Correction of Sit-to-Stand

CASE: The patient is a 57 yo male who had a CVA with L-sided hemiplegia in 2018. He was hospitalized in 04/2022 due to arrhythmia, and was transferred to the SNF on 04-18-2022. I treated the patient on 05-20-2022.

When I asked the patient to transfer from sit-to-stand, he was exerting a substantial amount of effort, and still required extensive assistance to complete the task. The video on the left was taken later as an after-thought to illustrate his difficulty in performing the task. He originally attempted to stand up in a "chaotic" manner, with quick bouts of pulling to stand using his right upper extremity while at the same time going into trunk extension while still sitting, illustrating sufficient strength but severely impaired coordination and timing to be successful in completing the task.

Using the tubing freed me from providing the extensive physical assistance required during the transition from sit-to-stand , and allowed me to provide manual cuing to facilitate correct timing and to address missing components of the transfer task. I was able to cue forward progression of the trunk, hip extension, and knee extension, with the patient (and me)  secure that he is not going to fall.

It is unfortunate that I only treated the patient once, and that this controlled transfer from sit-to-stand will not be replicated during a few more sessions.

This can be adapted to the home health setting using a chin-up bar as  a point of attachment. This brings up critical considerations when using this technique.

1. The tubing has to be checked before and after every treatment session for nicks or bruises. Old, unused tubing can become brittle.  Use tubing with "back-up" connection, inside or outside the tubing.

2. Points of attachment outside the patient has to be fixed, negating the chance of creating a "sling shot."

3. Velcro used in patient straps becomes ineffective over time. They need to be replaced regularly.

ALTERNATIVE SET-UP

This activity can be performed at home with alternative equipment: (1) C-clamp, (2) black bungee cord and (3) climbing harness. This will allow weight-bearing, weight-shifting, sit-to-stand, and  standing with minimal assistance (depending on  the bungee cord used). The duration and number of repetitions are determined by patient fatigue (and not caregiver fatigue).

USE HOME-MADE EQUIPMENT or PERFORM THESE EXERCISES AT YOUR OWN RISK. Ask a physical therapist for guidance and assistance.