4.- sit to stand determinants

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ResearchReport

Determinantsofthe

Sit-to-StandMovement:AReview

###########################################################################################################################################################################################################################################.

BackgroundandPurpose.Thesit-to-stand(STS)movementisaskillthathelps

determinethefunctionallevelofaperson.AssessmentoftheSTSmovement

hasbeendoneusingquantitativeandsemiquantitativetechniques.Thepurposesofthisstudy

weretoidentify


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thedeterminantsoftheSTSmovementand

todescribetheirinfluenceontheperformanceoftheSTSmovement.Methods.

AsearchwasmadeusingMEDLINE(19802001)andtheScienceCitationIndexExpanded

oftheInstituteforScientificInformation(19882001)usingthekeywordschair,mobility,rising,sit-to-stand,andstanding.Relevantreferencessuchastextbooks,presentations,andreports

alsowereincluded.


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Ofthe160identifiedstudies,onlythose

inwhichthedeterminantsofSTSmovementperformancewereexaminedusingan

experimentalsetup(n!39)wereincludedinthisreview.Results.Theliteratureindicatesthat

chairseatheight,useofarmrests,andfootpositionhaveamajorinfluenceontheabilitytodoanSTSmovement.Usingahigherchair

seatresultedin


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lowermomentsatkneelevel(upto

60%)andhiplevel(upto50%);loweringthechairseatincreased

theneedformomentumgenerationorrepositioningofthefeettolowerthe

neededmoments.Usingthearmrestsloweredthemomentsneededatthehipby50%,probablywithoutinfluencingtherangeofmotionofthejoints.Repositioning

offeetinfluenced


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thestrategyoftheSTSmovement,enabling

lowermaximummeanextensionmomentsatthehip(148.8N!mversus32.7

N!mwhenthefootpositionchangedfromanteriortoposterior).DiscussionandConclusion.

TheabilitytodoanSTSmovement,accordingtotheresearchreviewed,isstronglyinfluencedbytheheightofthechairseat,useofarmrests,

andfootposition.


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Morestudyoftheinteractionamongthe

differentdeterminantsisneeded.Failingtoaccountforthesevariablesmaylead

toerroneousmeasurementsofchangesinSTSperformance.[JanssenWGM,BussmannHBJ,Stam

HJ.Determinantsofthesit-to-standmovement:areview.PhysTher.2002;82:866879.]

KeyWords:Chair,Determinants,Review,Sit-to-standmovement,Variables.

WimGM

Janssen,HansBJ


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Bussmann,HenkJStam

Physical

Therapy.Volume82.Number9.September2002


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################################.

TThe

sit-to-stand(STS)movementisonefunctionpeoplefrequentlyuseastheychange

fromasittingpositiontoastandingposition(andthenoftentowalking).

Theabilitytogofromasittingpositiontoastandingpositionisanimportantskill;inelderlypeople,theinabilitytoperformthisbasic

skillcanlead


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toinstitutionalization,impairedfunctioningandmobilityin

activitiesofdailyliving(ADL),andevendeath.13Changesinabilityto

performtheSTSmovementarefoundinelderlypeopleandpeoplewithdisabling

diseasesandarerelatedtothedeterminantsoftheSTSmovement.417InasurveyofindependentlylivingDutchmenandwomenaged55yearsand

older,25%of


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themenreportedmoderatedisabilityand5%

ofthemenreportedseveredisability(ascomparedwith37.4%and7.8%

ofthewomen,respectively)ontherisingcomponentoftheHealthAssessmentQuestionnaire.1

ThemannerinwhichtheSTSmovementisdefineddependstosomeextentontheaimofthestudy.Roebroecketal,18for

example,definedthe


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STSmovementasmovingthebodyscenter

ofmassupwardfromasittingpositiontoastandingpositionwithout

losingbalance.VanderLindenetal19definedtheSTSmovementasatransitional

movementtotheuprightposture

requiringmovementofthecenterofmassfromastablepositiontoalessstablepositionoverextended

