Henry Hoffman
Saturday, September 30th, 2017
Last modified on October 11th, 2022
Regaining mobility after a stroke is often one of the largest and most critical challenges during rehabilitation. The independence to walk on your own not only leads to a higher quality of life, but also increases the body’s chances for a greater range of recuperation.
Hemiplegia—the weakening or paralysis of one side of the body—as well as other common neurological disruptions that occur following a stroke such as, loss of balance, weakened muscles, impaired spatial awareness, and poor overall physical coordination can make recovery very challenging. Because of this, many survivors require the assistance of a loved one, caretaker, or proper tools and support systems until these imbalances have been stabilized.
There are many exercises, medical treatments, and even surgical procedures to encourage the reintegration of mobility into daily life, especially when the different aspects of recovery are taken into account.
A stroke can impact a survivor’s ability to walk in many ways:
It is encouraging to know that a wealth of information and rehabilitation technology focuses on the lower extremities in particular. Canes, walkers, and support braces are excellent ways to help the rehabilitation process. Due to the range of therapy options for strengthening the legs, the recovery process can be relatively speedy.
But what about the toes? Often overlooked at the onset of rehabilitation, the toes may be an indicator of how the rest of the leg’s health is progressing, because they are often the last area of the leg to recover due to their distal proximity to the affected region. But the rehabilitation of these areas greatly benefit the walking and movement process.
For example, the loss of dorsiflexion—or the ability to point or flex the front of the foot upwards is a common issue associated with foot drop. With this particular impairment, neither the toes or foot are able to receive messages from the brain, causing the foot to remain limp and drag on the floor, even while walking.
Sometimes the four small toes take on a curled appearance, bending upward at the proximal joint or knuckle downwards toward the sole of the foot in the middle joint. This gives the four small toes a claw-like appearance, causing pain in the feet. Due to its shape, corns or calluses can form on the knuckles when they rub against adjacent socks or shoes. Physical therapy methods to re-extend the toes relieves pain and pressure from the feet and increases the chances of extended mobility.
Unlike claw toe, where all three joints are affected, hammer toe is constituted by a sharp curve in the middle joint only, keeping the toe locked in a bent position. This occurs due to an imbalance in the muscles and ligaments surrounding the toe itself. A hammer toe is either flexible or rigid, which is determined by the ability to move the toe while in the hammer-like position. Once the joint is rigid, tendon surgery may be required to release the hold on the toe’s position. Flexible hammer toe however is indicative of the early stages of the ailment and has a greater chance for recovery.
To improve flexibility in the toes, use your hands to gently pull your toes downward, causing the knuckles to raise as you bend. Lightly press your thumb into the arch of your foot to assist. You may feel some discomfort in the arch of the foot as the muscles attempt to strengthen, but it’s important to try to hold the position between 20 and 30 seconds. Once this part of the exercise is complete, reverse the direction of the toe stretch to assist in the re-straightening of the joint.
Sit on a comfortable chair and place 20 marbles or small round objects on the floor by a bowl or container. Using your toes, gently lift one marble at a time and place it in a bowl. For an added challenge, change the placement of the bowl to improve strength and flexibility.
To strengthen your arch muscles, try the towel curl exercise. Place a towel on the ground and safely stand on the towel with both feet, ensuring you have nearby support for balance. Scrunch the toes while gripping the towel below you, slowly pulling the fabric closer and closer until the towel can no longer advance.
A simpler exercise, toe taps stretch the joints in both the affected toe and foot. With your feet flat on the ground, press your big toe into the floor while trying to raise the smaller toes upward, separating the two sides of the foot. After a few seconds, tap your four small toes on the ground for a count of 10. Once you’ve completed this step, switch the position of the toes, and tap the large one in the same manner.
A wide variety of muscles and skill sets are essential for a healthy gait. Ongoing movements for the legs, hips, joints, and back help not only with strength, but also balance, coordination, and depth perception.
Once you have found a stable place to secure your balance, take a tall, sturdy standing posture and gently shift your weight to one side of the body. Swing the non-supportive leg up to the side and balance in this position for 10 seconds. After several repetitions, switch legs and repeat as long as your strength allows.
Move on to intermediate level exercises once you feel comfortable with the basic level above. Find the same position as earlier, with a strong balancing area in which to support yourself as you shift weight to one side. Bring the other leg in front of you and bend the knee as you go. As you balance, hold the position for a count of 10 and lower back down slowly. Switch legs when you’re ready.
