special subjects
Physical Therapy (PT)
Ambulation exercises
Before proceeding to ambulation exercises, patients must be able to balance in a standing position. Balancing exercise is usually done using parallel bars with a therapist standing in front of or directly behind a patient. While holding the bars, patients shift weight from side to side and from forward to backward. Once patients can balance safely, they can proceed to ambulation exercises. Aides should place one arm under that of the patient, gently grasp the patient’s forearm, and lock their arm firmly under the patient’s axilla. Thus, if the patient starts to fall, aides can provide support at the patient’s shoulder. If a patient is wearing a waist belt, aides use their free hand to grasp the belt. Ambulation is often a major goal of rehabilitation. If individual muscles are weak or spastic, an Therapeutic and Assistive Devices (eg, a brace) may be used. Ambulation exercises are commonly started after using parallel bars; as patients progress, they use a walker, crutches, or cane and then walk without devices. Some patients wear an assistive belt used by the therapist to help prevent falls. Anyone assisting patients with ambulation should know how to correctly support them (see figure As soon as patients can walk safely on level surfaces, they can start training to climb stairs or to step over curbs if either skill is needed. Patients who use walkers must learn special techniques for climbing stairs and stepping over curbs. When climbing stairs, ascent starts with the better leg, and descent starts with the affected leg (ie, good leads up; bad leads down). Before patients are discharged, the social worker or physical therapist should arrange to have secure handrails installed along all stairs in the patients’ home. 