Walking After Stroke: Is It Possible To Learn Again?

Walking is a complex task that requires the integration of multiple systems in the body. After a stroke, a person may experience difficulty with this seemingly simple action. The good news is that, with the right rehabilitation and mindset, it is possible to learn to walk again. Regaining mobility after a stroke is a challenging but rewarding journey that can lead to increased independence and an improved quality of life.

Gait training therapy

Gait training can include leg, core, and even arm exercises, as well as walking practice with real-time feedback from a physical therapist. It may also involve walking on different surfaces or navigating sidewalks and curbs to improve safety and independence.

• Side Stepping: Step to the side with one leg, then follow with the other. Repeat several times, then change directions. This exercise increases glute activation and dynamic stability and balance with lateral weight shifting. To make it more challenging, resistance bands can be added around the knees.
• Forward to Backward Weight Shifting: Take a step forward with one foot, then lift your leg up and move it back behind your body. Repeat several times, then switch sides. This exercise improves foot clearance, pelvis stability, and standing balance with weight shifting. Adding ankle weights or challenging yourself to not rely on arm support can increase the difficulty.
• Step-ups: Stand in front of a step and step up with one foot, then the other, and then step down. This exercise increases hip flexor strength, which improves foot clearance, step length, quadriceps, and glute strength for improved force generation and gait speed. It also improves pelvis stability and standing balance with weight shifting. To increase the challenge, you can try not using arm support to maintain your balance or increase the step height.
• Sit-to-Stand: Sit in a chair and lean forward to use your legs to stand up. Then, slowly lower yourself back into the chair with control. This exercise increases quadriceps and glute strength for improved stability and leg strength. To make it more challenging, you can add resistance bands around the knees to increase glute activation.
• Single-Leg Lift: While sitting or standing, lift one leg up, hold for two seconds, then lower. Repeat on the other side. This exercise increases hip flexor strength to improve foot clearance and single-leg strength and stability while standing and weight shifting. To increase the challenge, you can add ankle weights or try not to use arm support to maintain your balance.

Rehabilitation and physical therapy

The first step in physical therapy is to identify weaknesses in the body and address them through pre-walking exercises. For example, if a patient's trunk muscles are affected, causing them to lean to one side, a physical therapist may start with trunk exercises in a sitting position before progressing to standing exercises.

The next step is to work on the act of walking itself, which involves numerous muscles and isolated movements. Each segment of the walking motion must be relearned separately and then combined, much like a dancer learning a new piece of choreography. This process can be challenging and may require creative communication strategies, especially for patients with receptive aphasia who cannot process the therapist's directions.

Therapists use their hands and body to create sensory input for the brain, repetitively moving the patient's muscles until the movement is relearned. This process sends messages back to the brain and helps retrain it. In addition to passive exercises performed by the therapist, patients can also engage in active exercises that involve using their own strength to perform specific movements. Examples of active exercises include seated marches, toe taps, and sit-to-stands.

In addition to physical therapy, gait training therapy can also be beneficial. This type of therapy focuses on improving walking patterns and is especially useful for individuals who have sufficient movement and strength but have not yet achieved a normal gait pattern. Gait training may involve walking on different surfaces or navigating sidewalks and curbs to improve safety and independence.

To support the rehabilitation process, mobility aids such as canes, walkers, and support braces can be extremely helpful. These devices provide stability and reduce the risk of falling while the individual works on regaining their walking ability.

The likelihood of regaining the ability to walk after a stroke increases with the intensity of rehabilitation. It is recommended to start rehabilitation as soon as the patient is stable, and most improvements occur within the first six months. However, it is important to remember that recovery is a gradual process and may take longer for some individuals.

In addition to physical therapy and gait training, other treatments such as functional electrical stimulation (FES) and transcutaneous electrical nerve stimulation (TENS) can also be used to stimulate muscle growth and movement, as well as reduce pain.

Overall, the key to successful rehabilitation and physical therapy is consistency, patience, and a personalized approach that addresses the unique needs and abilities of the stroke survivor.

