Sit to Stand Transitions

Question 1

Standing

Answer 1

• Stable static balance –optimizing initial conditions
• Trunk postural adjustments for the maintenance and restoration of balance
• Under steady state and active movement conditions
• Combining postural (trunk) movements with extremity movements to accomplish standing tasks and for transitional movements

Question 2

Sit to Stand Phase 1

Answer 2

• weight shift or flexion momentum stage
• generate forward horizontal momentum through trunk/hip flexion
• promote weight transfer anteriorly

Question 3

When does sit to stand phase 2 begin?

Answer 3

As the buttocks leaves the seat and involves the transfer of momentum from the upper body to the total body allowing lift off

Question 4

How is sit to stand phase 2 achieved?

Answer 4

With momentum from phase 1; vertical rise occurs through minimal LE muscle activation but is dependent on speed

Question 5

what is sit to stand phase 3?

Answer 5

• Lift or Extension Phase
• Extension of hip/knees
• Vertical center of mass motion
• Center of mass should be within base of support, therefore minimal stability requirements for stage

Question 6

What is sit to stand phase 4?

Answer 6

Termination: braking forward and up movement and achievement of stability

Question 7

6 essential features of sit to stand

Answer 7

• foot placement
• inclination of trunk forward by flexion of the hips with extended neck and spine
• movement of knees forward
• extension of hips and knees for final standing alignment
• adequate strength in LE and trunk
• Coordination between horizontal posture adjustments and vertical COM motion for stable termination

Question 8

major contributor to horizontal maximum linear momentum of the COM

Answer 8

head-arms-trunk

Question 9

is magnitude of momentum important?

Answer 9

• not really
• more important for termination

Question 10

what is a major contributor to vertical maximal linear momentum of COM

Answer 10

• thigh
• changes considerably with changing speed

Question 11

initiation too fast

Answer 11

consider instructions

Question 12

initiation delayed

Answer 12

altered preparation

Question 13

What would you see if initiation of standing was altered due to delayed postural adjustments

Answer 13

increased body motion/instability in execution

Question 14

possibilities of reduced speed and amplitude in execution of standing

Answer 14

• Weakness –consider type of contraction, strengthen functionally (AAROM/AROM with respect to gravity), facilitation.
• Sensory –augment, recalibrate, substitute
• Hypertonia –slow stretch, inhibition techniques
• Do you observe altered direction?

Question 15

Termination of movement in standing-braking

Answer 15

• Motor planning (preparation)
• Practice slower, less-challenging tasks, shape into more challenging tasks
• Use of sensory information (feedback during movement)
• Augment, substitute, predictive strategies (what to feel, look for, expect)

Question 16

Asymmetric foot placement

Answer 16

consistently patients will have non-involved foot more posterior to do primary job of lifting through unaffected leg and weightbearing through
unaffected limb; want symmetry and to encourage use of involved side

Question 17

How should feet be in the initial conditions?

Answer 17

on the ground, symmetric, and ready for weight bearing

Question 18

Things needed to achieve good initial conditions

Answer 18

• scoot forward
• foot placement
• trunk engagement

Question 19

Fear

Answer 19

provide encouragement for weight shifting forward, provide words of support, provide targets to move forward to

Question 20

how can learned disuse occur during stand to sit?

Answer 20

if the patient significantly leans to the uninvolved side and does the full transition on uninvolved limb

Question 21

Considerations for treating - Seat height/surface

Answer 21

Higher the surface less lift needed- HI/Low mat table is firm and can be raised- can adjust height up or down to make more/less challenging

Question 22

considerations for treating- Wheelchair

Answer 22

provides back support for stand to sit transition- if patient having difficulty with descent can transition between chairs with support to surfaces without support

Question 23

Considerations for treating - firmness of surface

Answer 23

mat and wheelchair pretty firm; can transition to bed, cushioned chair in hospital or clinic; recliner chair or chair on wheels would be even more challenging (if safe)

Question 24

Considerations for treating - UE support

Answer 24

Can transition between pushing off from chair, surface next to person to no pushing
off

Question 25

considerations for treating - UE support in standing

Answer 25

Wall rail/Parallel Bars (allows patient to pull- don’t like them but sometimes have to); counter top or raised mat table- very stable but patient must push through; WBQC, NBQC, RW (depending on if knee blocking may not be best), SC

Question 26

what can use of AFO do?

Answer 26

negatively impact ability of involved side tibia to forward progress

Question 27

considerations of stand pivot transfer

Answer 27

Need trunk control, relatively good hip and knee control, and ability to lift/move each leg

Question 28

can you use equipment for stand pivot transfer?

Answer 28

yes
if going to be doing walking with a device, use it