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Rising from a Supine Position to Erect Stance Description of Adult Movement and a Developmental Hypothesis ANN F. V A N S A N T
Standing up from a supine position is important for physical independence. This study was designed to describe movements within specific body regions used to stand up from a supine position. Another purpose was to identify motor developmental sequences for the upper extremities, lower extremities, and axial region for this rising task. Thirty-two young adults were videotaped while rising from a supine position 10 times. Descriptive categories were formed to portray movements of the upper extremities, lower extremities, and axial region. Subjects varied greatly in the movement patterns they used to rise. Only 25% of the subjects demonstrated a similar combination of movements during rising. That combination involved symmetrical use of the limbs and trunk while flexing forward from a supine position, moving through sitting to squatting, then standing. An ordering of categories was found for each body region that was proposed as a developmental sequence of movement patterns for this task. The variability of subjects' movements while rising provides clinicians with numerous movement combinations that might be used when teaching patients to stand from a supine position.
Key Words: Functional training and activities; Kinesiology/biomechanics, general; Movement; Pediatrics, development.
The ability to stand up from the floor is a significant part of physical independence. Movement patterns used to stand up are a concern of physical therapists when evaluating their patients' performances and instructing them to perform this task.
The motor reeducation theories and techniques of Bobath and Bobath1 and Knott and Voss2 prescribe specific movement patterns to be used when teaching individuals to rise from a supine position. No formal studies, however, have been reported in the literature that describe clearly movements used by healthy adults in this task. When training disabled adults to stand up from a supine position, therapists must rely either on these authorities or their own informal observations as a reference for
their evaluations and selection of movement patterns they will teach.
The first purpose of this study was to describe adults' movements in the task of standing up from a supine position. I believed that my method of movement analysis might provide physical therapists with a more detailed description of this task that eventually might lead to more refined evaluation and treatment of young adults who experience difficulty in standing up.
The second purpose of the study was to hypothesize specific developmental sequences for this task. Rising from a supine position is an excellent task for studying life span motor development. From a theoretical perspective, rising from a supine position is a "righting" task.3,4 Righting encompasses all of the varied movements used in the process of assuming erect stance. Motor abilities such as rolling from a supine to a prone position, moving to sitting, getting up on all fours, and ultimately standing up from a supine position, have been considered righting tasks.1,3 Development of righting abilities during the first year of life represents progression toward physical independence. The ability to rise from a supine position without pulling up on someone or something is commonly acquired early in the second year of life5 and, under normal circumstances, can be expected to be maintained until the end of the human life span.
The form of movements used to rise from a supine position change during the preschool years.3-5 Little is known, however, about movement patterns used to right the body after the period of early childhood. Righting movements are assumed to reach mature form and then remain unchanged during later childhood and the adult years. These assumptions, however, have never been studied formally.
BACKGROUND Without studies of adults' rising
movements reported in the literature, I turned to the published research on righting in infants and young children. Schaltenbrand3 and McGraw4 have described development within the task of rising from a supine position. Both researchers implied that developmental change in this task was complete in early childhood. According to Schaltenbrand, the adult form of rising appears by the age of 4 to 5 years and is characterized by symmetry of body action.3 McGraw's description and illustration of a mature form of rising did not portray symmetry of body action, despite study of children up to 6 years of age.4
This discrepancy over mature form may have resulted from the varied points of emphasis when describing rising action or from differences in the samples of children studied. Nonetheless, a single mature form of rising from
A. VanSant, PhD, is Associate Professor, Department of Physical Therapy, Medical College of Virginia, Virginia Commonwealth University, PO Box 224, MCV Station, Richmond, VA 23298-0001 (USA). She was a doctoral candidate, Department of Physical Education and Dance, School of Education, University of Wisconsin-Madison, Madison, WI, when this study was conducted.
This study was completed in partial fulfillment of the requirements for Dr. VanSant's doctoral degree, University of Wisconsin-Madison.
This study was supported in part by a grant from the Foundation for Physical Therapy and was presented at the Sixty-First Annual Conference of the American Physical Therapy Association, New Orleans, LA, June 16-20, 1985.
This article was submitted June 26, 1986; was with the author for revision 27 weeks; and was accepted April 29, 1987. Potential Conflict of Interest: 4.
