- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- Brad's got a weapon today.
Okay, today we're gonna do another video for Clement.
I believe he's from Russia. - Mm-hmm.
- His dad had a stroke
and we're gonna show him another thing to work on here
which is gonna help with performing transfers.
- Sit to stand.
- Yep, sit to stand.
And again, this falls in the type of rehab
which is called functional training.
You're training the body to perform a specific task.
And they have found, research has found
that this has been the most successful type
of stroke training because it's practical
- Sure. - And you're reinforcing
something that the patient probably
already knew how to do at some time.
- Right. - So this is,
what you're gonna need here,
what we would prefer that you do,
we're gonna work on going from sit to stand.
And this is the weak leg, by the way.
We've forgot to put down the red stuff, but that's okay.
- Yeah, yeah. - This is the weak leg
and the weak arm.
What we'd prefer that is
that you're gonna have something that the patient
can grab onto that's solid. - Right.
- Now, if you have a grab bar on the wall already,
that would work great.
It might be worth the money to even spend
to have one attached to the wall-
- Right. - Maybe in a spot
where you could use it
because you need something for that patient
to really pull up on to start off with.
- Right, so in this case,
we're just gonna use this to represent a grab bar
that's mounted to a wall. - A wall, yeah.
- Imaginary wall that's here.
- Or this is Brad's stripper pole.
So anyway, what you're gonna wanna do,
if you don't have that as an option
you could grab onto a countertop or even a sink.
That would probably work.
- And as they get stronger, a solid armrest-
- Right. - May be enough.
But initially you need more leverage.
- Yes you do.
Okay, the first thing as far as where,
you're gonna talk about positioning in the chair itself.
When you're gonna try to get somebody up
from the chair, first thing you gotta realize,
it's very difficult to get up from the chair
from the back of the chair.
You gotta have the butt forward a little bit.
When we get outta chairs,
what's the first thing you do, Brad?
You kind of move your butt forward, don't you?
- Right, so when we go out to here,
it's much easier to stand from here-
- Than it is from the back, right.
- Right. - So we have two people,
there's two ways you can have a person
get their butt forward.
One is just to lean back
and kind of slide their butt forward.
If they can't do it,
why don't you go back again, Brad,
I've actually just gone in there sometimes and helped them
pull forward like that.
- Right. - Okay.
Now you don't wanna pull 'em off the chair, obviously.
- Right. - So you're gonna
get 'em forward like this
and the next thing is on the positioning thing here
is you're gonna wanna make sure the bar is far enough away
that when he grabs it,
that he's gonna be kind of putting his nose over his toes.
- Right there.
- Because that's the other thing,
it's very hard to get up straight up like this.
- Right, you need that lean forward.
- Yep. - And these are things
we all do, you just don't think about it.
- Right. - But when someone's
had a stroke, little things make a big difference.
- That's a cue that we're often giving people,
nose over toes.
So he's gonna grab onto the bar.
Now the other hint here is if the person's very weak,
maybe has virtually no strength on this side,
I would probably take a couple of pillows
or cushions and put 'em in the chair to raise 'em up,
so we're starting from an advantage.
Look at that, Brad, you're already taller.
- Right. - So that's gonna
make a big difference.
If you have one of those chairs that actually is electric
and actually raises up, a sit to stand chair,
use that, bring it up to the point where he's gotta work
a little bit or she's gotta work a little bit
but enough that they can do it without much help.
- Right. - So, all right,
we have a gate belt on, Brad?
- You bet. - Okay, he's got
a belt on already.
That that's one thing I can grab onto.
Where am I gonna be?
Now, first time you're gonna do this,
especially if he is very weak on the leg,
most people do have some push on the leg.
They may not have anything else
but they usually have some push.
You're gonna maybe wanna have two people even there.
- Right.
- So what I'm gonna do is I'm gonna,
I'm gonna block this weak leg
by maybe putting my knees on each side of his knee.
That's one way to do it.
Or sometimes I go like this, I cross over.
Sometimes I go over like this.
Whatever works comfortably for you.
I would go probably squeeze the leg
in between like that.
He's grabbed onto the bar and then I can grab
onto the belt and onto the pelvis a little bit.