lowerextremities.The


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STSmovementalsocanbedescribedusing

kinematicorkineticvariables,withdefinitionssuppliedforphasesandeventsduring

thismovement.2022Adefinitionofthesephasesthatisusedfrequentlyis

theoneprovidedbySchenkmanetal21andismarkedby4events.PhaseI(flexion-momentumphase)startswithinitiationofthemovementandends

justbeforethe


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buttocksareliftedfromtheseatof

thechair.PhaseII(momentum-transferphase)beginsasthebuttocksarelifted

andendswhenmaximalankledorsiflexionisachieved.PhaseIII(extensionphase)is

initiatedjustaftermaximumankledorsiflexionandendswhenthehipsfirstceasetoextend;includinglegandtrunkextension.PhaseIV(stabilizationphase)begins

afterhipextension


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isreachedandendswhenallmotion

associatedwithstabilizationiscompleted.21

StudyingtheSTSmovement,in

ouropinion,requiresabasicknowledgeofthefactorsinfluencinghowthemovement

isperformed.Thedeterminants,webelieve,shouldbeindependentfromthetechniquesusedtostudymovement.Theextentofthesedeterminantsinfluencecanbesmall

anddetectedonly


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whenusingspecificmeasurementorresearchtechniques

WGMJanssen,MD,isRehabilitationSpecialist,DepartmentofRehabilitation,University

HospitalRotterdam,DrMolewaterplein40,3015GDRotterdam,theNetherlands([email protected]).Addressall

correspondencetoDrJanssen.

HBJBussmann,PT,PhD,isAssistantProfessor,DepartmentofRehabilitation,ErasmusUniversityRotterdam,Rotterdam,theNetherlands.

HJ

Stam,MD,PhD,


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isRehabilitationSpecialist,ProfessorandHeadof

theDepartmentofRehabilitationMedicine,UniversityHospitalRotterdamandErasmusUniversityRotterdam.

Allauthorsprovidedconcept/idea/researchdesignandwriting.DrJanssenprovideddata

collectionandanalysis.DrStamprovidedprojectmanagement,fundprocurement,andfacilities/equipment.DrBussmannandDrStamprovidedconsultation(includingreviewofmanuscriptbeforesubmission).

No


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grantswerereceivedforthisstudy.

ThisarticlewassubmittedJuly19,2001,andwasacceptedMarch

19,2002.

PhysicalTherapy.Volume82.Number9.

September2002Janssenetal.867


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Table1.

Numberof

ExperimentsPerformedinthe39ReviewedStudiesInvestigatingDeterminantsoftheSit-to-Stand

Movementa

Chair-RelatedSubject-RelatedStrategy-RelatedDeterminantsnDeterminantsnDeterminantsn1.

Heightofchairseat121.Age01.Speed112.Witharmrests52.Disease(eg,stroke,arthritis,lowbackpain)02.

Footposition5


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3.Chairspecialtype33.Muscle

force03.Trunkposition/movement34.Withbackrest04.No

footwear04.Armusewitharmrest55.Terminalconstraint16.

Armmovement17.Darkversuslight28.Fixedjoints19.Kneeposition110.Attention011.Training1

a

Insomestudies,


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morethanonedeterminantwasinvestigated.The

constraineddeterminantsareindicatedinTable2(numbersincolumnsunderDeterminant

Constrainedheadingin

Tab.2refertothedetailsofdeterminantslistedinTab.

1).

(eg,momentsassessedbyforceplates).Knowledgeofthedeterminants,wecontend,isnecessaryinordertoconductresearchontheSTS

movementorto


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interpretresultsofreportedstudies,becausethe

resultscanbe,inpart,afunctionofadeterminant.