Volume 68 / Number 2, February 1988 185
a supine position cannot be described on the basis of previous reports.
Early researchers described righting movements in quite general terms. That is, a particular aspect of the rising movement was selected and used to characterize movements of the body as a whole. Schaltenbrand, for example, emphasized differences in the amount of body rotation used to accomplish righting from a supine position,3 and Mc-Graw concentrated on description of the characteristics of automaticity and volition in infants' and young children's righting movements.4 When developmental differences are described in terms of action of the whole body, precision is lost.6 Descriptions of movements are often incomplete. Movements of the extremities, for example, were not consistently reported when successive developmental levels in the righting task were described.3,4
Roberton tried to classify children's throwing movements by using whole-body descriptions of developmental steps for the task of throwing.6 She found that children might demonstrate upper extremity action corresponding to a description of one level of development and at the same time demonstrate trunk action corresponding to a different developmental step. Because descriptions of developmental levels for throwing were inadequate, Roberton adopted a "component approach" to movement description.6 She broke total body action down into constituent parts and then described movement within these specific regions of the body. Applying this method in a longitudinal study of development of the overarm throw in children, Roberton discovered that developmental change occurred at different rates in different components of body action.7 That is, the children demonstrated change in the movement pattern used in one component of body action, while the movement pattern used in another component remained stable across the same time interval. In addition, different children developed at different rates within each component of body action.
A major assumption of my study is that motor development is a lifelong process: Developmental or age-related change in movement patterns that may not be directly attributed to learning may occur throughout the human life span. Such an assumption allows the use of adult subjects in a developmental study. Traditionally, the term development refers to age-related behavioral
change that precedes a mature state. The mature state is characterized by behavioral stability.
Change in behavior that occurs in a mature individual is traditionally attributed to learning. Age-related behaviors that are not a result of specific learning experiences, however, possibly may appear in adults. Unless an individual had specific training in a particular motor task, the motor performance demonstrated at a particular point in time as-sumably is representative of naturally occurring, untrained performance. I designed this study to describe naturally occurring righting behavior. I did not train the subjects, and I assumed that they were never taught how to rise from the floor.
A survey of individuals of different ages is the most common approach to identifying developmental sequences.8
Cross-sectional research designs are based on the assumption that developmental change is age related. The behaviors of different age groups are used to order a developmental sequence.
An additional assumption is possible, however, that allows study of a single age group for the purpose of identifying developmental sequences. That assumption proposes that motor development is an orderly process. Developmental change in motor behavior is believed to occur in a sequence of identifiable steps. A logical corollary predicts that at any point in the life span, individuals should demonstrate motor behavior characteristic of their level within a developmental sequence. If an individual is in transition between steps of a developmental sequence, behaviors representative of adjacent developmental steps should be evident.6 Individuals who demonstrate variability in motor patterns while performing several trials of a task, therefore, may be demonstrating movement patterns that represent adjacent steps in a developmental sequence.
METHOD Subjects
Thirty-two adults (17 women, 15 men) comprised the study sample. I accepted subjects into the study who were at least 20 years old and no older than 35 years. Their mean age was 28.6 years. The sample was one of convenience, with subjects recruited from the campus of the University of Wisconsin-Madison. I eliminated any subject who reported acute or chronic physical or medical conditions that could limit physical
activity. The protocol for this study was approved by the university's Human Subjects Committee, and written informed consent was obtained from each subject.
Design
The research was conducted as a descriptive survey. From a developmental perspective, the study represented a single age-group, cross-sectional design.
Equipment
A Beta format portable videocassette recorder and tuner (VCR) were used in conjunction with a videocamera to record each subject's performance. The videocamera was located 7.6 m from the center of a 1.2- × 1.8-m exercise mat. The camera was positioned on a tripod such that the optical axis was approximately perpendicular to the long side of the mat at a height of 1 m above the floor. The camera obtained a side view of each subject at the beginning of taping. A television monitor was used to view the tapes during data analysis.
