Submitted by: Jeremy Nelson PT
Component One- Sitting to Standing
Another way to say that a person cannot stand up on their own is that they can successfully, repetitively fall back into the chair. Although this is not desirable we can ask the question, how do they do this? To find the answer consider the COG BOS relationship as primary. Everything else such as strength, mobility, and coordination is secondary, that is in support the dominant task of organizing the COG and BOS relationship. Beginning with this primary components, each can be investigated and evaluated as being supported by their component parts.
A person, who requires their hands to stand up needing several tries for success, typically has the center of gravity posterior to the base of support. This is evidenced by the observation of when they go to stand up they fall backwards, not forwards. The center of gravity is not supported by the base and as a result the person is falling back into the chair repetitively. It is not a function of leg strength, although that may be contributory. Instead it is a fault of position.
To investigate this claim, try to stand without first shifting your body weight forward between your separated feet. It will seem impossible, because it is. What must first occur is an anterior weight shift of the COG into the BOS. This is called the critical task. What strategy is employed to create this critical task is the choice of the clinician.
As the article series progresses each component of the Berg will also identify one of the critical task. Understanding the critical tasks for each movement supports the establishment of goals and sub goals. An interesting experiment is to examine how the scoring of each component can be the beginning consideration for each set of goals. Here is a deeper look at this first component of the Berg.
To score 0 on this component the patient needs moderate or maximal assist to stand. Whatever you call it, moderate or max, it’s not functional, and instead points to inadequate foundation for movement at both the COG and BOS levels. Here is a person who cannot generate the force required to counter the forces that are experienced during the sitting process, let alone the forces part of transitioning to standing. Typical reasons for why someone would need this type of assistance from going from sitting to standing posture are varied; however they all share the same elements of the two data points that produce structural tension.
The center of gravity/base of support relationship is the starting point when working with someone who has a moderate to maximal assist for sitting to standing. The goal will be to improve the body’s capacity to establish and maintain this relationship, and change the positions of each element to support functional movement. Bringing this relationship together decreases the amount of strain on the neuromuscular system. By simply rearranging those elemental parts, rapid changes in function can occur.
It’s not uncommon after using some of the establishing the base support techniques as well as teaching a hip hinge can a person go from a moderate to Max or Max to requiring a minimal to contact guard assist with utilization of bilateral upper extremities. Not in weeks, but in a few sessions. So the lesson here is to learn how to do anterior weight shift where the center of gravity is controlled and moved anterior within the base support moving from the posterior aspect of the day space support towards anterior aspect while maintaining control. In this way, the patient will complete the sitting to standing component and be well positioned to complete the more difficult tasks ahead.