My walking ability worsened after I stopped physical therapy. What could be the cause?
Signs of regression that relatives can observe, and how to continue training at home.
Gradual decline is normal; sudden weakness is an emergency.
Research by 11 people, 2008.
The effects are more pronounced in those over 65 years of age.
WHO guidelines for the elderly.
Call 1669 immediately.
While at the rehabilitation center, my father was walking further. A few weeks after returning home, he started getting up more slowly and taking shorter steps.Many families believe the illness is worsening. Reduced physical activity may be one cause, but it could also be due to new illnesses, infections, dehydration, effects of medication, low blood pressure, pain, or depression. Therefore, the cause should be evaluated, and it shouldn't be concluded that decline is solely due to reduced physical activity.
General information; this is not an individual training program.
The content in this article
1. My walking ability worsened after stopping physical therapy. What could be the cause?
Short answer:One common cause is deconditioning, or in stroke patients, learned non-use of the weakened side. However, it's important to rule out other conditions such as infection, dehydration, medication, hypotension, pain, and depression.
- Lie down or sit more.A study published in J Gerontol (2008) had 11 healthy elderly volunteers rest for 10 days. Isotonic knee extension strength decreased by an average of 13.2%, but physical performance tests in this study did not show a significant change. Limitations include the small size and the fact that the participants were generally healthy, so this study does not predict the same level of walking loss for all patients.
- Stop training.A review of 103 studies (2013) on resistance training interruptions found that longer interruptions and older age were associated with greater strength loss. However, many studies excluded patients with underlying medical conditions, so these studies support the principle of detraining, but are not specific predictors of stroke.
- Stop using the weaker side.A stroke patient may be able to move the weakened side when told to, but in real life, they use the better side instead. Therefore, the weaker side is used less and less over time (Taub et al., 2006).
Recession is inevitable.A follow-up study of 148 stroke patients who completed inpatient rehabilitation (2006) showed that in the second year, 12% had a decrease of at least 2 points in the Rivermead Mobility Index. Depression was the only significant predictor (OR 4.2, 95% CI 1.3–13.2).
Sitting for longer periods of time, little by little.
2. Sudden weakness may not be a regression, but rather a repeated stroke.
Short answer:Weakness from underuse usually becomes noticeable gradually over several days to weeks. If you experience sudden weakness, especially on one side, facial drooping, slurred speech, dizziness, unsteady gait, or blurred vision, call 1669 immediately. Do not wait to see if the symptoms develop.
Call 1669 immediately.
• Sudden weakness or numbness in an arm or leg, especially on only one side.
• Facial asymmetry, drooping mouth, slurred speech, or difficulty understanding speech.
• Sudden dizziness, unsteadiness, loss of balance, or blurred vision.
• Severe headache unlike any you've experienced before, or feeling depressed.
Read more about warning signs here.BEFAST: Warning signs of a stroke.
If walking worsens rapidly, along with fever, lethargy, confusion, poor appetite, decreased urination, or a recent fall, have a doctor assess the situation on the same day.Don't wait until after your physical therapy appointment. Other reasons, such as certain medications, may also be an issue. Read more.Elderly people take many medications.And post-stroke fatigue. (Read more)Easily fatigued after a stroke.
3. Signs of decline that relatives can observe at home.
Short answer:Getting up from a chair takes longer, steps are shorter, more people need assistance, almost falls more often, or you sit or lie down for longer periods. You should record these changes and compare them to your own progress weekly.
- Stand up.I had to shift my body several times and push the chair armrests further.
- Walking and balancing.Shorter steps, dragging feet, gripping the wall more, nearly falling more often.
- Routines and emotionsNeeds more help. Doesn't want to get up. Depressed.
A simple way to take notes every week.For those who have previously been assessed and taught this exercise by a physical therapist: Time yourself to perform 5 sit-ups from a stable chair against a wall on a non-slippery floor. Have someone stand beside you. Stop immediately if you lose balance. Compare this to the previous week. If you consistently slow down, consult a physical therapist.
4. Excessive assistance from family members may reduce the patient's opportunities for practice.
Short answer:Assistance reduces the patient's physical exertion; they should be allowed to do things themselves that are safe, with family members supervising.
Context: A review in JAMA (2011) indicated that about one-third of patients over 70 years old experienced reduced daily activities after hospitalization. This study did not examine the behavior of relatives but pointed out that physical fragility is common in the initial period after discharge.
- Do it yourself first.Getting up, sitting down, washing face - relatives can help only with parts they can't do themselves.
- Use the weaker side.In simple, safe tasks, as taught by a physiotherapist.
Do what is safe for yourself.
5. Guidelines for continuing home training after physical therapy (general type).
Short answer:Move around every day, reduce prolonged sitting, and engage in balance and strength-building activities at least three days a week. Gradually increase walking as you can, and the posture and intensity should be determined by a physical therapist based on the patient's condition.
| frequency | What to do | Source |
|---|---|---|
| every day | Get up and change your posture, reduce prolonged sitting, and perform daily routines independently as much as is safe. | WHO 2563 |
| At least 3 days a week | Multi-component activities, moderate to high intensity, focusing on balance and strength. | WHO 2020 (Elderly) |
| At least 2 days a week | Strengthen all major muscle groups. | WHO 2563 |
| Accumulate throughout the week. | Walk or exercise at a light to moderate intensity, or use a walking aid or have someone support you as recommended by your physical therapist. | WHO 2563 · AHA 2557 |
This is a general guideline, not an individual program. Post-stroke patients should have their posture and intensity adjusted by a physical therapist.
