How to Improve Your Walking After a Neurological Injury
Stroke, Brain Injury or Incomplete Spinal Cord Injury
If you or a loved one are working to regain walking ability after a neurological injury (stroke, brain injury, incomplete spinal cord injury, etc), it's important to know how the research says you should spend your time. This short blog post aims to summarise this recent article on the best practices to improve walking.
Recent research suggests that three key ingredients are vital for a better, faster recovery:
- Practice specificity
- Intensity
- Variability
Here is how you can use these ingredients to improve your walking and reclaim your independence.
1. Practice Specific Skills To Improve Those Skills!
Learning the violin isn't going to make me better at the Sunday crossword.
This seems obvious! However, typical physiotherapy often doesn't have enough practice of walking to get better at walking. Instead there tends to be a focus on the parts of walking (ie, strength, balance). This approach results in small amounts of practice for each task. We need LOTS of practice if we are going to change your nervous system. If your goal is to improve your walking you should be maximising the time you spend walking during therapy.
2. Intensity Is The Key!
There is a strong relationship between the intensity of training and improvements in walking speed and distance. Intensity is a measure of how hard you are working, usually tracked with a heart-rate monitor or by the therapist getting you to rate how hard you feel you are working.
High intensity walking is therapeutic to the nervous system! It produces both short-term and long-term changes to your brain, nerves and neurotransmitters. The intensity is the therapy!
How intense? The research suggests that the target heart-rate during a session should be around 60-85% of your maximal heart rate OR a rating on a self-reported exertional scale (eg, BORG Scale) of 14 to 17/20.
3. Variability - Challenge Your Brain with Variety
Our brains learn best by solving new problems. Repeating the exact same walking pattern over and over can be helpful, but introducing variety is what really makes the difference. It forces your brain to adapt and find new ways to move.
Once you start to improve your ability to walk, we need to increase the variability to continue to meet our intensity targets. This may mean that we walk up hills, on unstable surfaces, sideways, backwards, up stairs, down stairs, all sorts! Our brains tend to learn best with controlled and SAFE exposure to environments that challenge us.
Safety
Safety is a major factor in designing a program to assist someone to improve their walking. The fact is that if you've had a neurological injury the chances are that you are at an increased risk of a cardiovascular event. However, it is important to note that the research shows that this approach to improving walking is NOT any more dangerous than regular physiotherapy. With a thorough assessment and monitoring it is safe to engage in intensive therapy after a stroke, brain injury or incomplete spinal cord injury.
This type of training should always be done with the guidance of a qualified physical therapist. They are trained to monitor your vital signs (like heart rate and blood pressure) and know how to adjust the exercises to keep you safe. Above all else, when engaging in this type of therapy pay attention to how you feel. If you feel dizzy, in pain, or overly short of breath, it's a signal to slow down or stop. Communication is key, let your therapist know how you're feeling.
Take Home Message
By combining practice, intensity and variability, you are not just practicing a motion, you are actively re-training your brain and nervous system to work together in more complex ways. This approach does not just improve your walking; it can also help with your overall balance, coordination, and confidence.
Remember, your rehab journey is unique. Always communicate with your physical therapist about these ideas to ensure they are safe and appropriate for you. With a little extra effort and a smart approach, you can take meaningful steps forward.