Rising from a Supine Position to Erect Stance

Description of Adult Movement and a Developmental Hypothesis

ANN F. VANSANT

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 devel-
opmental 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 move-
ments 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 inde-
pendence. Movement patterns used to
stand up are a concern of physical ther-
apists 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 su-
pine position. No formal studies, how-
ever, have been reported in the literature
that describe clearly movements used by
healthy adults in this task. When train-
ing 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
A. VanSant, PhD, is Associate Professor, Depart-
ment of Physical Therapy, Medical College of Vir-
ginia, 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 Edu-
cation, University of Wisconsin-Madison, Madi-
son, 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 pre-
sented at the Sixty-First Annual Conference of the
American Physical Therapy Association, New Or-
leans, 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 Inter-
est: 4.
their evaluations and selection of move-
ment 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 thera-
pists with a more detailed description of
this task that eventually might lead to
more refined evaluation and treatment
of young adults who experience diffi-
culty 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 con-
sidered righting tasks.1,3 Development of
righting abilities during the first year of
life represents progression toward phys-
ical independence. The ability to rise
from a supine position without pulling
up on someone or something is com-
monly acquired early in the second year
of life5 and, under normal circum-
stances, can be expected to be main-
tained 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 de-
scribed development within the task of
rising from a supine position. Both re-
searchers 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 ris-
ing action or from differences in the
samples of children studied. Nonethe-
less, a single mature form of rising from

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 therisingmove-
ment was selected and used to charac-
terize movements of the body as a
whole. Schaltenbrand, for example, em-
phasized differences in the amount of
body rotation used to accomplish right-
ing from a supine position,3 and Mc-
Graw concentrated on description of the
characteristics of automaticity and voli-
tion in infants' and young children's
righting movements.4 When develop-
mental differences are described in
terms of action of the whole body, pre-
cision is lost.6 Descriptions of move-
ments are often incomplete. Movements
of the extremities, for example, were not
consistently reported when successive
developmental levels in therightingtask
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 develop-
ment and at the same time demonstrate
trunk action corresponding to a differ-
ent developmental step. Because de-
scriptions 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. Ap-
plying 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 develop-
ment refers to age-related behavioral
186
change that precedes a mature state. The
mature state is characterized by behav-
ioral stability.
Change in behavior that occurs in a
mature individual is traditionally attrib-
uted to learning. Age-related behaviors
that are not a result of specific learning
experiences, however, possibly may ap-
pear in adults. Unless an individual had
specific training in a particular motor
task, the motor performance demon-
strated at a particular point in time as-
sumably is representative of naturally
occurring, untrained performance. I de-
signed 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 develop-
mental change is age related. The behav-
iors 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 assump-
tion 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 character-
istic of their level within a develop-
mental sequence. If an individual is in
transition between steps of a develop-
mental sequence, behaviors representa-
tive of adjacent developmental steps
should be evident.6 Individuals who
demonstrate variability in motor pat-
terns while performing several trials of
a task, therefore, may be demonstrating
movement patterns that represent adja-
cent steps in a developmental sequence.
METHOD
Subjects
Thirty-two adults (17 women, 15
men) comprised the study sample. I ac-
cepted 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-Madi-
son. I eliminated any subject who re-
ported acute or chronic physical or med-
ical conditions that could limit physical
activity. The protocol for this study was
approved by the university's Human
Subjects Committee, and written in-
formed consent was obtained from each
subject.
Design
The research was conducted as a de-
scriptive survey. From a developmental
perspective, the study represented a sin-
gle 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 approxi-
mately 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 tap-
ing. 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 sub-
jects received no other instructions con-
cerning how the movements were to be
performed, although I occasionally pro-
vided them with indiscriminate praise
such as "Good" or "Great" to acknowl-
edge 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). Con-
centrating first on the axial region only,
I played back the videotapes using both
slow-motion and stop-action capabili-
ties of the VCR system and wrote de-
scriptions 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
PHYSICAL THERAPY

