1. Ambulation & Transferring Waleed Al-Shehri,BCs.PT King Saud university College of applied Medical Science Rehabilitation Science Department Physical Therapy Program

2. What is Your First Priority With Patient ?

3. Walking Is the final and highest level of motor control. Major requirements for successful walking include: 1- Support of body mass by the lower extremities. 2- Production of locomotor rhythm. 3- Dynamic Balance Control of the moving body. 4- Propulsion of the body in the intended direction. 5- Adaptability of locomotor responses to changing task and environment demand.

4. Preparatory Exercises Ready a patient for assuming the upright position. Based on developmental framework & progress from initial activity with a large (BOS) and low (COM)  small (BOS) and high (COM). Mobility  Stability  Dynamic Stability  Skill.

5. Goals 1.↑ Strength, Power, and Endurance. 2.↑ ROM. 3.Improve motor function. 4.Enhance sensory integration. 5.Instruct the patient in handling and moving the effected extremities. 6.Develop postural stability in sitting & standing. 7.Develop dynamic stability. 8.Improve trunk and pelvic control. 9.Develop functional balance responses.

6. Bridging Pelvic Elevation

7. Quadruped Posture

8. Sitting

9. Sit-To-Stand

10. Kneeling and Half-Kneeling

11. Standing

12. Focus of ControlPreparatory Activity Lower trunk Hip/ Pelvis Lower extremities Bridging Trunk Proximal and intermediate upper extremities Proximal lower extremities Quadruped Upper Trunk Pelvis Proximal and intermediate Upper extremities Sitting Trunk Pelvis Proximal and distal lower extremities (Knee & Ankle) Reciprocal control of lower extremity Kneeling and Half- Kneeling Trunk Upper extremities Proximal, intermediate and distal control of lower extremities Modified Plantigrade Trunk Lower Extremities Standing

13. Assistive Devices

14. Canes

16. Crutches

18. Crutch adjustment With feet and crutches in the position shown, you should be able to place 2- 3 fingers between your underarm and the top of the crutches. While standing up straight and down in this position, the handgrips should be at wrist level. Your elbows should be bent at approximately 20 degrees

19. Crutch adjustment

20. Sitting down or standing up with crutches Hold the crutches in one hand, by the crutch handles. Place your sore leg forward. Grip the seat with the other hand. Lean forward, gently bend your good leg and lower yourself onto the seat, or gently straighten your good leg and push yourself up from the seat. Do not take any weight through your sore leg if you’re not allowed to.

21. Going up and down stairs Going Up: The uninjured or good leg steps up first as you bear weight through the crutches. The injured leg follows with the crutches. Make sure that you are close to the step before you start and that the injured leg clears the step as you step up

22. Going up and down stairs Going Down: Place the crutches on the step below, and then step down with the injured leg. The good leg then follows. Make sure the crutch tips are not too close to the edge of the step. If a handrail is available, then the crutches can used as one on the opposite side of the handrail. The sequence remains the same as without using a handrail.

24. walker

25. Transferring

26. 1 2 3 4