TheSTSmovementhasbeenstudiedusingstandardizedclinicaltests,whichareused

inepidemiologicalstudies

3,23

andclinicaltesting.128MeasurementsofaspectsoftheSTSmovementhavebeenobtainedusingtechniques

suchas


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useofforceplates,20videoanalysis,17,2931use

of

15,3235

optoelectronicsystems,13goniometry,10,36andaccelerometry.37

Because

themostrecentreviewontheSTSmovementwaspublishedin1991,38we

believedanupdatewasnecessarytogaininsightintostudiesontheeffectsofvariablesontheSTSmovement,especiallyinviewofthenew

technologyavailableto


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studythemovement.Theaimsofour

articlearetoreviewresearchonSTSmovementdeterminantsandtodescribe

thetypeandmagnitudeoftheirinfluenceontheSTSmovement.Inaddition,

weaimedtoexposegapsintheliteratureandmakerecommendationsforfutureresearch.

Methods

AsearchwasmadeusingMEDLINE

(19802001)andthe


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ScienceCitationIndexExpandedoftheInstitute

forScientificInformation(19882001)usingthekeywordschair,mobility,rising,sit-to-stand,andstanding.Referencessuch

astextbooks,presentations,andreportsalsowereincluded.Afterreadingthearticlesor

abstracts,studieswereincludedonlywhenquantitativeinstrumentalanalyzingtechniqueswereusedtostudySTSmovementperformanceinthesubjects(patientsandpeoplewithoutknown

impairments).Thestudies


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inthisreviewwereincludedonthe

basisoftheirdesign(ie,thedesignhadtobeexperimentaland

aimedatelucidatingtheeffectofdeterminantsontheSTSmove

mentbymanipulatingthevariables).Thus,descriptiveandcomparativestudieswereexcluded,butbecauseweincludedtextbooks,presentations,andsimilarmaterials,therewasnota

requirementthatarticles


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bepeerreviewed.

TheSTS

movementdeterminantsarefactorsthatinfluencehowthemovementisperformed.We

categorizedthestudieddeterminantsaschairrelated(eg,seatheight),subjectrelated(eg,

age,muscleforce),orstrategyrelated(eg,speedorlightconditions)(Tab.1).Strategy-relateddeterminantsarethosethatarerelatedtotheexecutionofthe

STSmovement.Although


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subject-relateddeterminantscanbeinvestigatedonlyby

meansofcomparativestudies,whichwasbeyondthescopeofourstudy,

thetypesofpatientsinvestigatedareindicatedinTable2.Wejudgedstudies

accordingtothetechniquesused(eg,useofforceplates,optoelectronicdevices,orgoniometers),numberofmovementsanalyzed,thedeterminantsstudied(ie,chairrelated,subject

related,orstrategy


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related),andthedependentvariables(Tab.2).

STSMovementDeterminantsintheReviewedStudies

Of

the160studiesidentified,wefound39studiesthataddressedtheeffectsof

determinantsontheSTSmovementusinganexperimentaldesign(Tab.2).Wedidnotexaminewhethertheresultscouldbeobtainedconsistentlybymultipleresearchers

(ie,wedid


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notexaminereliabilityofthesejudgments).

Chair-RelatedDeterminants

Theliteratureindicatesthatthechairhas

aninfluenceontheperformanceoftheSTSmovement(eg,theheightof

theseatcanmakeanSTSmovementimpossible).39Mostresearchhasbeenfocusedontheheightoftheseat,andfewstudiestriedto

clarifytheinfluence


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of

868.Janssenet

alPhysicalTherapy.Volume82.Number9.September2002


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PhysicalTherapy.Volume82.

Number9.September2002Janssenetal.869

Table

2.