Regaining independence

• Gait training therapy: This type of therapy helps stroke survivors regain their ability to walk and improve their long-term health. It focuses on improving walking patterns and can include walking practice with real-time feedback from a physical therapist.
• Physical therapy: Physical therapists can design personalised exercise programs to help restore movement, improve balance, strengthen muscles, and retrain the brain. These exercises can include passive stretches, active exercises, and therapeutic modalities such as massage or electrical stimulation.
• Mobility aids: Canes, walkers, and support braces can be useful tools to help with rehabilitation and improve independence.
• Task-oriented training: This approach to rehabilitation focuses on motor learning by putting people into situations where they learn by doing. It challenges the brain to figure out the best solutions to accomplish specific tasks.
• Support systems: Meeting other stroke survivors, sharing experiences, and participating in community exercise programs can provide emotional support and motivation during the recovery journey.
• Starting slowly and building up: It is important to not overwhelm yourself by doing too much too soon. Start with small, achievable goals and gradually increase your level of activity as you build strength and confidence.
• Addressing health concerns: It is important to manage any health conditions, such as high blood pressure or diabetes, that may impact your ability to be active and regain independence.
• Continuing therapy at home: Consistency is key in rehabilitation. Continuing to practice therapeutic exercises at home can promote optimal recovery and help stroke survivors regain their independence.

The role of surgery

In cases where physical therapy, orthotics, and stretching exercises are not effective, doctors may recommend surgery to help stroke survivors walk again. Surgical options include nerve sutures, grafting, tendon transfer, or decompression.

One surgical option that may be recommended for individuals with severe spasticity is tenotomy. This procedure involves cutting the affected tendon to lengthen it, thereby relieving pain and allowing for a greater range of motion. Club Toe, a condition where the four small toes curl upward, is commonly treated with this surgery when physical therapy and stretching exercises are ineffective.

Tendon transfer is another surgical alternative for rehabilitating the damaged neurological region. This procedure involves moving the posterior tibial tendon to restore mobility.

In addition to these options, a relatively non-invasive version of tenotomy can be performed using a small incision and miniature camera.

For individuals who are still bedridden, cyclic multichannel stimulation to generate walking-like movements may facilitate the ability to walk later on. This approach has shown promising results in improving the chances of walking independently at six months.

The importance of support

Support is a vital component of the recovery process for stroke survivors. The road to recovery can be challenging and often requires the assistance of loved ones, caregivers, or specialised tools and support systems. Here are some reasons why support is crucial:

Emotional Support

Emotional support is essential for stroke survivors as they navigate the physical and mental challenges of recovery. Emotional support can come from family, friends, support groups, or therapists. This type of support helps stroke survivors stay motivated, positive, and determined throughout their recovery journey. It can also help them cope with any psychological or emotional difficulties that may arise due to the life-altering nature of a stroke.

Physical Support

Physical support is crucial for stroke survivors, especially in the early stages of recovery. This can include assistance with basic tasks such as getting out of a chair or into bed safely, or navigating their environment. Caregivers or loved ones can provide physical assistance to prevent falls and ensure the safety of the stroke survivor. Additionally, physical therapists play a key role in providing support by creating personalised therapy programs to improve gait, balance, and overall mobility.

Social Support

Social support is vital for stroke survivors to maintain social connections and combat social isolation. Support groups, community exercise programs, or social media groups can provide a sense of community and shared understanding. Social support can help stroke survivors stay motivated, exchange tips and stories, and encourage one another during the recovery process.

Tools and Technology

Specialised tools and technology can provide additional support for stroke survivors. This includes mobility aids such as canes, walkers, and wheelchairs, which can assist with balance and stability during the recovery process. Additionally, devices like the SaeboStep, a lightweight foot drop brace, can provide convenience and comfort while improving foot clearance and support during walking. These tools can enhance independence and make the recovery journey more manageable.

Medical Support

Medical support from healthcare professionals is crucial for stroke survivors. Rehabilitation nurses, physical therapists, and occupational therapists play a pivotal role in recovery. They design specific plans to help stroke survivors regain their abilities and provide exercises to rebuild strength, balance, and coordination. Additionally, doctors can provide guidance on the safety of resuming certain activities, such as driving, and offer recommendations for further treatment or surgical options if needed.

In conclusion, support is of paramount importance for stroke survivors aiming to regain their ability to walk. By having a strong support system in place, stroke survivors can improve their physical, mental, and emotional well-being, leading to a more successful and empowering recovery journey.

Frequently asked questions