Sitting Balance
Sitting balance is a significant component of independent daily living for people with SCI, especially those with cervical level injuries or those with complete injuries at the thoracic/lumbar level, due to limited motor control through the hips, pelvis, and spinal extensors (Lei et al. 2023). It may be especially important to consider sitting balance in people with SCI as they may have limited trunk control, and otherwise simple daily tasks, like reaching for something, moves the person’s center of gravity, and they may lose their balance putting them at risk for falls. Dressing, wheelchair handling, transfers, sitting on the edge of or across surfaces, and toileting all require a combination of static and dynamic postural control involving the trunk (Lee & Lee 2021; Tak et al. 2015). Therefore, the rehabilitation of sitting balance is beneficial for enhancing quality of life after SCI.
Numerous studies have investigated sitting balance training in rehabilitation after SCI. Research has investigated both unsupported sitting exercises and BWSTT on sitting balance outcomes. In addition, the use of VR or electrical stimulation as a therapeutic modality have led to favourable outcomes in sitting balance.
Multiple outcome measures were utilized in these studies to assess sitting balance. A systematic review by Arora and colleagues (2020) identified the modified functional reach test (mFRT) as the most used balance scale of those that evaluated sitting balance alone for people with an incomplete injury. The Berg Balance Scale (BBS) also assesses sitting balance alongside items evaluating balance with other tasks.
Falls are common among individuals living with SCI, even if they do not ambulate (Abou & Rice 2022). A recent review estimated that approximately 69% of non-ambulatory individuals with SCI experience at least one fall in a period of 6-12 months (Khan et al. 2019a). More recently, it has been reported that a shorter time since injury, higher mobility level (Spinal Cord Independence Measure version III [SCIM-III]), and lower FIST score represent significant risk indicators for falls in 59 wheelchair users with SCI (Abou & Rice 2022; Abou & Rice 2024). It should be noted that none of the studies included in this section (sitting balance) included fall data as an outcome measure. Future studies assessing different types of interventions and identifying the risk predictors for falls will be of interest.
It has been shown in individuals with motor-complete thoracic SCI that reaching forward while sitting with reduced thigh support provides more challenges in the dynamic sitting balance (postural control measured by the center of pressure parameters) than sitting with more thigh support (Ilha et al. 2020). Also, it has been shown that participants with cervical SCI are more reliant on visual and vestibular systems for sitting balance while depending less on proprioception and muscle control compared to controls (because they may not have control on these functions to maintain balance); showing that this strategy is ineffective in maintaining postural stability during unsupported sitting (Lei et al. 2023). Consequently, emphasizing the importance of proprioception and muscle control for seated postural stability and/or training during unsupported sitting to improve sitting balance is important in people with upper SCI (Ilha et al. 2020; Lei et al. 2023).