DetailsoftheExperimentalStudiesThatAddressedDeterminantsofthe

Sit-to-Stand(STS)Movementa

SubjectsDeterminantConstrainedbAuthorsYearPublishedStudyTechniqueRepNTypeAge(y)XRangeChairRelatedSubjectRelatedStrategy

RelatedDeterminantDependent


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VariablesAlexanderetal461991Video(3

samplesintotal)HandledynamometryChairinstrumented3(1)5117y

23o11o/d23.272.484.41931638675921,2,4

42,4With/withoutarmuseMovementtime,kinematicdata,phaseduration,handforcesArboreliusetal441992Forceplate(feet)Video(digitized)sEMGBorg

Scale29


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9m262334243

chairheights(kh,kh"1/3upperleg,kh"2/3upperleg)ArmrestDifficultyBorg

Scaleestimationofeffort,load-bearingseat,jointmoments,sEMGBurdettetal401985

ForceplateCinecamera(digitized)11410m4m/d33.352254119672,342,42typesofchair(with/withoutarm

use)Kinematicdata,


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jointmomentsCarr571992Forceplate(feet)

Video(digitized)666m203012,4,63

armmovementconditionsMovementtime,COMpositionandhorizontalandverticallinearmomentum,

supportmoment,angulardisplacementanklejointDoorenboschetal491994Forceplate(feet)Cinefilm,motionanalyzersEMG5(2)93m,6f27

11,2,


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4Trunkmovement(naturalvsfullflexion)

Movementtime,kinematicdata,jointmoments,sEMGFleckensteinetal591988Cinecamera

(digitized)1105m,5f25.4144,92

kneeangles(75,105)Movementtimekinematicdata,jointmoments,phasedurationGoulartandVallsSole371999AccelerometrysEMGChairswitch52012m,8

f34.72545


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12,3,46typesSTS

(trunkstraight,flexionoftrunk,feetanterior,kneesfirst,headsupported,reference)

EMGphases

########################.


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870.JanssenetalPhysical

Therapy.Volume82.Number9.September2002Table2.

Continued

SubjectsDeterminantConstrainedbAuthorsYearPublishedStudyTechnique

RepNTypeAge(y)XRangeChairRelatedSubjectRelatedStrategyRelatedDeterminantDependentVariablesGrossetal501998Forceplates(2,feet/chair)Motion

analysissystemsEMG


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Dynamometry1repetitionmaximum3(1)38

12f/y26f/o24.270.1648411,42speeds

(normal,asfastaspossible)Movementtime,moments,torquehip/knee,groundreaction

forces,kinematicsHankeetal291995Forceplates(2,feet/chair)2video5199m10f32.431.12538273611,2,

43speeds


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(normal,asslowandasfastas

possible)Movementtime,COMmomentum,phasedurationHesseetal541996Force

plates(2,feet/chair)5209m,11f27.8194012,4

3speeds(natural,asslowandasfastaspossible)Movementtime,COMdisplacementHesseetal601998Forceplates(2,feet/chair)153517

m/h18f/h


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64.8597912Pretraining/posttrainingMovement

time,timeseat-off,bodyweightdistribution,COMvelocity/displacementHughesandSchenkman151996

Forceplate(feet)Motionanalysissystem11818o/d74.814

42chairheights(khandlowestpossible)Movementtime,hipflexionvelocity,COM/baseofsupportseparationatlift-offHughesetal3919941video

(digitized)122


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22o/a/d72.064105442,

46chairheights(43.255.9cmwithanintervalof2.5cm)

Movementtime,COMmovement/velocityHughesetal321996Forceplate(feet)Motionanalysis

systemDynamometer1215m,5f/y5m,6f/o/d25782,43chairheights(58cm,khandlowestpossible)Joint

moments,isometricquadriceps


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femorismuscleforceItokazuetal361998

ForceplateChairswitchGoniometers(3)346tka16oa30

artncs1Kneeflexion#100and$1002chairheights(100%,120%

ofkh)Movementtime,hip/kneeflexionangleandangularvelocity


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Table

2.ContinuedAuthorsYearPublishedStudyTechniqueRepSubjectsNTypeAge(y)

XRangeDeterminantConstrainedbChairRelatedSubjectRelatedStrategyRelatedDeterminantDependentVariablesKawagoeetal55Khemlanietal65Kotakeetal22Moureyetal48

