Standing Safely
| Standing is not only difficult, but can be extremely frightening for many stroke survivors. Sensory loss, visual impairment, vestibular deficits and reduced motor control can all contribute to a patient’s fear while standing. |  |
| Good therapeutic handling methods can help reduce your patient’s fear and improve their safety while standing. Position yourself on their involved side, with close contact at the hip and trunk. Fearful patients feel more secure with firm (not forceful) contact and handling. Use a gait belt if necessary. |  |
| Create a safe, secure environment to help put your patient at ease. Place a chair (or wheelchair) directly behind them. Contact with a sink, kitchen counter, heavy table or other solid surface directly in front helps to reduce fear. (Standing in an open room, without environmental contact, can be especially frightening to stroke survivors.)
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| Engaging in meaningful, functional activities can also help decrease fear and improve function while standing. Tasks requiring weight shifts over the involved side help with lower extremity motor control. Patients with poor knee control feel more confident standing in front of a cabinet (with contact at the knee) rather than a table (without contact).
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| Begin with a good base of support, feet positioned comfortably apart. Place your hands on the pelvis and encourage small weight shifts toward the involved side. Patients can become frightened with quick or sudden movements. |
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| As your patient improves, choose more complex activities that combine standing and reaching, such as washing the windows. Maintain a good base of support (be careful that their feet are not too close together) and close contact at the hip and trunk. Encourage greater weight shift over the involved side with your hand along the opposite pelvis. |  |