differences. Where similarities of action
were apparent, I wrote more general
descriptions of head and trunk move-
ments that could serve as categorical
descriptions of axial component action.
I reviewed the videotapes as the cate-
gories were formed to ensure their ac-
curacy. This process was continued until
all trials across all subjects could be clas-
sified into one of the categorical descrip-
tions of axial component action.
I repeated the process to reduce the
data for each of the other two compo-
nents, the UEs and the LEs. After action
categories were formed for each com-
ponent, I reviewed the videotape and
used the categories to classify move-
ments 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 com-
ponent categorical descriptions. After
training, each rater independently clas-
sified 50 randomly selected trials of the
subjects' performances. I compared the
raters' classifications to my original clas-
sification of these trials by calculating
percentages of exact agreement. If less
than 90% of exact agreement was ob-
tained for any component, I met with
the raters to clarify the reasons for disa-
greement. We worked together to refine
the categorical descriptions of compo-
nent action or to generate decision rules
to improve the consistency of classifying
component action. I then randomly se-
lected 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 reclas-
sified 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 cal-
culated to portray the frequency of oc-
currence of each type of component ac-
tion. I also tabulated "profiles," the
combinations of UE, LE, and axial com-
ponent categories, displayed by each
subject on each trial and then deter-
mined the mode profile for each subject.
The frequency with which different sub-
ject 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 devel-
opmental sequence for that component.
Volume 68 / Number 2, February 1988
RESEARCH
TABLE 1 two possibilities is likely to be the devel-
Number of Trialsa in Each Category opmental sequence for younger or older
of Movement individuals. I used this procedure to
identify a developmental sequence for
Subject Category
each of the three components and then
Number X X' XX XX' referred to the works of Schaltenbrand3
1 6 4 and McGraw4 to help select the likely
2 9 1 developmental sequences for younger
3 8 2 subjects.
4 6 4
5 6 4 RESULTS
6 4 6
7 4 6 Categories of Component Action
8 9 1
Similarities and differences in the sub-
9 9 1
10 8 1 1 jects' rising movements resulted in five
11 3 7 categories of UE action, four categories
12 1 8 1 of LE action, and four categories of axial
13 1 9 movement. The action categories are
a delineated for the UE, LE, and axial
Each subject performs 10 trials of the
movement task. components in Tables 3, 4, and 5,
respectively.
Specifically, I constructed a table for
Reliability of
each component that included each cat-
Categorical Descriptions
egory of action and the number of trials
each subject demonstrated in each cat- I attained greater than 90% of exact
egory (Tab. 1). I then rearranged the agreement with each of the two trained
categories of action (represented by col- raters when we independently catego-
umns of the table) until an order was rized component action in a randomly
identified in which each subject varied selected set of 50 trials. I attained greater
only between adjacent categories (Tab. than 95% of exact agreement when I
2). Using this method, the reverse order recategorized component action in this
also is always a potential ordering for same set of 50 trials. The percentages of
the developmental sequence. That is, if exact agreement are reported in Ta-
action categories XX, X', XX', and X ble 6.
are one order in which all subjects vary
between adjacent steps, then the order- Description of Righting
ing X, XX', X', and XX also is a poten- in Adults
tial ordering of the developmental se-
quence. The researcher either must refer The frequency with which each cate-
to previous developmental studies of the gory of movement appeared across trials
task or must hypothesize which of the is presented for the UE, LE, and axial
components in Tables 3, 4, and 5, re-
spectively. In the UE component, a
TABLE 2 symmetrical pushing pattern was most
Order in Which Subjects Vary Among common. The most frequently observed
Adjacent Categoriesa
action of the axial region was symmet-
Subject Category rical flexion followed by extension. The
Number LEs most commonly demonstrated an
XX X' XX' X
asymmetrical squatting pattern.
1 4 6 Within this sample of 32 adults, 21
2 9 1
different combinations of component
3 2 8
4 4 6
action appeared across the 320 trials of
5 4 6 rising. Thirteen of these combinations,
6 6 4 or profiles, occurred as the mode per-
7 6 4 formance of at least one subject. The
8 1 9 different subject mode profiles and their
9 1 9 frequency of occurrence are listed in
10 1 1 8 Table 7.
11 3 7 The most common profile in rising
12 8 1 1 was characterized by symmetry of
13 1 9
movement within each component.
a
Order of development is proposed to be These subjects pushed symmetrically
XX, X', XX', and X. with the UEs as they flexed their heads
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 ob-
served 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 at-
tempting to rise from a symmetrical
squatting position, which resulted in a
stepping action.
Four subjects rose by flexing and ro-
tating 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 as-
suming 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 con-
tacting the surface. The LEs were either
brought to an asymmetrical squat pat-
tern or moved through a half-kneeling
pattern. Both UEs then pushed on the
support surface, elevating the trunk to-
ward a horizontal position with the ven-
tral 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 ac-
tion 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 com-
ponent, the subjects demonstrating var-
iability across trials of rising are listed in
Table 8. Thirteen subjects demonstrated
variability in LE action across their 10
trials. Analysis of this variability re-
vealed 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 ear-
liest appearing of the developmental
steps identified for LE action in this
task. Successive steps follow in alpha-
betical order.
188
TABLE 3
Percentage of Occurrence Across Trials (N = 320) for Upper Extremity (UE)
Component Categories
Occurrence
Category Description
(%)
A—Push and reach to One hand is placed on the support 12.2
symmetrical push 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.
B—Push and reach One hand is placed on the support 27.5
surface beside the pelvis. The
other UE reaches out to assist in
balance throughout the move-
ment. The supporting UE pushes
into extension and is then lifted,
assisting in balance.
C—Symmetrical push to Both hands are placed on the sup- 10.6
push and reach port 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.
D—Symmetrical push Both hands are placed on the sup- 46.6
port surface, one on each side of
the pelvis. Both hands push
against the support surface be-
fore the point when the UEs are
lifted simultaneously and used to
assist in balance.
E—Symmetrical reach The UEs reach forward, leading the 3.1
trunk, and are used to assist
in balance throughout the
movement.
TOTAL 100.0
The records of nine subjects who category C appeared to be using a com-
demonstrated variability in head-trunk bination of action seen in categories B
action across 10 trials of rising were and D. That is, they began the move-
analyzed to identify a developmental ment by pushing symmetrically, as in
sequence for this component. The hy- category D, but then switched to push-
pothesized order of development for the ing with just one UE later in the move-
axial component is presented in Table ment as in category B. I interpreted
5, with category A proposed to be the category C as a transitional pattern that
earliest appearing step in the sequence may appear in individuals moving be-
and successive steps labeled in alphabet- tween categories B and D, but believed
ical order. category C was not necessarily a devel-
Eight subjects demonstrated variabil- opmental step. I, therefore, merged cat-
ity in UE action. The movement cate- egory C with category B. Combining
gories could not be arranged into an categories B and C into a single descrip-
order in which each subject varied only tive category enabled me to hypothesize
between adjacent steps. A sequence was a developmental sequence in which no
found in which two subjects varied be- individual varied between other than
tween categories B and D without dem- adjacent steps. The proposed four-step
onstrating category C. At this point, I sequence of development for UE action
reinspected the categorical descriptions in the rising task is presented in Table
and videotapes of all subjects demon- 9. This sequence presents a revised de-
strating categories B, C, or D in the UE scription of UE category B that incor-
component. Individuals demonstrating porates asymmetrical movements of the
PHYSICAL THERAPY

