizing when additional support would be needed, how to modify the home environment as the disease advanced, and how to access respite care when caregiver burnout developed. This long-term perspective on caregiving is essential because families who expect the patient to steadily improve may become frustrated and exhausted when the reality of a progressive disease becomes clear.

Home Care Plan

Home Nursing

4 Visits Per Week (Initial 8 Weeks)

Blood pressure, pulse rate, respiratory rate, and body temperature monitoring at each visit
Neurological assessment: walking ability, muscle stiffness, fall frequency, swallowing changes, speech clarity, and fatigue levels
Medication management: timing compliance, side effect monitoring, constipation management, blood pressure medication review
Skin integrity assessment: pressure areas, skin hydration, early redness, signs of pressure injury
Patient and caregiver education: fall prevention, safe transfers, medication adherence, swallowing precautions, home safety modifications, exercise compliance, emergency symptom recognition
Coordination with the treating neurologist through documented progress reports

Physiotherapy and Balance Rehabilitation

5 Sessions Per Week

Supervised walking with the front-wheel walker adapted for PSP gait patterns
Specific turning techniques for PSP: turning en bloc rather than pivoting
Static standing balance exercises and weight-shifting activities
Controlled stepping exercises in multiple directions
Quadriceps and hip muscle strengthening for sit-to-stand ability
Core stability and trunk extension exercises for upright posture improvement
Hamstring, hip flexor, and calf stretching to reduce rigidity
Sit-to-stand practice and safe chair transfers
Stair practice with supervision
Walking endurance gradually improved from approximately 70 metres to nearly 350 metres with supervised rehabilitation

Patient Attendant

12 Hours Daily

Bathing, dressing, grooming, and toileting assistance with attention to safe transfers
Walking supervision with constant awareness of fall risk, particularly during turning and on uneven surfaces
Meal assistance with proper sitting posture and slow feeding techniques to reduce choking risk
Medication reminders and ensuring correct timing of all prescribed medications
Hydration reminders and fluid intake tracking throughout the day
Following the physiotherapy programme between formal sessions, including balance exercises and stretching routines
Position changes during prolonged sitting to prevent stiffness and discomfort
Emotional support, social interaction, and encouragement during rehabilitation
Wheelchair assistance during follow-up hospital visits

Speech and Swallowing Therapy

2 Sessions Per Week

Voice projection exercises to improve volume and clarity
Oral motor exercises to improve speech precision
Swallowing techniques including safe posture during meals
Food consistency recommendations when indicated by the therapist
Caregiver education on safe eating strategies and choking response
Regular reassessment of swallowing function over time

Medical Equipment and Home Modifications

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Front-Wheel Walker

🦽

Wheelchair

🚿

Shower Chair

🪑

Grab Bars

🚽

Raised Toilet Seat

🩺

BP Monitor

💓

Pulse Oximeter

💊

Pill Organizer

🧼

Anti-Slip Mats

Home modifications also included improved lighting, removal of all loose rugs, installation of handrails in frequently used areas, placement of chairs with armrests for safer sitting, and rearrangement of furniture to create clear walking paths. For families in areas like Sector 29, Sohna Road, New Gurgaon, and the Dwarka Expressway area, these modifications are practical changes that can significantly reduce fall risk without major renovation.

Risks Being Monitored

Recurrent backward falls

Head injury from falls

Aspiration during meals

Malnutrition and dehydration

Pressure injuries

Progressive mobility decline

Medication non-adherence

Caregiver fatigue and burnout

Hospital readmission

Short-Term Goals (Weeks 1 to 8)

Improve walking confidence with appropriate assistive devices
Reduce fall frequency through balance training and environmental modifications
Enhance balance during transfers and position changes
Maintain nutritional intake and hydration
Improve swallowing safety during meals
Increase participation in daily activities
Ensure medication compliance through organized systems

Long-Term Goals (Ongoing)

Preserve independence for as long as possible
Preventing serious falls through continued balance and environmental safety measures
Maintaining communication ability as speech changes progress
Supporting safe swallowing as the disease advances
Delaying functional decline through consistent rehabilitation
Improving caregiver confidence and reducing burnout
Enhancing overall quality of life despite progressive disease
Reducing avoidable hospitalizations

Recovery Timeline

Days 1 to 3: Establishing Safety Systems

Focus: Home safety assessment, fall prevention measures, and initiating the rehabilitation routine

The nursing team conducted a comprehensive home safety assessment on day one, identifying fall hazards and recommending immediate modifications. Loose rugs were removed, grab bars were installed in the bathroom, and the home lighting was improved. The attendant began 12-hour daily support, focusing on safe transfers and walking supervision. Mr. Khanna was anxious about falling again and initially resisted walking even with the walker. The physiotherapist conducted baseline assessments and introduced very gentle balance exercises while sitting and standing. Speech therapy began initial voice projection and oral motor exercises. The family received initial education on PSP progression, fall prevention strategies, and the importance of not rushing the patient during any activity.

