Regaining Leg Function Post-Stroke: A Comprehensive Guide

Stroke survivors often experience a loss of function in their legs, which can make everyday activities difficult and impact their independence. However, there is hope for improvement, and with the right rehabilitation plan, it is possible to regain leg function and improve mobility. This process typically involves working with a doctor and rehab team to create a customised plan that addresses individual needs and promotes recovery. This may include physical therapy, occupational therapy, and speech therapy, as well as the use of assistive devices such as walkers or canes. The key to success is consistency and repetition in performing the recommended exercises, which help to rewire the brain and improve movement.

Seated marching

• Start by sitting tall on the edge of your seat.
• Alternate lifting your knees as high as you can.
• Engage your core to keep your trunk from leaning.
• Practice for 3 rounds of 30 seconds.
• For the best results, focus on your posture rather than speed.

Remember, recovery is possible for the majority of individuals, even those with post-stroke paralysis. The key to success is consistent, long-term rehabilitation.

Passive exercise

Passive Range of Motion Exercises

Passive range of motion exercises are crucial in the acute phase after a stroke. These exercises involve moving the joints passively and examining spasticity and muscle tone. This type of exercise helps improve motor function and prevent local complications. It is recommended to perform these exercises within the first 48 hours of admission, 6 to 8 times a day, with each session lasting 15 to 40 minutes.

Leg, Ankle, and Foot Exercises

• Bridge Weight Shifts: This exercise improves balance, weight shift, and control for proper walking technique. Repeat this exercise until you can no longer maintain a level pelvis or until your leg muscles become fatigued.
• Calf Stretch: This exercise is excellent for maintaining ankle mobility, which is necessary for walking. Avoid pushing through pain, and hold the stretch for as long as you can, working up to one minute. Perform this stretch on both sides.
• Mini Lunge: This exercise strengthens the muscles in your hip, leg, and core while also facilitating proper weight shifting and balance control. Repeat this exercise 8 to 10 times on each side.
• Side-Lying Knee Flexion: This exercise improves control of knee motions for walking. Repeat 15 to 20 times or until your hips can no longer stay level.
• Side-Lying Hip Flexion with Affected Leg on Top: This exercise improves motion at the hip and knee, simulating walking movements. It can also be useful when moving to the edge of the bed before sitting up. Repeat 15 to 20 times or until your leg muscles are fatigued.
• Single-Leg Mini Squats with Support: This exercise stimulates proper weight shifts and knee control necessary for walking. It also strengthens your leg muscles. Repeat 8 to 10 times or until muscle fatigue.
• Small Step-Ups with Support: This exercise strengthens the muscles in your hips, thighs, and legs. Repeat 10 to 15 times on each side or until muscle fatigue.
• Standing Hip Abduction with Support: This exercise strengthens the hip and leg muscles while also working on weight shifts for better control during walking. Repeat 10 to 12 times on each side.
• Supine Heel Slides: This exercise enhances hip and knee control in preparation for walking. Repeat 20 to 25 times or until your leg muscles are fatigued.
• Supine Knees Side to Side (Trunk Rotation): This exercise promotes motion in the pelvis, hip, and knee, reducing spine stiffness and assisting with rolling over in bed. Repeat 15 to 20 times.
• Supine Leg Crossing: This exercise improves hip control as you prepare for walking activities. Stop when you can no longer cross the midline or when your leg muscles are fatigued.
• Supported Mini Squats: This exercise helps strengthen your legs for walking, endurance, and rising from a seated position. Perform 15 to 20 reps.

Remember to always consult your healthcare professional and/or physical therapist before performing any of these exercises.

Electrical stimulation

ES can be used to improve muscle strength and physical performance, increase the range of motion, and decrease muscle weakness and spasticity. It can also help in relearning the recruitment and timing of muscle activation in the affected limb, aiding in the production of a normal gait. ES can be particularly useful in correcting foot drop, a common issue post-stroke, where the muscles are unable to lift the foot during walking.

