Stroke Recovery: Walking Again After A Stroke

Stroke is one of the leading causes of disability in adults, with approximately two-thirds of stroke patients suffering from impaired mobility. Rehabilitation is key to helping patients regain their ability to walk. This involves retraining the brain through neuroplasticity, which is how all skills are learned or re-learned. The brain rewires itself by strengthening neural pathways through repeated tasks.

Rehabilitation nurses, physical therapists, and occupational therapists will be key in a patient's recovery. They will come up with a specific plan to help the patient, which may include gait training and balance training. Gait training involves re-learning the specific pattern of walking that occurs in several phases that require specific patterns of muscle activation to allow the joints of the lower limbs to move smoothly and synchronously in coordination. Balance training helps improve the patient's balance and coordination.

The majority of stroke patients can walk again within the first six months or, in cases where mobility has been severely compromised, within the first two years.

Gait training and balance training are key components of post-stroke rehabilitation

Gait Training

Gait training is based on an understanding of "normal" gait. During a therapy evaluation, it is important to gather information on the person with stroke's baseline level of activity and mobility. The ability to walk independently is a prerequisite for most daily activities.

Gait training involves breaking down parts of the gait cycle, training and improving the abnormal parts, then reintegrating them into ambulation to return to a more normal gait cycle. This can include:

• Symmetrical weight bearing between lower limbs in stance
• Weight shifting between lower limbs
• Stepping training (swinging/clearance) over level and unlevel surfaces
• Heel strike/limb loading acceptance
• Single-leg stance with stable balance and control
• Push off/initial swing of the moving leg

Balance Training

Balance training is also a key component of post-stroke rehabilitation. Balance training programs are encouraged for those stroke patients who fall or who have a fear of falling.

Balance training involves:

• Dynamic balance training as an integral part of stance and gait training
• Dynamic balance training during relevant ADL sessions
• Training with an unstable support base
• Training with a systematic reduction of the size of the support base
• Aquatic therapy

Gait and Balance Training Combined

It is important to note that there is not much carryover from one task to another. This is even true for the training of strength and endurance. Therefore, gait and balance training should be combined.

Other Training Components

In addition to gait and balance training, other components of post-stroke rehabilitation include:

• Passive exercise
• Electrical stimulation (e-stim)
• Task-specific training
• Foot drop exercises
• Devices to help stroke survivors walk

Physical therapy exercises are the best way to improve your gait after a stroke

Stroke is the leading cause of disability in America. It can cause changes in cognitive skills, motor abilities, sensation, vision, communication, and personality. When gross motor skills are affected, it can impact your gait.

Motor difficulties after a stroke often affect only one side of the body, which can cause balance problems that further disrupt your gait. Hemiparesis and hemiplegia, two conditions that affect movement on one side of the body, are common secondary effects of a stroke.

Rehabilitation is key to regaining the ability to walk after a stroke. It works by stimulating the brain with various physical therapy exercises and activities. A physical therapist can help restore movement and coordination, strengthen muscles, and retrain the brain.

Retraining the brain is arguably the most important aspect of gait rehabilitation after a stroke. The brain rewires itself through neuroplasticity, which is how all skills are learned or relearned. Neuroplasticity helps your brain become more efficient with the tasks that you do regularly by strengthening neural pathways.

• Seated marching: From a seated position, lift your thigh up into your chest. If necessary, you can use your arms to assist with this movement.
• Leg rotation: Start by lying on your back with your legs bent at 90 degrees. Then, let your legs fall to one side while trying your best to control the movement from your core.
• Ankle dorsiflexion: Cross your affected leg over your thigh and hold your foot in your hand. Then, assist your foot through dorsiflexion by moving the top of your foot back toward your shin and then back down.

In addition to these exercises, your physical therapist may also recommend the use of walking devices such as front-wheeled walkers, platform walkers, hemi walkers, four-wheeled walkers, quad canes, and single-point canes.

The ultimate goal of gait training in physical therapy is to help you walk normally and safely. With consistent and long-term rehabilitation, most patients regain the ability to walk within the first 6 months or, when mobility has been severely affected, within the first 2 years following their stroke.

Passive exercise involves assisting your affected limbs through an exercise, either by using your non-affected side or receiving help from a trained caregiver or therapist

Passive exercise is a form of rehabilitation that involves moving the muscles with an outside force, such as a machine, another body part, or another person. After a stroke, survivors often experience neurological damage that affects their motor system, causing weakness in the limbs and limiting movement. Passive exercises can help prevent stiffness in the joints, stretch the muscles, and increase and maintain the range of motion.

Passive exercises can be performed independently with the assistance of the non-affected side of the body or with the help of a trained caregiver or therapist. For example, a stroke survivor can perform finger flexing exercises by bending their fingers into their palm and then straightening them, or they can work on straightening their fingers if they are already bent. This can be repeated 5 to 10 times.

