Making turns in standing or walking can be difficult and awkward for some Stroke Survivors. Some folks are only able to turn well in one direction. Some folks take twice as many steps (or more) to complete a full 180 degree turn to go in the opposite direction. There are a few elements that can be focused on to improve the smoothness and ease of making a turn when walking.
Generally, the way a person is moving that makes the turn awkward or more time consuming looks something like this- In our example we are going to say that our Stroke Survivor has their left side more affected and they are turning 180 degrees to go back in the opposite direction (like they forgot their phone on the table in a restaurant and need to go back and get it)
When turning, they generally choose (intentionally or unintentionally) to turn to the right. In this case, the right foot leads the turn making a step partially in the opposite direction, then the left foot “catches up to the right”, landing next to it. Then the sequence is repeated until the Stroke Survivor is facing the direction of the table with the phone and they start heading straight in that direction. A more natural way of completing this turn is for the left step to step beyond and also be partially moving in the direction of the table.
In order to help a Stroke Survivor rehab this more natural movement back I look at some of the basics first. The first elements I like to assess and address (if needed) are flexibility and coordination in the “turning” movement in the more affected hip. This is the movement of the thigh “twisting” outward (medical term=external rotation) or “twisting” inward (medical term=internal rotation). First I will look to see if there is stiffness in either of these movements. I generally look at the flexibility of the less affected side and use that as my benchmark for the flexibility to achieve in the more affected. If there is stiffness in the more affected side, I manually stretch the person and then give them stretches to perform at home. Next, I look at how well the person can isolate that movement. I ask them to intentionally perform the “thigh twisting” movement while lying on their back, first. This position is a bit easier for folks to achieve the movement. Then, I may have them do the same in standing.
This “twisting” of the leg while taking a step is a key to turning the body in the desired direction. Once the person is getting pretty good (not perfect) at twisting the leg, I have them start to put that into stepping and turning, either in place or in “slow motion”. I give drills to practice the different parts of the turning movements and eventually I have them combine the different parts in walking with the turn.
The strategy that I use is to have a person get the flexibility, practice the parts of a movement/task then put it all together. So you could try the same strategy too.
I share the stretches and drills in my Walking and Balance Boot Camp. If you want to join the wait list for the next Boot Camp, click here.