What if relearning normal gait is a trap?

🌀 The Contrarian Insight

Hello neuro rehab enthusiasts!

The field has long prized “restoring normal gait,” but relentless pursuit of a traditional walking pattern may not serve every patient’s function or safety. Should rehab prioritise “learning to move differently”— not merely relearning lost gait?

For many years, I felt it was best to aim for the 60% stance/40% swing ratio and idolising what it looks and feels with all the parts of gait. Heel strike, rocker transitions, heel off and toe off? While some of this works as a framework and goal, when there is permanent weakness and paralysis and the need to adapt to different surfaces and contexts, the textbooks and articles don’t give enough options for therapists to think about.

🔬 The Science: Adaptation Outperforms Mimicry

• Task-specific gait retraining typically aims for pre-injury or “normal” walking patterns using repetition, technology (robotics, exoskeletons), and feedback (Krishnan et al., 2020)

• However, repeated practice of “ideal” movements can limit generalization—patients may walk well in one context but falter in daily life if conditions change. I realised that there is more than one way to walk.

• Compensatory strategies—adopting alternative movement patterns—are sometimes essential for meaningful independence but can also sabotage recovery if they lead to “learned non-use” or mask genuine progress (Shen et al., 2025).

• Research suggests that specific, high-repetition practice of new, functional patterns is often more effective than gradual progression toward an “ideal” gait—especially when safety or underlying neurology limits restoration (Krishnan et al., 2020).

🔍 What Does “Moving Differently” Mean in Practice?

• It may include using adaptive devices, asymmetrical gait, altered balance strategies, or conscious compensation for lost function.

• The best strategies focus on enabling patients to solve real-world movement problems, not forcing textbook steps or speed.

• For stroke survivors, compensations might include “hip hitch” or circumduction for foot clearance; for those with MS or post-TBI, targeted step-length or speed changes may support safe home navigation.

• For those who need an AFO, the forces applied by the AFO can mean we can’t get normal dorsiflexion and plantarflexion, and this means focussing on using quads, hamstrings and glutes in more dynamic swing and braking.

🧩 Therapist Toolbox: Choosing What to Train

👀 Clinical Example

A stroke patient could not restore ‘normal’ stride symmetry. After moving from standard gait retraining to a program emphasizing uneven step practice, obstacle negotiation, and use of a cane only on tough terrain, the patient’s community ambulation improved—and falls fell by 70%.

🚧 Common Therapist Dilemmas—and Solutions

• “Aren’t compensations dangerous, or a sign of giving up?”
  Solution: Not all compensations are equal. Train patients to use safe adaptive strategies, monitor for maladaptive habits, and revisit restoration goals regularly.

• “How do I measure progress if movement looks ‘abnormal’?”
  Solution: Track independence, participation, and incident metrics (falls, fatigue), not just appearance on the clinic walkway.

🚀 Quick Action Tips for This Week

1. Review one case: What specific real-world movement problems matter most to this patient?

2. Audit current therapy: Is the focus on textbook gait, or context-driven adaptation?

3. Trial an alternative task (steps with variable obstacles, functional device use, navigation under distraction)—and measure the difference in outcomes.

4. Watch your language - how we shift the idea is important so patients don’t view the deviation from normal as a failure.

📚 Further Reading

• Learning new gait patterns is enhanced by specificity of training

• Learning the spatial features of a locomotor task is slowed after stroke

• Rest the brain to get new gains in stroke

📝 Reflection for Clinicians