Setting Realistic Goals

Patient with  lesion at C6 level:

Propping in long sitting and moving weight forwards
Therapist's aim To improve the ability to prop in long sitting. Client's aim To improve your ability to prop in long sitting. Therapist's instructions Position the patient in long sitting. Instruct the patient to transfer their weight from behind their hips to in front of their hips. Client's instructions Position yourself sitting with your legs straight out in front of you. Practice transferring your weight from behind your hips to in front of your hips. Progressions and variations Less advanced: 1. Decrease the excursion of movement. More advanced: 1. Increase the excursion of movement. Precautions 1. Preserve tenodesis grasp.
Propping back and forth in long sitting
Therapist's aim To improve the ability to prop in long sitting. Client's aim To improve your ability to prop in long sitting. Therapist's instructions Position the patient in long sitting. Instruct the patient to transfer their weight from in front of their hips to behind their hips, and then bring their weight forwards again. Client's instructions Position yourself sitting with your legs in front of you. Practice transferring your weight from in front of your hips to behind your hips then bringing your weight forwards again. Progressions and variations Less advanced: 1. Transfer weight between the hands. More advanced: 1. Perform functional tasks in this position. Precautions 1. Preserve tenodesis grasp.
Sitting up via sidelying
Therapist's aim To improve the ability to move from lying to sitting. Client's aim To improve your ability to move from lying to sitting. Therapist's instructions Position the patient in half sidelying on a plinth. Instruct the patient to `walk` on their elbows around the side of their body and use their top arm to pull up into long sitting. Client's instructions Position yourself lying on your side on a plinth. Practice `walking` on your elbows around the side of your body and use your top arm to pull up into sitting. Progressions and variations Less advanced: 1. Transfer body weight from one elbow to the other. 2. Place stools under the elbows and practice transferring body weight from one elbow to the other. 3. Place a high plinth beside the body and `walk` the elbows along the plinth. 4. Perform the task in reverse. More advanced: 1. Perform the task on a soft mattress. Precautions 1. Maintain the integrity of the skin over elbows. Can use elbow pads for this purpose.
Sitting up via half-sidelying
Therapist's aim To improve the ability to move from lying to sitting. Client's aim To improve your ability to move from lying to sitting. Therapist's instructions Position the patient in half sidelying on a plinth with their elbows aligned with their knees. Instruct the patient to use their top arm to pull up into long sitting. Client's instructions Position yourself lying halfway on your side. Practice using your top arm to pull up into long sitting. Progressions and variations Less advanced: 1. Place a stool under the propping elbow. 2. Position the propping elbow onto a higher plinth beside the patient. 3. Secure the hand that is being used to pull up. More advanced: 1. Position patient on a soft mattress.
Rolling over using elbow splints Therapist's aim To improve the ability to roll over in bed. Client's aim To improve your ability to roll over in bed. Therapist's instructions Position the patient in supine with elbow extension splints in situ and their two wrists connected together. Instruct the patient to roll over by rapidly moving their arms across their body. Client's instructions Position yourself lying on your back with splints on your elbows and your wrists connected together. Practice rolling over by rapidly moving your arms across your body. Progressions and variations Less advanced: 1. Place pillow behind back so patient is quarter off supine. 2. Flex hips and knees. 3. Cross ankles. More advanced: 1. Remove assistive devices. 2. Position patient on a soft mattress. source physiotherapyexercises