Getting up from lying to sitting position
Generally, it is noted that an ataxic patient has a tendency to log roll rather than to perform segmental rolling. This tendency should be inhibited and the patient should be encouraged to perform segmental rolling. Once the patient is able to efficiently go into the side-lying position, he is taught asymmetrical push up with the upper limb and then trained to lower the legs from the bed onto the floor so that he can assume the position of sitting at the edge of the cot.
Once the patient achieves good head and trunk control, the therapist should progress to incorporate activities that will put the demand on the patient’s static and dynamic balance in sitting. The patient should be made to sit on a stable surface like cot or stool in an unsupported position and then the therapist gives gentle pushes in all directions.
Alternatively, the patient may be asked to sit on the unstable surface like a wobble board or vestibular ball without holding on to any support.
Once the patient develops good static balance dynamic balance can be trained by giving swaying and rotational activities in sitting. Reaching out activities also improves the dynamic balance in sitting. The patient is made to sit on a vestibular ball then he is asked to hold a cane or medicine ball in his hand which is held in elevated position above the shoulder and then the patient may be made to do various movements of the trunk. Thus the exercises can be made more complicated for the patient.
Performing various functional tasks like dressing, grooming or feeding needs a lot of repetition and goes a long way in making the patient functionally independent. The therapist should be skilful enough in allowing the patient to master a particular type of activity before progressing into the next realm of exercises.