Walking recovery
Hello. I decided to write something important about restoring walking after a stroke. The help of only professionals and specialists in this matter is not always needed; sometimes, relatives and those who are nearby can provide important and feasible assistance. The main thing is the desire to help.
Rehabilitation in this case is a multifaceted process and it is necessary to take into account all the factors that can contribute to recovery - from the patient’s internal mood to clothing and shoes, which can greatly facilitate and help take new independent steps.
In this article I want to talk about shoes that can be a good help when training to walk. Let's talk about what these shoes should be like and what to pay close attention to when selecting them. The topic is important and relevant.
What precautions should you take?
Stopping the use of VP may pose a serious threat to your safety.
If VP affects safety, then much more careful and in-depth consideration should be given to rejecting it. Stopping the use of some medications may put a person who has had a stroke at risk. Consult your physician about not using any VP or splint. Do not stop using the splint or OALS without your doctor's consent and approval.
Also, you may not be using the VI you need. VP can provide security, independence, and/or promote recovery. New VPs are being developed and put on sale every day. They can increase the efficiency and safety of your actions, acting as a temporary measure on the path to recovery. Some VPs have no disadvantages and provide great advantages. For example, handrails in the bathroom protect you in slippery places where it is dangerous to lose your balance.
How and how to help
Before we move on to the selection of shoes, a short introduction - let’s figure out why walking is impaired after a stroke. Loss of mobility and muscle strength, as a result of which a person loses the usual ability to move independently, is a common phenomenon after a stroke. The most common walking disorders occur with hemiparesis.
Restoring normal mobility is a complex process that requires not only pills, injections, etc. - everything that is called drug therapy, but also other recovery methods, including adaptation to environmental conditions. These adaptation methods may make a more significant contribution to the restoration of proper walking after a stroke.
Despite the fact that it is not always possible to restore any neurological disorder, one of the main goals of recovery after a stroke is to make a person as independent in everyday life as possible.
In most cases of post-stroke hemiparesis, there is an increase in muscle tone in the ankle extensors.
Fig. 1 Wernicke-Mann gait
Externally, this position looks like a person is pulling his toes, while the foot is slightly turned inward. Such a foot is unstable when walking, as a result of the fact that it can cling to the surface or turn under when a person takes a step. In addition to the fact that it is simply inconvenient to walk and independent walking becomes difficult, the restoration of walking itself is seriously hampered. The physiological step, in this case, is very difficult.
The more a person makes movements that are as close as possible to normal gait, the faster it (gait, in the sense) will recover. This works with an important condition - the biomechanics of the step should be as close as possible to the physiological (not pathological) step. To do this, you need to support the foot more and more often in a physiological position (from extended to half-bent).
A properly selected orthosis and/or shoes will help us with this. The topic of selecting an orthosis deserves a separate article, and I will definitely tell you about it in more detail.
First steps - technology of correct movement
After a stroke, the tone of the muscles of the limbs sharply increases, the legs and arms cease to obey, their movements become uncoordinated. The muscle tone of the diseased limb changes its position, as a result of which the gait becomes sideways - the knee joints are overly relaxed, the foot sag.
When moving, such a leg does not make a direct movement from heel to toe with further stepping on the heel, but moves in a semicircle with support on the toe. This causes the step to slow down, the sore leg clings to the floor and the entire process of movement becomes traumatic.
Learning to step on your foot correctly and practicing the correct position of your foot are prerequisites for starting to walk. The patient himself or his assistant must ensure that:
- from the first step, at the first contact with the floor, the foot rested on the heel, and not on the toe;
- the foot moved straight, rather than describing a semicircle;
- the knee bent at the moment before the foot hits the heel.
At this stage, the patient’s desire to restore walking is very important, and even while lying in bed, it is important for him to imagine himself walking upright, with the correct placement of his feet. This will help him directly learn to walk.
Physical and moral support
There are various rehabilitation simulators and assistants for teaching verticalization and movement after a stroke. In a hospital setting, these can be special technical devices; at home, doctors recommend knee supports (at the initial stage) and walkers, which allow the patient not only to take the first steps, but also to return walking as a habitual skill.
Walkers are the main and easiest to learn means of transportation for people suffering from walking disorders. Their selection is carried out based on the individual characteristics of the patient. Walkers are:
lightweight, “walking”, adjustable in height with anti-slip handles and bases;
- high, with armrests, for those patients who rely on their elbows rather than their wrists (due to their weakness);
- rigid, adjustable for patients with large body weight and large build;
- wheeled, with two or four wheels.
