Rehabilitation options

Here are rehabilitation options for a patient who:

• Requires assistance to Sit to Stand; and
• Unable to transfer weight forward and load affected leg

In the bedroom

Sit to Stand with assistance of two 

Aim:

• Improve Sit to Stand independence.
  
  

Set-up:

• Bed at 55 to 60cm to decrease assistance needed.
• Firm mattress.
• Non-slip mat under feet. 

"On the count of three, Shoulders forward quickly and stand up"

Mr T currently requires the assistance of two for sitting balance and assistance of two for sit to stand. He has significant weakness of all left leg muscles, reduced sensation of the left leg and a mild left sided neglect.

Therapist1 assists at upper back to bring trunk forward and helps to keep trunk stable. Therapist aims to minimise use of intact hand to maximise Mr T’s weightbearing on his affected leg. 

Therapist2 guides hip and knee extension. Therapist applies as little force as possible to maximise Mr T’s weightbearing on his affected leg. 

Variations

• Non-slip mat under buttocks if concerned that the stroke survivor may slide forward when sitting down.
• Table in front to increase hip extension.
• If using air mattress, can fully inflate it to provide firm seat.
• Therapist on affected side could sit on stool to guide knee extension if less assistance is required.
  
  

Changing the level of difficulty

Decrease difficulty:

• Increase height of bed.
• Use table in front so stroke survivor can use intact hand on table to bring weight forward.
  
  

Increase difficulty:

• Decrease height of bed.
• Decrease therapist assistance.

In the therapy area

Sit to Stand part practice with assistance of one ​

Aim:​

• Improve rapid hip flexion in Sit to Stand. ​
• Improve Sit to Stand independence.​

​

Set-up:​

• Wall on intact side, therapist on affected side for safety.​
• Plinth at approximately 55 cm high to decrease thigh support.​
• Table in front as a cue to indicate reaching forward.​
• Stopwatch to time repetitions.​

"Reach forward to touch the table 10 times as fast as you can"

Mr S currently requires standby assistance of one for sitting balance and Sit to Stand. He has significant weakness and loss of co-ordination of all left leg muscles.​

Therapist stays close on affected side to provide assistance as needed. Therapist tells Mr S how long each set of 10 repetitions takes to encourage him to increase his speed.​

Variations

• Non-slip mat under buttocks if concerned that the stroke survivor may slide forward on the plinth. ​
• Non-slip mat under feet if concerned that feet may slide forward. ​
• Manual guidance e.g. therapist pushing downwards through the affected knee, if not transferring weight forward onto the affected leg during reaching.
  
  

Changing the level of difficulty

Decrease difficulty:

• Decrease height of bed, increase thigh support.​
• Decrease distance to cue in front to decrease amount of hip flexion. ​
• Decrease speed.​

   

Increase difficulty:

• Increase height of bed, decrease thigh support.​
• Increase distance to cue in front to increase amount of hip flexion. ​
• Increase speed. ​