
Regaining the ability to walk after a stroke is a major goal for many survivors. Physiotherapy and rehabilitation are key to improving a survivor's gait (manner of walking) and can even lead to a full recovery. There are a variety of exercises that can help stroke patients walk again, including passive and active exercises, gait training, and balance exercises. Passive exercises involve assisting the affected side through movement, either with the help of a caregiver or by using the non-affected side. Active exercises, on the other hand, involve performing movements independently. Both types of exercises are important for improving strength, gait, and balance.
Characteristics | Values |
---|---|
Walking difficulties after stroke | Hemiparesis or hemiplegia, spasticity, foot drop, balance issues, pain, motor impairments |
Gait rehabilitation | Physical therapy, occupational therapy, passive stretches, active exercises, therapeutic modalities |
Passive exercises | Gentle stretches, performed by a therapist or trained caregiver, improve flexibility, prevent contractures, increase blood flow, stimulate the brain |
Active exercises | Leg and core exercises, seated marches, toe taps, sit-to-stands |
Gait training | Leg, core, and arm exercises, walking practice with real-time feedback, walking on different surfaces |
Mobility aids | Front-wheeled walkers, four-wheeled walkers |
Exercise devices | Anti-gravity treadmills, recumbent cross-trainers, stationary bikes, home rehabilitation devices |
Post-stroke walking impairments | Loss of balance, gait changes, loss of spatial awareness, muscle fatigue, lack of coordination |
Leg and toe recovery | Canes, walkers, support braces, physical therapy, rehabilitation technology |
Gait deviations | Decreased gait speed and cadence, decreased step length, decreased stance time on the weakened leg, decreased ankle dorsiflexion, decreased standing balance and stability |
Strength and balance exercises | Ankle dorsiflexion, hip flexor strength, glute strength, quadriceps strength, dynamic balance and stability |
Rehabilitation process | Inpatient rehabilitation, home health, outpatient rehabilitation, multiple hours of therapy per day |
What You'll Learn
- Passive exercises for stroke survivors with little to no active movement in their legs
- Active exercises for those with partial movement in their legs
- Gait training for those with sufficient movement and strength to walk but have yet to achieve their normal gait pattern
- Balance and core exercises to improve core stability and gait
- Leg exercises to improve strength, gait and balance
Passive exercises for stroke survivors with little to no active movement in their legs
Passive exercises are a great way to help stroke survivors with little to no active movement in their legs regain mobility and improve their gait. These exercises involve gentle stretches, often performed by a therapist or trained caregiver, and can be used to improve flexibility, prevent contractures, increase blood flow, and stimulate the brain. Here are some examples of passive exercises that can be performed by a caregiver to help stroke survivors with their leg movement:
Ankle, Knee, and Hip Movement
Passive exercises often focus on improving the range of motion in the ankle, knee, and hip joints. This can be done by gently moving the joints through their full range of motion, or by using a robotic device to assist with the movements.
Leg Raises
The survivor can sit on the floor with their legs outstretched. A caregiver can then gently lift the survivor's affected leg and guide it through a marching motion, focusing on raising the thigh and straightening the knee.
Knee Bends
The survivor lies flat on their back with their knees bent and feet flat on the floor. A caregiver can then gently press down on the survivor's affected knee and slowly lower it towards the floor, stretching the hamstring.
Hip Abduction
The survivor stands with their hands on a countertop or tabletop for support. A caregiver can then gently move the survivor's affected leg out to the side, keeping the leg straight and the foot pointing forward.
It is important to note that passive exercises should be performed gently and should not cause pain. If there is any discomfort, the exercise should be stopped immediately. Additionally, it is always recommended to consult with a physical therapist or healthcare professional before starting any new exercise routine.
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Active exercises for those with partial movement in their legs
Seated Marches
While sitting, raise one leg at a time towards your chest as if marching, then relax the leg back down. Repeat with the other leg.
Toe Taps
Starting with your feet flat on the floor, raise your toes up, then lower them back down.
Sit-to-Stands
Beginning in a seated position, push up to a standing position, using a table or countertop for support if needed, before returning to sitting.
