Learning to walk again after a stroke or brain injury
July 17, 2019 at 1:00 PM
by Sravani Mehta, MD
Learning to walk again after a stroke or brain injury

Recovering mobility after a brain injury is frequently one of the most difficult tasks during the rehabilitation process. The freedom to stroll without anyone else not just prompts a higher personal satisfaction, yet in addition builds the body's odds for a more noteworthy scope of recovery. I have a strong personal interest in working towards getting brain injury and stroke survivors mobile and independent.

According to the National Institute of Neurological Disorders and Stroke, over 700,000 people suffer from a stroke in the US annually. The two-thirds of people who survive a stroke have to go for rehabilitation to regain the ability to walk as well as other motor functions. Although rehab doesn’t exactly cure the effects of the stroke, it substantially helps people achieve the best possible long term outcome that can help them enjoy quality living once again. It's important to keep in mind that though that the goal may not going back to exactly how you were walking before, but rather to move around as independently as possible.

Lost mobility is a huge challenge after a stroke, and regaining may seem an even bigger challenge. Stroke survivors need to deliberately relearn how to walk because the damage done to the brain as a result of an injury can cause problems with controlling the various movements of the body.

Hemiplegia—the debilitating or loss of motion of one side of the body—just as other regular neurological disturbances that happen following a stroke, for example, loss of balance, weakened muscles, impaired spatial awareness, and poor generally speaking physical coordination can make recovery very challenging. Along these lines, many survivors require the help of a friend or family member or assistive instruments and emotionally supportive networks until these irregular characteristics have been balanced.

There are numerous therapies, restorative medications, and even medical interventional procedures to energize the regaining of mobility into day by day life, particularly when the various aspects of recovery are considered.

A stroke can impact a survivor’s ability to walk in many ways:

  • Loss of balance: Those healing from a stroke often struggle with decreased balance, threatening the safety of walking without a caretaker or device.
  • Gait changes: Due to the weakening of many of the lower extremities, as well as disruptions in the nervous system, common gait issues may occur, adding to the various imbalances in joints and muscle strength.
  • Loss of spatial awareness: Depth perception is often impaired in stroke sufferers, so it is important to avoid areas with poorly lit stairs, small obstacles, or other tripping risks.
  • Muscle fatigue: Both from the stroke effects itself and during the transition into rehabilitation, muscles can become weakened as time goes on, thus making the return to walking a gradual process.
  • Lack of coordination: As the body learns to communicate more clearly again, messages often become confused while en route from the brain to the body part, leading to coordination issues.However, through stroke rehabilitation programs, survivors can regain their lost mobility and independence. It may be a long process because learning to walk is indeed a complex task that involves different cognitive functions and muscle groups to work together, but it’s definitely worth it as the survivors are able to get back on their feet and attain the best possible quality of life.

So, if you or a loved one is a stroke survivor struggling with mobility issues, then continue reading as we share with you some of the best tips and exercises to overcome this challenge successfully and get back on your feet. Here are some techniques I have found to be extremely effective during my patient experiences.

Take a look:

Work on Your Toes, Feet, and Legs

The foundation of walking is your leg muscles, feet, and toes. After a stroke, survivors may have difficulty moving either one of their legs or lifting the front part of their foot because of the loss of dorsiflexion. However, in order to regain the ability to use these muscles again, survivors must retrain the brain and muscles by performing leg, toe, and foot drop exercises. These exercises will strengthen the legs, thereby speeding up the recovery process. Remember, the more that you do for yourself, the greater benefit you will see from an exercise.

Exercise#1—Extensor Stretch

This exercise will increase the flexibility in the toes. To perform this exercise, the stroke survivor should gently use their hands to pull their toes downward so that the knuckles are raised. Then, press the thumb lightly into the foot’s arch. Hold this position for at least 20 to 30 seconds. After that, reverse the direction of the toe stretch in order to assist the re-straightening of the joint.

