The ability to transfer from a seated position to standing (sit-to-stand [STS] transfer) or to another surface is an essential skill that many people who receive rehabilitation services need to reacquire after an injury or illness. Being able to transition from bed to wheelchair and from sitting to standing places the person in a position to begin locomotion and improves interaction with the environment. Although there are various types of transfers, the ability to transfer from a seated surface to standing (and back again) (Fig. 7.1) is the most basic and provides the foundation for other types of transfers. A person who cannot bear weight through his or her lower extremities (LEs) and stand (e.g., a person with a complete spinal cord injury [SCI]) may transfer from one surface to another (e.g., wheelchair) using a sit-pivot technique (Fig. 7.2). This chapter examines various training strategies that can be used to enhance a person's ability to perform these vital transfer skills.
A patient with stroke (left hemiparesis) transfers from sitting to standing.
A patient with T12 incomplete SCI transfers from a wheelchair to a mat.
Task analysis using critical observation skills serves as the foundation for examining how the patient performs the task1 and for developing task-oriented interventions to improve the patient's ability to transfer. Analyzing how the patient performs the movement in combination with an examination of underlying body structure and function impairments allows the therapist to determine what factors may be causing the difficulties in performance. With this information, the therapist can then develop a plan of care (POC) designed to enhance motor learning and improve the patient's performance.
It is important to have a good understanding of the normal biomechanics of the STS and sit-from-stand motion. The therapist uses this information as part of the task analysis to compare how the patient is performing the task and to identify possible impairments that may be causing the functional limitations observed. Sit-to-stand is commonly broken down into two phases: pre-extension and extension.2 The pre-extension phase involves a forward or horizontal translation of body mass, and the extension phase involves a vertical translation of body mass. The point when the thighs come off the sitting surface (thigh off) is the transition between the two phases. This breakdown into two distinct phases is done to organize the clinical analysis of the movement. Normally, the movement occurs in one smooth motion.
Initially, most of the body mass is resting on the thighs and buttocks in a stable sitting posture (Fig. 7.3A). During the pre-extension phase, the upper body (head and trunk) ...