Gait training in severely affected stroke patients

Background: Many people who have had a stroke find a way to be able to walk again. This recovery is an adaptation/compensation strategy of the individuals and their therapeutic team, searching for a way to bear weight and maintain control, especially of balance. Very quickly, support/aids are used and practiced with, but what are we actually doing? Is this training to build better coordination, or is that not possible? In any case, it is not relearning, because these individuals have to compensate.

Aim/Design: Searching for the reasons why so many, even severely affected individuals, are still able to stand and walk on the affected leg, while, for example, hand/arm and foot/leg selectivity is often very severely impaired. One of these reasons is the innervation of the trunk and the large joints from the hemispheres of the brain. Because the pathways from the cortex partially cross, a connection from both hemispheres remains present, and it appears that this crossing at lower levels even approaches a 70%-30% distribution.

Result: This result therefore means that muscle patterns are also influenced by unaffected areas in the brain and that this therefore plays a role in recovery, but of course also in the control of walking and especially of the stance phase. For example, the posterior diagonal is essential to activate the affected side/hip via the unaffected shoulder, yet we often see that this is not sufficiently successful.

Discussion and conclusion: The search for an adjustment/compensation after a stroke in order to be able to walk in some way often involves providing aids and “grooving in” that walking. That is not training according to training rules, and often no activation occurs in the muscles around the affected hip joint even though this is possible. By including this activation in the training program from the start, it will also be incorporated into the walking pattern. This therefore does not mean first looking for an adjustment/compensation, or “relearning,” but immediately actively training the coordination of the affected lower trunk/hip.