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These exerci?es aim to improve walking on level surfaces either inde-pendently or with the assistance of a person or device. Before starting ambulation exercises. a patient may need range-of-motion and muscle strengthening exerciscs. II” individual muscles remai?? weak or spastic, an orlhotic device, such as a brace, ?nay be used. Training may begin on parallel biirs, especially if the patients balance is impaired, and pro-gress to walkîng with aids. such as a walker, erutehes. or cane. With some patienls, an assislive belt hdps the therapist prevent falls. Any-one assist?ng patients should know how to propcrly supporl them (sec FlG. 29-2).
If the patient will need to use stairs after rehabilitative therapy, train¬ing should slart as soon as thc patient can walk safely on level surfaces. Ascent slarls with thc belter leg, and descent with the afieeted leg (ie, “good is up and bad isdovvn”). A patienl who will be vvalking outdoors should be taughl how to step över a curb. Patients who usc vvalkers must learn special lechniques for traversing curbs or using slairs. Before diseharge. the social worker or therapisl should arrange to have secure hat?drails installcd along ali stairs in the palient’s home

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