Walking independently after a stroke is one of the major goals in post stroke rehabilitation. Your gait is your specific pattern of walking that occurs in several phases that require specific patterns of muscle activation that allow the joints of the lower limbs to move smoothly and synchronously in coordination.
The signals to these muscles can become disrupted after stroke, especially if hemiparesis, or one sided muscle weakness, is present.
The Key to Stroke Rehabilitation: Gait & Balance Training
Gait training and balance training are key components of post stroke rehabilitation to help you learn to walk, improve your balance and coordination, and increase the strength of your hips, knees, and ankles to support your body when you move. Common gait deviations observed in patients post stroke include:
- Decreased gait speed and cadence, or steps per minute
- Decreased step length
- Decreased stance time on the weakened leg
- Decreased ankle dorsiflexion, limiting foot clearance
- Decreased standing balance and stability, especially with weight shifting
These changes result from a compromised ability to generate force to propel the body forward, instability of the pelvis that impairs balance, and decreased strength of the weakened leg, limiting the ability to bear weight through that side.
Gait deviations can reduce safety and efficiency of walking, resulting in increased fall risk.Key muscle groups that can benefit from strength training to improve gait quality after stroke include the:
- Tibialis anterior: to dorsiflex the ankle, the motion of lifting the foot up toward the body to clear the foot from dragging and prevent tripping when taking a step
- Quadriceps: to extend the knee, providing stability to the knee to improve weight bearing tolerance and to prevent knee buckling
- Hip flexors: to lift the leg up to increase foot clearance and step length
- Glutes: to extend the hip, increasing the amount of force generated to propel the body forward, and to increase stability of the pelvis, to support balance with weight shifting between each leg and changing directions
Strength and Balance Exercises for Better Walking
Good outcomes for post stroke rehabilitation require a high degree of motivation, participation, and engagement of the patient. The human leg contains a multitude of muscles that work together to support balance and walking.
1) Ankle Dorsiflexion
Goal: to improve ankle dorsiflexion strength to improve foot clearance
How-to: Loop a resistance band around your foot so that the force is pulling your foot down. Activate your tibialis anterior by drawing your foot up toward your body.
Progression: Increase the resistance with a higher level of resistance band.
2) Marching
Goal: to increase hip flexor strength to improve foot clearance, and increase single leg strength and stability when standing and weight shifting.
How-to: (Sitting) Begin seated in a chair. Lift one leg up, hold for 2 seconds, then lower. Repeat on the other side. (Standing) Stand next to a table, chair, wall, or other stable object for support. Weight shift over onto one leg while slowly lifting up the other, hold for 2 seconds, then lower. Repeat on the other side. Hold onto something for support if needed.
Progression: Add ankle weights in sitting or standing to increase difficulty. For standing marching, challenge yourself by not relying on arm support to maintain your balance.
3) Bridging
Goal: to increase glute strength to improve force generation, step length, and gait speed
How-to: Lay down on your back with your knees bent and feet flat. Draw your stomach in and squeeze your glutes to lift your hips up without arching your lower back, then lower.
Progression: Add a resistance band around your knees to increase glute activation by abducting, or pushing your legs out, against the band.
4) Sit to Stand
Goal: to increase quadriceps and glute strength for improved leg strength and stability
How-to: Sit in a chair, lean forward, and use your legs to stand up. Then slowly lower yourself back into the chair with control without “plopping.” Try not to use your arms to help push you up from the chair.
Progression: Add a resistance band around your knees to increase glute activation by abducting, or pushing your legs out, against the band, or lower the seat surface to make the movement more challenging.
5) Side Stepping
Goal: to increase glute activation and dynamic balance and stability with lateral weight shifting
How-to: Stand in front of a wall or counter to hold onto support if needed. Step to the side with one leg then follow with the other. Repeat several times, then change directions and repeat.
Progression: Add a resistance band around your knees to increase glute activation when side stepping. Challenge yourself by not relying on arm support to maintain your balance.
6) Forward to Backward Weight Shifting
Goal: to improve foot clearance, pelvis stability, and standing balance with weight shifting
How-to: Stand next to a table, chair, wall, or other stable object for support. Weight shift forward by taking a step forward with one foot, then lift that leg up and move it back behind your body to weight shift backward. Repeat several times, then switch sides.
Progression: Add ankle weights to increase difficulty. Challenge yourself by not relying on arm support to maintain your balance.
7) Step-ups
Goal: to increase hip flexor strength for improved foot clearance and step length, quadriceps and glute strength for improved force generation and gait speed, and pelvis stability and standing balance with weight shifting.
How-to: Stand in front of a step. Step with one foot followed by the other, then step down. Repeat several times, then switch sides.
Progression: Challenge yourself by not relying on arm support to maintain your balance. Increase step height for added difficulty.
Engaging Lower Body Rehab with Neofect Smart Balance
Neofect has developed a solution that encourages regular balance practice for people after stroke. Neofect Smart Balance emphasises core strength and lower body stability, allowing users to practise balance and posture during real-world training scenarios.
Paired with 16 Augmented Reality training games, the solution breaks the monotony of regular rehab exercises by adding in fun and sense of satisfaction. Real-time feedback (visual, auditory) also enables users to train in the right direction and to feel a sense of accomplishment.
The platform device is adaptable to sessions that incorporate sitting, standing, and stepping activities. Furthermore, its sturdy and spacious system design accommodates training with a wheelchair or assistive device. Clinicians can also use the platform to measure various performance metrics and evaluate the progress throughout a patient’s rehabilitation.
Looking for a fun and effective way to exercise leg and core muscles for improved walking outcomes? Learn more about Neofect Smart Balance via our page: bmec.asia/neofect
More Information
- Neofect | https://www.neofect.com/us/blog/walking-after-stroke-7-exercises-to-improve-strength-and-balance
- Wang, Yijia, et al. (2020). Gait characteristics of post-stroke hemiparetic patients with different walking speeds. International Journal of Rehabilitation Research. 43(1), 69-75. doi: 10.1097/MRR.0000000000000391
Kristen Gasnick, PT, DPT Kristen is a Doctor of Physical Therapy, health writer, and expert consultant based out of Northern New Jersey. Kristen is experienced in both inpatient and outpatient rehabilitation.
