fundamentals
Physical Therapy (PT)
Ambulation exercises
Walking (ambulation)—independently or with assistance—may be the main goal of rehabilitation. Before starting ambulation exercises, people must be able to balance while standing. To improve balance, people usually hold onto parallel bars and shift weight from side to side and from front to back. To keep them safe, the therapist stands in front of or behind them. Some people need to improve a joint's range of motion or muscle strength before they start ambulation exercises. Some people need an orthotic device such as a brace. For people who have difficulty walking, learning to safely move from bed to a chair or from a wheelchair to a toilet can help them live independently. When people are ready for ambulation exercises, they may begin on parallel bars, then progress to walking with mechanical aids, such as a walker, crutches, or a cane. Some people need to wear an assistive belt, which the therapist uses to prevent them from falling. As soon as people can walk safely on a level surface, they may be taught how to step over curbs or to climb stairs. When climbing up stairs, they are instructed to step up with the unaffected leg first. To climb down stairs, they are instructed to step down with the affected leg first. The phrase "good is up, bad is down" can help people remember. Family members and caregivers who help people walk should learn how to support them correctly. If a person needs support while walking, family members or caregivers can place their arm under the person’s arm and gently grasp the forearm. Then they should lock their arm, pressing their upper arm firmly against the person’s upper arm. Thus, if the person starts to fall, support is provided at the person’s shoulder. The person may wear a special belt that caregivers can grasp from the back, if needed, to steady the person. 