AIM:
To train standing by reaching for objects
Rationale:
Whole-task training is set up so the patient can practice reaching in standing 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 and stool
- Objects, eg, cup, bowl, powder bottle
- Targets eg tape
- Leg splint (if necessary)
- Arm sling (if necessary)
Key Points:
- Patient is positioned in standing, with feet shoulder-width apart, toes pointing forward, trunk, hips and knees extended
- A splint may be placed on the affected leg to maintain knee extension
- Patient reaches in various directions (with intact or affected arm) to pick up objects at up to 120% of arm’s length
- Therapist is positioned behind or to the side of the patient and provides manual guidance at the hip or knee or the affected arm if necessary
- Ensure patient shifts weight in the direction of the reach
- Ensure hip and knee are extended, lateral horizontal pelvic shift is appropriate
Common Errors:
- Therapist is too far away from patient to ensure safety
- Patient enlarges base of support
- Patient does not shift weight in the direction of the reach
- Patient holds stiffly
Progression and Variety:
- Decrease/remove manual guidance
- Decrease size of base of support
- Increase speed of movement
- Increase reach distance
- Change reach direction- reach to intact side, forwards, to affected side, to floor
- Include bimanual tasks
- Increase cognitive demand