Week 1: Building the Daily Routine

Focus: Establishing a structured daily schedule and gentle mobilization

By the end of the first week, a daily routine was taking shape. The attendant helped with all personal care, meals, and medication reminders. Physiotherapy sessions progressed to include assisted walking within the home with the walker, with the physiotherapist positioned directly behind the patient for fall prevention. Mr. Khanna walked approximately 70 to 80 metres per session with close supervision. The nurse monitored vital signs and assessed for any signs of constipation, a common problem in PSP due to reduced mobility and medication effects. Speech therapy continued voice exercises. The family reported feeling slightly less anxious as they observed the structured support system taking shape, though they remained concerned about the progressive nature of the condition.

Week 2: Addressing Specific PSP Challenges

Focus: PSP-specific mobility challenges and caregiver training

Walking distance reached approximately 100 to 120 metres per session. The physiotherapist introduced specific turning techniques for PSP, teaching Mr. Khanna to turn his entire body as a unit rather than stepping around, which is more stable for PSP patients. Neck mobility exercises were added because PSP typically causes significant axial stiffness that affects balance and head position. The nurse trained the attendant on recognizing early signs of urinary retention, a common PSP-related problem. Mr. Khanna began participating more actively in family interactions, which had diminished as his speech became more difficult. A follow-up call with the neurologist confirmed the care plan was appropriate and no medication changes were needed at this stage.

Weeks 3 to 4: Building Confidence Gradually

Focus: Progressive walking, balance improvement, and caregiver training

Walking distance reached approximately 150 to 180 metres per session with the walker. The physiotherapist introduced dynamic balance challenges such as weight shifting while standing, controlled stepping in different directions, and obstacle navigation within the home environment. Mr. Khanna’s confidence improved enough to walk short distances within the home with the attendant walking beside him rather than physically supporting him. The nurse continued to monitor for constipation and medication compliance. The attendant was trained to recognize when the patient was becoming fatigued and to insist on rest periods. For families in areas like South Delhi, Central Delhi, or along MG Road who may have relatives with similar conditions, this stage often brings the first meaningful improvement that suggests the programme was making a measurable difference.

Weeks 5 to 8: Functional Progress

Focus: Increasing independence, reduced fall frequency, and environmental adaptation

Walking distance reached approximately 240 to 280 metres per session. Mr. Khanna could now walk from his bedroom to the living room and kitchen with the attendant present but not physically supporting him. The number of near-fall incidents decreased significantly compared to the pre-admission period. Posture improved through consistent trunk extension exercises, and he sat more upright during meals. The nurse documented measurable improvements in balance and gait stability. The first formal review with the neurologist confirmed that the programme was meeting expectations. The family received additional education on recognizing when the disease was progressing and when to request reassessment. For families in East Delhi, West Delhi, and along the Dwarka Expressway, this stage often represents the point where families begin to understand that home care is not about getting better but about maintaining function as the disease progresses.

Weeks 9 to 12: Consolidation and Long-Term Planning

Focus: Stabilizing gains and planning for progressive disease management

Walking distance exceeded 320 to 350 metres per session with the walker. Mr. Khanna was now participating more actively in family activities and could manage short outdoor walks with the attendant. The physiotherapist shifted focus toward maintaining the gains achieved rather than expecting continued improvement. Speech therapy had contributed to clearer communication, and coughing during meals had reduced significantly. The care team began discussing long-term planning with the family, including when to increase attendant hours, when to add additional home safety modifications, and how to access respite care. A second neurological follow-up confirmed that the programme was meeting its objectives within the context of a progressive disease. The family understood that PSP would continue to progress, and the home care plan would need periodic adjustment over time.