And this often may be in a sling or something.
- Right. - Correct, Brad?
- Right, this arm is flaccid.
- So the cue is okay, Brad, lean forward.
And now we're gonna go ahead and stand up.
And push, pull, pull, pull yourself up.
And I can help this leg and I can hold up this pelvis
and he's holding on, on the other side.
So you've got both sides covered.
Then you're gonna go right back down again.
And then you're gonna try to do some repeats.
- Just be careful
on this arm, yep. - On the arm.
- If the arm is flaccid, you can hurt their shoulders.
- I'm not pulling on the arm here.
I'm just kind of steadying against his body.
- Right, the belt is where you're pulling from the waist.
- You could even go like this.
- Right.
- And that might even be better,
a better place for you to be. - Yeah.
- So you're gonna keep doing these repeats
over time until you get to be fairly decent at it,
where your strength is built up.
If nothing else, maybe your trunk strength
and your right leg strength is enough
that you can pull up fairly easy.
- And you'll see that what Bob is doing
with his knees against mine is very helpful
and all therapists are good at that
'cause we do it a lot. - Right.
- So if you haven't done this,
be patient with yourself
because your technique can make a big difference.
So it might take a few-
- You'll get better over time with it.
- Exactly. - So after you have
become good at that, then the next thing is
you're gonna try to get good at is
just actually pushing up from the chair itself.
And that way eventually you're gonna be able
to perform transfers no matter where you're at.
You know, if you're in the wheelchair.
So now he's going down, come down again.
If I'm still right here and now we're gonna go ahead,
I'm gonna grab here.
Okay, Brad, go ahead and stand up.
Nose over the toes.
And we're working on that.
So we're gonna do repeats on that.
We can do,
again, you can do three sets of 10 of these.
You can do 10, if you...
Now, by then at that point we get 'em up
and now we're gonna wanna start working on standing balance.
And one of the things we're gonna work on
is weight shifting. - Right.
- Because he's gonna want to take most
of the weight on his right leg.
He's gonna go like that.
And again, he'll probably have his arm
on something to steady himself,
maybe a walker or we'll use the back of the chair here.
And now we're just gonna work on shifting
the weight back and forth
so he's putting some weight on that involved leg.
- And people often come neglected.
You're gonna have to give verbal cues
and maybe even pull over- - Yep.
- and make the person get some weight to there.
Just be careful for this. - Right, yep.
And that's why I got both hands on the belt.
- Yep, this knee might have to cross in front of there.
- Yeah, or you can go like this.
- Yep, something to- - Yeah.
- You'll get a feel for that if that knee's wobbly.
If they're that weak, probably two people.
I've had one person stand there just to make sure.
- Yep, just hold on the knee end.
- Yep, get down on their knees
and hold and make sure it's supported.
- And if you're starting to get some strength in that leg,
then at some point you even wanna let go of the arm
and maybe reach for things. - Sure.
- You know, trying to work on the balance.
- Over here.
- Once the balance has improved to the point
where you're feeling pretty solid about this,
then we can work on that next step,
which is, he reaches,
actually I'd like to have a chair
with an arm on it, probably.
I'm just gonna switch arms, yeah.
- Yeah, arm chairs are much better.
- Yeah.
- So now when he gets up,
he's just gonna go ahead and reach for that arm,
he's got something solid.
And again, I can support the knee
and he can take the step
and he can just turn and pivot right into the chair.
But the key here is even if there's no strength
in that leg at all is to do those repeats.
So you can get, if nothing else,
the right leg is gonna get stronger,
the trunk, the muscles of your core
are gonna get stronger so that you can stand up
and you can stand and work on balance
and get better on the sit to stands.
- Right.
Again, two people to start with-
- Yeah.
- if you don't feel comfortable.
Safety- - Safety comes first.
- Right. - And I don't know
how big your dad is and I don't know how,
it all depends on,
if you have a little, tiny patient
and you're big, it's gonna be a lot different
than if you're tiny and the patient's big.
- Exactly. - So, all right.
I'm gonna be a struggle if I ever have a stroke,
'cause look how tall I am, Brad.
- Right, exactly.
- The therapist is just gonna shake their head.
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- Thank you. - Thanks.