Single-Leg Mini Squats with Support
Stand facing a countertop or a hard, flat surface. Place your hands on the surface for support. Gently move one leg out to the side, keeping your leg straight and your foot pointing forward. Repeat with the other leg.
Calf Stretch
This exercise is great for maintaining ankle mobility, which is needed for walking. Stand next to a stable chair or flat wall. Place your hands on the top of the chair or at a similar height up the wall. Bend your body to create a triangle and step one leg back, straightening the leg as much as is comfortable until you feel a stretch in your calf. Ensure your toe is facing straight forward. Hold this position for one minute or as long as is comfortable, then repeat with the opposite leg.
Mini Squats with Support
Stand facing the back of a chair and grasp either side of the top of the chair. Slowly bend your knees as if sitting down, keeping your knees, hips, and feet in line, and distributing your body weight equally over both legs. Push up through your feet, straightening your knees and spine until you return to the starting position. Repeat this exercise 15-20 times.
Side-Lying Hip Flexion
Lie on your unaffected side with your head resting on a bent arm. Ensure your hips are level and your hips, legs, and feet are in line. Slowly raise and bend your affected leg inward towards your chest or belly, then straighten it back. Repeat this exercise 15-20 times or until your leg muscles become fatigued.
Standing Hip Abduction with Support
Stand facing a countertop or a hard, flat surface. Place your hands on the surface for support. Gently move your leg out to the side, keeping your leg straight and your foot pointing forward.
Leg, Hip, and Balance Exercises for Walking After Stroke
A wide variety of muscles and skill sets are essential for a healthy gait. Ongoing movements for the legs, hips, joints, and back help not only with strength but also with balance, coordination, and depth perception.
Basic Standing and Balance Exercise
Stand in a stable place and take a tall, sturdy standing posture. Gently shift your weight to one side of your body. Swing the non-supportive leg up to the side and balance in this position for 10 seconds. After several repetitions, switch legs and repeat as long as your strength allows.
Intermediate Standing and Balance Exercise
Once you feel comfortable with the basic level, move on to intermediate-level exercises. Find the same position as before, with a strong balancing area to support yourself as you shift your weight to one side. Bring the other leg in front of you and bend the knee as you go. Balance and hold the position for a count of 10, then slowly lower your leg back down. Switch legs when you’re ready.
Advanced Standing and Balance Exercise
Only move on to the advanced level once you feel comfortable and stable with the intermediate level exercises. Brace yourself on a nearby wall or sturdy piece of furniture. Swing your leg behind your body as far as you can comfortably reach. If possible, hold the leg out for a count of 10 seconds, then gently lower it back down. Repeat on the opposite leg.
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Gait training for those with sufficient movement and strength to walk but have yet to achieve their normal gait pattern
Gait training is a key part of stroke rehabilitation and involves improving a person's ability to walk through practice and specific exercises. Gait training for those with sufficient movement and strength to walk but who have yet to achieve their normal gait pattern will focus on improving muscle strength and coordination, increasing walking velocity and endurance, maximising skill, increasing static and dynamic balance, and increasing cardiovascular fitness.
- Single-leg stance with stable balance and control: This exercise involves standing on one leg and maintaining balance and control. This helps improve balance and control during walking.
- Push off/initial swing of the moving leg: This exercise focuses on the push-off phase of gait, where the leg moves behind the body to propel forward. It helps improve the propulsion of the body in the intended direction.
- Weight-shifting between lower limbs: This exercise involves shifting weight from one leg to the other, helping to improve dynamic balance control and the support of the body mass by the lower limbs.
- Symmetrical weight-bearing between lower limbs in stance: This exercise aims to achieve equal weight-bearing on both lower limbs, which is essential for maintaining stability and balance during walking.
- Stepping training: This exercise involves practising stepping over level and uneven surfaces, which is crucial for navigating different environments and obstacles safely.
- Heel strike/limb loading acceptance: This exercise focuses on the initial contact of the heel with the ground during walking, which is important for absorbing impact and maintaining stability.
These exercises can be progressed and modified to challenge the individual and target specific areas of improvement. It is important to work with a healthcare professional or physical therapist to ensure the exercises are tailored to the individual's needs and performed correctly.
