Gait

I’ve written a lot about walking.  This is another thing that I first wrote about before I knew that I didn’t know anything.  They told us in PT school that gait and everything that goes along with gait is a PT’s bread and butter.  So I guess that means I’m supposed to know a lot about gait.  It’s been 2.5 years for me since the stroke and I forget how absolutely, devastatingly awful those first 6 months were.  Brooke emailed me once(I hope you don’t mind this Brooke) and she told me that the PT working with her husband had told her that he might never regain walking ability and that their focus in therapy was going to be transfers.  That’s crap.  First of all, he’s 30 years old.  He has like 60 years left on this planet.  Second, his injury was in the cerebellum.  Injuries to the cerebellum don’t affect strength or range of motion.  He’ll walk Brooke.  🙂  I told her that this is HIS therapy that THEY are paying for so if they want walking to be the main focus, walking should be the main focus.  A couple of people have e-mailed me asking if a certain exercise machine is good to buy.  If your main focus is walking, get a treadmill.  If your main focus is walking, then walk a lot.  You might need a therapist’s advice in order to fine tune some movements but if that’s your goal, then do it.  Even if you have to start for 10 minutes at 1 mph, do it.  I can walk really well now.  I guess it’s a tad obvious because 3 people at my gym have come up to me and asked if I sprained my ankle but they were all in absolute shock when I told them the real reason that my gait is a little off.  Still can’t run though, but I’m getting there.  My top interval speed on the treadmill is now 4.6 mph.

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Categories: Brain stuff, Health, Recovery, Rehab, Stroke stuff

Tags: , , , , ,

57 replies

  1. I would like to know more about cerebellum injury . When you say does not affect strength and range of motion, do you mean that is the only deficit which needs to overcome in order to walk? How about sending the right amount of signal to right set of muscles?

  2. Fantastic post! First, I’m so glad you set Brooke on the right track. Just wish it’d been the PT you’d gotten ahold of. Wish I could get ahold of him. Nut. Second, absolutely right. If you want to walk, just walk a lot. You’re so right about everything but then, heck, you know more about this stuff than I’ll ever know. Third, your walking improvement and perseverance truly is impressive. Walking with a stroke is tough! Which is why I love hearing stories about it. It’s motivational, and I’m always looking for motivational, so thank you! By the way, hope you don’t mind this? Just got my site up, at strokeselfrecovery.blogspot.com. Embarassingly new at this stuff, and posts are too long, so apologies are offered before anyone takes a look. Thanks!

    • I’ll add your blog to my list over at the left there. 🙂

    • Amy, I agree that any equipment related to your goal is what to get, but all of us have walking as a goal, and I fricking HATE treadmills, so I’m sticking with my rowing machine. My husband wants us to get a stationary bike, even though biking is the very last activity on my list.

      Scott, my blog entries go on and on, so don’t worry about yours. From my newspaper days, I would say that 500 words is perfect for attention spans, but insightful matters more. People seem to read them anyway – we’re always looking for gems of wisdom.

      • Barb can you do any exercise machine that’s weight bearing?

        • I’m afraid of both elliptical and treadmills; I used an elliptical at the gym and went only 10 steps before I was pitched sideways (to my good side), but couldn’t steady myself one-handed; I used a treadmill in therapy, but even at a slow speed I didn’t lift my foot rhythmically enough to keep up. I want something I can get on and do myself. Tom still has to attach my hand to the rowing machine, so it’s a problem when I want to exercise and he’s in the middle of something.

          Is there any other weightbearing equipment?

      • Thank you for the encouragement! I can only wish for gems of wisdom though. I think I have more rocks of boredom—

    • Right, pretty much. The facility he goes to for rehab has everything, even counseling. The counselor who worked with both Zack and I (when he was inpatient) asked me one day why I was having a hard day and I told her what Jefferson said and she even thought it was incredibly silly for him to make a statement like that…totally misguided. He works with Zack regularly now and is a nice guy…I think he just said it off the cuff…bad idea, dude.

  3. Not only a doctor told me that my husband will not be able to walk because of his ataxia and tremors but also one therapist. Amy your blog gives me hope. Thanks!

  4. Thanks friend. I don’t mind you sharing at all. He is already walking so much better since then, take that Jefferson! (that’s the therapist’s name) That’s the same therapist that recently sent me a picture of Z climbing up the 30 foot wall. boo-yah! We got the treadmill, btw. Zack can’t quite do level 1 yet, he is doing good to be able to keep up with .5. 😛 But he can do 8-10 minutes on it. And that’s what we’ll do…keep building.

