A Step-By-Step Guide to Walking After Brain Injury: Exercises & Rehabilitation Methods

Walking after brain injury is a common recovery goal during physical therapy. Many traumatic brain injury survivors are eager to improve their gait, or manner of walking, to regain independence and feel confident with the activities of daily living again.

To help you regain the ability to walk on your own, this guide will explain some of the challenges when learning to walk again after a traumatic brain injury (TBI) along with the steps you can take to improve your gait.

Table of contents

• Why can a brain injury affect walking skills?
• How can I train my brain to walk again?
• Rehab exercises to walk again after brain injury

Why Can a Brain Injury Affect Walking Skills?

There are several reasons why a brain injury can affect a person’s gait, or ability to walk. Some common causes of gait changes include:

• Balance problems. Between 30% and 65% of traumatic brain injury survivors struggle with balance issues. These can stem from a range of issues including muscle weakness, inner ear damage, and damage to the cerebellum, which plays a role in maintaining balance.
• Primary motor cortex damage. The primary motor cortex is also responsible for the coordination of muscle movements. If a brain injury damages this area, then activities that involve multiple muscle groups, like walking, can become impaired.
• Spasticity. When a brain injury disrupts the connection between the brain and the muscles, the brain can no longer send signals to the muscles telling them when to contract. As a result, spasticity and muscle tightness can set in, making walking after brain injury much more difficult.

With such a variety of different causes of poor gait after brain injury, it’s important for brain injury survivors to work closely with their therapists to diagnose and rehabilitate their walking abilities.  

How Can I Train My Brain to Walk Again?

Walking after brain injury involves retraining the brain to control the muscles involved in walking. This is possible thanks to neuroplasticity.

Neuroplasticity is the brain’s ability to rewire and reorganize itself. After a brain injury, neuroplasticity allows the brain to compensate for the damage. Although damaged brain cells cannot regenerate, neuroplasticity allows healthy areas of the brain to take on impaired functions.

For instance, if a brain injury affected the cerebellum, the function of balance can become impaired. Through neuroplasticity, the function of balance can be rewired to healthy areas of the brain. It does not happen on its own, though.

Neuroplasticity occurs through repetition and consistency. The brain likes to be efficient, so it will create and strengthen neural pathways for activities that are practiced regularly.

During gait rehabilitation after TBI, survivors practice therapeutic movements involved in walking. Depending on the problem area, the individual may practice leg or balance exercises. When these exercises are practiced with high repetition, it stimulates neuroplasticity and encourages the brain to improve efficiency of those movements.

To put it simply, an individual with brain injury can train their brain to walk again through repetitive practice of gait rehabilitation exercises.

Rehab Exercises to Walk Again After Brain Injury

Rehab exercises are a critical step towards regaining the ability to walk. It’s important to work with your therapists to create a custom rehabilitation regimen that caters to your unique needs.

Up next, we will discuss some common rehabilitation techniques that your therapist may suggest.

1. Passive Rehab Exercises

Individuals that have experienced a severe brain injury may have no movement in their legs and therefore cannot walk. This often means they rely on wheelchairs to get around instead of other less-restricting devices like a cane.

Fortunately, it is still possible to regain muscle movement and walking skills even if you have limited leg function. You can do this through passive exercise, which involves assisting your legs through targeted movements, rather than moving with your legs’ muscle power alone.

Passive exercise helps stimulate the brain and activate neuroplasticity, particularly when attention is paid to the movement. Focusing on and mentally visualizing the body completing a movement increases associated brain activation, optimizing neuroplasticity.

A therapist or trained caregiver can help a TBI survivor accomplish these passive exercises that target the legs, or the survivor may learn how to complete the exercises independently using their upper body to assist.

Passive techniques are a great place to begin learning how to walk again after brain injury. With time and practice, individuals may slowly regain movement in the legs; at which point they can move onto active exercises.

2. Leg Exercises

Perhaps the most obvious rehab exercises to walk again after brain injury are exercises that target movement and strength of the legs. Walking is a full-body activity, and the legs play a large role.

