Walking After Stroke; What You Need to Know

Independent walking is one of the major goals for stroke survivors and its easy to see why. Walking in itself is a form of freedom. If you can walk independently, you can get back to doing the things your love.

This article aims to answer the three most common questions related to walking after stroke. They include;

1. Why you’re unable to walk after a stroke.
2. Can a stroke patient walk again?
3. How long does it take a stroke patient to walk again?

Why you’re unable to walk after a stroke

Stroke is a condition where there is poor blood flow to the brain. The poor blood flow to the brain will then result in cell death, specifically brain cell death. The brain is responsible for controlling all the major operations of the body including movement. A region of the brain known as the primary motor cortex controls muscle movement. When cell death occurs in this region, the muscles can no longer receive instructions from the brain hence leading to difficulties in walking. Stroke usually occurs on one side of the brain which leads impairments on the opposite side of the body. One of these impairments is the inability to control the muscles.

Sometimes a cerebellar stroke might occur which affects the region of the brain known as the cerebellum. The cerebellum helps with coordination of movement and when this is affected it might lead to the inability to walk due to coordination issues.

Can a stroke patient walk again?

This is a particularly difficult question to answer as every stroke patient is unique. Luckily, numerous researches have been undertaken to try and answer this question. According to the KNGF (Royal Dutch Society for Physical Therapy) guidelines, about 70-80% of patients with a stroke eventually regain the ability to walk independently.

This is good news for stroke patients as it shows that the prognosis for being able to walk again is favorable. Achieving the ability to walk again after stroke is due to the brains capacity to modify, change and adapt structure and function throughout life. This known as neuroplasticity.

So, what are the chances that you, specifically, will be able to walk again after a stroke?

Over the past years, researchers have identified factors that when present within the first two weeks post-stroke, predict better walking outcomes. These factors include;

• Younger age
• Less lower-limb motor impairment
• Less sensory loss
• Absence of hemianopia
• Better sitting
• Trunk control

How long does it take for a stroke patient to walk again?

This is also another difficult question to answer as the stroke recovery timeline is unique for each patient. Factors like the intensity of rehabilitation will influence the recovery timeline, but other factors that are highly predictive if you’ll be able to walk again after a specific period of time are still being explored.

Research indicates that 60% to 85% of stroke survivors do learn to walk independently after 6 months post stroke.

In 2017, a study was created to explore factors that could be combined in an algorithm for predicting whether and when a patient will walk independently after stroke. This led to the formation of the TWIST algorithm that can accurately predict whether and when an individual patient will walk independently after stroke using simple bedside measures 1-week post stroke. According to the study;

• Most participants with good trunk control (TCT >40) at 1-week poststroke walked independently by 6 weeks poststroke.
• Participants with poor trunk control (TCT <40) only achieved independent walking by 12 weeks poststroke if they had hip extension of MRC grade 3 or more.
• Those with poor trunk control (TCT <40) and hip extension of MRC grade 2 or less at 1-week poststroke were predicted to be dependent at 12 weeks poststroke.

You can liaise with your physiotherapist to get a better prognosis specifically based on your case.

Other learning resources

The TWIST Algorithm Predicts Time to Walking Independently After Stroke