Interventions to improve sitting

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Static Sitting

see ch5¹

Varying UE/LE Support

See ch5¹

Varying BOS

Varying the BOS: Long-sitting, Short-sitting, Side-sitting¹

Applying Resistance to Promote Stability

Dynamic Sitting

Active Weight Shifts

Adding resistance ch5¹

Voluntary movement & Task Orientation

Resisted Limb Movements

Contraindications

For patients lacking stabilization, resistance may be contraindicated and the clinician should focus on active movements¹.

A clinician can add resistance to the extremities with a variety of changes.

Changes

• Enhances control of the limbs¹
• Enhanes automatic trunk control

Enhancement of limb control

• This is helpful when working with patients who are experiencing extremity weakness (i.e. brain injury)
• You should use this in order to simultaneously work balance and limb strengthening

Automatic Trunk Control

• By making the focus on the limb, this brings attention away from the trunk¹
• Patients will need to train automatic control when they begin to perform seated and standing ADLs¹

Regression

Complexity

The therapist typically starts with unilateral movements and progresses to combination (bilateral and reciprocal) movements¹

PNF Patterns Progression

Unilateral Patterns

• Unilateral PNF patterns are often used initially, when dynamic control is lacking or when one extremity is used for support¹.
• Even if the C/L arm is not being used for support, it can still be used as a counterbalance, thus reducing the requisite trunk control, which is why unilateral patterns are considered easier.

Bilateral Patterns

• As the patient’s control improves, progress to bilateral patterns, which will be more challenging¹. Examples:
  • Chop/reverse chop¹
  • lift/reverse lift¹

Examples

In addition, there is a weight shift from one side (buttock) to the other. Emphasis is on using the combined arm movements to enhance control and range of the trunk movements. See Chapter 3: Proprioceptive Neuromuscular Facilitation for a description of patterns and techniques.

flexion with rotation) combined with bilateral asymmetrical patterns of both UEs. In addition, there is a weight shift from one side (buttock) to the other. Emphasis is on using the combined arm movements to enhance control and range of the trunk movements. See Chapter 3: Proprioceptive Neuromuscular Facilitation for a description of patterns and techniques.¹

References

1.

O’Sullivan SB, Schmitz TJ, eds. Improving Functional Outcomes in Physical Rehabilitation. 2nd ed. F.A. Davis Company; 2016.