Stop training immediately. If you experience chest pain or tightness, difficulty breathing, fainting, loss of consciousness, or symptoms that do not improve with rest, or any of the symptoms described in item 2, call 1669 immediately.Minor symptoms that resolve with rest, such as slight palpitations or joint pain, should be discussed with a doctor before resuming training.
How much practice is enough? Read more at...How many hours of physical therapy per day are enough?
The posture and intensity should be determined by the physical therapist.
6. When should a physical therapist reassess your condition?
Short answer:When symptoms worsen continuously, leading to near-falls or falls, requiring more assistance, or experiencing new pain, stroke patients with long-standing conditions still have a chance to improve through training. Therefore, one should not wait until they are unable to walk.
The 2026 study (Physiother Res Int) was a single-group pilot study of 59 participants who completed the program. The average duration of the stroke was 41.87 months. After 8 weeks of the program, the ability to walk 10 meters and sit up 5 times improved to levels close to or exceeding the MCID claimed by the researchers. However, there was no control group, so it could not be concluded that the program was the cause of the changes.
"Returning home doesn't mean the recovery is over. We have to move forward little by little every day."
How does KIN help patients whose walking ability worsens after returning home?
KIN HomeCare's physiotherapists assess, create individual treatment plans, and monitor progress according to the rehabilitation standards established by Dr. Thanyachanok Chuthamasathit.
- Home Physical TherapyFor Bangkok and surrounding areas only: Assessment and program development based on patient condition, follow-up.
- Home caregiverWhether 12 or 24-hour shifts nationwide, help manage daily routines.
- Rent medical equipmentExamples include wheelchairs and hospital beds.
- I want to see a doctor.I have an outpatient appointment on Wednesday at Kin Hospital, Sukhumvit 107.
Consult KIN HomeCare | My walking ability has worsened after returning home.
Home physiotherapy available in Bangkok and surrounding areas only. Home caregiver services available nationwide.
KIN HomeCare
Home care services nationwide. Home-based physiotherapy available only in Bangkok and surrounding areas.
Home Physical Therapy095-767-6307
Home care · Nursing · Equipment rental061-881-9399
KIN Rehabilitation's Senior Rehabilitation and Care Center.
KIN Salaya
Buddhamonthon · Opening December 15, 2026 · Advance reservations are now available.
Central hotline:02-096-4996In case of emergency, call 1669.
Frequently Asked Questions answered by the KIN medical and multidisciplinary team.
My walking ability worsened after stopping physical therapy. Why?
One common cause is decline due to decreased physical exertion, but infection, dehydration, and medication must be ruled out. However, if the condition worsens suddenly or is unilateral, consider a recurrent stroke and call 1669.
How many days should I stop physical therapy before my muscles weaken?
Everyone is different. In 11 healthy elderly volunteers who were bedridden for 10 days, isotonic knee extension strength decreased by an average of 13.2%. However, this result is not a predictive value for all patients.
What should be done if a stroke patient returns home and experiences increased weakness on the same side of the body?
Sudden onset of facial asymmetry or slurred speech: Call 1669. Rapid worsening symptoms accompanied by fever, lethargy, or a recent fall: See a doctor the same day. If symptoms worsen gradually over several weeks, have a physical therapist reassess.
Can I practice walking at home, or do I need a physical therapist?
The position is as assessed and taught by the physiotherapist. Someone should stand beside the person, and a reassessment should be performed if the position worsens or the person nearly falls.
Do stroke patients need to do physical therapy for the rest of their lives?
It's not necessary to see a physiotherapist constantly, but you should consistently participate in long-term exercise programs (AHA) before stopping or reducing the frequency. The physiotherapist can then adapt the program into one you can do at home.
In which areas does KIN HomeCare offer home-based physiotherapy?
This service is available only in Bangkok and surrounding areas. Home-based care services are available nationwide. Please call 095-767-6307 for inquiries.
- Functional impact of 10 days of bed rest in healthy older adults — 2008
- Effect of training cessation on muscular performance — 2013
- The learned nonuse phenomenon — Taub E et al., Eura Medicophys, 2006.
- Change in mobility activity in the second year after stroke — 2006
- Hospitalization-associated disability — JAMA 2011
- WHO 2020 guidelines on physical activity — Br J Sports Med 2020
- Exercise recommendations for stroke survivors — AHA 2014
- Rehabilitation program for chronic stroke — Physiother Res Int 2026
Medical accuracy verified by Dr. Thanyachanok Chuthamasathit, License No. 62998, Medical Director of Rehabilitation Medicine | Supervised by Dr. Thongchai Chokthanomsap, Chairman of the Executive Board | Last updated: October 2026 |General information. This is not a personalized training program. For sudden weakness, call 1669. Research figures are not the result of KIN service users.