Mobility and Stroke
Mobility after a stroke varies from person to person. Stroke may affect mobility in the following areas:
Bed mobility: rolling, scooting up in bed, sitting up, or lying down.
Transfers: Sitting down or getting up from a surface such as a bed, chair, couch, toilet, tub, car, or floor.
Ambulation: Walking inside and outside, on smooth surfaces and uneven terrain, on ramps, curbs, and stairs. It also includes ambulation in the community, or in areas with obstacles and distractions.
Wheelchair mobility: Being able to move the wheelchair from one place to another; managing the brakes, footrests, and armrests; and managing barriers such as doors, carpet, and other obstacles.
How Stroke Affects Mobility
Physical, sensory, perceptual, and cognitive deficits affect mobility skills. Any, or all, of these deficits may exist, depending on the severity and the location of your stroke.
Physical deficits include muscle weakness, poor muscle coordination, abnormal muscle stiffness, and impaired or absent leg sensation. These deficits cause abnormal movement patterns, limited joint movement, and impaired balance.
Visual and Perceptual
Visual and perceptual deficits may include difficultly seeing and distinguishing objects. For example, impaired depth perception causes steps to look close together or further apart, or bigger or smaller than they are. Inattention or neglect may cause you to run into objects on one side.
Cognitive difficulties include impaired planning, safety, and judgment. For example, following a stroke, you may be physically able to do a task, but unable to put all the steps together in the correct order. You may over estimate what you're able to safely do, may move too fast, or become distracted by the environment. You may be able to physically walk without difficulty, but become disoriented or lost. Memory, attention, and concentration also have a great impact on the ability to perform mobility skills safely.
Depending on the severity of the physical, sensory, perceptual, and cognitive problems, you may need to use a wheelchair in the beginning to help with mobility. As improvements are made, you may:
Progress from using a wheelchair to a walker or cane
Require someone to be with you to ensure safety and assist with balance while walking
Be able to walk for short distances, but require a wheelchair for longer distances
Level of assistance after you leave Mary Free Bed depends on the severity of your stroke. Some stroke rehabilitation patients require assistance at all times after going home and some need no help at all after their discharge.
Treatment for Mobility Impairments
Your physical therapist will address areas of physical impairment that have an impact on your mobility. Weak muscles are strengthened through exercise. Abnormal muscle stiffness is reduced by stretching, positioning, or specific exercises. Stiff joints that may impair mobility are stretched. Even after you've completed your formal rehabilitation, you may need to continue to do some of these activities at home.
Some physical limitations require special attention to improve mobility. A splint or brace may be needed for a weak extremity. This may be used to prevent loss of movement at a joint, to support a joint, or to assist weak muscles during mobility activities such as transfers and ambulation.
Therapists determine the appropriate brace for you and monitor how well the brace works. Your therapist will establish the appropriate times for you to wear the brace.
A sling for a weak arm may be used to protect the arm during mobility tasks and to protect the joint by preventing overstretching of the weak shoulder muscles.
The Family's Role in Mobility
Your family is important to your recovery. As you progress, your Mary Free Bed physical therapist teaches your family how to help with transfers or with walking. When you're able to do this comfortably and safely, your rehab specialists allow you to do these activities with your family while at Mary Free Bed.