Chapter 35: Functional Activity Intervention in Sitting

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Describe normal patterns of movement in sitting.

2. Describe possible impairments underlying abnormal movements in sitting.

3. Identify safety considerations for the management of individuals with altered function in sitting.

4. Identify and describe components of an evaluation of function in sitting.

5. Describe appropriate interventions for various individuals who present with altered function in sitting.

6. Design appropriate goals, expected outcomes, and plan of care for a given patient with sitting dysfunction.

Introduction

Performing activities in sitting is essential to daily function. How much time we spend in sitting depends on our work/play/life demands, but it can be quite significant (e.g., working at a computer, attending meetings and conferences, reading, studying, and driving). In addition, many activities of daily living (ADLs) and instrumental activities of daily living (IADLs) take place in sitting, such as eating meals, toileting, putting on socks and shoes, writing, watching movies or sporting events, and paying bills.

Take a moment to review your day and identify just how much time you spent sitting. What activities did you do in sitting? How many activities required sitting, or did you choose to do them in sitting rather than in standing or in another position?

Because we spend so much time functioning in sitting, this is an important area to remediate or restore in our patients. This chapter focuses on functional activities in sitting such as seated scooting and transfers, as well as fostering the trunk control needed for these activities. Interventions specific to upper extremity (UE) function in sitting are addressed in Chapter 33.

Typical Characteristics/Patterns of Movement in Sitting

The terms sitting and seated position describe a posture in which the trunk is generally upright, with the base of support consisting mostly of the ischial tuberosities and perhaps the posterior thighs and feet. During sitting activities, the trunk moves in one or a combination of three planes of movement: flexion/extension, lateral flexion, and rotation. Furthermore, the head, trunk, and extremities move together in typical patterns depending on the task demands.

In addition to being able to isolate and separate movements of the upper and lower trunk in sitting, an individual must be able to combine trunk movements with UEs or lower extremities (LEs) to perform a functional task while maintaining balance and equilibrium under changing environmental contexts (e.g., feet on the floor or dangling, sitting with or without back support, sitting on a high stool, sitting on surfaces of varying compliancy).

A variety of head movements occur normally depending on the task at hand in sitting (Campbell, 2001). Campbell identified no consistent pattern of head flexion/extension during reaching; however, subjects tended to rotate their heads opposite to the direction of the reach slightly (12 ± 10 degrees). Table ...