Clinical Monitoring Parameters

Rigidity in PSP particularly affects posture and balance; tracking changes helps adjust physiotherapy approachImpaired downward gaze affects walking safety, reading, and eating; monitoring helps identify when adaptations are neededAspiration risk increases as PSP progresses; regular assessment allows early interventionReduced mobility and axial stiffness increase pressure injury riskConstipation is very common in PSP due to immobility and medication effectsHypertension medications must be monitored alongside PSP medicationsMissing doses of Parkinson’s medications may worsen mobilityCaregiver burnout leads to poor care quality and premature institutionalization

Parameter	Method	Frequency	Clinical Rationale
Fall Frequency and Pattern	Caregiver report and nurse observation	Continuous by attendant; documented by nurse	Backward falls are the single most dangerous complication in PSP; tracking patterns helps identify when environmental modifications need to be strengthened
Muscle Rigidity	Clinical assessment of tone and range of motion	Each nursing visit
Eye Movement Assessment	Observation of vertical and horizontal gaze	Each nursing visit
Swallowing Function	Observation during meals and speech therapy review	2x/week speech therapy; each nursing visit
Skin Integrity	Visual inspection of pressure areas	4x/week by nurse; daily by attendant
Constipation Management	Bowel movement monitoring and medication review	Each nursing visit; daily by attendant
Blood Pressure	Digital BP monitor	5x/week by nurse; daily by attendant
Medication Compliance	Pill organizer check and attendant report	Daily by attendant; verified by nurse
Caregiver Stress	Caregiver burnout assessment	Each nursing visit

Functional Progress Over 12 Weeks

Parameter	At Discharge	Week 4	Week 8	Week 12
Walking Distance (per session)	~70 metres	~120 metres	~280 metres	~350 metres
Walking Aid	Front-wheel walker (close supervision)	Walker (attendant alongside)	Walker (attendant alongside)	Walker (independent indoor with attendant nearby)
Fall Frequency	Frequent backward falls	Reduced with environmental changes	Significantly reduced	Rare
Bathroom Transfers	Required hands-on assistance	Minimal assistance	Standby supervision	Supervision only
Posture	Stiff, forward-leaning posture	Gradually improving	Noticeably more upright	Maintained with exercises
Speech Clarity	Mild slurring, low volume	Slightly improved with exercises	Clearer in conversation	Improved with voice exercises
Swallowing Safety	Mild coughing with liquids	Reduced coughing episodes	Safe with modified techniques	Significantly safer
Confidence During Walking	High, fear of falling	Gradually improving	Much reduced	Much reduced
Anxiety Level	High, affecting daily activities	Easing with routine structure	Noticeably reduced	Managed

Progress Summary

Walking Endurance~70m to ~350m

Fall ReductionFrequent to Rare

Posture ImprovementStiff Posture to Upright Posture

Medication AdherenceEstablished to Excellent

Caregiver ConfidenceAnxious to Confident and Empowered

Aspiration RiskMild Coughing to Minimal Risk

Note: Progress percentages are approximate visual representations. PSP is a progressive condition, and functional improvement represents optimization within the context of a disease that continues to advance. Actual assessment should use validated tools such as the PSP Rating Scale (PSPRS), Falls Efficacy Scale (FES), or Timed Up and Go test.

Family and Caregiver Education

Critical Warning Signs Requiring Immediate Medical Attention

The family was specifically instructed to seek immediate emergency care if the patient experienced repeated falls with head injury, a sudden inability to walk, choking episodes, high fever with worsening cough, persistent coughing during meals, severe dehydration, sudden confusion or altered consciousness, significant reduction in oral intake, or any sudden neurological deterioration.

🧠

Understanding that PSP is progressive and requires lifelong management with regular neurological follow-up

💊

Strict medication timing, safe storage, constipation management, and recognizing side effects

🛡

Fall prevention: loose rugs removed, grab bars installed, non-slip footwear, walker use for all outdoor activities, never rushing the patient

🫁

Safe swallowing practices: sitting upright during meals, small bites and sips, eating slowly, remaining seated for 30 minutes after meals

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Exercise compliance: following the home exercise programme, avoiding overexertion, pacing activities through the day

🛡

Infection prevention: hand hygiene, avoiding crowded places, annual flu and pneumococcal vaccination, maintaining good ventilation

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Emergency symptom recognition: severe breathlessness, choking, confusion, loss of consciousness, sudden inability to swallow, sudden falls

