Dr. Miller: How to get your strut back after a stroke. That's next on Scope Radio.
Hi, I'm here today with Dr. Stephen Edgley. He is an associate professor in the department of physical medicine and rehabilitation in the University of Utah. Steve, a patient has had a stroke and is having difficulty walking. What do they need to do, to be able to get back on their feet again and get around?
How to Get a Stroke Patient Walking
Dr. Edgley: This is an extremely critical point that so many patients, months in, actually years in, after struggling with a stroke. The typical stroke patients are by and large...
Dr. Miller: Now, we are talking about a stroke patient where one side of the body, one leg is affected. Am I right about thinking that?
Dr. Edgley: Usually.
Dr. Miller: Usually, Okay. It's not usually both, it's in one side.
Dr. Edgley: So usually one side is weak. I'm going to stress how the importance of being as active as possible and this carries huge health consequences. We know that the insistence of heart disease, diabetes, major risk factors can actually lead to death is much greater when you're inactive.
Dr. Miller: Getting back on your feet is important for more than one reason.
Stroke Walking Gait
Dr. Edgley: Yes, also the quality of life reasons being able to [inaudible 00:01:46] the community is also an important factor. We have a lot of research that clearly shows that if a stroke patient is able to achieve a good speed, walking speed of just 1.8 miles per hour, they will most likely an predictably be able to ask us the community, walking in the community rather than just walking and hobbling around the home.
Dr. Miller: So the need to do the physical therapy is one thing but these patients also have not just weakness sometimes but pain, spasticity of the affected side. Is that right Steve?
Physical Therapy for Stroke Patients
Dr. Edgley: Yes, That's another critical point. These patients typically need an intervention by a specialist in rehab to overcome the barriers to achieve better walking speed. Those barriers are typically things like spasticity of muscle tying their leg up, inhibiting fast walking. Things like pain and low endurance.
Dr. Miller: How often would pain occur in someone with a stroke?
Dr. Edgley: Well it depends, pain syndromes are typically exacerbated by the hemiparetic gait. So the gait mechanics being a little all off counter leads patients be more susceptible to common things like joint arthritis. There are some specific pain syndromes that occur as a result of stroke sometimes.
Dr. Miller: I would guess that the post-stroke patient who has suffered weakness to the leg is not getting this team approach that the physiatrist supplies, that their recovery is going to be delayed or really impaired.
Dr. Edgley: I see patients that have gone on for years being restricted to the home environment with little intervention and attention to these barriers can often achieve great results even to the extent of a much greater quality of life.
Dr. Miller: So what are the barriers to maybe walking faster than the 1.8 miles an hour. Can they eventually build up to a pace that is faster than that?
Dr. Edgley: Well, it depends on a lot of variables. We approach it like this, first try to break down as many barriers to walking speed as possible. And then get them into an aggressive physical therapy program. And then reevaluate the situation.
Typically if the patient can walk a limited distance at home, we can influence the situation to enable the patient to be somewhat effective at walking in the community by breaking down these barriers in a more specialized and team-oriented therapy approach.
Dr. Miller: So a patient with this stroke problem where they can't walk, once they get into therapy are we actually teaching another part of the brain to help take over?
Dr. Edgley: Often we are, the brain has significant potential to do, adapt, and change, even years after a stroke. What we are really doing in therapy, especially months and years after, a stroke is trying to capitalize on the brain's ability to be plastic and adapt. Teaching them the [inaudible 00:06:23] strategies for faster walking and more functional movement.
Dr. Miller: So, it's not just the walking? What you pointed out, is that patients after a stroke, who walk, are able to get going. As opposed to those who don't, do better in the long run, live better, and live healthier. It seems like such a simple thing, yet it has remarkable consequences.
Dr. Edgley: Indeed, it is an extremely critical and some people we now consider walking speed to be the fifth vital sign. It's something we measure in our clinic as an objective measure of how they're doing overall and how they're doing physically.
updated: July 15, 2020
originally published: August 5, 2014
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