Procedure
I recorded each subject performing 10 successive trials of rising from a supine position. I instructed each subject to lie supine on the mat and on my signal "Go" to stand up as quickly as possible. I used the preliminary instruction to stand quickly to facilitate automaticity in the subjects' movements. The subjects received no other instructions concerning how the movements were to be performed, although I occasionally provided them with indiscriminate praise such as "Good" or "Great" to acknowledge their efforts. Intervals between trials were self-paced by the subjects, but in no instance exceeded one minute.
Data Reduction
Body action was divided into three components: 1) the upper extremities (UEs), 2) the axial (head-trunk) region, and 3) the lower extremities (LEs). Concentrating first on the axial region only, I played back the videotapes using both slow-motion and stop-action capabilities of the VCR system and wrote descriptions of movements of the head and trunk for each subject's performance during the first trial. I then repeated this procedure for the 2nd through 10th trials in succession and compared my written descriptions for similarities and
186 PHYSICAL THERAPY
RESEARCH differences. Where similarities of action were apparent, I wrote more general descriptions of head and trunk movements that could serve as categorical descriptions of axial component action. I reviewed the videotapes as the categories were formed to ensure their accuracy. This process was continued until all trials across all subjects could be classified into one of the categorical descriptions of axial component action.
I repeated the process to reduce the data for each of the other two components, the UEs and the LEs. After action categories were formed for each component, I reviewed the videotape and used the categories to classify movements within each component across all trials and all subjects. Data Analysis
Reliability of categorical descriptions. I trained two raters to analyze righting movements with reference to the component categorical descriptions. After training, each rater independently classified 50 randomly selected trials of the subjects' performances. I compared the raters' classifications to my original classification of these trials by calculating percentages of exact agreement. If less than 90% of exact agreement was obtained for any component, I met with the raters to clarify the reasons for disagreement. We worked together to refine the categorical descriptions of component action or to generate decision rules to improve the consistency of classifying component action. I then randomly selected another set of 50 trials, and we repeated this process until 90% or greater of exact agreement was obtained for all three components. I also reclassified a randomly selected set of 50 trials to determine intrarater agreement.
Description of righting in adults. The percentage of trials observed in each category of component action was calculated to portray the frequency of occurrence of each type of component action. I also tabulated "profiles," the combinations of UE, LE, and axial component categories, displayed by each subject on each trial and then determined the mode profile for each subject. The frequency with which different subject mode profiles occurred across the sample was determined, and these data were then used to characterize adult body action in rising.
Developmental sequences. I used the records of those subjects who varied within a component to identify a developmental sequence for that component.
TABLE 1 Number of Trialsa in Each Category of Movement
Subject Number
1 2 3 4 5 6 7 8 9
10 11 12 13
X
8 6 6 4
9 8
1
Category
X'
6 9
4 9
1 3 8 1
XX
4
6 1
XX'
1 2 4 4 6
1 1 7 1 9
Specifically, I constructed a table for each component that included each category of action and the number of trials each subject demonstrated in each category (Tab. 1). I then rearranged the categories of action (represented by columns of the table) until an order was identified in which each subject varied only between adjacent categories (Tab. 2). Using this method, the reverse order also is always a potential ordering for the developmental sequence. That is, if action categories XX, X', XX', and X are one order in which all subjects vary between adjacent steps, then the ordering X, XX', X', and XX also is a potential ordering of the developmental sequence. The researcher either must refer to previous developmental studies of the task or must hypothesize which of the
two possibilities is likely to be the developmental sequence for younger or older individuals. I used this procedure to identify a developmental sequence for each of the three components and then referred to the works of Schaltenbrand3
and McGraw4 to help select the likely developmental sequences for younger subjects.
RESULTS
Categories of Component Action Similarities and differences in the sub
jects' rising movements resulted in five categories of UE action, four categories of LE action, and four categories of axial movement. The action categories are delineated for the UE, LE, and axial components in Tables 3, 4, and 5, respectively.
Reliability of Categorical Descriptions
I attained greater than 90% of exact agreement with each of the two trained raters when we independently categorized component action in a randomly selected set of 50 trials. I attained greater than 95% of exact agreement when I recategorized component action in this same set of 50 trials. The percentages of exact agreement are reported in Table 6.