🩺

Scheduled neurologist follow-up and long-term care planning

Medical Authority

Dr. Ekta Fageriya, Geriatric Medicine Specialist, AtHomeCare

Dr. Ekta Fageriya, MBBS

RMC Registration No. 44780 | Specialization: Geriatric Medicine | Clinical Experience: 7 Years

Dr. Ekta Fageriya is a Geriatric Medicine Specialist associated with AtHomeCare. With seven years of clinical experience, she focuses on the complex needs of older adults living with progressive neurological conditions. Her expertise includes PSP management, post-hospitalization care planning, medication management in complex patients, and coordinating multidisciplinary home healthcare programmes that address the unique challenges of conditions like Progressive Supranuclear Palsy.

Geriatric Medicine PSP Management Home Healthcare Neurological Rehabilitation Fall Prevention

Treating Doctor

QualificationTo be updated

HospitalTo be updated

Medical RegistrationTo be updated

Clinical CommentsTo be updated

Future RecommendationsTo be updated

Supporting Clinical Documents Referenced

Document	Role in Home Care Planning
Hospital Discharge Summary	Provided the PSP diagnosis, hospital treatment details, medications prescribed, fall risk assessment, and specific home care recommendations
Brain MRI Report	Confirmed the diagnosis of PSP with imaging findings characteristic of the Richardson syndrome variant
Neurologist Prescription	Outlined the symptomatic medication regimen and follow-up schedule for PSP
Physiotherapy Assessment (Hospital)	Established baseline balance, gait, strength, and functional measurements for home rehabilitation tracking
Speech and Swallowing Assessment	Documented baseline speech and swallowing function and recommended safe eating strategies
Occupational Therapy Assessment	Identified specific daily activities the patient could still manage and those requiring assistance
Nutritional Assessment	Provided dietary recommendations addressing safe food consistency for swallowing safety and adequate nutrition
Caregiver Counselling Notes	Documented the family’s caregiving capacity and identified the need for professional attendant support

Specific laboratory values, imaging details, and exact medication dosages are not reproduced in this educational case study as they were not included in the documentation available for review. In clinical practice, all home care decisions would be directly referenced to these specific findings.

Recovery Outcome After 12 Weeks

Outcome Summary

After twelve weeks of coordinated home healthcare, the patient demonstrated measurable improvements in safety and functional ability. It is important to state clearly that PSP itself did not improve. What improved was the patient’s functional status within the context of a progressive disease.

50m to 350m

Walking Endurance

Head Injuries from Falls

Aspiration Pneumonia Episodes

Hospital Readmissions

Stable

Blood Pressure

Excellent

Medication Adherence

Anxious to Confident

Caregiver Confidence

Walking endurance improved from approximately 70 metres to nearly 350 metres with supervised rehabilitation. Posture improved through consistent physiotherapy. Speech became clearer and the patient regained confidence in daily conversation. No aspiration-related respiratory infections occurred during the programme. Blood pressure remained stable. Constipation was effectively managed through medication, hydration, and dietary modifications. No fractures, pressure injuries, or emergency hospital admissions occurred. The collaborative approach between the family and healthcare professionals improved both patient safety and caregiver preparedness.

The patient’s wife and son became significantly more confident in preventing falls, assisting with transfers, supervising walking, supporting swallowing exercises, managing medications, recognizing warning signs, communicating with the neurologist, and coordinating follow-up care. The structured combination of Home Nursing, Patient Attendant, physiotherapy, speech therapy, and family education enabled safe community-based care for longer.

Discussion

Progressive Supranuclear Palsy is a chronic neurological disorder that often requires long-term, multidisciplinary management rather than short-term treatment. Unlike conditions that stabilize after the acute phase, PSP continues to progress regardless of the interventions provided. The role of home healthcare in PSP is not to reverse the disease but to optimize the patient’s current functional level, prevent avoidable complications, and prepare the family for the increasing care demands ahead.

This case study illustrates how a home healthcare programme addressed the specific challenges of PSP: fall prevention as the central safety concern, balance and gait training adapted to PSP-specific movement patterns, speech and swallowing therapy for communication and nutrition safety, and caregiver education that prepared the family for the progressive nature of the condition. The fact that no head injuries, aspiration events, or hospital readmissions occurred during the programme is a meaningful outcome, even though the underlying disease continued to progress.

