Understanding Stroke: Paralysis And Its Impact On Mobility

Stroke patients often experience difficulty walking due to the complex movements involved in walking and the impact of the stroke on the brain and body. The brain and body must work together to coordinate leg movements, maintain balance, and keep the body stable. A stroke can damage parts of the brain that control movement, resulting in issues such as muscle weakness, spasticity, foot drop, changes in sensation, tiredness, coordination problems, and balance issues. Rehabilitation and physical therapy are crucial for improving walking ability and can include exercises such as seated marches, toe taps, and sit-to-stands. Additionally, assistive devices like canes, walkers, and wheelchairs can aid in mobility. Recovery can be a gradual process, and it is important to work closely with a healthcare team to improve walking ability and overall independence.

Muscle weakness and spasticity: A stroke can cause muscle weakness and spasticity, making it difficult to walk

A stroke can cause muscle weakness and spasticity, making it difficult for survivors to walk. Spasticity is a common post-stroke condition, affecting 25% to 43% of survivors in the first year, that causes stiff or rigid muscles. It occurs when a muscle involuntarily contracts as the survivor moves, typically affecting the elbow, wrist, and ankle. This results in difficulty stretching the muscle and completing its full range of motion. If left untreated, spasticity can lead to frozen joints in the arm and leg, a condition called contracture.

Muscle weakness is a common issue for stroke survivors, who may experience weakness in a small area or across their whole body. This can make it difficult to move or control muscles. When combined with spasticity, the resulting muscle stiffness and rigidity can make walking particularly challenging.

To improve their ability to walk, stroke survivors often undergo rehabilitation and physical therapy to regain strength and balance. This may involve passive exercises, such as gentle stretches performed by a therapist, and active exercises that utilise the survivor's own strength. Additionally, assistive devices like canes, walkers, and wheelchairs can aid in mobility.

Treatments for spasticity include physical exercise and stretching, injections of botulinum toxin, oral medications, functional electrical stimulation, and surgical procedures. By managing spasticity and muscle weakness through appropriate treatments, stroke survivors can improve their walking ability and enhance their overall quality of life.

Foot drop: Weakness or paralysis of the foot and ankle can occur, making it hard to lift the foot and walk normally

Foot drop is a condition where the front part of the foot cannot be raised due to weakness or paralysis of the muscles that lift it. This can make walking difficult as it causes people to drag their toes when walking, and increases the risk of tripping and falling. Foot drop can affect one or both feet.

Foot drop is often caused by an injury to the peroneal nerve, a peripheral nerve that extends down the leg and controls the muscles that lift the foot. This nerve can be damaged by a traumatic injury to the knee, leg, or ankle, or by sitting with legs crossed at the knee, having a leg in a cast, or by a tumour or cyst.

Other causes of foot drop include lumbar radiculopathy, peripheral neuropathies, motor neuron conditions, and brain conditions such as multiple sclerosis, Parkinson's disease, and Lou Gehrig's disease.

Treatment for foot drop depends on the underlying cause. Physical therapy, braces, splints, or shoe inserts may be used to help stretch and strengthen the muscles and improve walking ability. In some cases, surgery may be required to relieve pressure on the peroneal nerve or to repair it.

Balance issues: Strokes can affect balance and coordination, leading to difficulties in walking and an increased risk of falling

Balance issues are a common occurrence after a stroke, and they can significantly impact a person's ability to walk and move around. Strokes can damage parts of the brain that control movement and coordination, leading to balance problems and difficulty walking. Here are some key aspects to understand about balance issues after a stroke:

Impact on Walking Ability

Strokes often affect balance due to motor changes, incoordination, numbness or tingling, vision problems, or vertigo. These issues can make it challenging for stroke survivors to maintain their balance and coordinate their movements effectively. As a result, they may experience difficulties with walking and increased risk of falling.

Rehabilitation for Balance Issues

Regaining balance after a stroke is possible through rehabilitation and targeted exercises. Physical therapists play a crucial role in helping stroke survivors improve their balance. They design personalized therapy programs that address the unique needs and abilities of each individual. These programs may include various exercises, such as passive stretches, active exercises, and gait training, to improve balance and coordination.

Neuroplasticity and Repetitive Practice

The brain has the remarkable ability to adapt and rewire itself, known as neuroplasticity. Through repetitive practice of balance exercises, survivors can strengthen the neural pathways associated with balance and coordination. This helps the brain adapt and improve its ability to control balance and movement.

Recommended Exercises

There are several effective exercises to improve balance after a stroke. These include functional weight-shifting exercises, balance tasks, and gait training. Additionally, addressing foot drop, a common issue after stroke, can help improve balance. This can be done through the use of ankle-foot orthotics or by practicing specific foot drop exercises.

Virtual Reality and Aquatic Therapy

Virtual reality training programs have emerged as a promising tool for improving balance. These programs provide engaging and interactive environments for balance practice. Aquatic therapy, or hydrotherapy, is another beneficial approach, as it reduces fear of falling and helps improve strength and coordination.

Safety Considerations

It is important to prioritize safety when addressing balance issues. Stroke survivors with balance problems may require the use of assistive devices such as canes, walkers, or wheelchairs. Practicing exercises near a stable surface or with a caregiver nearby can also help prevent falls.