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Balance and core exercises to improve core stability and gait
Balance and core exercises are crucial for stroke patients to improve their stability and gait, as well as their overall mobility and independence. Here are some exercises that can help:
Beginner Core Exercises
- Back Extensor Isometric Hold: Sit at the edge of a seat, lean back, and then use your core muscles to sit up straight.
- Trunk Rotation (Twists): Place your right hand on the outside of your left thigh and gently twist your torso to the left. Repeat on the other side.
- Lateral Trunk Flexion (Oblique Crunches): Dip your left shoulder towards your left hip and then return to an upright position, using your core muscles. Repeat on the other side.
- Seated Trunk Extension: While sitting at the edge of your seat with a straight back, lean forward at your hip, and then engage your core muscles to lean back.
Intermediate Core Exercises
- Forward and Lateral Punches: In a seated position, clasp your hands and punch forward, leaning your trunk forward. For lateral punches, interlace your fingers, extend your arms forward, and then lean and "punch" the air to the right and left.
- Leg Lifts: Sit on the edge of a seat and alternate lifting each leg, engaging your core.
- Leg Rotations: Lie on your back with bent knees and let your knees fall to the right, gently rotating your trunk. Repeat on the other side.
- Knee Extensions: Lie on your back with bent knees, extend one leg, and then bend at the hip to lift your leg. Repeat with the other leg.
Advanced Core Exercises
- Glute Bridges: Lie on your back with bent knees and use your core to scoop your glutes up, ensuring you don't sway to either side.
- Crossbody Leg Lift: Lie on your back with your arms and legs flat. Lift your left foot and tap it with your right hand. Alternate with the right leg and left arm.
- Crunches: Lie on your back with bent knees, place your hands on your thighs, and then lift your core, sliding your hands up towards your knees.
- Leg Taps: Assume a tabletop position by lifting your legs with bent knees. Bring one leg down to tap the floor and then lift it back up, keeping your core engaged.
- Kneeling Planks: Start in a tabletop position and then move your knees back until your body forms a straight line.
Balance Exercises
- Ankle Dorsiflexion: Stand on a step or ledge, holding on to a railing for support. Step one heel off the ledge and put your weight on it until you feel a stretch along the back of your leg. Repeat with the other leg.
- Hip External Rotator Stretch: Sit near the edge of your seat and cross one ankle over the opposite knee. Gently lean forward until you feel a stretch in your hip and buttock area. Repeat on the other side.
- Isometric Back Extensor Holds: Sit on the edge of your seat and gently press your back against the chair, contracting your back muscles. Repeat this movement 10 times.
- Lateral Trunk Flexion: While seated, tilt your right shoulder down towards your right hip. Hold for 5 seconds and then repeat on the other side.
- Hip Abduction Side Kicks: Sit with your legs shoulder-width apart. Raise your affected foot off the ground and kick your leg out to the side, challenging yourself to keep your trunk still.
- Wide-Based Gait Training: Stand with your legs spaced apart and practice walking with this wider stance until comfortable. Then, gradually narrow the distance between your legs.
- Standing Balance with Eyes Closed: Stand with your feet together and your arms crossed, and then try to maintain your balance for 20-30 seconds with your eyes closed.
- Standing Balance with Head Turns: Stand with your feet together and turn your head side to side while keeping your balance.
Additional Tips
- It's important to work closely with a therapist to adjust these exercises to your specific needs and ability level.
- Consistency is key. Practicing these exercises regularly will provide the necessary stimulation for your brain to rewire itself and improve control over your affected muscles.
- High repetition is important to stimulate neuroplasticity and encourage the brain to reinforce neural connections for movement.
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Leg exercises to improve strength, gait and balance
Stroke patients often experience muscle weakness and loss of control of an affected arm or leg. Exercises can help to restore strength and control, and teach skills to deal with the loss of certain body movements. Here are some leg exercises to improve strength, gait and balance:
Seated marching
Start from a seated position and lift your affected leg up into your chest. Then place your leg back down onto the floor. Keep your back straight and maintain controlled movement. Repeat on the other leg, alternating marching your legs up and down.
