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Common Challenges in Stroke Recovery

By: Eric Mace, Physical Therapist


In Physical Therapy, I have guided many stroke survivors towards recovery. A stroke is the leading cause of disability in the United States; so the common challenges seen in physical therapy are related to mobility.


For many, the first part of mobility is getting in and out of bed and being able to transfer from the bed to a chair.


As recovery progresses, the biggest challenge is with walking. Walking is a very complex motor task. We have been walking for so long, we often forget how long it took us to master it when we were children.

The biggest challenge is getting enough steps to create a change in the brain. It is important to realize that your muscles are not weak, so recovery has very little to do with strengthening. It is all about the repetition! Lots and lots of steps, not just walking in the parallel bars.


So, to allow that many steps to occur it may take an ankle brace or AFO. Using an AFO can allow the focus to be on the core, hip and knee. Taking the many steps required to recover is well suited for a treadmill.


There is fancy equipment that can help take some weight off and prevent a fall while allowing for all those steps, but the therapist can often provide the required support. Getting the speed up to at least 1.3 mph can start to tap into the automatic components of walking. Increasing the speed can create another important key to recovery – things must be difficult enough to make a mistake. Just going along getting a lot of steps is not enough, it has to be a challenge to the system to promote neurological recovery.


Just like not getting enough steps is a common challenge for improving walking, not getting enough practice of any leg task is a challenge. Doing mat exercises with sets of 10 reps is not the best approach. That task does not offer the high repetitions that it takes to recover and it is not difficult enough to make a mistake - two key elements.


Instead, doing a functional task like kicking a soccer ball off the wall and striking it when it comes back to you is much better. Doing this for 30 minutes would begin to have the high reps that are required to recover.


The more you recover with the high repetitions of a task that is difficult enough to make some mistakes, the more the other common challenges of recovery drop off. Spasticity will lessen, pain with decrease, balance will improve.



The most common question heard in physical therapy is “when can I stop using my walker or cane”. The best answer to that question is to be tested with a standardized balance test. There are many tests that determine fall risk. Using one or more of those tests and scoring low fall risk is the best way to know when you are ready to abandon your walker or cane.


So avoid the common mistake of doing exercises on the mat table and not getting enough repetitions to recover. Instead, get the high repetitions of functional tasks like walking on a treadmill or kicking a soccer ball and make sure it is tricky enough to have a challenge but not reckless.



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