Chances of walking after a stroke: How long does it take?

Post stroke mobility loss can lead to difficulty walking after a stroke and having to learn to walk again. Check out this post about regaining balance and mobility and how long it takes to walk after a stroke.

Within minutes, a stroke can ravage your brain, potentially robbing you of a world of skills that, until now, you've taken entirely for granted. Among the precious things you may lose is the ability to walk -- at least at the beginning.

"It was frustrating and scary. I couldn't stand or move," recalls Melanie Goldberg*, who suffered her stroke at the age of 52. "Basically you want to be independent and take care of yourself," Goldberg says. "But the staff had to help me onto a commode or into a wheelchair."

Loss of mobility is just one of the effects a stroke can have. Post stroke paralysis can require physical therapy or rehab to regain mobility and balance. Due to a stroke’s major physical effects and recovery timeline, it is important to recognize warning stroke signs.

In this post:

• Why is walking affected by a stroke?
• Can a person walk again after a stroke?
• How long does it take to walk again after a stroke?
• Steps of Physical therapy to walk again
• How common is fear of walking after stroke?
• Key Takeaway: What to Expect
• FAQ: Walking after a stroke

Why is walking affected by a stroke?

The majority of strokes injure the motor fibers connected to movement. Typically, strokes damage portions of one side of the brain and affect the opposite side of the body. A stroke can make one side of the body weak or paralyzed, making it difficult or impossible to walk. A stroke patient may also experience a complete lack of sensation in parts of the body.

"When you put your foot on the floor, you can feel it. They can't," explains Jen Aanestad, a physical therapy supervisor at St. Francis Memorial Hospital Acute Rehabilitation Center in San Francisco. "If you can't feel where your foot is in space, that's a huge deficit."

A patient's balance may also be shaky, if the cerebellum -- the part of the brain that controls equilibrium -- is injured. And along with the paralysis, weakness, numbness, and loss of balance, many stroke patients are left with distorted perceptions about where the body ends. "They don't have an idea that the affected part of their body exists anymore," says Aanestad.

Damage to the optic nerve, for example, can shrink one's field of vision, so that a stroke survivor may see only half of his body when he looks in the mirror. Interestingly, the other half of the body will come into view if the head is turned the other way, but patients often have to remind themselves to turn so they can "find" that half in the mirror.

Injury to the motor portion of the brain can also diminish muscle tone and control, another obstacle to walking. Muscles can lose the ability to contract altogether or, on the contrary, become overly contracted and too rigid to allow a simple walking motion.

Physical effects of a stroke that impact balance/coordination/mobility/walking:

• Muscle weakness/paralysis
• Foot drop
• Fatigue/tiredness
• Pain due to damage to tissues/nerves
• Spacticity
• Contractures
• Changes in sensation

Can a person walk again after a stroke?

After a stroke, most patients can walk again within the first six months or, in cases where mobility has been severely compromised, within the first two years. The likelihood of regaining function after a stroke increases with the intensity of rehabilitation, according to experts.

How long does it take to walk again after a stroke?

The majority of improvements happen within the first six months of the initial stroke. For stroke survivors who suffer from aphasia (25% to 40%) it can take up to two years to fully regain their speaking ability.

Recovery timeline:

• 5-6 weeks: Intense physical therapy/rehabilitation
• 3 months: Majority of recovery ending in a plateu
• 6 months: Gait improves
• 2 years: 74% of patients should be able to walk

A patient's rehabilitation should start as soon as the patient is stable. That could be anywhere from a couple of days to a few weeks or longer. Established guidelines, as well as a huge body of literature, insist that the earlier therapy is initiated the better the caring after stroke will be. Additionally, the American Heart Association stresses the importance of aerobic and strengthening exercises to improve overall health and reduce the risk of subsequent strokes. Walking is one step towards that goal.

Physical therapy steps to walk again

• First step: Pinpoint weaknesses

But before walking is even considered, a physical therapist will pinpoint weaknesses in the body that need to be addressed. First, the therapist may guide the patient through pre-walking exercises to prepare other pertinent muscles. If a patient's trunk muscles were affected, causing them to lean to one side or to the front, Aanestad says, she would start with trunk exercises in the sitting position. The next step might be to work on standing until the patient feels anchored and secure.

• Second step: Act of walking

Then therapist and patient can approach the act of walking itself, which involves scores of muscles and many isolated movements. There are eight major phases of movement that occur with each step. Often part of the complexity of relearning to walk is that each segment must be relearned separately, then combined, as if the survivor were a beginning dancer learning a new piece of choreography. That is why it is very important for a therapist to make walking safer for stroke patients.

• Third step: Sensory input

Usually, the brain tells the muscles in your body how to move, and they comply. Following a stroke, the process often works in reverse. The physical therapist creates sensory input for the brain. She repetitively uses her hands and body to move the patient's muscles, if the person is not able to move them alone. This process sends messages back to the brain until the movement is relearned.

