AT for balance and gait impairments

Patients with balance and gait impairments are at risk for falling (Volume II, Chapter 8). With training in the use of assistive devices, this risk may decrease. During AT intervention for falls, an increase in the frequency and duration of education can positively impact the safe and effective use of the device (Mann et al., 2002). When an individual initially obtains an assistive device, they are still likely to have a fear of falling. Simply moving from place to place within their residence may provoke anxiety, which further increases the person's risk of falling. The individual may rush through a transfer without using the assis-tive device appropriately and safely. Professional training is essential for safe and effective use of balance and mobility devices.

Grab bars are simple yet important devices that assist with impaired balance. They are usually made from metal but may be covered in a more attractive material. Grab bars are placed in critical locations in the home, such as near the toilet, bathtub, shower, and bed (Fig. 10.1).

There are several types of bathroom grab bar systems. These systems provide support during transferring on and off the toilet, during clothing management, and during pericare. For use by the toilet, grab bars may be floor mounted, wall mounted, wall to floor mounted, or attached to the toilet itself. A toilet seat with armrests may be installed to offer support (Abledata, 2004).

Grab bars in the shower or by the bathtub assist a person with a balance impairment in transferring safely in and out of the shower, and provide support while standing in the shower. Depending on the individual's needs, grab bars may be installed in several different configurations inside and outside of the shower/tub area. Grab bars can be attached to the shower wall or clamped to the side of the bathtub with a rubber-covered clamp (Abledata, 2004). The number and placement of grab bars will depend on how much support a person requires, and where the support is needed.

An individual with balance or gait impairment may benefit from a variety of devices when transferring in and out of bed including: a vertical pole, trapeze bar, or bed rail. The vertical pole extends from floor to ceiling. Often, a perpendicular arm extends from the vertical pole to facilitate grasping. A trapeze bar can assist a person in moving from a prone to sitting position, and is usually attached to the bed frame. Finally, a half-bed rail may be helpful in assisting people with rolling onto their side, sitting up, or moving from sitting to standing.

Handrails are also important in compensating for balance impairments. Stairs leading into the house or between floors should have at least one handrail. In some instances, handrails should be placed on both sides of the staircase. For a person with hemi-paresis, or weakness on one side of the body, handrails assist on one side when ascending a staircase and on the opposite side when descending the staircase. Moreover, some individuals use both handrails for added stability while climbing up and down stairs.

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