FUNCTIONAL REHABILITATION: AMBULATION: FALLING SAFELY/COMING TO STANDING FROM THE FLOOR

     The ability to fall safely and to come to standing from the floor is needed to ambulate, since ambulation involves falling. Following are the physical and skill prerequisites for falling safely and assuming a standing position from the floor.

  1. Physical and Skill Prerequisites
    • Greater than normal strength in the serratus anterior, pectoralis major, and triceps, and normal strength in the deltoids, the biceps, brachialis, and/or brachioradialis, and in the wrist and hand musculature, needed to fall safely and come to standing from the floor
    • Normal strength in the trapezius is needed, and some strength in the abdominals is helpful to come to standing from the floor
    • Greater than normal range of motion in scapular upward rotation, shoulder flexion and horizontal abduction, elbow, hip, and knee extension, and in combined hip flexion and knee extension, needed to come to standing from the floor
    • Normal range in scapular elevation and downward rotation, shoulder extension, internal rotation and horizontal adduction, and in ankle dorsification needed to come to standing from the floor
    • Normal range in scapular abduction and adduction and in elbow flexion needed to fall safely and come to standing from the floor
    • Ability to throw crutches and catch self on hands needed to fall safely
    • Ability to position self in proneand position crutches to stand; achieve dynamic balance in plantigrade and modified plantigrade; walk hands toward feet, grasp and position crutch in plantigrade; grasp and position second crutch with one hand on first crutch, and push torso to upright supported on two crutches in modified plantigrade; and walk crutches back while standing with crutches positioned forward, to come to standing from the floor

  2. Functional Skills
    • Falling Safely - When falling, the patient:
      • Throws the crutches laterally, or laterally and posteriorly, away from the path of the fall, and gets the tips of the crutches off the floor, to prevent injuries from landing on a crutch or excessive force on the arm
      • Allows the elbows and shoulders to "give" as he/she lands on the palms, to prevent the arms from being in a rigid position when he/she lands on them
    • Assume Standing Position from the Floor - The patient:
      • Assumes the prone position (with the hips adducted and externally rotated), places a crutch to each side of the body (with the crutch tips pointed away from the feet and the grips placed at or caudal to the level of the greater trochanters), and places the palms on the floor next to the shoulders

      • Lifts the pelvis from the floor, by pushing down and forward while tucking the head, to move from prone to plantigrade, and then, with the pelvis as high as possible, keeps the head tucked and walks the hands toward the feet as far as possible, to elevate the pelvis further and place the legs in the most vertical position

      • Shifts the weight to and balances on one hand, and grasps a crutch with the unweighted hand

      • Balances on one crutch, by aligning the tip of the crutch with the midline of the torso, grasps the second crutch with the free hand and positions it on the forearm

      • Shifts the weight onto the second crutch, positions the first crutch on the arm, supports the body on both crutches, pushes the pelvis forward, assumes a standing position, and walks the crutches back until an upright position is 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.