Moureyetal53


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Munroetal30Muntonetal10Pai

andLee3520001999199319982000199819841994Forceplates

(2,feet)MotionanalysissystemsEMGForceplate(footright)sEMGVideoPressure-sensitive

chairswitchMotionanalysissystemIsometricdynamometerForceplate(feet)Motionanalysissystem,3camerasForceplate(feet)Motionanalysissystem,2camerasForceplate

(feet)VideoArmrest


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loadcellCinecameraGoniometersEMGForceplate

(stool)Motionanalysissystem562333(1)1

510912137129910m9m

12m7y5o4m/y,3f/y7o12o/f/ra54art4m,5f30.22930.722.873.222.8

75.165.5ncs


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2035224020257182202571822739

1111,41,42,3,414

422,3,41,2,44,73,4,7

3,42,453chairheights(30,40,50cm)3footpositionsMovementtime,temporaldata,kinematics,center-of-gravityposition,groundreactionforce

2footpositions


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(anterior/posterior)Movementtime,EMGphasing,extensionmoments,

temporaldata3speeds(natural,fast,slow)Movementtime,kinematicdata,phase

duration,jointmomentsYoungvselderly,darkandlight,2speeds(normal,fast)

Movementtime,kinematicdata,headstabilityYoungvselderly,darkandlight2speeds(normal,fast)Movementtime,kinematicdataHigh(54cm)vslow

(45cm)chair


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seatEjectvsnonejectuseMovementtime,

kinematics,armrestforce,exertion(BorgScale),pain(VAS)2chairseatheights

(42and59.5cm)With/withoutarmuse2footpositions(normal,posterior)sEMG

pattern3speeds(natural,asfastaspossible,fast"fall)Movementtime,temporalparameters,COMdisplacement,moments########################.


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Therapy.Volume82.Number9.September2002Table2.

Continued

SubjectsDeterminantConstrainedbAuthorsYearPublishedStudyTechnique

RepNTypeAge(y)XRangeChairRelatedSubjectRelatedStrategyRelatedDeterminantDependentVariablesPaiandRogers131991Forceplates(2,feet/chair)Motion

analysis58


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4m,4f263811,

43speeds(natural,slow,fast)Movementtime,kinematicdata,jointmoments

systemPaiandRogers341990Forceplates(2,feet/chair)Motionanalysissystem5

105m,5f263811,43speeds(natural,slow,fast)Movementtime,COMmovement,impulsemomentumPaietal331994Force

plates(2,feet/chair)


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WATSMARTLEDmotionanalysissystem5(3)

328m/y,8f/y8m/o,8f/o31.972.12538

63841

1,43speeds(natural,slow,fast)Movementtime,COMmomentum,

COMmovement,phasedurationPapaandCappozzo521999Forceplate(feet/chair)Loadcell5126m,6f223411,2,3,

42speeds


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(selfselected/maximal)Movementtime,kinematicdata,rotational/linear

actuatorPapaandCappozzo512000Forceplate(feet/chair)Loadcell5

517m/y,9f/y12m/o,23f/o2234658111,

2,3,42speeds(selfselected/maximal)Movementtime,kinematicdata,rotational/linearactuatorRodoskyetal421989ForceplateMotionanalysissystem2left2

right105


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m,5f25.5203542,

44chairheights(65%,80%,100%,115%ofkh)Kinematicdata,

jointmomentsSchenkmanetal141996Forceplates(2,feet)Motionanalysissystem

22111y10o28.967.32536617941,2,44chairheights(65%,80%,100%,and115%ofkh)Kinematic

data,phaseduration


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ScholzandSchoner581999Motionanalysissystem

2cameras1095m,4f222812,3,

4,83conditions(normal/rigidboots/narrowbase)COM,head,handtrajectorySeedhomand

Terayama451976Forceplate(feet)CinecameraUVoscillograph22ncsncs1,2,4With/withoutarmuseMoments,force(quadricepsfemoris,hamstring,calfmuscles)


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Table

2.

