If you struggle with walking after stroke, rehabilitation can help you get back on your feet with confidence again. Your manner of walking, also known as your gait, can often be recovered after a stroke, at least partially if not fully, by customizing a consistent rehabilitation program to your unique needs and abilities. This article will explain everything you need to know to get started.
We have updated this article to be detailed and comprehensive. There’s a lot of information in here, so bookmark this extensive article and use the links below to jump straight to any section:
Table of contents
- Why does walking become difficult after stroke?
- How gait rehabilitation works
- Recovering gait after post-stroke paralysis
- Walking exercises for stroke patients
- Devices to help stroke survivors walk
- Other tips for gait rehabilitation after stroke
- What are the chances of walking after a stroke?
- How long does it take to walk again after a stroke?
Why Does Walking Become Difficult After Stroke?
Stroke is the leading cause of disability in America. It occurs when the supply of blood in the brain is compromised, depriving brain cells of oxygen and subsequently causing brain tissue damage.
Secondary effects of stroke vary greatly based on which areas of the brain sustained damage. These effects can include changes in cognitive skills, motor abilities, sensation, vision, communication, and personality. When gross motor skills (large movements of the torso, leg, and/or arm) are affected as the result of a stroke, it can impact your gait.
Motor difficulties after a stroke often impact only one side of the body, which can cause balance problems that further disrupt your gait. This is because each hemisphere of the brain controls movement on the opposite side of the body, and a stroke often affects one hemisphere, not both. (However, multiple strokes on both sides of the brain are possible.)
Therefore a right hemisphere stroke may cause difficulty with movement on the left side of the body and a left hemisphere stroke may affect the right side of the body. This is why hemiparesis and hemiplegia, two conditions that affect movement on one side of the body, are common secondary effects of a stroke.
Hemiparesis involves weakness on one side the body while hemiplegia, the more severe condition, involves paralysis on one side of the body. Hemiplegia may affect only half of the face, an arm, or a leg; but most commonly it affects one entire side of the body.
The amount of weakness or paralysis varies from person to person because every stroke is different. Fortunately, recovery is possible for the majority of individuals, even those with hemiplegia/post-stroke paralysis. Next, you’ll discover how it works.
How Gait Rehabilitation Works
Rehabilitation is key to regaining the ability to walk after stroke. It works by stimulating the brain with various physical therapy exercises and activities. A physical therapist is an excellent resource for gait recovery as they are specially trained in helping people restore movement.
After a stroke, patients are typically sent to an inpatient rehabilitation center where they participate in multiple hours of one or more types of therapy per day. During physical therapy, your therapist will guide you through various exercises and activities with the goals of restoring movement and coordination, strengthening the muscles, and retraining the brain.
Retraining the brain is arguably the most important aspect of gait rehabilitation after stroke. The brain rewires itself through a phenomenon known as neuroplasticity, which is how all skills are learned or re-learned. Neuroplasticity helps your brain become more efficient with the tasks that you do regularly by strengthening neural pathways.
For example, when first learning to ride a bike, it’s difficult because it’s new and your brain has not yet established efficient neural pathways for the task. But each time you practice, your brain forms and strengthens its pathways. At first, your pedaling may be awkward, but the more you practice, the smoother your movements become as the brain adapts.
The same concept applies to gait rehabilitation: practice makes perfect. Re-learning to walk after stroke is all about practice. By repeating physical therapy exercises on a consistent basis, you will help rewire your brain and improve your gait.
Recovering Gait After Post-Stroke Paralysis
But what if you can’t exercise in a conventional way because of hemiplegia/post-stroke paralysis? This is where passive exercise and therapeutic modalities can help.
Passive exercise involves assisting your affected limbs through an exercise, either by using your non-affected side or receiving help from a trained caregiver or therapist. Although the movement is done for you, it helps stimulate the brain and spark neuroplasticity, especially when attention is paid to the movement.
Every time you move your affected side through therapeutic movements, and you bring this movement into your awareness, you help stimulate the brain and create positive changes. Results will come slowly – you may see muscle twitches initially as your movement abilities return – and that’s a sign of progress.
Understanding the difference between active exercise and passive exercise is important when customizing a rehabilitation program to your unique needs.