Another example of a passive exercise is arm stretching. At least 3 times a day, stroke survivors can allow their arms to move through their full range of motion, stretching tight muscles as much as possible and holding the stretch for 60 seconds. This can be done independently or with assistance.

Passive exercises can also target the wrists. One such exercise involves lying on the back with arms straight up and clasping the hands together, then bending the wrists from side to side between 5 and 10 times.

These passive exercises can help stroke patients regain movement and prevent further complications. They are especially beneficial for those with limited mobility and strength, and can even help paralyzed patients regain the ability to move without assistance.

In addition to passive exercises, active exercises that require muscle exertion and body movement are also important for stroke rehabilitation. Active exercises help retrain the brain to communicate with the body and strengthen neural signals. A combination of active and passive exercises is often recommended for optimal recovery.

Walking devices that are used following a stroke can vary greatly depending on your skills

• Front-wheeled walkers
• Platform walkers
• Hemi walkers
• Four-wheeled walkers
• Quad canes
• Single-point canes

Over time, your physical therapist may try to transition you to less stable walking devices, until you are able to walk without one at all.

• Medline Rollator Walker with Seat and Drive Medical 2-Button Folding Walker with Wheels: These are examples of rolling walkers, which may be appropriate if the stroke victim has use of both arms and legs but still presents with some balance problems or slight weakness.
• Medline Quad Cane, Small Base and Hugo Mobility Adjustable Quad Cane, Large Base: These are examples of quad canes, which may be needed when the stroke victim is paralyzed and does not have good use of one side, such as in the case of hemiplegia or hemiparesis.
• Drive Medical Side Style Hemi Walker: This is an example of a hemi-walker, which is another option for stroke victims who are paralyzed and do not have good use of one side.
• Medline Offset Handle Canes with Comfortable Foam Grip: This is an example of a single-tip cane, which may be appropriate if the stroke patient only needs minimal support for steadying.

Rehabilitation is key to regaining the ability to walk after a stroke

Stroke is the leading cause of disability in America. It occurs when the supply of blood in the brain is compromised, causing brain tissue damage. The effects of a stroke vary depending on which areas of the brain are damaged, but they often include changes in motor abilities, sensation, vision, communication, and personality.

Retraining the brain is crucial to gait rehabilitation after a stroke. The brain rewires itself through neuroplasticity, a phenomenon that helps the brain become more efficient at tasks that are done regularly by strengthening neural pathways. Re-learning to walk after a stroke is all about practice. By repeating physical therapy exercises consistently, stroke patients can help rewire their brains and improve their gait.

Gait training and balance training are key components of post-stroke rehabilitation. These exercises help stroke patients learn to walk, improve their balance and coordination, and increase the strength of their hips, knees, and ankles to support their bodies when they move. Common gait deviations observed in post-stroke patients include decreased gait speed, step length, stance time on the weakened leg, and standing balance and stability. These changes result from a compromised ability to generate force to propel the body forward, instability of the pelvis that impairs balance, and decreased strength of the weakened leg.

Key muscle groups that can benefit from strength training to improve gait quality after a stroke include the tibialis anterior, quadriceps, hip flexors, and glutes.

Good outcomes for post-stroke rehabilitation require a high degree of motivation, participation, and engagement from the patient. It is important to note that the human leg contains a multitude of muscles that work together to support balance and walking.

• Ankle dorsiflexion: Loop a resistance band around your foot so that the force is pulling your foot down. Activate your tibialis anterior by drawing your foot up toward your body.
• Hip flexor strength: Begin seated in a chair. Lift one leg up, hold for 2 seconds, then lower. Repeat on the other side.
• Glute strength: Lay down on your back with your knees bent and feet flat. Draw your stomach in and squeeze your glutes to lift your hips up without arching your lower back, then lower.
• Quadriceps and glute strength: Sit in a chair, lean forward, and use your legs to stand up. Then slowly lower yourself back into the chair with control.
• Dynamic balance and stability: Stand in front of a wall or counter for support if needed. Step to the side with one leg then follow with the other. Repeat several times, then change directions.
• Forward to backward weight shifting: Stand next to a table or chair for support. Weight shift forward by taking a step forward, then lift that leg up and move it back behind your body. Repeat several times, then switch sides.
• Hip flexor strength, quadriceps, and glute strength: Stand in front of a step. Step with one foot followed by the other, then step down. Repeat several times, then switch sides.

The likelihood of regaining function after a stroke increases with the intensity of rehabilitation. Most patients can walk again within the first six months or, in cases where mobility has been severely compromised, within the first two years. The majority of improvements happen within the first six months, but for stroke survivors with aphasia, it can take up to two years to fully regain their speaking ability.

Frequently asked questions