After reading this chapter, the reader will be able to:
Understand mechanical leverage and its application to functional mobility
Describe how the principles of motor learning can be applied to mobility skills
Understand the fundamental elements of joint protection for the preservation of joint integrity in both the paralyzed and the intact limbs
Describe the strategy for teaching balance to a newly spinal cord-injured individual
Understand the basic mechanism of an efficient short-sitting transfer
Discuss factors that contribute to optimal wheelchair push mechanics
Mobility after spinal cord injury (SCI) requires the acquisition of new movement strategies and skills. The individual with a recent SCI is has altered voluntary control over his or her body and must learn to use it to acquire an entirely new set of mobility skills. These skills include the ability to move within a wheelchair, to move forward and back on the seat, to move from side to side, and to pick up a leg and cross the foot over the opposite knee. Mobility also includes the ability to move on a bed, to roll to either side or from prone to supine position and back to prone, to get up from supine to sitting position, to move over in the bed or off the bed, and to lift the lower extremities up onto the bed or off the bed, among other abilities. All of these functional tasks require relearning after SCI. Mobility is important as it represents the ability to get around in the environment, but it is important for other reasons as well. Immobility can cause pain, discomfort, and skin breakdown. Immobility can also lead to frustration, hopelessness, and even depression. Through mobility training, the therapist empowers the individual with SCI by providing opportunities for early and successful movement, while attending to issues such as passive range of motion, joint integrity, skin health, and optimal postural alignment.
For individuals who will not return to walking as the primary means of over-ground mobility, skilled wheelchair use is the key to independence. An understanding of body mobility is a prerequisite to skilled wheelchair use and to the ability to transfer (i.e., to move from one seated position to another seated position). In addition, the ability to maintain balance during movement (i.e., dynamic balance ability) and the ability to stop or change direction of a movement are essential to mastering independent mobility. These skills become intuitive with repeated practice and allow the individual to capitalize on the mechanical assistance provided by leverage and body (or body part) alignment in order to move the body fluidly into and out of the desired positions. The experienced therapist has an understanding of the fundamental concepts and essential elements of successful movement and is able to identify the optimal strategies and approaches to use to train the individual for independence in these skills.