If you are working with a patient with SMA, you will most likely find that they are in their wheelchair full time. This makes sitting balance very important for many reasons. If they have good sitting balance, this will make traveling up and down ramps easier and more independent, as well as improvement with transfers.
It is important to note that each individual patient is very different and has different strengths and weaknesses. With my patient, Michael, it was important to work on his core strength before we tried sitting unsupported to improve sitting balance. We did this by using Thera bands and concentrically, eccentrically, and isometrically working trunk forward bending, backward bending, and bending sideways.
We use a sliding board to transfer Michael from his wheelchair to the table, using two people to increase his safety. We started with just working on unsupported sitting first. With being in a wheelchair with back support full time, this was a big challenge for Michael to begin with. He had to engage his core to maintain sitting in an upright position unsupported. Over time, he was able to sit for longer periods of time secondary to increase trunk strength.
Once this became easier for him, we began external perturbations such as leaning on the table or bumping the table to knock him off balance and have him work to recover from different angles. Next, we began applying perturbations directly to different sides of his trunk to throw him off and challenge him to recover. There is always someone in front and behind him in case he requires assistance to recover.
This was becoming not so challenging for Michael, so to continue to improve his balance, we placed a foam cushion underneath him on the table, to decrease the firmness of his seat. This makes Michael work harder to maintain his balance.
We will continue to work to increase his tolerance to sitting unsupported and ability to regain balance once thrown off. This will continue to improve Michael’s daily life and ability to have increased trunk control.