Continued

SubjectsDeterminantConstrainedbAuthorsYearPublishedStudy

TechniqueRepNTypeAge(y)XRangeChairRelatedSubjectRelatedStrategyRelatedDeterminantDependentVariablesShepherdandKoh171996Forceplate(feet)Pressure

switchVideoncs


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66f21.3182512,

43footpositionsMovementtime,kinematicdata,jointmoments,momentof

supportShepherdandGentile311994Forceplate(stool)VideoChairswitch66

6m2030142,43trunkpositionsKinematicdata,phaseduration,jointmoments,momentofsupportStevensetal561989Forceplate

Photographic1sEMG


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82ncsncs12,4

Legpositionguided/unguidedGroundreactionforces,headmovement,sEMGpatternSuet

al431998Forceplates(2,feet)Motionanalysissystemncs3812tka,

4m,8f12o,5m,6f14oa,2m,12f64.861.7ncs5775547544chairheights

(65%,80%,100%,


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115%kh)Movementtime,kinematicdata,COM

displacement,jointflexionmomentsVanderLindenetal191994ForceplateMotion

analysissystemsEMG5(4)81m,7f68.861771

1,2,42speeds(selfselected,fast)2footpositions(18or5dorsiflexion)Movementtime,kinematicdata,phaseduration,groundreactionforces,sEMGpattern

Weineretal41


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1993MotionanalysissystemVAS122

o/a/dncs442,46chairheights(1722in,interval

1in)Kinematicdata,difficulty(VAS),STSsuccessratioWheeleretal471985

Video1manual(1sample)ElectrogoniometerEMG32010f/y10f/o2475222867811,442typesofchairMovement

time,kinematicdata,


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sEMGpattern,hand/footplacement

a

Rep!repetitions(numberanalyzedinparentheses),m!male,f!female,y!young,o!old,a!able,d!disabled,h!hemiplegia,

art!arthritis,ra!rheumatoidarthritis,oa!osteoarthritis,tka!total-kneearthroplasty,ncs!notclearlystated,sEMG!surfaceelectromyography,kh!kneeheight,

COM!centerofmass,VAS!visualanalogscale,WATSMART!WaterlooSpatialMotionAnalysisRecordingTechnique,LED!light-emittingdiode;UV!ultraviolet.bNumbersrefertodeterminantslistedinTable1.

########################.


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thearmrestposition,useofarmrests,

orthetypeofchairontheSTSmovement.

Seat

height.LoweringtheheightoftheseatmakestheSTSmovementmoredemanding

orevenunsuccessful

accordingtotheliteraturewereviewed.10,14,30,3943Theminimumheightforsuccessfulrisingforelderlypeople(community-dwellingandnursing

homeresidents64105


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yearsofage)withchairrisedifficulties

appearstobe120%oflowerleglength.41Alowerseatapparently

leadstoincreasedangularvelocityofthehipinordertostand14,30,39,42and

tomorerepositioningofthefeet(alsocalledthestabilizationstrategy).14,39Inyoungsubjects(2536yearsofage)withoutimpairments,loweringtheseatofthe

chairfrom115%


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to65%ofkneeheightresultsin

anincreaseintrunkflexionangularvelocityofalmost100%inorder

tostand.14Alowerseathasbeenshowntoincreasetrunk,knee,and

ankleangulardisplacement.30,42,43Changingtheseatheightaffectsthemaximummomentneededatthehipandknee.15,4244Differencesforhipandkneemomentscan

beaslarge


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as50%to60%,withseatheight

havingagreaterinfluenceonthemomentsneededatthekneethan

atthe

hip.15,4244

Thechangesinseatheightcan

resultinchangingbiomechanicaldemands(eg,theneedtomovethebodyscenterofmassoveralargerdistance)orinanalteredstrategy(eg,

stabilizationstrategy,due


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totheimposedbiomechanicaldemandsbya

differentfoot,trunk,orarmposition).

Armrests.Issuesrelatedto

thearmrestuseincludepositioningofthehandsonthearmrests,heightof

thearmrests,andthemomentsexerted.Thereisnoresearchontherelationshipamongtheheightofthearmrests,seatheight,handpositioning,andtheir

cumulativeeffecton


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performanceoftheSTSmovement.