Description of Righting in Adults
The frequency with which each category of movement appeared across trials is presented for the UE, LE, and axial components in Tables 3, 4, and 5, respectively. In the UE component, a symmetrical pushing pattern was most common. The most frequently observed action of the axial region was symmetrical flexion followed by extension. The LEs most commonly demonstrated an asymmetrical squatting pattern.
Within this sample of 32 adults, 21 different combinations of component action appeared across the 320 trials of rising. Thirteen of these combinations, or profiles, occurred as the mode performance of at least one subject. The different subject mode profiles and their frequency of occurrence are listed in Table 7.
The most common profile in rising was characterized by symmetry of movement within each component. These subjects pushed symmetrically with the UEs as they flexed their heads
TABLE 2 Order in Which Subjects Vary Among Adjacent Categoriesa
Subject Number
1 2 3 4 5 6 7 8 9
10 11 12 13
XX
4
6 1
Category
X'
6 9
4 9
1 3 8 1
XX'
1 2 4 4 6
1 1 7 1 9
X
8 6 6 4
9 8
1
aEach subject performs 10 trials of the movement task.
a Order of development is proposed to be XX, X ', XX', and X.
Volume 68 / Number 2, February 1988 187
and trunks symmetrically forward and flexed their LEs assuming a symmetrical squat pattern. Extension of the LEs and axial region brought the body to erect stance as the UEs were lifted from the support surface (Fig. 1). Although this profile was most common, it was observed as the mode in only 8 of the 32 subjects. Another eight subjects differed from this symmetrical profile only in LE action. These individuals either demonstrated an asymmetrical squat (Fig. 2) or lost their balance when attempting to rise from a symmetrical squatting position, which resulted in a stepping action.
Four subjects rose by flexing and rotating their trunk to one side, while pushing with one UE and reaching with the other (Fig. 3). The LEs moved through a half-kneeling pattern in assuming the standing position. Another four subjects rolled to face the support surface, with one UE reaching across the body while the other pushed against the mat keeping the abdomen from contacting the surface. The LEs were either brought to an asymmetrical squat pattern or moved through a half-kneeling pattern. Both UEs then pushed on the support surface, elevating the trunk toward a horizontal position with the ventral surface of the trunk facing the mat. The UEs were then lifted as the axial region and LEs were extended vertically.
Of the remaining body action profiles, four were seen as the mode in at least two individuals, and another three were idiosyncratic. Eight additional body action profiles were observed in the sample but were not the mode performance of any subject.
Developmental Sequences for Each Component
Variability in component action within subjects permitted me to identify a developmental sequence for the LE and axial components. For each component, the subjects demonstrating variability across trials of rising are listed in Table 8. Thirteen subjects demonstrated variability in LE action across their 10 trials. Analysis of this variability revealed a sequence in which no subject varied to other than adjacent categories. That sequence is presented in Table 4, with category A proposed to be the earliest appearing of the developmental steps identified for LE action in this task. Successive steps follow in alphabetical order.
TABLE 3 Percentage of Occurrence Across Trials (N = 320) for Upper Extremity (UE) Component Categories
Category
A—Push and reach to symmetrical push
B—Push and reach
C—Symmetrical push to push and reach
D—Symmetrical push
E—Symmetrical reach
TOTAL
Description
One hand is placed on the support surface beside the pelvis. The other UE reaches across the body, and the hand is placed on the support surface. Both hands push against the support surface to an extended elbow position. The UEs are then lifted and used for balance.
One hand is placed on the support surface beside the pelvis. The other UE reaches out to assist in balance throughout the movement. The supporting UE pushes into extension and is then lifted, assisting in balance.
Both hands are placed on the support surface, one on each side of the pelvis. Both hands push against the support surface as the trunk moves forward. One hand leaves the support surface before the other to assist in balance.
Both hands are placed on the support surface, one on each side of the pelvis. Both hands push against the support surface before the point when the UEs are lifted simultaneously and used to assist in balance.
The UEs reach forward, leading the trunk, and are used to assist in balance throughout the movement.
Occurrence (%) 12.2
27.5
10.6
46.6
3.1
100.0
The records of nine subjects who demonstrated variability in head-trunk action across 10 trials of rising were analyzed to identify a developmental sequence for this component. The hypothesized order of development for the axial component is presented in Table 5, with category A proposed to be the earliest appearing step in the sequence and successive steps labeled in alphabetical order.
