3. Practical advice and tips for carers > Physical deficits

Physical deficits

12) Sitting balance

In the early stages following a stroke, being able to sit up without support may be difficult. However it is important to get somebody up and out of bed as soon as is medically possible. The therapist will provide the most suitable chair available on the ward so that the person is well supported and in a good position. Sitting even with extra support can be tiring for some people after stroke and a timetable with specific periods for sitting up may be used to help manage their fatigue. Therapists will work on balance in the gym and during functional tasks like washing and dressing. Support and rest periods will be reduced as the person becomes more able.

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Additionally sitting up can help with

  • Breathing. Sitting in a good supported position allows the lungs and diaphragm to work more efficiently.
  • Circulation. By sitting the person can move their body and change the position easier which increases circulation.
  • Pressure care. Sitting using a pressure care cushion can help to prevent bed sores. Sitting also reduces the risk of sores on other parts of the body such as heels and shoulders.
  • Communication. It is difficult for a person to have a conversation when lying in bed. They are more likely to be able to see, hear and participate more when sitting.
  • Stimulation/ Socialisation. Many daily tasks are made easier in a sitting position, having a conversation, reading or watching television for example.
  • Eating and drinking. This is much safer for the person in a sitting position. Eating is also a social activity and this can be encouraged when sitting.
  • Mood. Once the person can sit up they are less likely to be isolated than if they have to be in bed for long periods. Sitting is one of the first milestones in stroke recovery and this can lift the persons mood and give confidence in the early stages.
  • Daily functional tasks. Washing and dressing become easier to attempt and by doing a functional task, in turn the balance will improve too. Reaching for objects. Being able to do small things for themselves.

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Additionally sitting up can help with

  • Breathing. Sitting in a good supported position allows the lungs and diaphragm to work more efficiently.
  • Circulation. By sitting the person can move their body and change the position easier which increases circulation.
  • Pressure care. Sitting using a pressure care cushion can help to prevent bed sores. Sitting also reduces the risk of sores on other parts of the body such as heels and shoulders.
  • Communication. It is difficult for a person to have a conversation when lying in bed. They are more likely to be able to see, hear and participate more when sitting.
  • Stimulation/ Socialisation. Many daily tasks are made easier in a sitting position, having a conversation, reading or watching television for example.
  • Eating and drinking. This is much safer for the person in a sitting position. Eating is also a social activity and this can be encouraged when sitting.
  • Mood. Once the person can sit up they are less likely to be isolated than if they have to be in bed for long periods. Sitting is one of the first milestones in stroke recovery and this can lift the persons mood and give confidence in the early stages.
  • Daily functional tasks. Washing and dressing become easier to attempt and by doing a functional task, in turn the balance will improve too. Reaching for objects. Being able to do small things for themselves.

Sometimes the person may have lost proprioception ( loss of awareness of body position in space) They may not realise when they are slipping down in a chair or leaning over heavily to the affected or weaker side.

Some strokes cause overactive muscles with spasticity and increased or stiff muscle tone. These people tend to shuffle and wriggle which makes them more susceptible to falling out of a chair. It is hard for them to maintain a good supported sitting position. Pain also adds to increased risk.They may require specialist seating.

Once the person is at home they may need a more supporting chair which is at a suitable height to make getting in and out easier.