AIM:
To train sitting by reaching for objects
Rationale:
Whole-task training is set up so the patient can practice reaching in sitting with feedback and/or manual guidance from the therapist if necessary. Training is structured so that flexibility of performance is encouraged, ie, the cognitive and/or physical demands of the activity are increased.
Equipment:
- Adjustable height plinth
- Chair
- Objects, eg, cup, bowl, powder bottle
- Targets, eg, tape, ruler
Key Points:
- Patient is positioned in sitting with <100% thigh support, feet shoulder-width apart, knees directly over feet, ie, no hip external rotation) and ankles plantargrade
- Patient reaches in various directions (with intact or affected arm) to pick up objects placed on the plinth at 120-160% of arm’s length
- Therapist is positioned to the side of the patient and provides manual guidance at the knee or the affected upper limb if necessary
- Ensure patient shifts weight in the direction of reach
Common Errors:
- Therapist is too far away from patient to ensure safety
- Affected hip externally rotates
- Patient does not shift weight in the direction of the reach and compensates by excessively protracting the shoulder and fully extending the elbow
- Patient holds stiffly
Progression and Variety:
- Decrease/remove manual guidance
- Reduce thigh support
- Increase speed of movement Increase reach distance
- Vary reach direction – reach to intact side, forwards, to affected side, to floor, high reach
- Include bimanual tasks
- Increase cognitive demand