Eight subjects demonstrated variability in UE action. The movement categories could not be arranged into an order in which each subject varied only between adjacent steps. A sequence was found in which two subjects varied between categories B and D without demonstrating category C. At this point, I reinspected the categorical descriptions and videotapes of all subjects demonstrating categories B, C, or D in the UE component. Individuals demonstrating
category C appeared to be using a combination of action seen in categories B and D. That is, they began the movement by pushing symmetrically, as in category D, but then switched to pushing with just one UE later in the movement as in category B. I interpreted category C as a transitional pattern that may appear in individuals moving between categories B and D, but believed category C was not necessarily a developmental step. I, therefore, merged category C with category B. Combining categories B and C into a single descriptive category enabled me to hypothesize a developmental sequence in which no individual varied between other than adjacent steps. The proposed four-step sequence of development for UE action in the rising task is presented in Table 9. This sequence presents a revised description of UE category B that incorporates asymmetrical movements of the
188 PHYSICAL THERAPY
RESEARCH
TABLE 4 Percentage of Occurrence Across Trials (N = 320) for Lower Extremity (LE) Component Categories
Category
A—Half kneel
B—Asymmetrical squat
C—Symmetrical squat with balance step
D—Symmetrical squat
TOTAL
Description
The LEs are brought toward the trunk assuming an asymmetrical crossed-leg position with one foot and the opposite thigh contacting the support surface. Body weight is transferred from the thigh to the knee of the same LE, as the body is rotated over the LEs into a half-kneeling position. Weight is then transferred to the opposite foot as the LEs extend.
One or both LEs are brought toward the trunk, assuming an asymmetrical or crossed-leg position with the soles of the feet contacting the support surface. The LEs (or LE if one remained extended) push(es) up to an extended position. Crossing or asymmetry may be corrected during the extension phase by circumduction or stepping action.
The LEs are flexed synchronously and symmetrically, placing the soles of the feet on the support surface. Foot placement is adjusted before extension or at the end of straightening by stepping or hopping.
The LEs are brought symmetrically into flexion with the heels approximating the buttocks. Weight is transferred from buttocks to the feet, and the LEs then extend vertically.
Occurrence (%) 15.9
40.9
16.9
26.3
100.0
UEs, including those that begin with a symmetrical push pattern but end with asymmetrical use of the UEs.
DISCUSSION
Utility of Component Approach The results of this study illustrate the
usefulness of using the component method of movement analysis for description of motor behavior in tasks of interest to physical therapists. The level of detail in description seems to be appropriate as a beginning step toward characterizing movement patterns used to accomplish such fundamental motor tasks as rising from a supine position, assuming a sitting position, or rolling. This method may lead to more precise descriptions of body movements for tasks that previously have been described only in general terms. For physical therapists, such detail is necessary
when faced with the task of retraining individuals to perform these functional motor skills. In addition, the component method could be used more extensively in pathokinesiology to describe and characterize movement disorders resulting from neuromuscular or musculoskeletal dysfunction. Indeed, Brunns-trom has proposed that recovery from stroke may proceed at different rates within different regions of the body.9
The results of the study also imply that biomechanical studies of motor tasks such as rising from a supine position would best be performed within component action categories or a single body action profile. The kinesiological differences between the various categories of component action are too great to be ignored, particularly if movements are to be described in terms of kinematic variables such as angular displacements, velocities, and accelerations of body segments.
Implications for Clinical Practice
The relatively high degree of intersub-ject variability, evidenced by 21 different combinations of component action, demonstrates the many forms of rising that are possible. The results of my study refute the notion that all adults perform the rising task using the same movement patterns. From a practical perspective, this variability provides the physical therapist with options when selecting movement patterns to be used when teaching the task of rising. Which combination of movements might be an appropriate set for a specific patient is now a question of interest. Should a patient be trained to perform the rising task using the profile most commonly encountered in their age group? Is one form of rising more "efficient" than another? Are certain body dimensions related to the use of component movement categories? Do biomechanical constraints restrict an individual's choice of combinations of component action during the rising task? Surely, knowing the answers to such questions could provide a degree of specificity for physical therapists concerned with motor reeducation that is yet unrealized.
