Sit-to-Stand Practice

In sit-to-stand practice, physical therapists and occupational therapists often work with patients who are at a level where they can 'somehow manage to stand' by providing assistance or supervision.

This is a slightly embarrassing but unforgettable experience from when I had just become a physical therapist.

At the time, I was in charge of practicing with a patient with hemiplegia who, although unsteady during the sit-to-stand movement, seemed capable of standing up on their own.

I was trying my best.
I observed the movement, built a story of the problems in my head, and stood right in front of the patient, very close, to provide assistance.

'As the hip joints flex, the trunk leans forward, and then the knee joints extend to lift the buttocks off the seat...'

I was conducting the practice while thinking about, and sometimes speaking out loud, the flow of the movement.

However—
The patient just couldn't stand up.

No matter how many times we tried, the knees wouldn't extend, and they would end up sitting back down with a 'thud'.

'Why...?'

But then, I suddenly felt it.
This wasn't the patient's problem.

At the time, I would sometimes look at a full-length mirror during practice to objectively check my assistance and positioning.

The moment I casually looked at the mirror—
I understood everything.

I was standing too close directly in front of the patient, and I was blocking the very path of the trunk's forward lean that accompanies hip flexion with my own body.

They wanted to lean forward, but they couldn't.
Since I was urging them to 'extend your knees' in that state, there was no way they could stand up.

I hadn't been able to imagine how I was 'moving' the patient.

So, to ensure the patient could lean their trunk forward with confidence,
I took a step back and secured enough space.

Then—
The sit-to-stand practice went surprisingly smoothly.

Through that repetition, the patient was eventually able to perform the sit-to-stand movement independently.

From this experience, I learned a powerful lesson.

That with just one change in a therapist's positioning,
you can either 'help or hinder' a patient's movement.

When we are too focused on treatment,
we sometimes unknowingly block the direction the patient wants to move or the flow of their movement.

That is precisely why,
• Checking our treatment sessions in a mirror
• Reviewing them on video

These opportunities are the best way to learn, not just about the patient's movements,
but also to re-evaluate the therapist's own posture and handling.

Honestly, it is a little embarrassing.
But beyond that embarrassment, I am sure a better treatment awaits than what I have now.

And I believe that realization
leads to the patient's smile when they say, 'I did it.'