Usingarmrests,accordingtothearticleswereviewed,resultsinlowermoments

atkneeandhip;atthehip,areductionofabout50%of

theextensionmomentneededtoperformtheSTSmovementhasbeencalculated.40,44,45Burdettetal40foundnoinfluenceoftheuseofarmson

jointanglesin


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subjectswithoutimpairments(2541yearsofage).

InastudybyAlexanderetal,46youngandoldsubjectswithout

impairmentsusedahandbarpositionedinfrontofthemtoperformthe

STSmovement.Theyfoundnodifferencesinbodysegmentrotationsintheyoungsubjects(1931yearsofage).Adifferenceintrunkrotationwasobserved

intheold


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subjects(6386yearsofage),althoughthis

movementwasanalyzedonlyatthemomentofmaximumanteriorheaddisplacement.46

Chairtype.Wefoundonly3studiesontheinfluenceof

speciallydesignedchairs.30,40,47DifferenttypesofchairsdesignedtoeasetheSTSmovementwerestud

874.Janssenetalied.30,40,47Wheeleret

al47suggesteda


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negativeinfluenceofseatposteriorslantbecause

oftiltingthebodyscenterofmassfartherbackward.Useofan

ejectormechanismloweredverticalimpulsesappliedtothearmrestsby47%inpatients

witharthritis,butnodifferenceswerefoundforkneeandanklemoments.30

Backrests.Wefoundnoexperimentalstudiesconcerningtheinfluenceofbackrests

onSTSmovement.


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Inonly

8studies30,39,41,42,45

48wasachairwithabackrestused.Whenabackrestwas

used,itwastostandardizetheSTSmovementstartingposition.Theinfluenceof

trunkpositionhasbeenstudied;however,thisinfluencecannotnecessarilyberelatedtobackrestuseorbackrestposition,becausethetrunkpositionstudiedwasnot

comparabletothe


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trunkpositionusingabackrest.31

Strategy-RelatedDeterminants

Speed.IncreasingspeedoftheSTSmovementincreases

thehipflexion,kneeextension,andankledorsiflexionjointmoments.13Toincreasereproducibility

andcomparabilityoftheresultsoftheirstudies,some

authors14,18,49

didnotallowsubjectstoriseattheirself-selectedspeeds.Subjects

hadtorise


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atapresetspeedindicatedby,for

example,ametronome.18Otherresearchersstudiedtheinfluenceofspeedonstrategy,

peakjointmoment,phasechanges,andlateraldisplacement.Paiandcolleagues33,34reportedthat

afasterSTSmovementinfluencesthepeakverticalmomentumofthecenterofmasswhilethepeakhorizontalmomentumremainsrelativelyunchanged(dataweregiven

ingraphs).A


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fasterSTSmovementgaveashorterflexion

andmomentum-transferphase.19,29VanderLindenandcolleagues19reportednoinfluenceofspeed

onjointexcursions.Grossetal50andPapaandCappozzo,51,52however,describedless

hipflexionatthemomentofseat-offinelderlysubjectswhostoodrapidly.Inseveralstudies,48,50,53,54elderlysubjects(6484yearsofage)wereless

abletoincrease


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thespeedoftheirSTSmovement.

Footpositioning.Shepherdandcolleagues17studiedtheeffectoffootposition

(posterior,preferred,andanteriorpositions)priortothestartoftheSTSmovement,

andtheyshowedashortermovementtimewithfeetplacedposterior.Withtheposteriorplacementofthefeet,hipflexionandhipflexionspeedwere

lowered,whereasanterior


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placementofthefeetincreasedthepre-extension

phase.17Kawagoeetal55alsoshowedaninfluenceofposteriorfootplacement.