Developmental Implications Theoretically, the component ap
proach offers a more insightful model of motor development than previous approaches. Previous studies of rising were based on a model that views neuromotor development as a process of heirarchical integration of reflexes that ultimately come under volitional or cortical control.3,5 When the cortex exerted control over motor behavior, development was considered to be complete. The model of neuromotor organization suggested by the studies of Kuypers and colleagues proposes that axial and limb regions may be primarily controlled through medial and lateral neu-roanatomical structures, respectively.10
Subsequent primate studies based on Kuypers' model suggested that motor development may be viewed as progressive dissociation of limb movements from an early linkage with axial movement.11 The component method of movement analysis is ideally suited to examination of the relationship between movement patterns occurring in different regions of the body during the process of development.
The findings of this study raise several additional issues. First, applying the
Volume 68 / Number 2, February 1988 189
TABLE 5 Percentage of Occurrence Across Trials (N = 320) for Axial Component Categories
Category
A—Full rotation, abdomen up
B—Partial rotation
C—Symmetrical, interrupted by rotation
D—Symmetrical
TOTAL
Description
The head and trunk flex and rotate to the side. Rotation continues until the ventral surface of the trunk faces, but does not contact, the support surface. The pelvis is then elevated to or above the level of the shoulder girdle. The back extends from this position vertically, with or without accompanying rotation of the trunk.
Flexion and rotation of the head and trunk bring the body to a side-facing position, with the trunk inclined slightly forward of the vertical plane. The trunk extends vertically, with or without accompanying rotation.
The head and trunk begin to flex forward symmetrically. The symmetrical movement is interrupted by rotation to one side or by extension with rotation. Forward movement then continues until the head and trunk are forward of the vertical plane. The trunk may rotate counterclockwise during extension to the upright position. A frontal or diagonal facing may result.
The head and trunk move forward symmetrically past the vertical plane; the back then extends symmetrically to the upright position.
Occurrence (%) 14.4
19.7
19.7
46.2
100.0
adjacent criterion to order action categories demonstrated by adults into developmental sequences has not been reported previously. Although Roberton successfully used this criterion to identify developmental sequences within components for the task of throwing, she initially identified the movement patterns that were to become developmental steps by using children as subjects.6 Whether the component action categories evident in adult subjects are representative of developmental steps in movement used to right the body and whether the proposed sequences are ordered correctly can only be answered by further study. Although longitudinal study is the ultimate validation procedure for the sequences, a more practical approach might be a cross-sectional study of individuals of different ages. The purpose of a cross-sectional study would be to determine whether the action categories rise and fall in frequency in the order predicted.8
Assuming that these categories do represent developmental differences, another issue arises. Do these various forms of component action observed in
TABLE 6 Percentages of Exact Agreement Across Trials (N = 50) by Component
Rater
1 vs 2 1 vs 3 1 vs 1
UE (%) 92 94 98
Component
LE Axial (%) (%) 94 100 94 100 96 96
Fig. 1. Most common form of rising to a standing position: upper extremity component, symmetrical push; axial component, symmetrical; lower extremity component, symmetrical squat.
Fig. 2. Second most common form of rising to a standing position: upper extremity component, symmetrical push; axial component, symmetrical; lower extremity component, asymmetrical squat.
190 PHYSICAL THERAPY
RESEARCH adults possibly represent lack of progress to advanced symmetrical form in rising or might they represent developmental regression? Are these movement patterns specific to young adults and, therefore, different from those seen in younger and older individuals? Studies of both older and younger subjects could begin to answer these questions.
CONCLUSIONS
The component approach to movement description is a useful method of describing fundamental movement patterns of interest to physical therapists for both theoretical and practical reasons. Great variability exists in the patterns of movement used by adults in the rising task. Differences in adult movements used in rising from a supine to a standing position may well represent different developmental steps within components of body action. Only further cross-sectional and longitudinal studies of this movement task in individuals of various ages will support or refute the proposed component developmental sequences. Until additional studies are performed to further identify factors that might affect which component action pattern is most appropriate for any patient, physical therapists are faced with selecting from a wide range of possible movement pattern combinations when teaching patients to rise from the floor.