A physical therapist may also utilize different treatment options, such as electrical stimulation (e-stim), to retrain the brain to activate the muscles needed for walking. E-stim involves placing electrodes on the skin and using an electrical current to stimulate the muscles to contract. Again, it tends to be most effective when purposefully focusing on the movement.
Now that you understand how rehabilitation works, let’s dive into the walking exercises.
Walking Exercises for Stroke Patients
Physical therapy exercises are the best way to improve your gait after a stroke. Your physical therapist can recommend some appropriate exercises for you based on your ability level.
Here are some example gait training exercises that your PT may recommend to help improve your ability to walk:
When we think of walking, we often think of our legs. While there is much more that goes into your gait, targeting your legs is a great place to start. Ask your PT for exercises that help with walking and (s)he will likely recommend some leg exercises along with a mix of others.
A helpful leg exercise to begin with for gait rehabilitation is seated marching. From a seated position, lift your thigh up into your chest. If necessary, you can use your arms to assist with this movement. (This turns the movement into active assisted or passive exercise for individuals with hemiplegia or severe hemiparesis.) Adding an ankle weight can make this more difficult for those who are ready to focus on increasing strength and muscular endurance.
Balance and core rehabilitation exercises
A strong core is essential for maintaining balance while you walk and preventing falls. Along with your leg exercises, incorporate core and balance exercises that target your trunk too.
One example is leg rotation (which, despite its name, focuses more on your core more than your legs). Start by lying on your back with your legs bent at 90 degrees. Then, let your legs fall to one side while trying your best to control the movement from your core.
Again, if you cannot do this movement independently, ask a trained caregiver or therapist for assistance to make the exercise passive. All movement is beneficial and helps rewire the brain.
Foot drop exercises
Foot drop is a post-stroke condition that can make it difficult to lift the front part of your foot up — a movement known as dorsiflexion. This movement is critical for the ability to walk safely and reducing the risk of tripping and falling.
A good exercise for foot drop is ankle dorsiflexion. Cross your affected leg over your thigh and hold your foot in your hand. Then, assist your foot through dorsiflexion by moving the top of your foot back toward your shin and then back down. This can be done passively with assistance until you can practice it actively with no assistance.
Devices to Help Stroke Survivors Walk
Your physical therapist will recommend an appropriate walking device for you as needed.
Walking devices that are used following a stroke can vary greatly depending on your skills include front-wheeled walkers, platform walkers, hemi walkers, four-wheeled walkers, quad canes, and single point canes. Over time, your physical therapist may try to help you to transition to less stable walking devices, until you are able to walk without one at all.
It’s important to use any walking device your therapist recommends and also practice rehabilitation exercises consistently.
Following along to written sheets of exercises can be tough due to low accountability and potential boredom. If you struggle with motivation to exercise, then it can be worth exploring exercise devices to help you stick with a home therapy program and see better results.
Here are some exercise devices and machines that help improve your ability to walk after stroke:
Assistive treadmills help support your body while you practice walking. These devices are very expensive and usually offered at rehabilitation facilities. Due to their high cost, it’s often best to take advantage of these resources while insurance still covers therapy and explore other, more-affordable devices that you can use at home.
The NuStep is a type of recumbent cross-trainer frequently used in rehabilitation clinics for individuals following a stroke. It allows you to sit while moving both your arms and legs forward and back, alternating sides, in a gentle gliding motion to activate muscles commonly used during walking. Again, these are rather expensive and therefore often best to use during physical therapy sessions.
A good device for recovering your gait at home is a stationary bike. These devices help with gait recovery by targeting your legs through bilateral movement: when both limbs are used in unison to contract the muscles.
This is particularly appealing for individuals with hemiplegia or severe hemiparesis because you can use your non-affected side to assist your affected side, which helps encourage neuroplasticity.
Stationary bikes primarily target your legs and core, so it’s important to combine it with other rehabilitation methods to target the full body.
FitMi home therapy
There aren’t many affordable home rehabilitation devices that are both motivating and target the full body. This is why we created FitMi home therapy, a rehab device that turns your physical therapy exercises into an interactive experience. It’s like having a virtual therapist available right from your computer.
In the image below, you can see a stroke survivor doing leg exercises with FitMi (by stepping on the motion-sensing “pucks” beneath his feet) while following along on the computer.
