Getting Stroke Patients To Stand: Strategies And Techniques

Stroke is a sudden and devastating illness that affects over 100,000 people per year in the UK. The most common physical deficit caused by a stroke is muscle weakness, which limits a person's mobility. The inability to sit-to-stand independently can prevent independent function during activities of daily living.

The aim of positioning the patient is to try to promote optimal recovery by modulating muscle tone, providing appropriate sensory information, increasing spatial awareness, and preventing complications such as pressure sores, contracture, pain, respiratory problems, and assisting with safer eating.

The most appropriate position in which to place a patient following a stroke remains unclear. However, five main positions have been recommended: sitting in an armchair, side lying on the unaffected side, side lying on the affected side, sitting in a wheelchair, and lying supine.

It is vital that as soon as the person is capable of sitting out, they are facilitated to do so. Sitting out is essential to build up tolerance, provide maximum stimulation, and give a sense of normality.

Sitting in a chair or wheelchair

• The patient's feet should be in a neutral position and supported.
• The patient's weight should be evenly distributed between both buttocks.
• The patient's arm should be protracted forward and supported.
• The patient's back should be in slight extension.

Side lying on the unaffected side

To help a stroke patient stand, they can first be positioned on their unaffected side. This is a commonly recommended position for stroke patients, with 97% of physiotherapists suggesting it.

To get into this position, the patient's stroke arm should be kept straight and supported on a pillow. The stroke leg should be brought forward, with the knee bent and supported on a pillow, to prevent the patient from rolling onto their back. A small pillow can be placed under the patient's waist to maintain the alignment of the spine. When lying on their side, the patient should have two pillows under their head.

This position can help to reduce the risk of shoulder subluxation, contractures, and pain. It can also enhance motor recovery, range of motion, and oxygen saturation.

Side lying on the affected side

This position should always be encouraged with the stroke shoulder well forward so that the body weight is supported on the flat of the shoulder blade and not on the point of the shoulder.

Use one or two pillows for the head. Place the stroke leg with the thigh so that it is in line with the trunk, and bend the knee slightly.

The unaffected leg should be brought forward and placed with the knee bent on a pillow in front of the affected leg for comfort. This prevents the patient from rolling onto their back.

Lastly, bend the head forward a little.

Lying supine

• Place two pillows under the patient's head and help them bend their head slightly towards their unaffected shoulder.
• Gently turn their head towards their stroke side, but do not use force.
• Place a small pillow under the buttock of the stroke side, which should extend just to the knee. This will relax the leg and prevent it from turning out at the hip.
• Place a pillow under the stroke arm, which should be kept straight at the elbow. If possible, the palms of the hand should be facing upwards.
• Ensure that the bed is at the correct height to promote independence and safety for the patient, their family, and healthcare workers.

Sitting up in bed

Sitting and lying have different weight distributions. When seated, nearly half of the body weight is supported on 8% of the sitting area at or near the ischial tuberosities. Therefore, interface pressures are much higher in sitting than lying.

• Shift weight side to side: Keeping a straight back, slowly shift your weight to one side, hold it for a few seconds, then go back to the centre. Repeat on the other side. This exercise can be repeated 20–30 times per session, or as many times as is safe.
• Reach for a ball: Have a partner hold a ball a little more than an arm’s length away from you. Carefully reach for the ball as they place it in different locations. You may need a second helper to catch you if you become unsteady and start to fall. Repeat the exercise 10–15 times.
• Leg lift: Start by sitting upright and steadying yourself with your hands. Lift one leg while keeping the knee bent, and hold it for about 5 seconds. Repeat with the other leg. Repeat the exercise 5–10 times, depending on strength.
• Single-leg knee extensions: Seated upright with your core engaged, extend one leg at the knee, then lower to the ground. Repeat with the other leg. Do two sets of 15 exercises.
• Reach with clasped hands: Keeping your hands clasped together, reach your hands straight forward to the point where your whole body is working but you are not in danger of falling. Hold for 5 seconds, then lean back in your chair and sit normally. Repeat the exercise 10 times. You can also practice reaching to either side of your body.

Frequently asked questions