Relearning how to walk requires physical and mental strength

Dear Doctor: Why is it so hard to relearn to walk? Our dad recently had a stroke, and getting back on his feet has been a long struggle. It’s like his body can’t remember what to do. What will happen with the physical therapy he started doing? It’s going slow, and he’s frustrated.

Dear Reader: Once the excitement that accompanies our first baby steps dies down, we quickly take the ability to walk for granted. It’s an accepted and expected part of human development, and, yet, it’s a remarkable feat.

Walking is basically a series of tiny controlled falls. Not only does each one require a complex combination of strength, balance and coordination to complete successfully, there’s also the added challenge of stringing a series of steps together into a smooth and efficient gait. That means pushing off with one leg, reaching from the hip with the other, extending and then bending the knees, flexing the ankles and controlling the momentum of the fall by rolling through the foot. All of this is monitored by various nerve centers, which keep the hundreds of moving parts involved in constant sync. Add in the ongoing spatial awareness required to remain upright and navigate ever-changing terrain, and it’s little wonder that relearning to walk can have a steep learning curve.

Elizabeth Ko, MD and Eve Glazier, MD

For all of the intricacies of walking that we just discussed, recent research has revealed it’s even more complex than we thought. When we walk, each step feels the same. Yet motion-capture studies have found that every part of every step is packed with tiny variations. The hips, knees, feet, ankles, spine and pelvis each tilt, shift, bend or swing in a slightly different way with each step. This requires a series of continual minute adjustments to maintain balance and achieve a smooth gait. So, while retraining one’s body to walk may seem like a matter of being strong enough to stand and then go, like playing a scale on the piano, it’s actually closer to being asked to learn an entire symphony.

The type and extent of injury caused by a stroke can vary greatly. That means each person’s rehab program will be unique to their particular situation. When it comes to learning to walk again, though, all patients have common goals. These are to achieve stable balance, increase mobility and develop overall strength. The way forward is a structured and sometimes rigorous course of rehab. This will include strength training, including a special emphasis on the feet, ankles and legs. Stroke patients often have weakness on one side of the body, as well as joint pain and rigidity. Your father’s rehab will be tailored to address those issues. It’s also likely that your dad will tire easily during these exercises, so rebuilding stamina will be a goal. Expect to see equipment like wheelchairs, canes, walkers and parallel bars, as well as the use of specially designed shoes. Recovery involves not just the body, but also the mind, and your family’s support, patience and understanding will be important to his recovery.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)


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