Learning to remain upright in a standing position is the first step in ambulating. If the lower extremities are not innervated as a result of the injury, posture and KAFOs (knee-ankle-foot-orthoses which stabilize the feet, ankles, and knees) are the keys to balanced standing. The patient:

  1. Stabilizes the hands on parallel bars (or crutches)

  2. Retracts the scapulae and throws the head back to thrust the pelvis forward. In this position, the weight line falls posterior to the hips and the hips are momentarily extended (and therefore stable). If the hips momentarily flex, the weight line will fall anterior to the hips, and the patient will lose stability and "jacknife" as a result.

  3. Frees at least one hand while standing balanced; this is necessary if functional ambulation is to be achieved

The PoinTIS SCI Physical Therapy site of the SCI Manual for Providers is based on information in Spinal Cord Injury: Functional Rehabilitation, by M.F. Somers, Norwalk, CT, Appleton & Lange, 1992, and information in "Respiratory Rehabilitation of the Patient with a Spinal Cord Injury", by J.L. Wetzel, B.R. Lunsford, M.J. Peterson, and S.E. Alvarez, Chapter 28 in Cardiopulmonary Physical Therapy, S. Irwin and J.S. Tecklin, eds., St. Louis, Mosby, 1995, unless otherwise indicated.