Sit to Stand Transitions Flashcards
Standing
- 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
Sit to Stand Phase 1
- weight shift or flexion momentum stage
- generate forward horizontal momentum through trunk/hip flexion
- promote weight transfer anteriorly
When does sit to stand phase 2 begin?
As the buttocks leaves the seat and involves the transfer of momentum from the upper body to the total body allowing lift off
How is sit to stand phase 2 achieved?
With momentum from phase 1; vertical rise occurs through minimal LE muscle activation but is dependent on speed
what is sit to stand phase 3?
- 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
What is sit to stand phase 4?
Termination: braking forward and up movement and achievement of stability
6 essential features of sit to stand
- 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
major contributor to horizontal maximum linear momentum of the COM
head-arms-trunk
is magnitude of momentum important?
- not really
- more important for termination
what is a major contributor to vertical maximal linear momentum of COM
- thigh
- changes considerably with changing speed
initiation too fast
consider instructions
initiation delayed
altered preparation
What would you see if initiation of standing was altered due to delayed postural adjustments
increased body motion/instability in execution
possibilities of reduced speed and amplitude in execution of standing
- 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?
Termination of movement in standing-braking
- 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)
Asymmetric foot placement
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
How should feet be in the initial conditions?
on the ground, symmetric, and ready for weight bearing
Things needed to achieve good initial conditions
- scoot forward
- foot placement
- trunk engagement
Fear
provide encouragement for weight shifting forward, provide words of support, provide targets to move forward to
how can learned disuse occur during stand to sit?
if the patient significantly leans to the uninvolved side and does the full transition on uninvolved limb
Considerations for treating - Seat height/surface
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
considerations for treating- Wheelchair
provides back support for stand to sit transition- if patient having difficulty with descent can transition between chairs with support to surfaces without support
Considerations for treating - firmness of surface
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)
Considerations for treating - UE support
Can transition between pushing off from chair, surface next to person to no pushing
off
considerations for treating - UE support in standing
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
what can use of AFO do?
negatively impact ability of involved side tibia to forward progress
considerations of stand pivot transfer
Need trunk control, relatively good hip and knee control, and ability to lift/move each leg
can you use equipment for stand pivot transfer?
yes
if going to be doing walking with a device, use it
