28/07/2025
𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜 𝙞𝙣 𝙎𝙩𝙧𝙤𝙠𝙚
Gait dysfunction is one of the most common and disabling consequences after a stroke. Effective gait training plays a crucial role in restoring functional ambulation and improving the quality of life in stroke survivors.
Why is Gait Affected After Stroke?
Stroke leads to neurological deficits that affect motor control, muscle tone, balance, and coordination. Common gait abnormalities post-stroke include:
-Hemiparetic gait
-Circumduction of the affected leg
-Reduced weight bearing on the affected side
-Foot drop
-Knee hyperextension
-Spastic synergy patterns
Goals of Gait Training
1. Improve symmetry and stability
2. Enhance weight bearing on the affected limb
3. Promote independent ambulation
4. Increase speed, endurance, and efficiency
5. Improve balance and reduce fall risk
6. Restore normal gait pattern as much as possible
Principles of Gait Rehabilitation
•Neuroplasticity: Encourage repetitive, task-specific training to promote cortical reorganization.
•Motor learning: Use feedback, cueing, and practice to enhance skill acquisition.
•Proximal to distal control: Restore trunk and pelvic stability before addressing distal function.
•Weight shift training: Essential for symmetry and balance.
•Intensity and frequency: High-repetition training yields better outcomes.
𝘼𝙨𝙨𝙚𝙨𝙨𝙢𝙚𝙣𝙩 𝘽𝙚𝙛𝙤𝙧𝙚 𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜
•Functional Ambulation Categories (FAC)
•Berg Balance Scale
•Fugl-Meyer Assessment (Lower Limb)
•Timed Up and Go (TUG)
•10-Meter Walk Test
Observation of gait phases (Stance, Swing, Heel Strike, Toe Off)
𝙋𝙝𝙖𝙨𝙚𝙨 𝙤𝙛 𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜
1. Early Phase (Bed Level to Standing)
-Positioning to prevent contractures
-Bridging exercises
-Sitting balance training
-Sit-to-stand practice
-Weight shifting in standing
-Parallel bar walking
2. Mid Phase (Assisted Walking)
-Walking with support (walker, hemi-walker, cane)
-Step training with affected limb
-Stair climbing initiation
-Theraband resistance gait drills
-Treadmill walking with harness (BWSTT)
3. Advanced Phase (Independent Mobility)
-Dual-task gait training
-Obstacle navigation
-Speed and endurance training
-Uneven terrain and community walking
-Balance-challenging activities (foam surface, dynamic balance)
𝙂𝙖𝙞𝙩 𝙏𝙧𝙖𝙞𝙣𝙞𝙣𝙜 𝙏𝙚𝙘𝙝𝙣𝙞𝙦𝙪𝙚𝙨
🔹 Treadmill Training (with or without Body Weight Support - BWSTT)
-Facilitates repetitive gait cycles
-Reduces fear of falling
-Encourages proper foot placement
🔹 Overground Gait Training
-More functional and realistic
-Practice turning, obstacle negotiation, curbs
🔹 Robotic-Assisted Gait Training
-Lokomat, Exoskeletons
-Helps with consistent and repetitive stepping
-Used especially in severe hemiplegia
🔹 Functional Electrical Stimulation (FES)
-Especially for foot drop
-Stimulates dorsiflexors during swing phase
🔹 Mirror Therapy and Mental Imagery
-For motor cortex activation and preparatory training
🔹 Visual and Auditory Cueing
-Improve step length, cadence, and posture
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Gait Training Exercises
-Marching in place
-Forward, backward, sideways walking
-Heel-toe walking
-Step-ups
-Ladder walking drills
-Obstacle crossing
-Toe clearance drills for foot drop
-Pelvic and trunk dissociation exercises
Assistive Devices in Gait Training
-Parallel bars (initial phase)
-Quad cane or hemi-walker
-Ankle Foot Orthosis (AFO) – for foot drop/spasticity
-Knee brace – for genu recurvatum
-Gait belts – for safety
-Harness systems – for treadmill training
𝘾𝙤𝙢𝙢𝙤𝙣 𝙂𝙖𝙞𝙩 𝘿𝙚𝙫𝙞𝙖𝙩𝙞𝙤𝙣𝙨 𝙞𝙣 𝙎𝙩𝙧𝙤𝙠𝙚 𝙋𝙖𝙩𝙞𝙚𝙣𝙩𝙨
Deviation--> Likely Cause
•Circumduction of leg--> Hip flexor weakness, foot drop
•Hip hiking--> Compensatory for knee/ankle weakness
•Knee hyperextension--> Quadriceps weakness, poor proprioception
•Foot slap--> Weak dorsiflexors
•Vaulting on sound limb--> Compensation for weak swing phase
𝙁𝙧𝙚𝙦𝙪𝙚𝙣𝙘𝙮 𝙖𝙣𝙙 𝘿𝙪𝙧𝙖𝙩𝙞𝙤𝙣
-Minimum 30–60 minutes/day, 5–6 days/week
-Progress from 2–5 meters to community ambulation
-Continue gait training for at least 3–6 months post-stroke with regular re-evaluation
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Tips for Effective Gait Training
Use mirrors for visual feedback
Incorporate verbal cues ("lift your toe", "step through")
Emphasize trunk control and posture
Correct gait deviations early to avoid compensation habits
Include dual-task walking to improve real-world skills
Conclusion
Gait training is central to stroke rehabilitation. A tailored approach involving task-specific, repetitive, and progressive strategies, combined with proper assistive technologies and patient education, leads to the best functional outcomes.
