Conklyn Method for Gait Reintegration

Walking After A Stroke

Gait instability is often a symptom of a brain accident, such as a stroke.  There are two areas that have the biggest impact on walking impairment after such an accident, the inability for the brain to properly sequence a functional gait pattern and impaired proprioception of the affected side.

Sequencing is one of the most important and integrated aspects of our lives.  From the firing of our neurons to the actions we take, from the sentences we speak to how we eat with a fork, everything in our lives is in some form, a sequence. Any type of brain incident causes a myriad of sequences to be disrupted.  Yet once the event has occurred and therapy begins it can be more difficult to assess at what levels our functional sequences need to be addressed. When working on improved walking, therapists often encourage patients to take a “step”, forgetting that the wiring previously used for the sequencing of that “step” has been damaged.  Unintentionally, this often leads to compensatory patterns that are far from “normal” walking.  Practicing the individual movements involved in taking a “step” is paramount to helping the brain rewire the appropriate sequence for walking.

Proprioception is the ability to sense stimuli arising within the body regarding position, motion, and equilibrium. The sense of proprioception is disturbed in many neurological disorders.  In the case of walking after a stroke, the area most affected by loss of proprioception is the foot on the affected side.  This is often the most difficult area to improve, yet without it, it becomes virtually impossible to regain independent functional walking.  If you can’t tell where your foot is in space how do you know if you are, or aren’t, walking correctly?  And more importantly, how can you appropriately engage in your own therapy? This should be one of the first area addressed when working on regaining walking.

Through our experiences working in both acute and chronic stroke care, we have identified exercises that address these issues.  Combined, they make up The Conklyn Method of Gait Reintegration and should be done in the following order. Music is the key element in the success of this program as it is the music that helps to drive each exercise, allowing for more efficient movements and faster integration of each piece of the walking pattern. Optimal results will be achieved with a Music Therapist trained in the Conklyn Method but we have provided videos below to assist in being able to practice these at home with appropriate music.

The Conklyn Method for Gait Reintegration

We have identified 5 core exercises for relearning a more functional gait pattern and improving proprioception, irregardless of where you are in your recovery process, and should be done in this order.  These exercises are most effective when done barefoot.  If you are not comfortable doing these barefoot we recommend doing them in shoes without the use of any orthotics.  These exercises can be done using a counter, or balance bar, for support but as you gain strength and confidence we recommend trying these unassisted. For safety reasons please have someone there to assist when necessary.

 1. Forward and Back Rocking Weight Shift: Standing with your strong side next to a counter or balance bar place one foot in front of the other in a normal stride position.  Keeping your knees straight rock forward onto your front foot, slightly lifting the heel of the back foot.  Then rock back onto the back foot, slightly lifting the toes of the front foot.  Use your strong hand for support throughout this exercise.  Try not to bend either knee as you rock back and forth.  After completing a set, switch feet so that you get a set with your weaker foot in both the back and front positions.

My Bonnie

House of the Rising Sun

Hallelujah

2. Standing Plantar Flexion: Stand facing either a counter or balance bar.  Place your feet next to each other, they should be even and touching.  Using your hand for support, roll up onto the toes of your feet and then back to a standing position.  Try to go up as straight as possible and do not rock backwards when you come back down.

Swing Low Sweet Chariot

Oh What a Beautiful Morning

3. Standing Knee Flexion: Standing with your strong side next to a counter or balance bar place your feet a little less then shoulder width apart.  Alternate bending your knees, raising your heels as high as you can. If necessary use your strong hand on the counter for support.

Hey Good Lookin

Fulsom Prison

Swing Low Sweet Chariot

4. Knee Drop: Standing with one foot in front of the other in a normal stride position, drop, or bend, your back knee.  This will force your weight onto your front foot.  As you straighten the back knee make sure to shift your weight back so that you plant your back heel.  The front knee should remain straight during this exercise. This exercise should be done twice, so that your weaker foot has been in both the back and front positions.

Joshua Fought The Battle

Oh Susannah

You Are My Sunshine

5. Heel Strike: Standing with one foot in front of the other in a normal stride position, drop, or bend, your back knee.  Allow your lower leg to come forward, the knee acts as a hinge here, lifting your toes throughout this phase so your heel touches first when your leg reaches a forward position.  As your heel comes down your front knee should be straightened and you should not allow your toes to come down to the floor.  Once your heel has made contact with the floor, bend the front knee to pick up your leg to return it to a stride position behind your stronger leg. Your support leg should be straight through this exercise.  This exercise should be done twice, so that each leg has worked on an appropriate heel strike.

Sixteen Tons

Sixteen Tons-Back

Proprioception/Vestibular Exercises

Swaying Side-to-side and front-to-back: This exercise is primarily designed to help with improved proprioception but also addresses vestibular issues.  Standing as tall and centered as you can focus on moving side-to-side using only your feet (no upper body, hips, knees etc).  Your posture should stay straight the entire time.  Pay attention to whether you can feel the bottoms of both of your feet the entire time.  Stop in a position that you feel centered and in good posture and again, use our feet to move you forward-and-back.  All of the movement changes should occur from your feet and your feet should stay flat the entire time.

My Bonnie 

After completing the previous exercises we encourage you to walk, trying to put all of these elements into your walking pattern.  Again, having a Music Therapist provide you with music appropriate for walking will maximize your results.