For families in Delhi and Gurgaon, whether in Central Delhi, South Delhi, New Gurgaon, along the Golf Course Extension Road, Sohna Road, Sector 29, or Manesar, this case study demonstrates that professional home healthcare can meaningfully support patients with rare neurological conditions even when the condition itself cannot be cured. The key is matching the care plan to the specific needs of the disease.

Key Clinical Learnings

PSP is a rare neurological disorder that requires long-term, individualized management rather than short-term treatment. The rehabilitation goals differ from Parkinson’s disease because balance impairment is the primary early problem rather than bradykinesia, and backward falls are the primary safety concern rather than freezing of gait.
Professional Home Nursing provides ongoing neurological monitoring, medication management, skin care assessment, caregiver education, and coordination with the treating neurologist. In PSP, where cognitive function often remains relatively preserved, the nursing role focuses on physical safety, medication compliance, and preparing the family for the progressive nature of the condition.
A trained Patient Attendant provides assistance with mobility, personal care, nutrition, medication reminders, and fall prevention. In PSP, the attendant’s role in fall prevention is especially critical because backward falls are both common and dangerous, and family members may be unable to prevent injury during a sudden backward fall.
Physiotherapy remains the cornerstone of PSP management. The specific techniques used differ from Parkinson’s rehabilitation, including en-bloc turning, trunk extension exercises, and safe turning techniques, because PSP affects posture and balance in a way that Parkinson’s typically does not.
Speech and swallowing therapy play an increasingly important role as PSP progresses. As swallowing difficulty increases, aspiration risk rises. Early introduction of safe swallowing techniques and caregiver training on food consistency helps manage this risk.
A coordinated approach involving neurologists, nurses, physiotherapists, speech therapists, patient attendants, caregivers, and family members can significantly improve quality of life while helping patients remain safely at home for longer.

Frequently Asked Questions

What is Progressive Supranuclear Palsy (PSP)?+

Progressive Supranuclear Palsy is a rare neurodegenerative disorder that affects balance, eye movements, walking, speech, swallowing, and overall mobility. It gradually progresses over time and requires comprehensive supportive care.

Why are Home Nursing Services important for PSP patients?+

Home nursing helps monitor neurological symptoms, manage medications including those prescribed for associated conditions, assess swallowing difficulties, prevent pressure injuries, educate caregivers, and coordinate ongoing care with the treating neurologist.

How can a Patient Attendant help someone living with PSP?+

A trained patient attendant assists with mobility, transfers, personal hygiene, meal support, medication reminders, fall prevention using PSP-specific techniques like walking behind the patient during turns, and emotional encouragement while reducing caregiver burden.

Is physiotherapy beneficial for Progressive Supranuclear Palsy?+

Yes. Physiotherapy focuses on balance training, gait improvement, strengthening exercises, posture correction, and specific PSP mobility techniques that help reduce falls and maintain functional independence for as long as possible.

Why is speech and swallowing therapy recommended in PSP?+

Speech therapy helps improve communication, while swallowing therapy teaches safe eating techniques that reduce the risk of choking and aspiration pneumonia, a common and serious complication of PSP.

Can people with PSP safely remain at home?+

Many individuals with PSP can continue living at home safely when appropriate home modifications, skilled nursing, patient attendant support, rehabilitation services, and caregiver education are provided. The key is ensuring the care plan adapts as the disease progresses.

Does every PSP patient require a Home ICU Setup?+

No. Most individuals with PSP do not require a Home ICU setup. However, advanced home medical equipment or specialized monitoring may be considered in selected cases based on the treating physician’s assessment of the individual patient’s clinical needs.

When should a PSP patient seek urgent medical attention?+

Immediate medical evaluation is recommended if the patient experiences repeated falls with injury, sudden inability to swallow, severe choking episodes, high fever, persistent coughing during meals, loss of consciousness, or any sudden neurological deterioration.

Medical Disclaimer

This case study is entirely fictional and has been created exclusively for educational and awareness purposes. The patient profile, treatment plan, and outcomes are illustrative and should not be considered a substitute for professional medical advice, diagnosis, or treatment.

Every patient is unique. Treatment decisions must always be made by qualified healthcare professionals based on the individual patient’s clinical condition.

Emergency symptoms require immediate hospital care. Home healthcare complements, but does not replace, emergency medical services.

If you or someone in your care is experiencing a medical emergency, please call your local emergency number or go to the nearest hospital immediately.