For many people who have had a stroke, simply walking again can be extremely daunting. And if there are steps to climb or narrow doorways to pass through, it may seem downright impossible.
Barriers to safe walking pop up in places that people wouldn't have considered dangerous terrain before having a stroke. Outdoors, inclines in the sidewalk can change from block to block -- and that's one of the easier hurdles. Suddenly there are also hazards lurking in gravel parking lots, lawns of lush grass, and on sidewalks full of cracked cement and uneven curbs. Navigating indoors isn't much easier: Carpeting, throw rugs, stairs, and slippery hardwood floors can also trip up the newly unsteady.
Before stroke patients ever take to the street, therapists often must teach them new skills in the safety of a rehabilitation center. There, patients practice catching a ball for balance, stepping over mats and other obstacles, and keeping a steady pace when there are people walking in front of or behind them.
"In a crowded hall stroke patients may stop every time a person walks by them. Or their balance may be thrown off a bit. Or they'll try to walk faster because they think they're in the way," says Darlene Harrier, a physical therapist at Beth Israel Deaconess Medical Center Outpatient Rehabilitation Department in Boston, Massachusetts. How do they get beyond such obstacles? Repetition and practice, says Harrier.
"A lot of people think after a certain number of years they're not going to make progress," continues Harrier. "That's just not true."
Making the home safe
When a stroke patient leaves the hospital, he or she is often in a wheelchair. Before a patient goes home, a physical or occupational therapist usually visits his or her home to check for potential hazards and suggest changes to make getting around the house easy and safe.
"It takes a lot more awareness and attention to make a home safe because there are so many more things to pay attention to," says Elvie Bast, a physical therapist who works at California Pacific Medical Center Acute Rehabilitation Unit in San Francisco, California.
During her visits to patients' homes, Bast looks at the entrances to the house, the type of furniture in it, and the layout of the rooms -- especially the bedrooms and bathroom. For someone in a wheelchair, the doors need to be wide enough to maneuver in and out of. Also, grab bars may have to be installed near the toilet to help the patient get into and out of the wheelchair. Others may need a bench installed in the shower, or sturdy bars attached to the wall for easier access to the tub.
If a stroke patient is using a cane or walker, Bast may recommend that furniture be moved out or rearranged. Some people need to wear a brace to help them walk, but it's not convenient to put it on for a midnight trip to the bathroom. Instead, a portable toilet placed by the bed could be one temporary solution. Other typical suggestions for safe walking include:
- Putting a lamp next to the bed so there's never any reason to walk around in the dark
- Removing throw rugs or securing them to the floor
- Putting double railings in stairways
- Using cordless phones, or making sure telephone cords are not positioned across any high-traffic areas
- Installing nightlights in hallways and bathrooms
Getting care at home
If a stroke has left you partially paralyzed or with weakened limbs, ask your doctor if he or she could refer you to a physical therapist. Rebecca Boodt, a therapist at West Bay Home Health and Community Services in Daly City, California, says that if patients are able to walk in the hospital, she'll encourage them to try walking up stairs. She'll also show people muscle-strengthening exercises to do either alone or with the help of a family member.
Physical therapy involves more than just working on building strength or endurance. It can also include coming up with strategies for moving around safely outside of the home, as well. For example, if a patient is moving slowly while using a walker, what can she do to get in and out of an elevator before the door closes? If there's no one around to hold the door open for her, she can block it with her walker, says Boodt. If you know you're only going to get halfway into the elevator, stop and position your walker against the wall in the path of the closing door. It will open again after bumping against the walker, and then you can go the rest of the way in.
Eventually, even some stroke patients who believe they'll never walk again experience great improvement. Harrier, the physical therapist from Boston, recounts the story of a patient who had a stroke in Mexico 15 years ago and moved to the United States to live with her sister. "Prior to seeing me, she was tripping over her foot," she says. "After five months of physical therapy, she was able to jog."
National Stroke Association http://www.stroke.org
National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov
Interview with Elvie Bast, physical therapist and home evaluation specialist at California Pacific Medical Center Acute Rehabilitation Unit in San Francisco, California
Interview with Rebecca Boodt, physical therapist and clinical coordinator of West Bay Home Health and Community Services in Daly City, California
"HOPE, The Stroke Recovery Guide, Exercises and Recommendations," National Stroke Association, http://www.stroke.org/admin/pdf/out/hope4.pdf
Interview with Darlene Harrier, physical therapist, Beth Israel Deaconess Medical Center Outpatient Rehab department in Boston, Massachusetts
The Stroke Recovery Book, by Kip Burkman, M.D., Addicus Books Inc. 1998.