Walking after 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, proprioception and being able to properly sequence the gait cycle.

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 weaker 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 the first area addressed when working on regaining walking.

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.

Through our experiences working in both acute and chronic stroke care, we have identified exercises that address these issues.  They have been separated into 2 concurrent programs, one for improved proprioception, the other for relearning the sequential gait pattern.  Combined, they make up The Conklyn Method of Gait Reintegration.

Music for the treatment of sensorimotor issues.

Sensorimotor issues present themselves in many different ways, from difficulties with walking to balance issues, from difficulties moving an arm or leg to trouble picking up a pencil.  DBC3 Music Therapy employs several research-based techniques developed to help rehabilitate these different sensorimotor deficits and will tailor your treatment plan to meet your functional needs, helping you achieve the highest level of independence.

Rhythmic Auditory Stimulation (RAS): RAS utilizes the principles of rhythmic entrainment to effect physiological change through the use of a steady rhythmic beat, often facilitated via metronome (or percussive instrument) or embedded within a song. The steady rhythm, set at the patient’s walking speed, and slowly increased, is used to cue the patient’s gait parameters, such as stride length, step length and cadence.

RAS in treatment of Stroke.

Patterned Sensory Enhancement (PSE): This technique utilizes different types of musical cues (spatial-depending on how big or small the movement is, tempo-depending on how fast or slow we want the movement to be, force-to emphasize the parts of the movement in which the most effort is being made), often within the context of a song, to facilitate functional movements. PSE can be used for strengthening and endurance, to work on individual movements/muscle groups or to help pattern more complex movements, such as going from sitting in a chair to a standing position.

PSE in treatment of Stroke.

Therapeutic Instrumental Music Playing (TIMP): Many of the same musical properties and cues used in PSE are employed in TIMP, only with instruments added, providing targets to define range of motion exercises, as well as work on areas such as grasping (when using mallets), balance and coordination.

TIMP in treatment of Stroke.