Stroke patients should pay attention to wheelless options, as they are more helpful in coordinating movements and are more stable.
During the first training sessions with walkers, it is mandatory to secure an assistant who not only supports the patient, but also controls the correct position of the foot, its straight movement, as well as flexion of the hip, knee, and ankle joints. The assistant must find a comfortable position that provides the necessary support, the ability to easily push the patient’s hip, and the ability to correct an oblique step.
In addition, at this stage, moral support for the patient is very important - this will speed up the success of restoring walking.
Indications for implementation
Exercises are prescribed after a stroke in the absence of motor activity, loss of sensitivity, and also in the following conditions:
- memory impairment;
- decreased hearing acuity;
- speech defects;
- increased tone or paralysis in the muscles;
- lack of motor activity in most of the body;
- swelling of the limbs;
- fast fatiguability;
- lack of coordination;
- changes in intellectual abilities.
The patient often cannot perform rehabilitation exercises after a stroke on his own. This is an additional burden for relatives and friends who want to help the patient.
Why is walking impaired?
During an ischemic stroke, areas of the brain responsible for motor functions remain without nutrition. These are sections of the pyramidal system with the help of which a person makes conscious (voluntary) movements. Depending on the location of ischemia and the degree of damage, complete paralysis or paresis of certain muscles develops.
Special brain cells generate impulses to initiate movement, which are transmitted to the muscles using a complex system of neurons. When some of them are turned off from the process, the muscle does not receive commands “from above” and remains motionless. At the same time, all possible motor programs are stored in the “card file” of the lower motor system.
The goal of motor rehabilitation is to restore lost connections between the brain and muscles, help the body “remember” the necessary motor programs and restore the brain’s ability to control them.
Types of pathology
Doctors distinguish two main types of stroke, each of which has its own characteristics. Pathology is divided into the following types: ischemic and hemorrhagic. The first option is much more common; it is diagnosed in approximately 80% of cases.
During an ischemic attack, a blockage of the vessel occurs, which can be caused by a blood clot or atherosclerotic plaque. Because of this, blood flow is disrupted and subsequent death of brain tissue occurs. If measures are not taken in a timely manner, then death may occur.
The ischemic type is easier to treat, and it is also easier to recover from it. If you call an ambulance in a timely manner, then there will be a chance to return the person to normal life. In this case, there will be negative consequences in any case, and they will have to be dealt with after the patient’s condition improves.
Hemorrhagic stroke occurs in approximately 20% of cases . In this situation, the vessel ruptures, which can occur due to the thinning of its walls. Hypertension often leads to the problem, because the brain cannot withstand regular pressure surges. To prevent an attack from occurring, it is extremely important to first take care of your health and take preventive measures.
A hemorrhagic stroke is much more difficult to bear; during it, a hemorrhage occurs in the brain. A person experiences more negative consequences that arise due to disruption of the organ.
There are many factors that lead to the appearance of pathology. In most cases, it is caused by other diseases, which are often chronic. If a person does not want to experience pain in the legs after a stroke and suffer from speech impairment, then he will definitely need to eliminate negative factors from his life and, if possible, carry out disease prevention.
Atherosclerotic plaques appear in the brain. Because of them, the lumen in the vessels becomes blocked, and as a result, a person may experience acute circulatory disorders. Actually, diabetes mellitus leads to the same result.
Read also: Neurorehabilitation after stroke
If a person smokes and drinks alcoholic beverages, then he may be more likely to experience a stroke. It is for this reason that it is important to get rid of addictions, so that later you do not have to suffer from various diseases. Excess weight in general significantly increases the load on the body . It is for this reason that it is important to control the condition of your body so that you do not have to suffer from problems with blood vessels later.
Some people prefer to sit more and move less. Such behavior cannot be called correct, because it has a bad effect on well-being. If a person has to lead a sedentary lifestyle due to work, then it is imperative to find time for walking and also for playing sports.
Some people, on the contrary, get too tired, for example, due to regular weight lifting. There are also those who are forced to spend the whole day on their feet and not sit down even for a few minutes. As a result, the body will suffer from overwork, which is why you need to reconsider your lifestyle. In another situation, you may encounter health problems.
