The ability to stand up from the floor their evaluations and selection of move- The form of movements used to rise
is a significant part of physical inde- ment patterns they will teach. from a supine position change during
pendence. Movement patterns used to The first purpose of this study was to the preschool years.3-5 Little is known,
stand up are a concern of physical ther- describe adults' movements in the task however, about movement patterns
apists when evaluating their patients' of standing up from a supine position. I used to right the body after the period
performances and instructing them to believed that my method of movement of early childhood. Righting movements
perform this task. analysis might provide physical thera- are assumed to reach mature form and
The motor reeducation theories and pists with a more detailed description of then remain unchanged during later
techniques of Bobath and Bobath1 and this task that eventually might lead to childhood and the adult years. These
Knott and Voss2 prescribe specific more refined evaluation and treatment assumptions, however, have never been
movement patterns to be used when of young adults who experience diffi- studied formally.
teaching individuals to rise from a su- culty in standing up.
pine position. No formal studies, how- The second purpose of the study was BACKGROUND
ever, have been reported in the literature to hypothesize specific developmental
that describe clearly movements used by sequences for this task. Rising from a Without studies of adults' rising
healthy adults in this task. When train- supine position is an excellent task for movements reported in the literature, I
ing disabled adults to stand up from a studying life span motor development. turned to the published research on
supine position, therapists must rely From a theoretical perspective, rising righting in infants and young children.
either on these authorities or their own from a supine position is a "righting" Schaltenbrand3 and McGraw4 have de-
informal observations as a reference for task.3,4 Righting encompasses all of the scribed development within the task of
varied movements used in the process rising from a supine position. Both re-
of assuming erect stance. Motor abilities searchers implied that developmental
A. VanSant, PhD, is Associate Professor, Depart-
such as rolling from a supine to a prone change in this task was complete in early
ment of Physical Therapy, Medical College of Vir- position, moving to sitting, getting up childhood. According to Schaltenbrand,
ginia, Virginia Commonwealth University, PO Box on all fours, and ultimately standing up the adult form of rising appears by the
224, MCV Station, Richmond, VA 23298-0001
(USA). She was a doctoral candidate, Department from a supine position, have been con- age of 4 to 5 years and is characterized
of Physical Education and Dance, School of Edu- sidered righting tasks.1,3 Development of by symmetry of body action.3 McGraw's
cation, University of Wisconsin-Madison, Madi- righting abilities during the first year of
son, WI, when this study was conducted. description and illustration of a mature
This study was completed in partial fulfillment life represents progression toward phys- form of rising did not portray symmetry
of the requirements for Dr. VanSant's doctoral ical independence. The ability to rise of body action, despite study of children
degree, University of Wisconsin-Madison.
This study was supported in part by a grant from
from a supine position without pulling up to 6 years of age.4
the Foundation for Physical Therapy and was pre- up on someone or something is com- This discrepancy over mature form
sented at the Sixty-First Annual Conference of the monly acquired early in the second year may have resulted from the varied
American Physical Therapy Association, New Or-
leans, LA, June 16-20, 1985. of life5 and, under normal circum- points of emphasis when describing ris-
This article was submitted June 26, 1986; was stances, can be expected to be main- ing action or from differences in the
with the author for revision 27 weeks; and was tained until the end of the human life
accepted April 29, 1987. Potential Conflict of Inter- samples of children studied. Nonethe-
est: 4. span. less, a single mature form of rising from
TABLE 4
Implications for
Percentage of Occurrence Across Trials (N = 320) for Lower Extremity (LE) Clinical Practice
Component Categories
The relatively high degree of intersub-
Occurrence ject variability, evidenced by 21 differ-
Category Description
(%) ent combinations of component action,
A—Half kneel The LEs are brought toward the trunk 15.9 demonstrates the many forms of rising
assuming an asymmetrical crossed- that are possible. The results of my study
leg position with one foot and the refute the notion that all adults perform
opposite thigh contacting the sup- therisingtask using the same movement
port surface. Body weight is trans- patterns. From a practical perspective,
ferred from the thigh to the knee of this variability provides the physical
the same LE, as the body is ro- therapist with options when selecting
tated over the LEs into a half-kneel-
movement patterns to be used when
ing position. Weight is then trans-
ferred to the opposite foot as the
teaching the task of rising. Which com-
LEs extend. bination of movements might be an ap-
B—Asymmetrical squat One or both LEs are brought toward 40.9 propriate set for a specific patient is now
the trunk, assuming an asymmetri- a question of interest. Should a patient
cal or crossed-leg position with the be trained to perform the rising task
soles of the feet contacting the using the profile most commonly en-
support surface. The LEs (or LE if countered in their age group? Is one
one remained extended) push(es) form of rising more "efficient" than an-
up to an extended position. Cross- other? Are certain body dimensions re-
ing or asymmetry may be corrected
lated to the use of component move-
during the extension phase by cir-
cumduction or stepping action.
