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.

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.

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

Good outcomes for post stroke rehabilitation require a high degree of motivation, participation, and engagement of the patient.

Strength and Balance Exercises for Better 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.
  

References
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

Looking for a fun and effective way to exercise leg and core muscles for improved walking outcomes? Check out the Neofect Smart Balance system for therapy clinics here.