Chapter 18: Spinal Cord Injury: Ambulation Skills

For the Instructor Guide and Worksheet Key please contact user services at userservices@mheducation.com

OUTLINE

Objectives:

The student will:

1. Effectively teach and safely guard a client with spinal cord injury (SCI) in sit to stand, standing, and pre-gait activities.

2. Effectively teach and safely guard a client with SCI in ambulation using parallel bars and loftstrand crutches.

3. Effectively teach and safely guard a client with SCI in negotiation of stairs and curbs, to optimize community ambulatory skills.

4. Describe and demonstrate locomotor training principles and manual assistance, including donning of a body weight support harness.

Introduction

Discuss introductory material with students as a group.

Activity 1. Pre-Gait Activities in the Parallel Bars

Practice teaching the client pre-gait activities in the parallel bars focusing on teaching to balance in standing and working on dynamic standing balance in preparation for gait.

Activity 2. Sit to/from Stand and Locomotor Training

Place students in pairs and have them practice the following activities switching so each practices the role of the therapist.

Sit to/from stand from the wheelchair with loftstrands—Three ways:

1. Come to standing using both hands on the wheelchair.

2. Come to standing using one hand on the wheelchair and one on the crutch.

3. Come to standing using both hands on the crutches.

Activity 3. Gait Training

Students practice the four different gait techniques typically utilized by individuals with paraplegia; first in parallel bars and then using lofstrand or axillary crutches.

1. Drag-to

2. Swing-to

3. Swing-through

4. Four-point gait

Activity 4. Falling and Coming Back up to Standing From the Floor With Crutches

Students practice teaching a client how to fall down and how to get back up from the floor after a fall.

Activity 5. Ambulation Up/Down Curbs and Stairs With Loftstrand Crutches

Students practice teaching client to ascend and descend a curb with loftstrand crutches and then to do the same on stairs.

Activity 6. Locomotor Training

Discuss the neuroplastic model of rehabilitation OR demonstrate treadmill training with body weight support.

WORKSHEET

Introduction

Typically, an individual who finds himself or herself in a hospital and unable to perform his or her normal activities has an immediate and strong desire to regain the ability to move the way she/he did prior to injury. Many individuals with spinal cord injury (SCI) immediately express the desire to be able to walk again. It is important for the therapist to recognize that underlying this desire is the need to regain independent mobility.

A ...