Comparative Kinematic and Electromyographic Assessment of Clinician- and Device-Assisted Sit-to-Stand Transfers in Patients With Stroke

• Published in: Physical therapy 2013-10, Vol.93 (10), p.1331-1341
• Main Authors: Burnfield, Judith M, McCrory, Bernadette, Shu, Yu, Buster, Thad W, Taylor, Adam P, Goldman, Amy J
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Ankle; Ankle Joint - physiology; Ankles; Assistive technology devices; Biomechanical Phenomena; Care and treatment; Cross-Sectional Studies; Electromyography; Ergonomics; Female; Handicapped access device; Hip Joint - physiology; Humans; Knee Joint - physiology; Lower Extremity - physiology; Male; Methods; Middle Aged; Movement - physiology; Moving and Lifting Patients; Muscle, Skeletal - physiology; Nursing; Nursing home care; Occupational safety; Paresis - etiology; Patients; Prevention; Rehabilitation; Self-Help Devices; Self-help devices for the disabled; Stroke; Stroke - complications; Stroke patients; Therapists; Torso - physiology; Work related injuries
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20120500

Workplace injuries from patient handling are prevalent. With the adoption of no-lift policies, sit-to-stand transfer devices have emerged as one tool to combat injuries. However, the therapeutic value associated with sit-to-stand transfers with the use of an assistive apparatus cannot be determined due to a lack of evidence-based data. The aim of this study was to compare clinician-assisted, device-assisted, and the combination of clinician- and device-assisted sit-to-stand transfers in individuals who recently had a stroke. This cross-sectional, controlled laboratory study used a repeated-measures design. The duration, joint kinematics, and muscle activity of 4 sit-to-stand transfer conditions were compared for 10 patients with stroke. Each patient performed 4 randomized sit-to-stand transfer conditions: clinician-assisted, device-assisted with no patient effort, device-assisted with the patient's best effort, and device- and clinician-assisted. Device-assisted transfers took nearly twice as long as clinician-assisted transfers. Hip and knee joint movement patterns were similar across all conditions. Forward trunk flexion was lacking and ankle motion was restrained during device-assisted transfers. Encouragement and guidance from the clinician during device-assisted transfers led to increased lower extremity muscle activation levels. One lifting device and one clinician were evaluated. Clinician effort could not be controlled. Lack of forward trunk flexion and restrained ankle movement during device-assisted transfers may dissuade clinicians from selecting this device for use as a dedicated rehabilitation tool. However, with clinician encouragement, muscle activation increased, which suggests that it is possible to safely practice transfers while challenging key leg muscles essential for standing. Future sit-to-stand devices should promote safety for the patient and clinician and encourage a movement pattern that more closely mimics normal sit-to-stand biomechanics.