AIM:
To train moving into the upright position (supine to long sitting, complete C6 tetraplegia)
Rationale:
An important component of moving from lying to sitting is moving into the upright position. Training is set up so the patient can practise something similar but simpler, with manual guidance from the therapist, if necessary.
Equipment:
- Wide bed
- Block
- Pillow
Key Points:
- Therapist positions the patient in long sitting (trunk in front of hips), with one elbow down on the bed and the other wrist extended and hooked under the uppermost knee
- Therapist is positioned on the bed behind the patient
- Therapist places one hand on the patient’s uppermost hip and the other
- hand on the patient’s opposite shoulder
- Therapist provides manual guidance at the hip to guide the patient into a midline position
- Encourage patient to pull through the arm hooked under the knee and push through the arm on the bed to move the trunk into the midline
- Simplify practice by elevating the position of the arm on the bed (using a block and pillow)
Common Errors:
- Therapist provides all manual guidance at the shoulder and not at the hip
- Therapist is too far behind patient to provide optimal manual guidance or prevent a fall backwards
- Patient does not position the supporting arm far enough forward of the hips
- Patient does not maintain flexion of the hips
- Patient does not maintain wrist extension of the arm under the knee
Progression and Variety:
- Practise in reverse
- Position a pillow or block under the bottom arm
- Decrease/remove manual guidance