As before, only move on to the advanced level once you feel comfortable and stable with the intermediate level exercises. Brace on a nearby wall or sturdy piece of furniture, and swing your leg behind your body as far as you can comfortably reach. If possible, hold the leg out for a count of 10 seconds and gently lower it back to the ground. Repeat on the opposite leg.
Pair these three levels of hip strengtheners with Seabo MayoTrac Infiniti for biofeedback triggered stimulation.
Strengthening the core and hips is also highly beneficial during recovery. Stroke is particularly difficult on these two areas, and focusing on their stability will steady the whole body. Bridging exercises are a dependable way to rebuild strength, coordination and resilience during the recuperation process.
“Inner Range Quad Movement,” or basic bridging workouts, focus on strengthening the thigh muscles with the use of a pillow or towel for support. Find a sturdy and comfortable spot in which to lie down, and place a rolled towel or pillow below your knee joint. Once you’ve found a good position, press the knee into the pillow and pull and left the heel gently off the floor.
As your strength continues to improve, try “Ski Squats,” or intermediate bridging work. Find an open wall and lean your standing body flat against it. Place your feet slightly in front of you and very slowly lower yourself down so that your legs create a 90-degree angle. Hold this position for 10 seconds or as long as you are able. Then safely slide back up with the help of the wall until you are back to standing.
When you’re feeling stable in Ski Squats, find a flexible ball to place between your knees as you bend down into a squatting position.
Researchers have found that underwater treadmill treatment, especially after the event of a subacute stroke, may be beneficial to the recovery of aerobic and function recovery. In a study of 21 patients, two exercise variations were compared—first on a standard treadmill, and the next on a treadmill with chest-level water. Most importantly, patients did not express a significant change in required energy between the two, but more progress was reported while using the underwater variation. The presence of the water removes weight-bearing pressure from the body while requiring the same amount of aerobic vitality.
A consistently used treatment for those with neurological loss throughout the body after a stroke or similar injury, FES—or Functional Electrical Stimulation—places electrodes on areas of the affected muscles to stimulate growth and movement. Small electrical impulses encourage a response from the injured muscle when messages to and from the mind have weakened.
Another similar method is TENS Therapy, or Transcutaneous Electrical Nerve Stimulation. Differing from FES, which stimulates motor neurons, TENS focuses on the sensory nerves to decrease pain sensation. Stimulating the nerves in the affected area can be helpful therapy for stroke survivors in their recovery.
Support systems in the form of orthotic shoes or braces have come a long way in the rehabilitation world, focusing more on the wearer’s comfort and quality of life during the recuperation process. Newer designs make it much easier for stroke survivors to begin walking again comfortably and more easily.
The SaeboStep is a lightweight foot drop brace that provides convenience and comfort while offering optimum foot clearance and support during walking. The SaeboStep was designed to be easy to don and can be worn in tandem with almost any shoe. It is exceptionally supportive and effective for foot drop rehabilitation, gently guiding and supporting the ankle as the leg moves. It replaces uncomfortable, stiff, or bulky splints that go inside the shoe, as well as poorly manufactured braces designed to be worn outside of the shoe.
SaeboStep is patient-focused due to its affordability, discreet placement, and comfort. Since this brace is also easier to order than most physical therapy aids, recovering at home with a caretaker can begin sooner and progress more smoothly. SaeboStep is easy to place on the ankle, one does not need a doctor to fit the brace before using it to its full capacity. Its effects lead to an immediate improvement in safety and strength.
In cases where orthotics and physical therapy and stretching exercises are not effective, doctors may recommend surgery involving nerve sutures, grafting, tendon transfer, or decompression.
One example,of surgery that may be recommended for individuals with severe spasticity is tenotomy. This approach involves cutting of the affected tendon in order to lengthen it, relieving pain, and allowing for a greater range of motion. Club Toe is a condition that is commonly treated with this surgery when physical therapy and stretching exercise did not work.
A version of this surgery is relatively non-invasive, done only with a small incision and miniature camera. Additionally, tendon transfer, another alternative for surgery treatment, rehabilitates the damaged neurological region by moving the posterior tibial tendon.
Self-reliance after a stroke is an ongoing journey that takes time and resilience. When developing a strategy for an individual’s rehabilitation, success is often found when these exercises are completed in combination with other treatment methods.
All in all, walking rehabilitation is unique to each body and stage, and both can and should be personalized to your particular needs.
All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.
