Stroke Patients: Regaining Mobility And Independence

Stroke patients can experience a wide range of mobility issues, including weakness, planning and coordination problems, changes in muscle tone, balance issues, contracture, changes in sensation, swelling, fatigue, and pain. The type and severity of these issues depend on the area of the brain affected by the stroke.

Rehabilitation for stroke patients focuses on improving their specific difficulties. This may include relearning how to move from sitting to standing, or from a bed to a chair or toilet. Specific exercises can improve strength, coordination, balance, sensation, and fitness. Repetition is key to improvement, so movements and exercises are often repeated many times.

The cerebellum and the primary motor cortex are the areas of the brain that, when affected by a stroke, are most likely to cause mobility issues. The cerebellum controls coordination, posture, balance, and movement, while the primary motor cortex is responsible for producing nerve impulses that lead to the execution of movement.

The chances of stroke recovery are highest during the first few months, so it is important to begin rehabilitation as soon as the patient is medically stable. Physiotherapy can help improve balance, gait, walking, strengthen weakened and spastic muscles, improve functions of arms and hands, and decrease weakness in the shoulders.

Physiotherapy can help stroke patients regain mobility by improving balance, gait, and walking

Balance

Balance difficulties are common for many individuals post-stroke, usually due to a combination of reduced limb and trunk motor control, altered sensation, and sometimes a centrally determined alteration in body representation. Impaired balance often leads to reduced confidence, fear of falling, and an increased risk of falls. Trunk exercise training can improve trunk performance and dynamic sitting balance, while task-specific training improves dynamic balance in both sitting and standing.

Gait

Gait training is a common intervention to improve walking ability in people with stroke. Gait training strategies include neurodevelopmental techniques, muscle strengthening, treadmill training, and intensive mobility exercises.

Neurodevelopmental techniques, such as the Bobath Concept, involve inhibiting excessive tone, stimulating muscle activity, and facilitating normal movement patterns through hands-on techniques. However, these techniques have been found to be equivalent or inferior to other approaches for improving walking ability.

Muscle strengthening interventions can improve the ability to generate force but may not transfer to improved walking ability. Combining strength training with walking practice or incorporating strengthening within functional tasks may be optimal.

Treadmill training, particularly at faster speeds, is effective for improving walking speed. Treadmills with body-weight support can enable lower-functioning individuals to participate in early walking practice.

Walking

Intensive mobility training incorporates repetitive practice of a wide variety of mobility tasks, including graded strengthening using functional tasks, an aerobic component, and a variety of challenging walking activities with substantial postural control demands. Intensive mobility training has been found to improve gait ability in both sub-acute and chronic stroke patients.

Overall, physiotherapy can help stroke patients regain mobility by improving balance, gait, and walking through various interventions tailored to the individual's needs.

Stroke patients may need to relearn basic tasks like getting out of a chair or into bed

Rehabilitation nurses, physical therapists, and occupational therapists play a crucial role in helping stroke patients regain their mobility and independence. They work with patients to develop a specific plan for recovery, which may include relearning basic tasks like getting out of a chair or into bed. This process can involve a range of exercises to rebuild strength and balance, as well as the use of assistive devices such as canes, walkers, or wheelchairs.

The recovery process can be frustrating for stroke patients, as it may take time to regain their previous level of mobility and independence. However, with dedicated rehabilitation and consistent practice, stroke patients can improve their movement and reduce their risk of having another stroke.

Stroke patients can improve their strength, coordination, balance, sensation, and fitness through rehabilitation

Regaining Mobility After a Stroke

Stroke is a leading cause of disability in adults, with two-thirds of stroke patients suffering from impaired mobility. The brain functions as the body's control centre, transmitting signals to execute even the smallest tasks. When this process is interrupted, it can result in paralysis or weakness on one side of the body, known as hemiplegia or hemiparesis, respectively. Additionally, stroke survivors may experience planning and coordination problems, changes in muscle tone, balance issues, contractures, altered sensation, swelling, fatigue, and pain. These challenges can make everyday activities difficult and increase the risk of falling.

Rehabilitation for Improved Mobility

Rehabilitation plays a crucial role in helping stroke patients regain mobility and independence. Physiotherapists work with patients to set goals and develop tailored rehabilitation programs. Specific exercises can improve strength, coordination, balance, sensation, and fitness. Task-specific activities, such as standing or walking, are particularly effective, and repetition is key to progress. Electrical stimulation and equipment like treadmills or video games may also be incorporated.

Addressing Weakness and Spasticity

Weakness or paralysis in the legs, hands, or facial muscles can make movement difficult. Spasticity, characterised by muscle stiffness and spasms, can further hinder walking ability, causing a stiff knee and pointed foot. Physiotherapy can help reduce spasticity and improve balance, gait, and muscle strength.

Timing of Rehabilitation

The first six months after a stroke offer the greatest scope for functional recovery, so early and intensive rehabilitation is crucial. Starting rehabilitation immediately after the patient is medically stable can promote neuroplasticity, helping the brain re-wire itself and form new connections. Regular physiotherapy and exercise not only improve mobility but also enhance overall fitness, reduce the risk of another stroke, and address issues like fatigue, depression, and pain.

Stroke patients may experience muscle stiffness and pain, which can be reduced through movement and exercise

Stroke patients may experience muscle stiffness, spasms, and pain, which can be reduced through movement and exercise. This is known as spasticity, which affects up to 43% of stroke survivors within a year of their stroke. Spasticity can cause muscles to become stiff, tight, and rigid, and can make it difficult for stroke patients to control their muscle movements. For example, a stroke survivor might not be able to move their arm easily or as much as they would like, and their arm may shake after movement.

To reduce muscle stiffness and pain, stroke patients should aim to be as active as possible and perform regular exercises to improve their range of motion and strength. Exercises that can help include:

• Shifting weight while sitting
• Shoulder blade protraction
• Hand exercises with a stress ball
• Wrist exercises with a water bottle
• Supported reach and grasp
• Side-lying hip flexion
• Knee extensions

These exercises can help to improve mobility, maintain independence, and reduce pain. In addition to exercises, stroke patients may also benefit from physical therapy and, in some cases, prescription medication to help manage muscle stiffness and pain.

Stroke patients may need to use a walking frame, stick, or wheelchair to aid their mobility

A stroke can affect how well a person sits, moves, balances, stands, and walks. The impact on mobility will depend on which part of the brain is affected. If the cerebellum is affected, the patient's movement may become uncoordinated and slow, and they may experience tremors and muscle weakness. If the primary motor cortex is affected, the patient may experience hemiparesis, or weakness on one side of the body, which can make it difficult to move.

In some cases, a stroke patient may experience spasticity, where the muscles become stiff and tight, or hypotonia, where the muscles become floppy and loose. Foot drop, where the foot or ankle drops when lifting the leg, is also common and can make walking difficult. Other possible issues include changes in sensation, swelling, fatigue, and pain.

Physiotherapy is an important part of stroke rehabilitation and can help improve balance, gait, and walking, as well as strengthen weakened and spastic muscles. Treatment should begin as soon as the patient is medically stable, and regular physiotherapy is key to regaining physical function and ensuring maximum recovery.

The use of mobility aids can help stroke patients regain their independence and improve their quality of life. Walking frames, sticks, and wheelchairs can provide support and stability, reducing the risk of falls and allowing patients to move around more easily.

It is important to work with a physiotherapist to determine the most appropriate type of mobility aid for the patient's specific needs and to ensure safe use.

Frequently asked questions