Ambulation - Its Importance and Benefits

What Is Ambulation?

Ambulation is defined as the ability of an individual to walk independently without needing assistance. This term is most often used in physiotherapy as a milestone after therapy or recovery from surgery. For some patients, ambulation might require assistance for some time before they can walk independently.

Why Is Ambulation Important?

Ambulation is important in patients with chronic illnesses who are bedridden and also in those who have undergone surgery. Prolonged immobilization can cause many complications, such as bed sores, deep venous thrombosis, and a higher risk of infections. Deep venous thrombosis refers to a condition in which blood clots are formed in the deep veins of the lower extremities most often.

What Are the Assistive Devices Used for Ambulation?

Many assistive devices are used to help in ambulation. Some of them are:

1. Canes: It is a device that is held in the hand opposite to the affected lower limb. At the same time, while walking, the opposite limb and the hand move together. Holding the cane in the opposite hand helps to reduce the stress on the affected lower limb. Originally canes were made from tree branches. Now tubular aluminum crutches are available, which are lighter and adjustable. Stability can be increased by adding extra legs, for example, a tripod and quad cane. The advantage is that it is free-standing, which enables the person to use their hands for other activities.

2. Walkers: There are several types of walkers. Some of them are:

• Parallel Walker: It is a miniature portable parallel bar that helps in walking without falling.

• Rollator: There are two rubber wheels in front and two rubber tips at the back. It helps in walking safely in carpeted areas.

• Forward Pusher: It consists of an adjustable type of hand grip and is mainly used for a child with cerebral palsy for teaching reciprocating gait (walking pattern).

3. Crutches: Crutches give better stability than canes as it has two-point contact with the body. There are two types of crutches. Axillary crutches provide better trunk support and can transmit as much as 80 percent of body weight. Non-axillary crutches transfer 40 to 50 percent of body weight.

4. Wheelchair: Wheelchairs are useful for patients that find difficulty in walking with assistive aids. It is also helpful in transferring patients to their beds. Proper lumbar support is necessary for a wheelchair. The back height should be low enough to avoid pushing the shoulders forward. When the back is too low, it causes excessive pressure at its upper edge. It will help in preventing and minimizing any injury or deformity that may occur.

5. Knee Ankle Foot Orthosis: These are assistive devices that help in moving the knee joint as it does not move in one single plane. It is given to reduce the excessive forces that are being applied to the knee. The orthosis is applied to the knee straight to reduce the bending of the knee.

Exercises to Improve Ambulation:

1. Range of Motion Exercise for Lower Extremity:

• Hip Rotation - The patient is made to sit on the bed, and the therapist puts one hand on the thigh of the patient and the other hand below the knee. Then the therapist slowly bends the knee at a right angle to the hip towards the chest. The therapist then slowly pulls the leg towards his body and then pushes it away. Then the leg is lowered to the starting position.
• Ankle Rotation - The therapist holds the ankle steady with the knee straight, and the other hand is placed around the foot. Then the therapist turns the foot inward and outward.

2. Range of Motion Exercise for Upper Extremity:

• Elbow Extension and Flexion - The therapist holds the upper arm with one hand and the forearm with the other hand. The therapist then bends the arm at the elbow so that the hand touches the shoulder. After which the arm is straightened back to full extension.

• Thumb Extension and Flexion - The patient is asked to move the thumb towards the little finger. Then the patient is asked to stretch the thumb outside.

3. Positioning Training:

The patient is trained on how to sit, stand, and walk. The patients who can move independently are also taught to maintain their posture while ambulating. While positioning the patient in bed, assistance can be made using pillows, blankets, and rolls. The patient is also taught how to get up from bed and lie in bed from a sitting position.

Important Points to Be Remembered During Ambulation:

• Proper posture should be maintained as it prevents back injuries and also provides balance and support.

• Patients should not keep their arms around their shoulders as it can lead to severe back injuries.

• Patients should not ambulate when there is a dizzy or fainting feeling.

• In the state of rehabilitation, ambulation should be done under the supervision of a therapist or a nurse.

• Proper wearing of orthoses and assistive devices is important to prevent falls.

• The patient can walk only after learning to stand independently.

• Adequate rest after ambulation is important to prevent fatigue.

• The surface of the floor is also important as slippery surfaces can lead to serious injuries if the patient trips and falls.

What Are the Benefits of Early Ambulation?

• Early ambulation helps improve circulation and accelerates healing.

• It ensures adequate oxygen supply, therefore, improving breathing.

• Blood clot formation in certain disorders can be prevented through early ambulation.

• The urinary tract function and bowel movements are improved through ambulation.

• It also helps improve muscle strength and improves independence.

• Patients will feel confident, and their self-esteem will be improved when they can do all their work on their own.

• Hospital stays will be decreased, and discharge will be earlier.

• In pregnant patients, ambulation before childbirth can help decrease the time of labor, and the need for analgesia is reduced.

• In patients with spinal cord injury, it has been proven that the healing period is shorter in early ambulating patients.

Conclusion

Ambulation is a very important part of rehabilitation and has to be done as quickly as possible after surgery. It has to be done after being medically cleared by a physician. Early ambulation helps in quicker recovery and accelerated healing. Assistive aids are also helpful in improving ambulation. After the patient has undergone a few weeks of rehabilitation, the patient will find it easier to walk without any help or assistive aids.