Chapter 36: Functional Intervention in Sit-to-Stand, Stand-to-Sit, and Standing

Chapter Objectives

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

1. Describe the biomechanical and motor control characteristics for sit-to-stand, standing, and stand-to-sit.

2. Identify at least three control parameters for sit-to-stand, standing, and stand-to-sit.

3. Hypothesize impairments of body structure/function that will interfere with the functional skills/activity of sit-to-stand, stand-to-sit, and standing.

4. Identify tests and measures that can be used during an examination of sit-to-stand, stand-to-sit, and standing; include both quantitative and qualitative tests.

5. Alter the biomechanics of sit-to-stand or stand-to-sit to make the task easier or harder for a patient.

6. Demonstrate a progression of standing interventions in which the patient exhibits (1) quiet standing, (2) standing with head, arms, or trunk movement, and (3) weight shift within the base of support.

7. Apply the concept of practice intensity to the skills of sit-to-stand and stand-to-sit by demonstrating a task-intensive practice session.

8. Teach a patient to move sit-to-stand or stand-to-sit with minimally explicit directions to emphasize implicit learning.

9. Design a functional therapeutic exercise program using sit-to-stand and stand-to-sit, including a progression of the activities using added weight, tubing, or changes in the biomechanics of the tasks.

10. Given a case study of a patient with hemiparesis who has difficulty standing symmetrically and moving sit-to-stand, design a plan of care that includes functional training strategies, electrotherapeutic modalities, and an orthosis or heel wedge to improve symmetry.

11. Given a case study of a patient with a progressive neurological disease, suggest two types of home modification equipment to assist with sit-to-stand and standing.

12. Develop a home exercise program to enhance the functional skills of (1) sit-to-stand, (2) stand-to-sit, and (3) standing and weight shifting.

Introduction

When asked about their personal rehab goals, most people with neurological impairments immediately reply “I want to walk again!” Patients rarely acknowledge standing up as an important goal, despite the fact they must stand in order to walk. Clinically, it is possible to see a patient who can walk with supervision but who needs physical assistance to stand up from a chair.

Sit-to-stand (STS) and stand-to-sit (SIT) are critical functional skills and the ultimate transitional movements because they are the gateway between seated activities and standing/gait functions. Standing facilitates many important functions/activities: (1) the ability to access home/work/play tools or equipment that is above wheelchair height, such as a standard refrigerator and closet shelves; (2) the ability to transfer to the toilet, car, bathtub, or exercise equipment; and (3) the ability to move to a position that assists in the prevention of lower extremity (LE) contractures and ischial tuberosity/sacral pressure sores. Likewise, the ability to stand independently, even when the patient is unable to walk, allows functional independence for self-care, home/work/school management, and participation in the community with or without environmental adaptation.

This chapter focuses on the transitions from STS, SIT, and standing as key tasks crucial to functional independence and mobility for patients ...