Why is it very important for patients to be able to perform sit to stand movements independently?
If they need assistance with sit to stand they are usually discharged to a nursing care facility or need a full time caregiver
What are 3 prognosis indicators of sit to stand for individuals with hemiplegia?
knee extension force
standing balance
symmetry in standing
What are common patient identified problems related to difficulty with sit to stand?
“I need help to stand up from my couch”
“It requires so much effort to stand up”
“I feel like I’m going to fall when I stand up”
What are the four critical events for sit to stand? What are the events that take place in each?
Flexion momentum (initial foot placement backward ~10cm behind knee and momentum generation at the trunk)
Momentum Transfer (continued flexion of the hips with ankle dorsiflexion)
Extension (sequence of lower limb extension ((knee hip and ankle)))
Stabilization (ankle strategy)
What are the main outcome measures for sit to stand?
Measures which require efficiency in movement- 5 x sit to stand (poor efficiency if over 12 sec.) timed sit to stand (poor efficiency if over 4.5 sec.) and 30 sec. sit to stand tests
Measures which allow assistive devices during the transition- timed up and go (TUG)
Measures which examine ability to transition- BERG, Functional independence measure, gross motor function measure, dimension D (GMFM-D)
What control parameters can be altered for sit to stand movements?
- Speed of the movement (rapid trunk lean=less effort, slow trunk lean=more effort, during extension and stabilization faster movements are harder to control)
- Foot position (symmetrical foot position=reduced STS time)
- Seat Height (higher seat height=less effort)
- Armrests (no armrests reduces STS time)
- Chair cushion (increased cushion thickness requires more hip flexion)
True or False: Feedback (both auditory and visual) improves sit to stand but the feedback must be faded
True
True or False: Standing calf stretch combined with repeated task practice of sit-to-stand improves independence of sit to stand performance
True
How would you promote timing for sit to stand movements?
Increase speed of the movement
How would you promote activation of sit to stand movements?
Increase size of movement; decrease facilitation
What are atypical movement patterns during the flexion momentum phase of sit to stand?
- reliance on arms
- insufficient trunk speed and flexion
- insufficient ankle dorsiflexion (get feet back)
What are atypical movement patterns during the momentum transfer phase of sit to stand?
- Insufficient flexion of the hip, knee, and ankle
- asymmetry in loading
What are atypical movement patterns during the extension phase of sit to stand?
- Insufficient extension of knee and ankle
- insufficient extension of the hip and trunk
- asymmetry in extension
What are atypical movement patterns during the stabilization phase of sit to stand?
- Excessive Sway
- Insufficient extension of hip and trunk
Which muscle impairs the ability of a hemiplegia patients to get proper dorsiflexion?
How can you improve the poor timing of this muscle?
tibialis anterior
Rhythmic auditory stimulation (RAS)
FES to TA (with switch activation)
EMG biofeedback
How can you improve the reduced activation of tibialis anterior activation/force production in hemiplegia patients during sit to stand?
- decrease friction (trash bags or socks on tile floor to slide feet back)
- Target Training (provide a visual or tactile target for foot placement)
- FES to TA
- Seated Stool Walking (promotes forward tibial translation with foot fixed)
How can you improve the reduced gastroc-soleus flexibility in patients during sit to stand?
- whole practice with active-dynamic stretching
- HEP for stretching
How can you improve the reduced ankle proprioception in patients during sit to stand?
- visual or joint position feedback improves sit to stand
- target training (first with EO then EC, can cause tactile cues as target with EC)
- Approximation
How can you improve the excessive gastroc/soleus activation/spasticity in patients during sit to stand?
EMG Biofeedback while moving feet backward
What is the order in which lower limb joints extend in the extension phase of sit to stand?
Knee-Hip-Ankle
How can you improve the impaired force production of rectus femoris and/or paraspinals in patients during sit to stand?
trunk target training during forward trunk momentum change speed/amplitude-Add resistance as appropriate to increase motor unit recruitment
-C-curve training
What is impaired fractionation during trunk momentum and what interventions can improve this?
- Impaired sequencing of gastroc/TA
- Impaired timing and sequencing of rectus femoris and paraspinals
Interventions
- Rhythmic Auditory Stimulation
- Target Training and visual feedback
- forced use
How can you improve the reduced force/power of the TA in patients during sit to stand?
- manual facilitation and approximation to drive knees forward
- target training to drive knees forward
- pulling forward on rolling stool
What causes asymmetric loading patterns during sit to stand?
inability to transfer weight to paretic limb