Exercise#2—Towel Curl

Try the towel curl exercise to strengthen the arch muscles. This exercise is performed by placing a towel on the ground. Stand on the towel with both feet and scrunch your toes while tightly gripping the towel below you. Next, pull the towel slowly closer until it can no longer advance.

Exercise#3— Ankle Dorsiflexion

To perform this foot drop exercise, cross the affected leg over the other leg. Then move your foot up towards the knee and then back down. Try to focus on imitating all movement from your ankle. Repeat it 10 times.

Exercise#4—Brisk Walk

Research shows that regular brisk walking after a stroke can improve mobility, quality of life, and physical fitness. According to a study conducted in Jamaica, researchers took 128 stroke survivors and divided them into two groups. One group performed brisk walking in an outdoor setting thrice a week for 3 months while the other group had therapeutic massages and no supervised exercise.

In comparison group that only got the massages, the group that went on the brisk walks reported significant improvements in their ability to walk and their overall health. For example:

 16.7% reported improvement in their quality of life

 They walked farther than the massage group by 17.6%. This result was seen in a 6-minute endurance test.

 Had a resting heart rate that was 1.5% lower than the massage group

Work on Your Core and Balance

In order to walk properly, you must work on your core and balance. Initially, it may be difficult, but as you practice, it will become easy, and you’ll start seeing results, too. It is suggested to start with basic standing and balancing exercises and then gradually advance forward.

Doing the Basics

For this, find a stable place that can provide you with proper balance. Then, stand in a tall and sturdy position and shift your weight gently to one side of your body. Now swing the non-supportive leg up and try to balance it for at least 10 seconds. Repeat this motion several times and then switch.

Jump to the Intermediate Level

Once you are comfortable with the basic balance exercise, try challenging yourself by jumping to the intermediate level. It starts off in the same way as the basic, however, once you shift your weight to one side, you need to bring the other leg in front of you and bend the knee. Try to balance your posture and position for at least 10 seconds. Then lower your leg slowly. Switch and repeat.

Go Advanced

Next is the advanced level. To perform this exercise, find a wall or a piece of furniture to balance yourself. Then swing your leg behind your body as far as you feel comfortable. Try holding it for 10 seconds. Then lower it gently back onto the ground. Repeat this exercise with the opposite leg.

Bridging Exercises

Bridging exercises are best for strengthening the core. The basic bridge exercise is called the inner range quad movement that focuses on the thigh muscles. For this, you will need a towel. Begin by finding a comfortable yet sturdy spot to lie down and then place a rolled towel below the knee joint. Now press the knee into the towel and pull.

When you’ve started to get comfortable with this movement, you can move to the intermediate level.

This involves ski squats. To perform this exercise, find a wall and then lean your body flat against it. Now place your feet slightly in front of you and then lower yourself down, slowly creating a 90°angle. Hold the position for 10 seconds and then slide back up gently.

Evidence Based Techniques to Improve Your Walking Skills

To help you walk again, I also recommend other techniques like:

Functional Electrical Stimulation

This technique is mostly recommended to survivors with a neurological loss after a stroke. The treatment focuses on placing electrodes on areas of the affected muscles, thereby stimulating movement and growth. The electrical impulses encourage a response from the injured muscles. This therapy is helpful for the recovery of stroke survivors.

Tone Management with Botulinum Toxin Injections

If stiffness or tight muscle tone is limiting progress of recovery, botulinum toxin is used by physiatrists to loosen up muscles with range of motion limitations. Comprehensive tone management programs, such as the one developed by Dr. Mehta in Nashville, TN are widely available throughout the country to assist brian injury and stroke survivors overcome functional limitations to be able to walk with less assistance, faster and easier.

Foot Splints and Orthotics

During the recovery process, orthotics and foot splint systems provide support, comfort and convenience while offering optimum foot clearance and support while walking.

A combination of all these treatments can help you regain mobility and empower you to walk again, thereby ensuring that you are once again able to perform everyday activities without any limitation.

Sravani Mehta, MD practices medicine in Nashville, TN at Brain & Stroke Care.  focuses on Brain Health in Aging, Brain Injury & Stroke.