TABLE 4
Percentage of Occurrence Across Trials (N = 320) for Lower Extremity (LE)
Component Categories
Occurrence
Category Description
(%)
A—Half kneel The LEs are brought toward the trunk 15.9
assuming an asymmetrical crossed-
leg position with one foot and the
opposite thigh contacting the sup-
port surface. Body weight is trans-
ferred from the thigh to the knee of
the same LE, as the body is ro-
tated over the LEs into a half-kneel-
ing position. Weight is then trans-
ferred to the opposite foot as the
LEs extend.
B—Asymmetrical squat One or both LEs are brought toward 40.9
the trunk, assuming an asymmetri-
cal 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. Cross-
ing or asymmetry may be corrected
during the extension phase by cir-
cumduction or stepping action.
C—Symmetrical squat with The LEs are flexed synchronously 16.9
balance step 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.
D—Symmetrical squat The LEs are brought symmetrically 26.3
into flexion with the heels approxi-
mating the buttocks. Weight is
transferred from buttocks to the
feet, and the LEs then extend
vertically.
TOTAL 100.0
UEs, including those that begin with a when faced with the task of retraining
symmetrical push pattern but end with individuals to perform these functional
asymmetrical use of the UEs. motor skills. In addition, the component
method could be used more extensively
in pathokinesiology to describe and
DISCUSSION characterize movement disorders result-
ing from neuromuscular or musculo-
Utility of Component Approach skeletal dysfunction. Indeed, Brunns-
The results of this study illustrate the trom has proposed that recovery from
usefulness of using the component stroke may proceed at different rates
method of movement analysis for de- within different regions of the body.9
scription of motor behavior in tasks of The results of the study also imply
interest to physical therapists. The level that biomechanical studies of motor
of detail in description seems to be ap- tasks such as rising from a supine posi-
propriate as a beginning step toward tion would best be performed within
characterizing movement patterns used component action categories or a single
to accomplish such fundamental motor body action profile. The kinesiological
tasks as rising from a supine position, differences between the various cate-
assuming a sitting position, or rolling. gories of component action are too great
This method may lead to more precise to be ignored, particularly if movements
descriptions of body movements for are to be described in terms of kinematic
tasks that previously have been de- variables such as angular displacements,
scribed only in general terms. For phys- velocities, and accelerations of body
ical therapists, such detail is necessary segments.
Volume 68 / Number 2, February 1988
RESEARCH
Implications for
Clinical Practice
The relatively high degree of intersub-
ject variability, evidenced by 21 differ-
ent 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
therisingtask 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 com-
bination of movements might be an ap-
propriate 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 en-
countered in their age group? Is one
form of rising more "efficient" than an-
other? Are certain body dimensions re-
lated to the use of component move-
ment 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 mo-
tor reeducation that is yet unrealized.
Developmental Implications
Theoretically, the component ap-
proach offers a more insightful model
of motor development than previous ap-
proaches. Previous studies ofrisingwere
based on a model that views neuromo-
tor development as a process of heir-
archical integration of reflexes that
ultimately come under volitional or cor-
tical control.3,5 When the cortex exerted
control over motor behavior, develop-
ment 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 con-
trolled through medial and lateral neu-
roanatomical structures, respectively.10
Subsequent primate studies based on
Kuypers' model suggested that motor
development may be viewed as progres-
sive dissociation of limb movements
from an early linkage with axial move-
ment.11 The component method of
movement analysis is ideally suited to
examination of the relationship between
movement patterns occurring in differ-
ent regions of the body during the proc-
ess of development.
The findings of this study raise several
additional issues. First, applying the
189
TABLE 5
Percentage of Occurrence Across Trials (N = 320) for Axial Component Categories
Occurrence
Category Description
A—Full rotation, abdomen up The head and trunk flex and ro-
