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CHAPTER 33
On getting up in the parallel bars, the patient has to lean forward and place his hands
along the bars as far in front of his body as possible. Furthermore, he must place his feet
on the ground, with legs kept in extension by calipers or walking plasters, at such an
angle as to prevent them from slipping forwards during the act of pulling himself up on
to his arms. In due course, paraplegics with strong arm muscles can acquire the tech
nique of an athlete in getting on to the parallel bars—i.e. swinging their feet forward
along the floor, pushing up quickly on to their arms and swinging their feet backwards.
Balance in standing position without corsets is at first maintained under visual guid
ance—i.e. by placing a mirror in front of the patient, so that he can correct his postural
disturbance, until the new scheme of postural sensibility along the normal back muscles,
mentioned previously, is sufficiently developed. Paraplegics with low and mid-thoracic
lesions may eventually learn to keep their balance in standing position by supporting
themselves with one arm only on the parallel bar and throwing and catching a ball or
sandbag with the other hand. Balancing exercises in standing position are also helpful
for improving the patient's confidence and skill when later he graduates to the use of
crutches. When standing with crutches, he leans on one crutch and lifts the other forward,
sideways and upward.
Paraplegics with complete lesions above T5, where the splanchnic control is crippled
and consequently the circulatory adaptation to sudden change of posture is inefficient,
may complain about a feeling of giddiness and fainting, during their first standing exer
cises. Therefore, the paraplegic should be warned not to get up too quickly and, more
over, the period of standing in these cases should be increased only very gradually. In
due course, the patient learns to overcome the circulatory disturbance by contracting his
back muscles or by deep inspiration.
The great therapeutic value of daily standing and walking exercises, and the need for
the paraplegic to continue these permanently at home, after leaving hospital, should
always be stressed. In particular, their beneficial effect in the restoration and main
tenance of a good blood circulation, in promoting a satisfactory renal and bladder
function, in overcoming spasticity, and in preventing contractures of hip and knee
joints and obesity should be fully explained to the patient and his attendants, the more
so as some patients have the tendency to discontinue standing exercises at home.
Paraplegics with spastic lesions, who have developed a preponderance of extensor
spasms, may be taught to use them advantageously for standing without the aid of
appliances. In this connection, attention may also be drawn to the beneficial effect of
weight-bearing on bone growth by standing exercises in paralysed children.
In the beginning of standing exercises, the physiotherapist's position in relation to
that of the patient is important to control his dysbalance. She should stand behind the
patient holding one hand over the iliac crest and her other round the chest wall (Fig.
224).
Sitting down from the standing position has also to be learned, under supervision.
This should be done slowly, to prevent the legs from slipping forward, and at first the
physiotherapist has to assist by holding the feet and pressing them to the floor (Fig. 2413).
In particular, the patient must be taught to avoid sitting back into his chair with force,
and knocking his ischium against the chair. In lesions above T6, a second physiotherapist
