Regaining Mobility After A Stroke: Is It Possible?

A stroke occurs when the blood supply to the brain is interrupted, causing brain cells to be deprived of oxygen and nutrients, which can result in brain tissue damage. The impact of a stroke varies from person to person, with some recovering within days or weeks, while others may experience long-term physical and mental impairments. For those who experience difficulty walking after a stroke, rehabilitation and physical therapy can significantly improve their mobility and gait.

Gait rehabilitation

Physical therapists are crucial resources for gait recovery, as they are trained in movement restoration. They can design personalised therapy programs to meet the survivor's unique needs and abilities, which can include passive stretches, active exercises, and therapeutic modalities. These exercises can be challenging yet not overly difficult to perform and can include:

• Seated marches: raising one leg at a time towards the chest while sitting, then relaxing the leg back down.
• Toe taps: raising the toes and then lowering them back down while starting with the feet flat on the floor.
• Sit-to-stands: beginning in a seated position, pushing up to standing, and then returning to sitting, using support if needed.

In addition to physical therapy, there are also exercise devices that can help with gait rehabilitation, such as anti-gravity treadmills, stationary bikes, and home rehabilitation devices like FitMi. These devices can make rehabilitation more engaging and interactive, encouraging survivors to practice their exercises consistently.

It's important to note that stroke survivors who have difficulty walking are at a heightened risk of falls. Therefore, it's recommended to practice exercises with a caregiver nearby or close to a stable surface. Additionally, vision problems after a stroke can also impact walking ability, so it's important to seek help from optometrists, neurologists, or occupational therapists.

Overall, gait rehabilitation is an important aspect of stroke recovery, and consistent participation in personalised therapy programs can boost recovery outcomes.

Physical therapy

Passive exercises, which involve gentle stretches performed by a therapist or caregiver, can be used to improve flexibility, increase blood flow, and stimulate the brain. Active exercises, on the other hand, involve using one's own strength to perform specific movements, such as seated marches, toe taps, and sit-to-stands. Both types of exercises are important for regaining mobility and independence.

In addition to these exercises, physical therapists may also recommend aquatic therapy, massage, or electrical stimulation to improve walking ability. Aquatic therapy, for example, can relax muscles and aid in pain relief, while the buoyancy of the water reduces the fear of falling. Electrical stimulation, such as electromechanical devices or direct stimulation of the motor cortex, can also augment cortical plasticity and learning during physical therapy.

The use of mobility aids, such as walkers or canes, is also an important aspect of physical therapy. These devices can provide stability and support during the recovery process, reducing the risk of falls. However, as strength, balance, and coordination improve, individuals may be able to transition to less stable walking devices or walk without assistance.

Overall, physical therapy plays a crucial role in helping stroke survivors regain mobility and independence. Through a combination of exercises, therapies, and mobility aids, individuals can improve their gait, strengthen their muscles, and retrain their brain to improve their overall quality of life.

Mental health support

Strokes can have a significant impact on mental health, and it is crucial to address these issues as part of the recovery process. Here are some ways to provide mental health support during stroke recovery:

Cognitive Behavioural Therapy (CBT)

CBT is a type of talk therapy that can help manage the emotional and psychological consequences of a stroke. It can assist in dealing with anxiety, depression, and tiredness, which are common issues faced by stroke survivors. CBT aims to help individuals understand the connection between their thoughts, feelings, and behaviours, and develop effective coping strategies.

Cognitive Rehabilitation

Cognitive rehabilitation focuses on improving mental abilities affected by a stroke, such as memory, concentration, thinking skills, and mood. It involves engaging in activities that stimulate the brain and help restore or improve cognitive functions. This can include exercises to enhance attention, problem-solving, decision-making, and organisational skills.

Support Groups and Social Interaction

Encourage the stroke survivor to join support groups or seek out social interactions. Connecting with others who have gone through similar experiences can provide a sense of community and reduce feelings of isolation. Social activities can also help improve communication skills and provide emotional support during the recovery journey.

Addressing Caregiver Stress

Caring for a stroke survivor can be demanding and stressful for caregivers. It is important to provide support and resources to help them manage their own mental health and well-being. This can include respite care, support groups, or counselling services specifically for caregivers.