There are different types of ES, including neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), and transcutaneous electrical nerve stimulation (TENS). NMES involves sending electrical impulses to the muscles to imitate signals from the nervous system, causing muscle contraction. FES is a type of NMES that combines electrical stimulation with a functional movement, such as lifting the foot while walking. TENS, on the other hand, is often used to manage post-stroke pain by sending impulses to nerve cells to block pain signals.

ES has been shown to be effective in improving gait performance and balance in stroke patients. It can help strengthen weakened dorsiflexor and hip abductor muscles, which are important for supporting weight-bearing and upright posture. Additionally, ES may also help improve muscle mass and strength, potentially counteracting muscle atrophy.

However, ES may not be suitable for everyone, and it is important to consult with a healthcare professional before starting this treatment. Some contraindications for ES include the presence of a pacemaker or other implanted electrical devices, numbness or decreased sensation, open wounds, tumours, or pregnancy.

Overall, ES is a promising treatment option for stroke patients experiencing leg function impairment and can be combined with other rehabilitation techniques to maximise recovery.

Gait training

• Preventing adaptive changes in lower limb soft tissues
• Eliciting voluntary activation in key muscle groups in lower limbs
• Increasing muscle strength and coordination
• Increasing walking velocity and endurance
• Maximising skill, e.g. increasing flexibility
• Increasing static and dynamic balance
• Increasing cardiovascular fitness
• Increasing safety awareness
• Education on the proper use of assistive devices

Conventional 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

The following components of gait are key to successful ambulation:

• Support of the centre of gravity (COG) by the lower limbs
• Propulsion of the COG by the lower limbs
• Balance of the COG as it transitions between weight-bearing limbs
• Controlling knee and toe paths for toe clearance and foot placement
• Optimising rhythm and coordination

Other gait training interventions include:

• Body weight supported treadmill training
• Biofeedback
• Functional electrical stimulation
• Robotic-assisted training

Foot drop exercises

Foot drop is a condition that makes it difficult to lift the front part of the foot and toes, often resulting in difficulty walking. Fortunately, there are ways to regain strength and mobility in the foot, and one of the best methods is through foot drop exercises. These exercises are designed to strengthen the lower limb muscles to improve the ability to lift the foot again. Exercise also helps stimulate and rewire the brain, which makes it an effective way to overcome foot drop after a stroke or brain injury.

Ankle Dorsiflexion

• Start with your affected leg crossed over your other leg.
• Use your non-affected arm to move your foot into dorsiflexion (lifting your foot towards your shin).
• If you struggle with this movement, you can wrap a towel or belt around your foot to assist.

Ankle Adduction/Abduction

• Cross your affected leg over your other leg.
• Use your non-affected hand to move the front part of your foot side to side, focusing on initiating the movement from your ankle.
• For an active exercise, try doing this movement without assistance from your hand.

Assisted Toe Raises

• Place your affected foot on top of your non-affected foot.
• Use your non-affected foot to lift the other foot up and then lower it down slowly.
• Repeat this movement 10-15 times.

Toe Raise "Negatives"

• Lift your affected foot up into a flexed position (toes towards your shin).
• Instead of dropping your foot back down quickly, try to lower it as slowly as you can.
• This exercise requires some control of your foot and can be challenging.

Heel Raises

• Start with your feet flat on the ground.
• Point your toes and lift your heels off the ground.
• Keep your feet in proper neutral alignment by pressing actively through your first and second toes, ensuring your ankles don't turn outwards.
• Repeat this exercise 10 times.

Single Leg Stance

• Stand on your affected leg for 15 seconds at a time while holding onto the back of a chair for support.
• This exercise challenges your ankle stability and balance.

Hip External and Internal Rotation

• Start in a seated position.
• Kick your affected leg inward toward your midline (hip external rotation) and then outward (hip internal rotation) like you're kicking a ball to the side.
• Repeat this movement back and forth.

It is important to consult with your healthcare professional before starting any exercise program. They can provide guidance and ensure that the exercises are safe and suitable for your specific condition.

Frequently asked questions