Hip internal and external rotations
Sit in a chair and lift your affected leg slightly off the floor. Your knee should remain bent at 90 degrees, but your foot should hover over the floor. With your leg slightly lifted, rotate your knee in and your foot out, then bring your knee out and your foot in toward your midline. Repeat, maintaining the 90-degree bend at your knee.
Clamshell exercise
Start by sitting in a chair with your feet and knees together. Keeping your feet together, press out with both knees as if you are opening a clamshell. Then, bring your knees back together. If this exercise becomes too easy, you can add resistance by placing an exercise band around your knees.
Inner thigh squeezes
Sit with your feet on the floor. Make two fists with your hands and place them side by side between your knees. Then, squeeze your knees and fists together and hold for 5 seconds. Resistance training can help improve strength during daily activities.
Heel raises
Sit with your feet on the floor and knees bent at 90 degrees. Slowly lift your heels from the floor, raising up onto your toes, then slowly lower your heels back down. To add resistance, apply pressure to your knees with your arms. This exercise can also be performed standing.
Hamstring curls
Sit with your feet on the floor. If you are on a hard floor, wear a sock to allow your foot to slide. Slide one heel forward to straighten your knee, then pull your foot back to the starting position. Repeat with the other side. To add resistance, tie a resistance band in a loop around your ankle and a stationary object.
Basic standing and balance exercise
Stand in a sturdy position and gently shift your weight to one side of your body. Swing the non-supportive leg up to the side and balance in this position for 10 seconds. Repeat on the other side.
Intermediate standing and balance exercise
Stand with your weight shifted to one side. Bring the other leg in front of you and bend the knee. Balance and hold the position for a count of 10, then lower your leg slowly. Switch legs.
Advanced standing and balance exercise
Stand and brace yourself on a nearby wall or sturdy piece of furniture. Swing your leg behind your body as far as you can comfortably reach. Hold for a count of 10 seconds, then gently lower your leg. Repeat on the opposite leg.
Basic bridging exercise
Lie down and place a rolled towel or pillow below your knee joint. Press the knee into the pillow and gently lift the heel off the floor.
Intermediate bridging exercise
Lean your standing body against a wall. Place your feet slightly in front of you and slowly lower yourself down so that your legs create a 90-degree angle. Hold this position for 10 seconds, then slide back up with the help of the wall.
Advanced bridging exercise
Perform the intermediate bridging exercise, but this time place a flexible ball between your knees as you bend down into a squatting position.
Mini squats with support
Stand facing the back of a chair and grasp either side of the top of the chair. Slowly bend your knees as if sitting down, keeping your knees, hips, and feet in line. Push up through your feet and straighten your knees and spine to return to the starting position. Repeat 15-20 times.
Single-leg mini squats with support
Stand with your feet hip-width apart. Reach your hips back and bend your knees as if you are about to sit down, but stop halfway and return to standing. Focus on controlling the motion and squeezing your glutes as you stand up.
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Frequently asked questions
Seated marching is a good exercise for stroke patients who are just starting to walk again. Start from a seated position and lift your affected leg up into your chest. Then place your leg back down onto the floor. Keep your back straight and maintain controlled movement. Repeat on the other leg, alternating marching your legs up and down.
The hamstring stretch is a good exercise for stroke patients who are working on improving their gait. Extend one leg out in front of you by straightening your knee and placing your weight on your heel. Then, keeping your chest up tall, reach forward toward your toes while staying seated in your chair. Make sure to bend at your hips and not at your lower back. As long as there is no pain, hold the stretch for 20-30 seconds and then come up slowly before switching sides.
Dynamic weight shifts are a good exercise for stroke patients who are working on improving their balance. Sit upright in a chair. For increased difficulty, try sitting on an unsteady surface such as a yoga ball. Shift your chest and upper body to one side, while shifting your pelvis to the opposite side. Repeat this exercise 10–20 times.
Resisted supine diagonal shoulder flexion is a good exercise for stroke patients who are working on improving their strength. Get a resistance band and lie down with both hands resting near the hip on the ground on the unaffected side of your body. Holding an end of the resistance band with each hand, slowly raise the affected arm up and across your body, aiming for the ground above your head. Ensure the elbow is not bent and completely straight the whole time. Repeat this exercise 15–20 times.