Objectives: Movement transitions including sit to stand, stand to sit and lying to sitting have been explored thoroughly in the literature both in normal and post stroke populations (Silva et al. 2013, Alexander et al. 2000). To date sit to lie is a transition that has received very limited investigation (Meadows and Williams 2009). The ability to transfer from sitting to lying is an essential component of independent living. The movement components of sit to supine include core strength and control, dissociation of the lower limbs, appropriate use of the upper limb and weight transfer. These are fundamental to other movement transitions and functional activities including locomotion, for example to achieve selective lateral pelvic tilt, single leg stance and change direction whilst mobilising. The aim of this case report was to examine the sequence of movement during sit to supine in a patient post left basal ganglia stroke. The findings of this analysis were used to guide treatment hypotheses using the Bobath framework for clinical reasoning.
Method: Burst photography was used to capture the movement sequence of sit to supine from in front, side and behind. Photo analysis then determined the components of sit to supine. Comparison was used to explore the effect of both environmental and manual facilitation. The Bobath framework for clinical reasoning was used to generate hypotheses based on the sequence of movement observed. These hypotheses formed the basis of a treatment plan for this patient which included mobilisation of soft tissue structures, realignment prior to strengthening of both lower limbs, right upper limb and trunk in variety of positions.
Results: Photographic analysis revealed the compensatory movements, particularly of the trunk and lack of selective activity present post basal ganglia stroke. Manual and environmental facilitation improved the motor sequence during the transition. An infarct of the basal ganglia resulted in decreased postural control however relative preservation of selective muscle strength, evident during the movement. A hypotheses driven treatment plan resulted in enabling the patient to access the activity she had preserved post stroke more efficiently and highlighted the need to treatment both the hemiplegic and non-hemiplegic side. This resulted in an improvement in outcome measures including 10 metre walk test, trunk impairment scale and an improvement in functional ability including bed mobility and locomotion.
Conclusions: This case report takes a novel look at the components of sit to supine in a patient post stroke. The Bobath concept is a useful framework for clinical reasoning and to guide treatment plan. The resulting case report highlights the need for postural control in order to be able to access selective movement and the importance of addressing both hemiplegic and non-hemiplegic sides post stroke.
Reference:
1. Silva A., Sousa A., Pinheiro R., Ferraz J., Tavares J., Santos r. and Sousa F. 2013. Activation timing of soleus and tibialis anterior muscles during sit-to-stand and stand-to-sit in post stroke vs healthy subjects. Sensory and motor research 30(1) 48-55.
2. Alexander N., Grunawalt J., Carlos S. and Augustine J. 2000. Bed mobility task performance in older adults. Journal of Rehabilitation Research and Development Vol 37(5) 2000.
3. Meadows L. and Williams J., 2009. An understanding of functional movement as a basis for clinical reasoning. Bobath Concept, Theory and Clinical Practice in Neurological Rehabilitation.
Ethical Approval: Ethical approval was not required for this case study. Written informed consent has been received from the patient presented in this study to use of the photographic images for publication.
