Jul 30

Working Without Parallel Bars

One of the first things noticed by prosthetist as they enter the gym at Bankstown-Lidcombe hospital is the lack of parallel bars. As they make their final modifications before the patient starts off for their first walk, their eyes gaze around wondering whether it is just an illusion that they cannot see the parallel bars. Finally they ask “So, umm …… where are the parallel bars”. In fact there are no parallel bars in the entire hospital.

Based broadly on two principles: First a study by Cordo and Nashner (1982) that demonstrates if you hold on when you are standing your arms become your postural muscles; and second that people don’t have parallel bars in their homes, it was purposely decided when the physiotherapy gyms were being designed that there would be no parallel bars added.

There is a strong emphasis on strength training and part practice in the physio department. Weight bearing exercises are the priority and this is achieved through such exercises as hip and knee extensions using a sliding tiltable (the reverse leg press), sit to stand practice, stepping up onto a block, stepping practice as well as lots of walking.

Stepping practice without parallel bars

Stepping practice without gripping parallel bars

Understanding that the majority of amputees can’t simply put on a new prosthesis and mobilise we use flat surfaces such as standing tables and plinths to assist patients when they start to increase their weight bearing on their prosthesis. The advantages of using flat surfaces for support when practising, is that they are forced to use their hip extensors to propel them forward, rather than just using their arms to pull themselves along the parallel bars.

Working without parallel bars can be a scary thing for some physiotherapists initially, however it has the ability to expand your clinical reasoning skills. It forces you to analyse the environment used for each patient and promotes reflection about your clinical decision making.

Daniel Treacy
Senior Amputee Physiotherapist,
Bankstown-Lidcombe Hospital, Sydney, NSW

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