Sit to stand transfers require not only leg strength but leg power – the quads and hip extensors must be able to lift the body weight against gravity.
There must be adequate sitting balance. Rule of thumb – if independent sitting balance is not there – it is NOT a good idea to try standing unless you have 3-5 people to help.
Range Of Motion
Range of motion requirements for sit to stand transfers vary depending on how low your sitting surface is and how tall you are. It also varies with different orthopedic conditions that require precautions i.e. hip replacements need to limit hip flexion/trunk flexion to 90 degrees.
In general, in order to stand, you need about 100 degrees of knee flexion in one or both knees. You need about 110-120 degrees of hip flexion/trunk flexion and the ability to bring your arms from pushing off the bed to holding onto a walker.
Remember that the higher the sitting surface, the less power is needed and less range of motion is needed.
Aside from these basic needs (that are not set in stone for obvious reasons) there are other tips that will transform your sit to stand transfer overnight!
Drum roll please…
These are simple and basic tips that you may find helpful.
Before tugging and pulling on your patient – raise the surface. If it is a bed, remove the wheels and put cut pieces of 4×4 block or heftier as you see fit. If it is a chair, a wood pallet with a piece of plywood over it makes for a nice platform.
I put 4 concrete block under a patients chair about a month ago. It raised his chair about 7 1/2 inches! But, he is over 6 foot tall! He also had a 75 degree hip flexion limit so this worked perfectly.
Inspire your patient to become independent. To do this YOU need to sit in a chair the same height and stand up in slow motion to understand the importance of each additional tip. The next tips assume your patient is sitting in chair.
First things first. Have your patient scoot their bottom to the edge of the chair. This may take some time but let them struggle (less and less of course as they get stronger).
If they can not scoot forward, have them push their back against the chair creating a counter force to be able to scoot their bottom forward.
Here is where knee flexion or bending comes in to play. Your patient needs to bring his feet back to the chair so that he has something ‘underneath him to stand on’ when he is finally up.
Here your patient needs to be able to lean forward (trunk/hip flexion) in prep for standing. It is imperative that they lean their ‘nose over their toes.’ This brings the weight far enough forward to continue (sometimes with some help but less then normal!)
In sit to stand transfers, this is often the toughest position for seniors to move into as they already have a fear of falling but they most do this for this next step – while bringing their nose over their toes, they now must push with their legs and push their bottom up. They must push down on the chair arms with their arms as counter leverage.
If they do not lean nose over toes, they will push themselves right back into your efforts or the chair. Your efforts will come from the gait belt NOT their arm pits. If you pull them up at the armpits, they can not push down with their arms and the whole process is ruined.
Once up, one hand grabs the walker, then the other to maintain the safety and security that seniors need as their balance decreases.
Do not let patients grab you around the neck, the shoulders, the waist, the back the arms in order to stand. If they fall you fall or at best get injured in the process. An injured caregiver is no longer an able caregiver.
Now that you can get up… get up once every hour to gain or maintain strength – you won’t be sorry.
These simple steps keep everyone safe and improve independence. Apply these steps to your manual wheelchair to car transfers too and get out into life!