Walking After A Stroke

Learning how to walk again after a stroke is a long, arduous process. But with commitment and consistency it is possible to recover fully. In this article we focus on getting people back on their feet and the sooner physical or occupational therapy gets started, the better. Time is an important factor because muscle tone and strength need to be maintained and redeveloped in order to avoid permanent damage.

Relearning to walk after a stroke requires a positive, motivated mindset, patience and determination. The physical exercises are important along to the mental exercises, which are crucial.

The brain needs to be retrained, or "rewired", in order to get the affected body parts back in working order. For this to work, the physical exercises must be done everyday and results may not be instant. That's why consistency and patience are also needed. Support from friends, family or a local support group will also go a long way in the recovery process. Around 15 million people, worldwide, suffer from strokes every year. Of these, 80% will suffer from mobility and cognitive function disabilities. A further third will go on to experience spasticity, which is a chronic stiffness in the muscles.

Why do stroke patients lose their ability to walk after a stroke?
Strokes happen when blood flow to the brain is interrupted. This can occur from a burst blood vessel or a blood clot. The brain is starved of essential oxygen and nutrients, and brain tissue is destroyed. Because of the neurological damage that occurs, stroke patients get left with distinct physical disabilities. These effects usually occur on one side of the body only, and range from mild muscle weakness to extreme muscle weakness, which is called paralysis.

Why is it important to learn to walk again as soon as possible?
After a stroke muscles will either contract or become flaccid. In both cases, the muscles need regular stimulation. Passive exercises will keep circulation flowing until movement returns. But the mental training is as important, if not more. Getting mobility back is a major victory for stroke patients. It gives a person back their independence. After a stroke it is common to get frustrated because you lose the ability to do basic things. Relying on others leaves one feeling powerless, overwhelmed and even angry.

Challenges of learning to walk again – What to expect

Pain – There may be both local and central pain. Post-stroke pain can be treated with medication but it is vital to start rehab 24 to 48 hours after being stabilized. The brain may send false signals to the body, causing patients to suffer from chronic pain syndrome.

Changes in physical sensations – There may be numbness or over sensitivity on the affected side of the body. This can cause confusion as a patient may not be aware of their limbs or be able to feel temperature or tight clothing.

Emotional setbacks can affect sleep and mood. Depression is not uncommon. Initial treatment with anti-depressants may help. But stroke survivors that learn to walk again, or regain their cognitive function will soon get their independence back.

Muscle weakness may result in stiffening of muscles (spasticity) or loosening (flaccidity). Conditions like drop foot may occur. This is when the foot cannot lift the front of the foot up voluntarily. Patients may develop hemiplegia and hemiparesis, whihc are the terms used when referring to muscle weakness only present on one side.

Going Forward – The Rehab Program
The severity of the stroke will be assessed by the rehab team and from here an exercise plan will be formulated. This will include the very important physical exercises that will get stroke survivors walking again. On top of this there may be scheduled appointments with speech therapists and occupational therapists. Some people may benefit from counseling sessions others may prefer joining a support group. While occupational therapy focuses on getting patients to carry out daily activities, the physical therapy is beneficial for retraining the brain and the body to walk again, as well as certain lifestyle changes may reduce the risk of further strokes. Finding ways to reduce stress and making minor changes to diet can be advantageous.

Walking Again – Physiotherapy
The goal of physical exercises is to help patients regain their strength, improve flexibility and increase stamina. Physical therapy may indirectly improve the feelings of numbness or tingling that occurs alongside the paralysis. Over time these sensations will lessen and may disappear altogether as the brain heals. Movement increases circulation and the more blood flow and oxygen that gets to the brain, the better.

Certain aids like resistance bands, walking sticks, stress balls and a chair is all that may be needed for some of the exercises.

A treadmill is ideal for increasing cardiovascular fitness and building strength. It is also a great way to practice walking because you can hold onto the sides for support until better balance is gained.

Further aids like an ankle-foot brace, also known as an ankle-foot orthosis (AFO), can lend support to weak ankles and allow patients to lean their weight on the weaker foot without losing balance.

Balance is often affected after a stroke and many stroke survivors will experience falls during recovery.

The body is an amazing machine that can heal from the most chronic and debilitating conditions, with your determination and commitment. Walking is such an important part of life and learning to walk after a stroke is possibly one of the most important aspect of the healing process. This is because the exercises help both the body and the brain to recover, giving you back quality of life and independence.

References:
https://www.stroke.org
https://www.who.int/topics/cerebrovascular_accident/en/ https://www.who.int/bulletin/volumes/94/9/16-181636/en/
https://www.flintrehab.com/2018/stroke-exercises/
https://medlineplus.gov/magazine/issues/spring13/articles/spring13pg6-7.html