In summary, balance issues after a stroke can significantly impact walking ability and increase the risk of falling. However, through dedicated rehabilitation, targeted exercises, and neuroplasticity, stroke survivors can improve their balance and coordination, enhancing their ability to walk and move confidently.

Gait changes: The weakening of lower extremities and disruptions in the nervous system can lead to gait changes and imbalances in joints and muscle strength

Gait changes are a common occurrence in stroke patients, with nearly two-thirds experiencing difficulty walking post-stroke. This is because strokes can damage parts of the brain that coordinate movements, causing issues such as muscle weakness, spasticity, and foot drop, which can affect the patient's gait and ability to walk.

The weakening of the lower extremities in stroke patients can lead to gait changes and imbalances in joints and muscle strength. This weakness can be mild, affecting a small area, or more severe, impacting one side of the body entirely. As a result, patients may experience difficulty in moving their muscles, including an inability to move them at all. This can cause an abnormal gait, such as a hemiplegic gait, which is commonly seen in hemiplegia. The affected leg is typically stiff, and the patient will drag their affected leg in a semicircle due to foot drop and extensor hypertonia in the lower limb.

Disruptions in the nervous system can also lead to gait changes. Stroke patients may experience issues with their nervous system, such as flexion hypertonia in the upper limb and extensor hypertonia in the lower limb, impacting their gait. Additionally, they may develop distal weakness, resulting in foot drop, which further affects their walking pattern.

The combination of weakening of the lower extremities and disruptions in the nervous system can lead to significant gait changes and imbalances in stroke patients. These issues can make walking difficult and increase the risk of falls. Rehabilitation and physical therapy are often necessary to help improve gait and regain walking abilities.

Rehabilitation strategies: The effectiveness of rehabilitation strategies, such as physical therapy, occupational therapy, and speech therapy, in improving walking ability after a stroke

Rehabilitation is a crucial part of recovery for stroke survivors, and numerous studies have examined various exercises and treatments. The goal of stroke rehabilitation is to minimize patients’ impairment and recover daily activities. The therapy and training for stroke have been studied for a long time, but the results of the various interventions are too sporadic to be chosen efficiently for practical aspects.

Rehabilitation programs required by stroke patients are different according to the stage of stroke. Previous studies defined early subacute as less than three months, late subacute as three to six months, and chronic as more than six months. According to this time frame, the results are as follows, except for the study of Annino (2019), without the description of the phase.

Six papers dealt with the early subacute stage. Cecchi et al. and Jong et al. used electrical stimulation or robotic rehabilitation focusing on patients diagnosed with stroke 43–46 days previously. Conducting a study on patients at a similar stage, Han et al. and Jung et al. used resistance-combined exercises. A study by Shimodozono et al. applied functional exercises for participants who were diagnosed six weeks prior. The papers reviewed relating to the early subacute phase mainly used equipment for treatment, or passive exercise.

Five papers dealt with the late acute period for three to six months after occurrence. Three of them conducted aerobic rehabilitation using treadmill or ergometry. Emmerson et al. identified the effect of home-based exercise for stroke patients in the late acute phase. Corti et al. compared resistance training and functional task practice.

The chronic stage was dealt with in nine articles. Four of these used complex exercise which is the combination of functional, aerobic, and resistance exercises. In the case of single rehabilitation, there are three articles for chronic patients. Stuart et al. used APA-stroke, which contains progressive exercises and coordination trainings necessary for daily activities. Chae et al. studied the effect of home-based functional therapy using smart watches to help chronic patients train steadily. Further, Kerimov et al. conducted isokinetic training in the paretic upper body. Hung et al. and Hsieh et al. both examined robot-assisted therapy, which is relevant to functional therapy.

The majority (up to 85%) of all stroke survivors are able to walk independently by 6 months after their stroke. However, only 60% of survivors who initially required assistance with walking after stroke regain the ability to walk independently.

While stroke recovery timelines can vary greatly, studies have found some common predictors of regaining the ability to walk after stroke. According to the Time to Walking Independently after STroke (TWIST) prediction tool, individuals who are younger, have greater knee extension strength, and have better sitting and standing balance are more likely to regain the ability to walk after stroke.

This does not mean that those who are older, have poor knee extension strength, or lack sitting and standing balance will never recover the ability to walk. It simply means that rehabilitation may require more effort and hard work.

Participating in rehabilitation early on in the stroke rehabilitation process can boost outcomes. Neuroplasticity is enhanced during the first 3-6 months after stroke, thus the greatest improvements tend to occur in this timeframe. However, even if independent walking is not achieved during this time, it is still possible to make improvements years after stroke.

Hope for Walking After Stroke

The ability to walk independently is a major goal of many stroke survivors. Participating in physical therapy and consistently practicing targeted exercises and activities can help individuals achieve this goal.

Repetitively practicing exercises both during therapy and at home can promote optimal results. Therefore, using regularly home exercise programs and/or home therapy devices like FitMi can encourage adaptive brain rewiring and help survivors regain the ability to walk after stroke.

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