Activity-sitting (L20)

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