tate to the side. Rotation con-
tinues until the ventral surface
of the trunk faces, but does
not contact, the support sur-
face. The pelvis is then ele-
vated to or above the level of
the shoulder girdle. The back
extends from this position
vertically, with or without ac-
companying rotation of the
trunk.
B—Partial rotation 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.
C—Symmetrical, interrupted The head and trunk begin to flex
by rotation forward symmetrically. The
symmetrical movement is in-
terrupted by rotation to one
side or by extension with ro-
tation. Forward movement
then continues until the head
and trunk are forward of the
vertical plane. The trunk may
rotate counterclockwise dur-
ing extension to the upright
position. A frontal or diagonal
facing may result.
D—Symmetrical The head and trunk move for-
ward symmetrically past the
vertical plane; the back then
extends symmetrically to the
upright position.
TOTAL
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
adjacent criterion to order action cate-
gories demonstrated by adults into
developmental sequences has not been
reported previously. Although Roberton
(%) successfully used this criterion to iden-
14.4 tify developmental sequences within
components for the task of throwing,
she initially identified the movement
patterns that were to become develop-
mental steps by using children as sub-
jects.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 or-
dered correctly can only be answered by
19.7 further study. Although longitudinal
study is the ultimate validation proce-
dure 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 ac-
19.7 tion categories rise and fall in frequency
in the order predicted.8
Assuming that these categories do rep-
resent developmental differences, an-
other issue arises. Do these various
forms of component action observed in
TABLE 6
Percentages of Exact Agreement Across
Trials (N = 50) by Component
46.2 Component
Rater UE LE Axial
(%) (%) (%)
1 vs 2 92 94 100
1 vs 3 94 94 100
100.0
1 vs 1 98 96 96
PHYSICAL THERAPY
 RESEARCH
adults possibly represent lack of progress TABLE 7
to advanced symmetrical form in rising Profiles Demonstrated as Mode Performance by Subjects (N = 32)
or might they represent developmental
regression? Are these movement pat- Component Number
terns specific to young adults and, there- UE Axial LE of Subjects
fore, different from those seen in
Symmetrical push symmetrical symmetrical squat 8
younger and older individuals? Studies Symmetrical push symmetrical asymmetrical squat 5
of both older and younger subjects could Asymmetrical push and partial rota- half kneel 4
begin to answer these questions. reach tion
Symmetrical push symmetrical symmetrical squat, 3
with balance
CONCLUSIONS steps
Asymmetrical push and full rotation, half kneel 2
The component approach to move- reach to symmetrical abdomen
ment description is a useful method of push up
describing fundamental movement pat- Asymmetrical push and full rotation, asymmetrical squat 2
terns of interest to physical therapists for reach to symmetrical abdomen
both theoretical and practical reasons. push up
Great variability exists in the patterns of Symmetrical push to symmet- asymmetrical squat 2
push and reach rical, in-
movement used by adults in the rising
terrupted
task. Differences in adult movements by rota-
used in rising from a supine to a stand- tion
ing position may well represent different Symmetrical reach symmetrical asymmetrical squat 1
developmental steps within components Asymmetrical push and symmet- symmetrical squat 1
of body action. Only further cross-sec- reach rical, in-
tional and longitudinal studies of this terrupted
movement task in individuals of various by rota-
ages will support or refute the proposed tion
component developmental sequences. Asymmetrical push and symmet- asymmetrical squat 1
Until additional studies are performed reach rical, in-
terrupted
to further identify factors that might
by rota-
affect which component action pattern tion
is most appropriate for any patient, Asymmetrical push and full rotation, asymmetrical squat 1
physical therapists are faced with select- reach abdomen
ing from a wide range of possible move- up
ment pattern combinations when teach- Asymmetrical push and partial rota- symmetrical squat 1
ing patients to rise from the floor. reach tion with balance
steps
Asymmetrical push and symmet- symmetrical squat 1
reach rical, in- with balance
Acknowledgments. I thank Mary
terrupted steps
Baldwin, MS, and Randy Richter, MS,
by rota-
for their assistance in determining the tion
objectivity of the component categories.