Acknowledgments. I thank Mary Baldwin, MS, and Randy Richter, MS, for their assistance in determining the objectivity of the component categories.
TABLE 7 Profiles Demonstrated as Mode Performance by Subjects (N = 32)
UE
Symmetrical push Symmetrical push Asymmetrical push and
reach Symmetrical push
Asymmetrical push and reach to symmetrical push
Asymmetrical push and reach to symmetrical push
Symmetrical push to push and reach
Symmetrical reach Asymmetrical push and
reach
Asymmetrical push and reach
Asymmetrical push and reach
Asymmetrical push and reach
Asymmetrical push and reach
Component
Axial
symmetrical symmetrical partial rota
tion symmetrical
full rotation, abdomen up
full rotation, abdomen up
symmetrical, interrupted by rotation
symmetrical symmet
rical, interrupted by rotation
symmetrical, interrupted by rotation
full rotation, abdomen up
partial rotation
symmetrical, interrupted by rotation
LE
symmetrical squat asymmetrical squat half kneel
symmetrical squat, with balance steps
half kneel
asymmetrical squat
asymmetrical squat
asymmetrical squat symmetrical squat
asymmetrical squat
asymmetrical squat
symmetrical squat with balance steps
symmetrical squat with balance steps
Number of Subjects
8 5 4
3
2
2
2
1 1
1
1
1
1
Fig. 3. Third most common form of rising to a standing position: upper extremity component, asymmetrical push and reach; axial component, partial rotation; lower extremity component, half kneel.
Volume 68 / Number 2, February 1988 191
TABLE 8 Individual Patterns of Variability in Body Action Components
Component
UE
Axial
LE
Subject Number
4 7
14 23b
25 26 29 31b
1 4 7
12 13 14 23 25 31 4 7 9
10 13 14 20 22 27 28 30 31 32
A
9
1 1
6
4
6 1
Number of Trials in Category
B
1 3 1 3 1 9 9 1
4
4
6 9
4 9
1 3 8 1
C
2 9
3
2
5 6 2 1 3 3 1
1 2 4 4 6
1 1 7 1 9
D
5
7 6
9 8
5
8 9 7 7 9
8 6 6 4
9 8
1
Ea
TABLE 9 Proposed Developmental Sequence for the Upper Extremity (UE) Component
Proposed Order of Categories
A—Push and reach to symmetrical push
B—Push and reacha
C—Symmetrical push
D—Symmetrical reach
Description
One hand is placed on the support surface beside the pelvis. The other UE reaches across the body, and the hand is placed on the support surface. Both hands push against the support surface to an extended elbow position. The UEs are then lifted and used for balance.
One or both hands are placed beside the pelvis on the support surface. One hand continues to support and push against the support surface as the other reaches forward to assist in balance.
Both hands are placed on the support surface, one on each side of the pelvis. Both hands push against the support surface before the point when the UEs are lifted synchronously and used to assist in balance.
The UEs reach forward, leading the trunk, and are used to assist in balance throughout the movement.
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3. Schaltenbrand G: The development of human motility and motor disturbances. Archives of Neurology and Psychiatry 18:720-730, 1927
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5. Bayley N: The development of motor abilities during the first three years. Monogr Soc Res Child Dev 1:1-26, 1935
6. Roberton MA: Stability of stage categorizations across trials: Implications for the "stage theory" of overarm throw development. Journal of Human Movement Studies 3:49-59, 1977
7. Roberton MA: Longitudinal evidence for developmental stages in the forceful overarm throw. Journal of Human Movement Studies 4:167-175,1978
8. Roberton MA, Williams K, Langendorfer S: Pre-longitudinal screening of motor development sequences. Research Quarterly for Exercise and Sport 51:724-731, 1980
9. Brunnstrom S: Movement Therapy in Hemiplegia: A Neurophysiological Approach. New York, NY, Harper & Row, Publishers Inc, 1970
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a Category E does not apply to the axial or the LE component. b Subject varied to nonadjacent steps in this proposed ordering of categories.
a Category B represents a combination of categories B and C presented in Table 3. Category A is the same as presented in Table 3. Categories C and D were labeled as categories D and E, respectively, in Table 3.
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