How common is fear of walking after stroke?

Many patients develop a fear of walking after a stroke due to the risk of falling. Fear of falling could be caused by accurate perceptions of impaired balance ability and unrealistic beliefs about one’s risk of falling. The fear of falling in people with a history of stroke can be effectively reduced by balance training, according to research.

Another intervention, cognitive behavior therapy (CBT), aims to change irrational beliefs that can fuel unfavorable feelings and actions. Through changing these self-defeating beliefs, CBT can lessen fear-avoidance behavior and its negative effects, such as restricted social interaction.

One of the social skills that many stroke survivors struggle with is the ability to communicate. A hands-on therapeutic approach is particularly important for stroke survivors suffering from receptive aphasia, a condition in which all language sounds like gibberish.

A person with receptive aphasia can't process the therapist's directions, so "I'll place my hands at the pelvis muscles to tell them where to move. I'm constantly facilitating the appropriate muscles," says Aanestad. "Even if they may not be cognizant of what I'm saying, I'm working with the part of their brain that deals with movement."

For other impairments in thinking, a physical therapist has to devise different ways of getting the message across. Aanestad recalls the way one client was able to translate her request to straighten his knee. "One guy said, 'Oh you want me to stand like a flamingo,' so that's what I'd say to him to get him to do it," she says.

The patient may also need his or her own verbal cues. "You're trying to get your muscles to remember what they're supposed to do, and you have to consciously tell them" -- sometimes out loud -- "which is very strange," says Goldberg of her first attempts to walk following her stroke.

Regardless of how a stroke survivor learns to walk, one thing is certain: "There is no singular way to reintroduce walking into their lives," says Aanestad. "You have to have as big a bag of tricks as you can."

The months or years it takes may seem overwhelming, but survivors like Goldberg keep in mind that the potential for progress is always there. "If I couldn't park right in front of where I was going, a couple years ago I couldn't go there," she says. "I still don't have the total use of my arm or leg. But now if I have to walk two blocks, I can do it."

Key Takeaway: What to Expect

Post stroke mobility loss can lead to difficulty walking after a stroke and having to learn to walk again. After a stroke, most patients can walk again within the first six months or, in cases where mobility has been severely compromised, within the first two years. Though recovery takes time, walking is the first step a stroke survivor can take toward achieving a full recovery.

FAQ: Walking After a Stroke

• How are strokes treated?

The most important part of the treatment process is seeking theraputic support as soon as possible. The sooner a stroke survivor begins the recovery process, the better chance there is of reducing long-term damage.

• Can stroke patients fully recover?

Stroke patients can fully recover, but some may require special care due to more severe impairments. Strokes have a bit impact on the brain and nervous system. Fortunately, the damage is sometimes temporary and the brain is able to replace dead cells with healthy ones.

• Can young people have strokes?

A person of any age could suffer from a stroke. This includes teenagers, children, and infants. This is why it is so important to know and recognize the warning signs of a stroke.

• How do strokes affect speech?

Trouble speaking is one of the most common side effects of a stroke. This is because a stroke can damage the area of the brain that processes language and therefore leaves the patient with difficulty speaking or comprehending speech.

• What are the signs of a stroke?

The main signs of a stroke are if a person notices sudden changes in their physical ability or mental status. Strokes can present in many different ways, but there are a few common signs. A way to remember the signs of a stroke is by thinking of “F.A.S.T”

F - Face dropping to one side/is numb

A - Arm weakness/numbness on one side

S - Speech difficulty, slurred speech, inability to talk

T - Time is vital. Alert a medical professional as soon as possible.

* Melanie Goldberg is a pseudonym.

Further Resources

National Stroke Association 800-STROKES (800-787-6537) http://www.stroke.org

American Physical Therapy Association 800-999-APTA (800-999-2782) http://www.apta.org

References

U.S. Department of Health and Human Services. Post-stroke rehabilitation fact sheet. National Institute of Neurological Disorders and Stroke. 2022.

Liu TW, Ng GY, Chung RC, Ng SS. Decreasing fear of falling in chronic stroke survivors through cognitive behavior therapy and task-oriented training. Stroke. 2019;50(1):148-54.

Interview with Jen Aanestad, Physical Therapy Supervisor, St. Francis Memorial Hospital Acute Rehabilitation Center, San Francisco.

Luckman, Joan and Sorenson, Karen, Medical-Surgical Nursing: A Psychophysiologic Approach, Third Edition. W.B. Saunders Company. Philadelphia. 1980.

Rosenberg CH, and Popelka GM. Post-stroke rehabilitation: A review of the guidelines for patient management. Geriatrics (Basel, Switzerland) 2000:1;(55):75-81

Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T. Physical activity and exercise recommendations for stroke survivors: an American Heart Association scientific statement from the Council on Clinical Cardiology. Circulation. 2004;109(16):2031-4