ment categories? Do biomechanical
C—Symmetrical squat with The LEs are flexed synchronously 16.9 constraints restrict an individual's
balance step and symmetrically, placing the choice of combinations of component
soles of the feet on the support action during the rising task? Surely,
surface. Foot placement is adjusted knowing the answers to such questions
before extension or at the end of could provide a degree of specificity for
straightening by stepping or physical therapists concerned with mo-
hopping. tor reeducation that is yet unrealized.
D—Symmetrical squat The LEs are brought symmetrically 26.3
into flexion with the heels approxi- Developmental Implications
mating the buttocks. Weight is
transferred from buttocks to the Theoretically, the component ap-
feet, and the LEs then extend proach offers a more insightful model
vertically. of motor development than previous ap-
TOTAL 100.0 proaches. Previous studies ofrisingwere
based on a model that views neuromo-
tor development as a process of heir-
UEs, including those that begin with a when faced with the task of retraining archical integration of reflexes that
symmetrical push pattern but end with individuals to perform these functional ultimately come under volitional or cor-
asymmetrical use of the UEs. motor skills. In addition, the component tical control.3,5 When the cortex exerted
method could be used more extensively control over motor behavior, develop-
in pathokinesiology to describe and ment was considered to be complete.
DISCUSSION characterize movement disorders result- The model of neuromotor organization
ing from neuromuscular or musculo- suggested by the studies of Kuypers
Utility of Component Approach skeletal dysfunction. Indeed, Brunns- and colleagues proposes that axial and
The results of this study illustrate the trom has proposed that recovery from limb regions may be primarily con-
usefulness of using the component stroke may proceed at different rates trolled through medial and lateral neu-
method of movement analysis for de- within different regions of the body.9 roanatomical structures, respectively.10
scription of motor behavior in tasks of The results of the study also imply Subsequent primate studies based on
interest to physical therapists. The level that biomechanical studies of motor Kuypers' model suggested that motor
of detail in description seems to be ap- tasks such as rising from a supine posi- development may be viewed as progres-
propriate as a beginning step toward tion would best be performed within sive dissociation of limb movements
characterizing movement patterns used component action categories or a single from an early linkage with axial move-
to accomplish such fundamental motor body action profile. The kinesiological ment.11 The component method of
tasks as rising from a supine position, differences between the various cate- movement analysis is ideally suited to
assuming a sitting position, or rolling. gories of component action are too great examination of the relationship between
This method may lead to more precise to be ignored, particularly if movements movement patterns occurring in differ-
descriptions of body movements for are to be described in terms of kinematic ent regions of the body during the proc-
tasks that previously have been de- variables such as angular displacements, ess of development.
scribed only in general terms. For phys- velocities, and accelerations of body The findings of this study raise several
ical therapists, such detail is necessary segments. additional issues. First, applying the
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.
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.
TABLE 9
Proposed Developmental Sequence for the Upper Extremity (UE) Component