Many patients have improved their gait by using FitMi consistently at home. See what other survivors have said about it:
“After suffering from a left side hemorrhagic stroke, I have been using the FitMi for 4 months in conjunction with physical therapy and it really has helped. I started with 0 mobility on right side and can now walk without a cane. You really have to put in the work but you should see results.” –Dwayne, stroke survivor
“I have noticed real-world results from using FitMi. For one, I drive one-footed now rather than two-footed because I can target the gas pedal and the brake with my right foot. I can target the cruise control set button with my right hand. These accomplishments are due to the exercises and feedback of the FitMi.” –Ronald, stroke survivor
FitMi encourages you to accomplish high repetition of therapeutic exercises, which helps spark neuroplasticity and rewire the brain. When you use it consistently, you’ll see the best results — like Dwayne and Ronald. You can read more FitMi reviews here.
Once you are able to walk with assistance, you can start doing task-specific training, which involves directly practicing the skill you want to get better at: walking! The more you walk, the better your gait will become.
Try to walk as much as you can – making sure to use any equipment recommended by your therapist, such as a walker or cane – without overexercising. Pushing yourself too hard can cause other complications such as post-stroke fatigue. Aim for your exercise to help you feel challenged but not exhausted.
Also, as you explore your ability to walk with less assistance, be extremely careful and do so in the presence of a caregiver or therapist to help prevent any tripping or falling. Falling after stroke could result in further reduced mobility and setbacks, so take all the precautions you can to avoid it.
Other Tips for Gait Rehabilitation After Stroke
Of course, there’s more that goes into your gait than just muscle movement. Your vision also deserves attention if you want to improve your ability to walk after stroke.
If you have vision problems, it will negatively impact your ability to walk safely. Your vision is important for navigating the world around you and preventing falls.
Optometrists, neurologists, occupational therapists, and speech-language pathologists are all great resources for improving vision after stroke.
Your therapist or speech-language pathologist can also screen you for a condition called hemineglect, which can cause stroke survivors to be completely unaware of their affected side. This condition must also be addressed before patients can safely walk again after stroke.
Now that you know what goes into gait rehabilitation, let’s look at some statistics about potential recovery chances and timelines.
What Are the Chances of Walking After a Stroke?
Survivors are thought to have a good chance of regaining the ability to walk within 6 months after stroke if they have the ability to sit and balance independently and the ability to contract the muscles of the ankle, knee, and hip.
A study from 2015 found that hemiplegic patients had a 93.8% chance of achieving independent gait within 6 months if could demonstrate these two abilities in the first 72 hours after stroke.
This does not mean that you cannot recover your ability to walk if are unable to achieve these movements. It simply means that rehabilitation may require more effort and hard work through long-term rehabilitation and home exercises.
How Long Does It Take To Walk Again After A Stroke?
Most patients regain the ability to walk within the first 6 months or, when mobility has been severely affected, within the first 2 years following their stroke. Experts can agree that the chances of recovering function after stroke increase with the intensity of rehabilitation.
However, recovery does not happen on its own. It requires consistent, long-term rehabilitation. For instance, one study followed 51 stroke survivors that could not walk 3 months post-stroke. After 2 years of long-term rehabilitation, researchers found that 74% of patients had regained their capacity to walk without assistance.
We cannot stress enough that rehabilitation is the key to stroke recovery. When it’s neglected, survivors are unlikely to reach new milestones. A sobering study found that stroke patients without long-term rehabilitation stagnate. Their level of mobility measured 5 years post-stroke was equivalent to levels measured just 2 months post-stroke.
This demonstrates the importance of long-term rehabilitation for anyone that wants to keep recovering – especially individuals that want to walk again. After discharge from therapy, recovery is in your hands. You will see the best results by picking a home therapy program that you find motivating and sticking with it.
Hope for Walking After Stroke
Your chances of regaining the ability to walk after stroke increase with regular rehabilitation. During inpatient and outpatient therapy, your therapist will help guide you through various exercises to improve your gait.
You will see the best results if you practice a home therapy program between outpatient therapy visits. Home therapy devices like FitMi help motivate you to accomplish the repetitions necessary to improve your gait.
Stimulating the brain with consistent, repetitive exercise is the best way to create results. We wish you the best of luck on the road to recovery.