F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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or orderly may at first assist the sitting down procedure by standing at the patient's side
holding one arm and hand round the front of the patient's waist and the other hand
gripping the back of the patient's trouser waistband.
Preliminary exercises to walking
These consist in mobilizing the pelvis and are of particular importance for the four-point
gait. The patient is taught to tilt the pelvis alternately right and left upwards, in lower
lesions with both the abdominal and trunk muscles, in lesions above T6 mainly with
latissimus dorsi and trapezius. The patient practises alternate right and left pelvic tilting,
standing in parallel bars and keeping his body as upright as possible. These tilting exercises
have proved most essential for increasing the strength and action of the abdominal and
trunk muscles as well as triceps. While carrying out pelvic tilting, the patient is taught to
swing the leg forwards and backwards and by standing parallel to one bar, to swing the
legs sideways. Furthermore, he has to learn to place his feet accurately on the floor.
This is particularly important in spastic lesions with preponderance of plantar flexor
spasms or contractures, and to overcome these he has to stand with the full weight of the
body on his heels.
Walking
In most paraplegics, even those with complete lesions of the upper thoracic and lower
cervical cord, walking capabilities can be restored to variable degrees. Walking exercises
are started in parallel bars, and the patient is taught to walk forwards, backwards and also
has to learn turning in parallel bars, which in itself is an excellent balancing exercise,
especially in transverse lesions above Tio (Fig. 24ib). He then continues in a walking
frame, before graduating to crutch walking. The writer's own design of a walking frame
for paraplegics and tetraplegics is equipped with hand-brakes on either side, which
increases safety and stability of the frame and gives the paraplegic greater confidence,
particularly in the beginning of walking exercises outside the parallel bars. Moreover, it
enables the paraplegic in the course of his training to walk not only in a forward direction
but also, by putting on one brake only, to turn towards the side of that brake, which in
itself helps to improve his postural control. Furthermore, the frame is equipped with a
seat with wedge-shaped cushion for resting during the exercise (Fig. 242). In all these
exercises, time and distance are gradually increased. Naturally, the walking capabilities
of a paraplegic, especially those with higher lesions, will always remain limited, but,
however small it may be, it greatly increases his range of activity and independence
at home and place of employment.
Types of gait
Amongst the various types of walking, the following are taught as routine at Stoke
Mandeville:
Four-point gait.
The patient moves his left hand forwards, along the bar, then swings the
right leg through by tilting the pelvis upwards. He now transfers the body-weight on to