Managing Depression

Depression is a common complication after a stroke, affecting up to 40% of survivors in the first year. It is important to recognise and address depression through appropriate treatment, which may include medication and psychotherapy. Treating depression can improve participation in rehabilitation activities and enhance overall recovery outcomes.

Psychological Support for Family Members

A stroke not only impacts the individual but also their family members. Family members may experience a range of emotions, including anxiety, depression, and stress. Offering psychological support and counselling services to family members can help them cope with the changes and challenges that arise following a stroke.

It is important to remember that mental health support is an integral part of stroke recovery. By addressing the psychological and emotional aspects of stroke, individuals can improve their overall well-being and enhance their physical recovery journey.

Home adaptations

After a stroke, your home may need to be adapted to make it easier to move around and perform everyday tasks. Here are some ways you can modify your living space to aid your recovery:

Install Handrails and Grab Bars:

• Place handrails along hallways and in bathrooms to provide support and balance when walking or transferring between locations.
• Grab bars can be installed near the toilet, in the shower, or by the bathtub to assist with sitting, standing, and maintaining balance.

Remove Tripping Hazards:

• Ensure that walkways are clear of clutter, cords, and loose rugs to prevent falls.
• Secure or remove loose carpets or use double-sided tape to keep them in place.
• Opt for non-slip mats in the bathroom to prevent slipping.

Adjust Furniture Layout:

• Rearrange furniture to create wider pathways and ensure there is enough space to manoeuvre, especially if using a walker or wheelchair.
• Consider using furniture with a smooth, rounded design to avoid sharp corners.

Improve Lighting:

• Install bright lighting, especially in hallways, stairways, and entrances, to enhance visibility and reduce the risk of falls.
• Use night lights in bedrooms and bathrooms to provide illumination during the night.

Modify Stairs:

• If possible, consider installing a stairlift or ramp to avoid climbing stairs.
• Ensure handrails are securely attached on both sides of the staircase and extend the full length of the stairs.
• Opt for contrasting colours for the edges of steps to improve visibility.

Adapt Kitchen and Bathroom:

• Adjust the height of kitchen counters or sinks to make them more accessible, especially if using a wheelchair.
• Install lever-style handles on doors and faucets for easier operation.
• Transfer frequently used items to lower shelves or cabinets for easier access.

Remember to consult with your healthcare team and seek their advice on specific home modifications that would be most beneficial for your recovery journey.

Speech and language therapy

Initial Assessment

Firstly, a speech and language therapist will assess a patient's swallowing and communication difficulties following the acute stages of a stroke. This is recommended within 24 hours.

Training

Speech and language therapists also train other healthcare professionals to carry out screening and provide long-term rehabilitation as part of a wider transdisciplinary team.

Coaching

They also coach and train family members, friends, carers and other professionals to be 'communication partners' for people with communication difficulties.

Consent

Speech and language therapists also support with mental capacity assessments in cases where it is difficult to obtain consent.

Communication Aids

Therapists are able to assess and advise on communication aids and assistive technology to minimise the impact of communication difficulties following a stroke.

Dysphagia Therapy

Up to 78% of stroke survivors will initially experience some level of difficulty in swallowing (dysphagia). Speech and language therapists assess and support stroke survivors to minimise the risk of aspiration and choking. Dysphagia therapy is important to avoid further health complications. Stroke survivors with dysphagia may report feeling embarrassed about eating and drinking in front of others and may become socially isolated. Speech and language therapists support stroke survivors to enjoy food and drink as safely as possible and devise strategies for them to enjoy eating out and socialising.

Aphasia

The medical term to describe some of the communication problems that happen due to a stroke is "aphasia". There are several kinds of aphasia, including non-fluent, or Broca's, aphasia, which occurs when a stroke damages the language network in the left frontal area of the brain. People with non-fluent aphasia can understand what others say but have trouble forming complete sentences and putting together the words they want to use.

Rehabilitation

Rehabilitation may include working one-on-one with a speech-language pathologist and participating in groups with others who have aphasia. The group setting can be particularly helpful as it offers a low-stress environment where people can practice communication skills such as starting a conversation, speaking in turn and clarifying misunderstandings.

Frequently asked questions