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A Step-By-Step Guide to Walking After Brain Injury

Man exercising on an assistive treadmill and learning to walk after brain injury while a therapist stands near to help him

Many people report changes to their walking abilities after traumatic brain injury. This can occur for a variety of reasons, and sometimes the cause of walking difficulties are hard to identify.

To help you regain the ability to walk on your own, this article will explain some of the challenges that brain injury patients face when learning to walk again after a TBI. Then, we will show you the best steps to take to help you get back up on your feet again.

Why Does Brain Injury Affect Walking Skills?

There are several reasons why a brain injury might cause a person difficulty walking. Some common explanations include:

  • Balance problems. Between 30% and 65% of traumatic brain injury patients suffer from balance issues. These can be caused by a range of problems including muscle weakness, inner ear damage, and damage to the cerebellum.
  • Primary motor cortex damage. The primary motor cortex is responsible for most coordinated muscle movements. If an injury causes damage to it, functions like walking, which involve multiple muscle groups, will be impaired.
  • Spasticity. Brain damage can sever or impair the connection between the brain and the muscles. When this occurs, the brain can no longer send signals to the muscles telling them when to contract. As a result, spasticity and tightness can set in, making walking after brain injury much more difficult.

To regain the ability to walk, therefore, you must address these and any other problems that might impair your walking skills.

How to Start Walking After Brain Injury

Walking after brain injury will chiefly involve retraining your brain to control the muscles involved in walking.

The most common techniques that therapists use to help their TBI patients accomplish this include:

  • Passive neurophysiological techniques
  • Motor learning

Below we will show you some examples of these techiques.

1. Passive Neurophysiological Techniques

therapist helping patient move their legs

If you have experienced a severe brain injury, you may have difficulty moving your legs at all. This will make it nearly impossible for you to stand on your own, let alone walk.

Fortunately, it is still possible to regain muscle movement and walking skills even if you have no leg function. You can do this by starting with passive neurophysiological techniques.

With passive neurophysiological techniques, therapists help patients improve their leg strength by supporting correct movement patterns. By moving your legs for you, the therapist helps your brain re-establish connection to your muscles. They do this by engaging the brain’s natural neuroplasticity.

Neuroplasticity is the mechanism your brain uses to rebuild new neural pathways. When these new pathways are established, the connection between your brain and muscles will improve. As this connection grows, you will begin to gain function back in your legs.

Normally, you must activate neuroplasticity through repetitious movement. However, if you can’t move on your own, having someone else do the movement for you will still activate your brain.

Just passively practicing walking movements, in fact, will help your brain relearn the correct motions. Therefore, passive techniques are a great place to begin learning how to walk again after brain injury.

2. Leg Strengthening Exercises

Once you regain the ability to use your legs, you should begin strengthening them. Strengthening your leg muscles is crucial if you want to improve your walking and balance skills after brain injury.

The following are a few exercises you can use at home to strengthen your legs:

  • Hip flexion with hold. Start in a seated position. Use your hand to lift your affected leg up to your chest. Hold for three seconds, then slowly let it down. Repeat on other leg.
  • Knee extension. Sit on a stool or chair. Next, extend your knee as far out as you can. Then slowly bring your foot to the floor. Repeat on other leg. This exercise is a little more advanced so don’t get discouraged if you can’t do it yet

For more examples of leg exercises for brain injury recovery, click here.

3. Foot Drop Exercises

therapist helping patient do foot drop exercises which will improve her walking after brain injury

Foot drop is a common side effect of TBI that impairs dorsiflexion, i.e. your ability to lift the front part of your foot. This can make activities such as walking after brain injury nearly impossible.

Therefore, relearning to walk may need to involve retraining the brain to control dorsiflexion. You can do this through foot drop exercises.

Some of the best foot drop exercises include:

  • Passive ankle dorsiflexion. Sit in a comfortable position and cross one leg over your other. Then, use your hand to move your foot up towards your knee and back down. Repeat ten times, then switch to your other foot. This exercise is great for patients who have weak or paralyzed ankle muscles.
  • Assisted toe raises. If you can only move one foot, this exercise can help you strengthen your other ankle. First, place your strong foot underneath your affected one. Then, use your good foot to lift up your weak foot. Make sure you keep your heel on the ground at all times. Finally, lower the foot back down. Repeat ten times.

Once you have strengthened your legs and feet, you can move on to the next stage of relearning how to walk after brain injury: weight bearing.

Step 4. Weight Bearing Exercise

Now that your muscles are strong enough to support your weight, you must retrain them to actually do that.

You can do this through weight bearing exercises. These exercises will help your legs and core muscles relearn how to hold your body upright.

Some great weight bearing exercises include “sit to stands” where you practice going from a seated position to standing.

You can also do some weight shifting where you put most of your weight on one leg then move to the other.

When your body has gotten used to weight bearing again, you can finally move on to improving your balance.

Step 5. Improve Your Balance

therapist guiding young man down parallel bars as he learns how to walk again

Balance is crucial for both walking and standing, so naturally the next step in learning how to walk is to work on your balance.

Balance exercises can help you regain your strength to stand. Some good exercises you can try are:

  • Stand for 10 seconds with your eyes closed
  • Start standing with your feet far apart then work on moving them close together

Sometimes balance issues can stem from inner ear or vision problems, which may require a different approach.

Fortunately, vestibular therapy and vision therapy can often treat these problems and help you regain your balance again.

After you have strengthened your muscles and have had enough practice standing, it’s time to finally start learning how to walk.

Step 6. Task-Specific Gait Training

Task-specific gait training refers to exercises that directly involve walking.

Whenever you perform an action, your brain forms new neural pathways in response. Therefore, the more you practice an action, the more these new pathways are reinforced.

When those pathways gets stronger, the connection between your brain and muscles will improve, making it easier for you to walk.

Therefore, if you want to get better at walking after brain injury, the best thing you can do is to practice walking.

That’s where task-specific gait training comes in. It usually starts with assisted forms of walking first, such as walking on a treadmill with a body harness. Then you will work your way up to using a walker or cane, until finally you can walk unsupported!

Think of it like learning to ride a bike. At first, you will start with training wheels while you learn the correct movement. Eventually, however, the training wheels will come off and you will ride your bike on your own.

Step 7. Intensive Mobility Gait Training

tbi patient undergoing iintensive gait training to walk again

The last step in learning to walk again is intensive mobility gait training.

This type of gait training includes an aerobic aspect, where you will continuously perform a movement at moderate intensity.

Some examples of this training include riding a stationary bike or repeatedly standing up and sitting down. Anything that gets your heart pumping.

The goal of intensive mobility training is to increase your endurance so that you can walk without tiring out too quickly.

Recovering Skills for Walking After Brain Injury

Walking after brain injury can be a long and difficult process, but it is achievable with hard work and dedication.

You’ll first need to strengthen your leg and core strength, then improve your balance. Finally, you must learn to stand on your own.

Once you regain the ability to stand, then the real work begins.

You’ll start with task specific exercises, then move up to intensive mobility exercises. Functional electrical stimulation should be used in tandem with these exercises to boost your mobility.

Eventually, if you follow these steps and faithfully stick to your rehab program you’ll be able to get back on your feet and start walking again on your own.

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