    I do have to add, Zack is no longer 30…yep, he turned 31 today. 🙂 Good riddance, dirty thirty, you were pretty miserable about half way through. And he stayed home sick today…bummer. 😛

    Thanks for all the encouragement, everyone. You are all so incredibly inspiring. ❤

  5. One thing I’d like to add about walking. If your progress seems slow, I think I might have an explanation. I had virtually no progress for three years, and I walked forever. During this last stage of improvement, however, improvement has come at an unbelievably fast rate. It’s noticeable everyday, whether I walk or not. My guess is that walking is a whole movement thing, meaning all parts on both legs have to be functioning well before everything comes together in a team-like movement. The improvements that propelled speed forward for me were the toe push-off and the automatic pendulum swing, and those came last. Also, neuroplasticity seems to take off at the end, I think because progress has now allowed the full brain to become involved, and also because now the walking function has many more neurons and pathways diverted and connected to it so now progress is much easier for the brain.

    • Scott do you take naps during the day?

    • My progress with walking was very slow at first but it has been speeding up. I agree with Scott that many parts need to come together before walking can happen. My first goal was to walk with a cane. I ditched the brace early on and haven’t gone back. I think the brace impeded my progress, but if you have a brace that helps you, don’t listen to me (standard disclaimer since I am an MD and do not want to get sued if you fall after taking your brace off). I have taken walking apart and practice each piece separately. The toe push-off is one of the hardest things to get because it involves articulating the forefoot separately from the mid foot, fighting the inversion synergy to keep the foot flat, then weighting the bad side on a bent knee that is weak without pitching forward. Then there is the promised land – the swing forward followed by the heel strike. You need to have a bit of dorsiflexion for the heel strike, but it is less than I thought. I watch people walk all the time and my PT gave me the slides from a lecture she gave on the gait cycle and I refer to them frequently. I am practicing all of these pieces separately. I am also starting to put them together but I still have a long long way to go before my gait is even close to fully functional. I walk walk walk. I am up to a mile in my apartment with the cane. I go outside when I have company since I’m not going out on my own yet. And I just started walking inside without my cane (only when my husband is home in the evening as I take chances and could go splat). Very slow. And my walking speed even with my cane is not “normal”, only 2ft/sec and normal is 3 ft/sec. I think Dean had a post on this. I also do 2 hours of strengthening exercises each day for the walking muscles that are weak and for core strength. You need to be obsessed, unfortunately, to succeed but I suppose the good news is that obsession works – look at Amy! look at Scott! I am hoping for that burst of progress that you guys seem to have experienced.

      • Working on parts separately might be a real good idea. My big progress-makers were: knee getting spongy and absorbing shock, foot pointing forward instead of at a right-angle, toe push-off and pendulum-swing. Geez, don’t know any terms, no wonder I flunked human anatomy. Great job on all the hard work—

        • I think the push-off is tied to the foot pointing forward. If you weight your forefoot in a committed fashion with the toe pointing forward then push off it stays that way instead of turning to a right angle (turnout out to this ex-ballet dancer). Easier said than done though. Amy, what is your take on this?

  6. Mine was a basal ganglia stroke. Everything was affected with a 1 cm clot and subsequent bleed except for my executive function ability. I’ve had PTs tell me before that I would never **** again and my response was watch me. They don’t know it all. I believe in short term goals and long term goals.

  7. Amy, I am working daily on walking again but can only do just so much before I become nauseous. I can’t seem to get passed the dizziness and fuzzy feeling in my head. I did have part of my cerebellum removed when I had my stroke 7/8/12. Am I expecting too much too soon?

  8. Did they tell you anything in school about spasticity or any objective way to identify gait problems? accelerometers?

    • No objective ways to measure spasticity, no. Lots of different objective ways to measure gait stuff.

      • Dean, when Grace and I were at Petwr’s seminar re spasticity, we were guinea pigs while a roomful of PTs evaluated us. I don’t know the name of the scale, and it was evaluative, so subjective,BUT the scale was only 0,1 or 2, so everyone arrived at the same total, which is whatyou hope for using an objective measure.

        Of course, grace did really well, and Petwr stopped having them evaluate me – I twiddled my thumbs (i wish) while Grace performed – because we all knew I’d be zero.

  9. Amy – Great post! I strongly hate any medical professional that tells a patient “You’ll never do…” So many stories out there that show their opinions were wrong. Along with gait, have you done any writing on drop-foot? That is one of my problems and I my one big goal is to fix that. I’ve been told I won’t drive safely again using my right foot, so we are looking into hand controls.

  10. I just worked on walking with Zack for the first time in a week, he has been sick so any extra work (he is at therapy four hours everyday) at home didn’t happen this week. Anyway, he did great! Way better than last Sunday. He was faster, his legs had better form, and his gait was more normal. I am super impressed. yeeeah! Just thought I’d share my celebration with you all. 🙂

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