level for PHYSIOLOGICAL AMBULATION ?

[shahidheera]

for a patient of paraplegia what is an ideal level for physiological ambulation, can any body tell me ?

[perfphysio]

Ideal is an interesting term. Having wrked in spinal rehab and in disabled sport at an international level I would say it comes down to the energy cost involved and hence quality of life. Anyone with their abdominals intact can walk with calipers, some more easily than others, but it costs alot in effort and time. One could easily zip down the street in a wheelchair, so why walk you might say???
Some basic gluteal strength and some L2 motor control would be nice however the individual has to be careful of knee hyperextension and the long term effect of this in ambulation. I am sure the other neuro PT's will have sound ideas but in my experience, teach them to walk if they want to try, let them then store the calipers in the hall cupboard for a rainy season. Most need to try and make their own decisions based on their individual experience. Oh and get along to a disabled sporting event to really see what people can achieve with a minimal amount of innervation.

[reeces]

It depends on what muscles (the muscles that are working) the paraplegic has. A T10 complete paraplegic should be able to work swing to/through with calipers and 2 crutches. T11/T12 one gets the quadratus lumborum which hitches the pelvis up laterally - thus, one can teach 4 point gait with calipers and 2 crutches. L1 - the client has hip flexors making it easier to do 4 point gait with crutches and calipers. In all of the above cases, the gluteals are paralysed, thus it is essential to train balance and walking while maintianing hip extension beyond neutral (using the abdominals). This is just a guideline - it also depends on the client's motivation and other factors - fitness, age, social background. Hope this helps? Try looking at "Tetraplegia and Paraplegia by Ida Bromley" - it is a fantastic textbook, it basically covers everything on SCIs.