If a person is forced to constantly be nervous, then he may develop health problems. It can be recommended to strive for a calm lifestyle and respond more easily to troubles. In another situation, you may experience significant damage to your health.
It is also important to note that high blood pressure often leads to an attack, because it has a detrimental effect on blood vessels. It is important to keep it under control, otherwise you will have to face negative consequences later. Age plays an important role, because it is older people who most often experience a stroke. This is explained by the fact that over the years the arteries become thinner and lose their elasticity.
As a result, they become prone to rupture or blockage. If a person tries to avoid negative factors, then his health will improve significantly. There will also be a chance to avoid an attack, which is extremely important for maintaining the body in normal shape.
Some people may not immediately realize that they are having a stroke. This is explained by the fact that during an impact consciousness is often disturbed. As a result, a person may suffer from negative manifestations of pathology. To improve the situation, it is extremely important to take timely measures for successful treatment.
Often, some time before an attack, warning signs arise that are a direct reason to visit a doctor. Let’s say that ischemic attacks may appear, which in their manifestations are similar to a stroke. The only difference is that all symptoms disappear within a few hours, less often they can last up to one day. In this case, a person may experience headaches, problems with speech and coordination.
It is imperative to know the main symptoms of a stroke in order to recognize an attack in time. The headache does not have a specific localization and occurs suddenly. It can often happen even during sleep, causing a person to immediately wake up . In this case, the headache cannot be eliminated with the help of conventional medications, for this reason it is extremely important to consult a doctor immediately.
Dizziness appears even in a calm state and intensifies with movement. It is not recommended for a person to stand up to avoid falling. The patient may not remember recent events and even the names of close relatives, as well as information about himself. Much will depend on how extensive the brain damage is.
The patient has difficulty speaking and understanding other people's speech. Difficulties may arise with the pronunciation of sounds, as well as with the selection of words. Thoughts may be confused, causing the person to ramble incoherently. Tinnitus can be either temporary or permanent. In addition, the eyes may darken, which indicates a violation of cerebral circulation.
Increased restlessness, aggressiveness and generally atypical behavior for a person. At the moment of impact, the patient may behave inappropriately, which is associated with blockage or rupture of blood vessels. Nausea and vomiting are observed against the background of other signs, but do not serve as the main symptoms.
Walking after a stroke is often difficult because the person suffers from numbness in the limbs during the attack. It is for this reason that it is extremely important to start treatment on time and take care of proper rehabilitation. Considering the fact that a person is often in an inadequate state, such a task falls on loved ones and doctors.
Ataxia after stroke - symptoms, diagnostic tests, treatment
Ataxia is a type of movement disorder that occurs in patients after a stroke. This is a collective concept that includes several types of movement coordination disorders. In clinical practice, cerebellar ataxia most often occurs, the cause of which is impaired blood circulation in the cerebellum. According to statistics, cerebellar stroke is not so common - in about 10% of cases.
However, more than half of the episodes of this type of stroke are fatal, and a very high percentage of disability is recorded among survivors.
Ataxia is a disorder of movement and motor coordination
Crutches - in the trash
Photo from neurologyadvisor.com
Classic wooden crutches, with which a person can hang from their armpits, according to Elena Andrev, should absolutely not be used, and are absolutely prohibited for older people. In the armpits - the intimate sphere, lymph nodes. Often grandparents sit in a wheelchair because their armpits cannot withstand the load with crutches, although they could still walk with a walker.
— Crutches are “goodbye shoulder.” They should remain in photographs of post-war times, says Elena Andrev. – Perhaps for a young man after an injury they may be acceptable, but even then it’s worth being more modern. Walking with crutches after rollators have been spread is like cauterizing bedsores with potassium permanganate.
Walking walkers
Walking walkers for the disabled imitate human walking: the elderly patient alternately raises and lowers the left and right sides of the walker. From the picture they cannot be distinguished from the most ordinary walkers, but their end and side parts are not fixed at an angle of 90 degrees. There are movable joints, and you can move the left side of the walker while you lean on your right leg, and then vice versa.
“For a young man after an injury, maybe this is a good option. Older people usually do not master this model and use walking walkers as if they were not walking: they rearrange the entire structure in front of them at once,” says Elena Andrev. — Such walkers require good coordination of movements from the user, and older people are afraid of losing their balance.