Practicing rehab exercises that target the legs will help retrain the brain to use the legs with increasing coordination. As movements become more coordinated, individuals can also focus on strengthening the legs through exercise.

Some examples of leg exercises for gait rehabilitation include:

• Seated marching. Start in a seated position. Lift your affected leg up toward your chest, hold for one second, then slowly let it down. Repeat on the other leg. If this is too difficult, you can do this exercise passively by using your arms to assist your legs.
• 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 the other leg.

Although some leg exercises may seem to be only addressing movement, it is important to remember that you can build strength by lifting only your own body weight, rather than always having to rely on additional weights.

As with all rehab exercise, high repetition and consistency are key to rewiring the brain and improving movement after brain injury.

3. Foot Drop Exercises

Foot drop is a common challenge following TBI that impairs dorsiflexion of the ankle, which involves your ability to lift the front of the foot up towards the shin. Difficulty with dorsiflexion can make activities, such as walking or climbing stairs, after brain injury nearly impossible. Therefore, improving dorsiflexion is critical for relearning to walk after brain injury. 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 improved strength and coordination in your legs and feet, you can move on to the next stage of relearning how to walk after brain injury: weight bearing.

4. Weight Bearing Exercise

Weight bearing exercises 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.

There are even ways to practice weight bearing without putting your full body weight onto your legs. These can be great methods to slowly build strength in the legs and confidence with walking, while often minimizing the risk of falling. Some partial weight bearing options include:

• Using parallel bars: your arms are able to support some of your body weight
• Practicing aquatic therapy: the buoyancy of water makes you “lighter” than on land
• Using a body weight support system (such as a specialized harness attached to an overhead track)

Be sure to check with your therapist before attempting any exercises without recommended assistive devices such as walkers or canes.

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

5. Balance Exercises

Balance is crucial for both walking and standing, and rehab exercises that help with balance are an important part of any gait rehabilitation program.

Many leg and core exercises naturally help with balance because they help increase the coordination necessary for balance.

6. Motivating Exercises

If you struggle with practicing your rehab exercises with enough repetition and consistency, then you can try motivating home therapy devices like FitMi.

FitMi helps brain injury survivors regain the ability to walk by encouraging high repetition of full-body rehab exercises. Unlike written sheets of exercises, which can grow boring and tedious, FitMi creates an interactive home therapy experience. Users interact with the blue and yellow “pucks” (by gripping, pressing, or stomping, for example) to practice therapeutic exercises.

FitMi is also adaptive and unlocks more difficult exercises as you improve. Before every session, you can choose which muscles groups you want to work on, including the legs and core, which help target the areas necessary for walking.

7. Vestibular/Vision Therapy

Sometimes balance issues stem from inner ear or vision problems, which may require a different approach to treatment. In these cases, vestibular therapy and/or vision therapy can often treat these problems and help you regain your balance again.

8. Task-Specific Gait Training

Individuals that have enough movement to walk with assistive devices, such as walkers or canes, can also benefit from task-specific training, which simply involves walking.

Walking provides great stimulation to the brain and helps you practice the very activity that you want to improve. Individuals should practice care and caution when attempting this step, though.

As your walking skills improve, you may progress to more difficult walking tasks, such as walking on uneven surfaces or up and down stairs.

Never abandon assistive devices without a green light from your therapist. If you rely on a walker or four-point cane, it can be dangerous to abandon these devices and attempt to walk on your own.

Individuals with impaired gait are at a greater risk of falling, which can set back your recovery. Take great care with yourself and use any devices recommended by your therapist.

9. Intensive Mobility Gait Training

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.

Relearning to Walk After Brain Injury

As you make your way through all of these steps, your gait should slowly improve as you stimulate the brain and spark neuroplasticity. Walking after brain injury can be a long and difficult process, but it is achievable with hard work and dedication.

Be sure to work closely with your therapist, who can recommend exercises you can do at home. You can also motivate yourself with interactive at-home therapy programs like FitMi, which is therapist-approved. We hope these steps help you get back on your feet with confidence.