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

 REFERENCES
TABLE 8
Individual Patterns of Variability in Body Action Components 1. Bobath B, Bobath K: Cerebral palsy. In Pear-
son PH, Williams CE (eds): Physical Therapy
Subject Number of Trials in Category Services in the Developmental Disabilities.
Component Springfield, IL, Charles C Thomas, Publisher,
Number A B C D Ea 1972, pp 31-177
UE 4 9 1 2. Knott M, Voss DE: Proprioceptive Neuromus-
cular Facilitation: Patterns and Techniques, ed
7 3 2 5
2. Baltimore, MD, Williams & Wilkins, 1968
14 1 9
3. Schaltenbrand G: The development of human
23b 3 7
motility and motor disturbances. Archives of
25 1 3 6 Neurology and Psychiatry 18:720-730, 1927
26 1 9 4. McGraw MB: Neuromuscular Maturation of the
29 1 9 Human Infant. New York, NY, Hafner Press,
31 b 1 9 1945
Axial 1 2 8 5. Bayley N: The development of motor abilities
4 6 4 during the first three years. Monogr Soc Res
7 5 5 Child Dev 1:1-26, 1935
12 4 6 6. Roberton MA: Stability of stage categorizations
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13 2 8
of overarm throw development. Journal of Hu-
14 1 9 man Movement Studies 3:49-59, 1977
23 3 7
7. Roberton MA: Longitudinal evidence for devel-
25 3 7 opmental stages in the forceful overarm throw.
31 1 9 Journal of Human Movement Studies 4:167-
LE 4 4 6 175,1978
7 9 1 8. Roberton MA, Williams K, Langendorfer S: Pre-
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a
Category E does not apply to the axial or the LE component. dence concerning the role of corticomotoneu-
b ronal connections. Brain 99:235-254, 1976
Subject varied to nonadjacent steps in this proposed ordering of categories.

TABLE 9
Proposed Developmental Sequence for the Upper Extremity (UE) Component

Proposed Order of Categories Description

A—Push and reach to One hand is placed on the support surface

symmetrical push 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 ex-
tended elbow position. The UEs are then
lifted and used for balance.
B—Push and reacha 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.
C—Symmetrical push Both hands are placed on the support sur-
face, 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.
D—Symmetrical reach The UEs reach forward, leading the trunk,
and are used to assist in balance
throughout the movement.
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.

192 PHYSICAL THERAPY