Difficulty walking is one of the most common consequences of stroke, with up to 80% of survivors experiencing gait impairment in the acute phase. While many people regain some walking ability, a significant proportion continue to walk more slowly, less efficiently, and with greater fall risk than before their stroke.
Why Does Stroke Affect Walking?
Stroke-related gait changes typically include reduced walking speed, shortened step length on the affected side, reduced cadence, asymmetrical weight bearing, and reduced dynamic balance. These changes arise from a combination of muscle weakness, spasticity, impaired proprioception, reduced coordination, and central fatigue.
The Evidence for Gait Retraining
Repetitive, task-specific gait training is strongly supported by the evidence. Treadmill training with or without body weight support has been shown to improve walking speed and endurance in ambulatory stroke survivors. Over-ground walking practice also demonstrates significant benefits and is more functional and accessible for community-based rehabilitation. Electromechanical-assisted gait training combined with physiotherapy has been shown to increase the odds of independent walking after stroke.
Falls Risk After Stroke
Stroke survivors are at significantly elevated risk of falls, with approximately 40% falling in the year following stroke. Gait retraining should therefore incorporate balance training, dual-task practice, and environmental risk assessment as standard components.
References
French, B. et al. (2016). Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews, Issue 11. https://doi.org/10.1002/14651858.CD006073.pub3
Mehrholz, J. et al. (2020). Electromechanical-assisted training for walking after stroke. Cochrane Database of Systematic Reviews, Issue 10. https://doi.org/10.1002/14651858.CD006185.pub5
Schmid, A.A. et al. (2010). Disability and satisfaction poststroke are associated with patient perception of recovery. BMJ Quality & Safety, 20(1), 18–25. https://doi.org/10.1136/qshc.2009.038166
