Stroke: Leg Recovery

Following a stroke, your leg may be weaker, tighter or you may find it hard to control the movement. You may also struggle to feel it or sense when it is touching the ground.

Below, we have provided a more detailed overview of why you may experience these symptoms and how you can manage or improve them.

Leg Weakness

A stroke can damage parts of the brain that control signals to the muscles. This can cause them to get weaker because you are not able to use them. With time, they gradually become more deconditioned and weaker. Doing exercises aims to improve strength in your muscles and help your brain to recover the parts of it that control your muscles.

We have provided an overview of some exercises that could support your recovery.

If your occupational therapist or physiotherapist has advised that you need support when you are completing exercises, try some of the Assisted Exercises. Ensure you seek help of a family member or carer. Your helper will need to adjust the level of support they give you depending on how much you can do.

Spasticity

A stroke can damage part of the brain that control signals to the muscles. This can result in an increase or decrease in muscle stiffness. When the muscle stiffness is increased, it is known as increased ‘tone’. Increases in tone can make it harder to stretch and move. For example, as you walk, you might find your arm gradually starts to bend. This is likely the result of increased tone.

It is likely that you will have been assessed for these changes while you were in hospital. Your physiotherapist or occupational therapist might have given you exercises, stretches and a splint to manage the changes in ‘tone’ and maintain the range in your joints. It is important you follow the advice previously given as these changes often require long term management.

If you have been given a splint, you should use the splints as prescribed by your therapist. If you notice any discolouration or marks on your skin, you should contact your GP or your therapist.

Sometimes, when tone is not managed effectively, it can lead to long term changes in muscle length and movement. For example, you may find it difficult to wash your hand because you are unable to straighten your fingers to get to your palm.

If you have difficulty managing the changes in your tone, you should seek further advice and support from your physiotherapist, occupational therapist or GP.

Splints/Orthosis

As a result of weakness or increased tone you may be required to wear an orthotic to support the position of your leg when walking or a splint to help stretch your leg when you are resting.

If you have been given a splint or orthotic for your leg, you should use the splints as prescribed by your therapist. If you notice any discolouration or marks on your skin, you should contact your GP or your therapist.

Splints and orthotics are provided by surgical appliances at Ashford and St Peter's Hospitals NHS Foundation Trust.

If your splint is wearing out, broken or not fitting well please ask your GP to refer you to the surgical appliances at Ashford and St Peter's Hospitals.

If there are changes to your needs affecting your mobility it may be useful to also ask for a review with a neurophysiotherapist.

Sensory Changes

After a stroke, your sensation can be affected. The pathways from the brain to areas of the body are complicated and sensory problems are different for everyone.

The changes in sensation may mean:

  • you are unable to feel someone touching your arm or leg
  • you experience more pain when there isn’t a true cause for this. For example, you may have pain when your arm or leg is touching sheets on your bed
  • you may not notice whether something is hot or cold in temperature, or it may be harder to tell the difference
  • you may also find it difficult to know the position your body is in
  • you may not be able to recognise objects in your hand

You may also experience tingling, prickling, numbness, aching, burning or pins and needles.

Change or lack of sensation can make the hand and foot vulnerable to damage.

Therefore, to reduce this risk, it is important to:

  • change positions frequently to prevent too much pressure on the affected limb or areas
  • always make sure your hand or leg is in a safe position and not stuck underneath anything or hanging down
  • be conscious of applying more force than necessary when gripping objects
  • observe your skin for damage regularly
  • keep skin soft and hydrated by washing and massaging it
  • be aware of scalding or burning and take care with hot water, radiators, sitting too close to a fire

To prevent burns:

  • Check the temp of water with the unaffected hand first
  • Wear silicon gloves while cooking
  • Use insulated mugs for hot drinks

Treatment

Treatment for sensory changes includes sensory re-learning. This means attempting to retrain or stimulate sensory pathways.

Techniques include

  • Touching different textured objects
  • Touch discrimination exercises such as touching or holding objects of different sizes, shapes, and weights
  • Tactile object recognition. This means trying to distinguish what object is in or touching your hand. For example, trying to recognise whether you are holding a pen or pencil.
  • Massage
  • Vibration e.g. using a vibrating massage ball over the affected limb
  • Exercises that reflect daily activities e.g. placing your hand on the kitchen work top while you make a cup of tea or resting your hand on the toothpaste tube while you brush your teeth
  • Temperature discrimination exercises
  • Joint position exercises. For example, replicating the position of your unaffected arm or leg on the affected leg and vice versa.

Evidence suggests you should do 60 minutes a day 3 times a week.