Positioningthefeetmoreposteriorlyenabledlowermaximummeanextensionmomentsatthe

hip(148.8N!mversus

32.7N!m)tobeusedfortheSTSmovement.55Hughesetal39describedrepositioningofthefeetasa

movementstrategyto


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lowermomentsusedfortheSTSmovement,

PhysicalTherapy.Volume82.Number9.September2002


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########################.

whichthey

calledstabilizationstrategy.Muntonetal10foundnodifferenceinelectromyographic(EMG)

activityof6largelower-extremitymusclegroupswithfeetplacednormalorposterior.

Stevensetal56studiedtheeffectoftheinitiallower-extremityposture,includingfootposture,ontheSTSmovementandreportedthatthepreferredlower-extremityposition

giveslesshead


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movementandlowergroundreactionforces.

Trunkpositioning/movement.AccordingtoShepherdandGentile,31changingtheinitialtrunk

positiontohavemoreflexiondidnotchangethepeaksupportmoment,but

thedurationofmaximumsupportmomentdidincrease.Thedurationoftheextensionphasealsobecamelongerwhenthetrunkinitiallywasmoreflexed.31Starting

fromatrunk


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positiondifferentfromerectaltersthekinematics

andkineticsoftheSTSmovement.Fortheconditionflexionofthe

trunk(first

flexthetrunktowardtheknees,beforerisingfromthechair),

GoulartandValls-Sole37describedalongermovementtimethanfornormalSTSmovementconditionanddelayedseat-off,withoutjointangularchanges.Thisobservationwassupported

bySchenkmanet


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al,21whodescribedamomentumtransferstrategy

inwhichthemomentumgeneratedbytheupperbodyisusedduring

theextensionphase.

Doorenboschetal49studiedtheeffectofan

STSstrategyaimedatmaximumflexionofthetrunkduringtheSTSmovement.Thisstrategyresultedinkinematicchangesaroundthehip,buttherange

ofmotionof


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thekneeandankledidnotchange.

Usingthemaximumflexionstrategy,27%lower(net)kneejointmomentsthan

innaturalrisingwerefound.49

Armmovement.StudyoftheSTS

movementisoftendonewithconstraintsontheuseofthearms.57Inmoststudies,useofthearmsduringtheSTSmovementwasnot

allowed.Subjectswere


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ofteninstructedtostandupwiththeir

handsintheirlap,folded,sideways,placedontheknees,orfixating

anobject.Someauthors16,47havereportedthatuseofthearmsduringthe

STSmovementisverycommonamongelderlypeopleandevenamongyoungpeople.OnlyCarr57studiedtheeffectofarmmovementstrategyonthebodys

centerofmass.


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ArmpositionduringtheSTSmovementappears,

basedontheliterature,toinfluencethepositionofthebodyscenter

ofmass.57Thebodyscenterofmassmovesforwardattheendof

theSTSmovementwhensubjectspointwiththeirarms.57Restrictingthearmsleadstoadifferentpatternofankleangulardisplacement,withamuchhigher

meanstandarddeviation


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thanoccurswiththearmsfree.This

findingsuggeststhatmoreadjustmentofthestrategyofrisingisneeded,

usingongoingadjustmentattheanklejointduringrestrictedarmmovement.57

Terminalconstraint.TheterminalconstraintistherequiredbodypositionoractivityattheendoftheSTSmovement.TheSTSmovementhasbeenstudied

whilethemotion


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wasaimedatstandingquietlyatthe

endofthemovement.PaiandLee35conductedastudywitha

constrainttofallafterthemovementinsteadofstandingquietlyattheend.

Nostudyhasquantitativelyexploredthesit-to-walkmovement.

Darkversuslight.VisualcontrolwasmanipulatedwhilesubjectsperformedtheSTSmovementinlight

anddarknessat


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2speeds.48,53Noeffectonmovementtime

wasfoundinyoung(2025yearsofage)andelderly(7182years

ofage)peoplewhenvisualcontrolwasvaried.48,53Thespeedofthecenter

ofmass,however,waslowerintheblindfoldedconditionfortheelderlysubjects.53

Fixedjoints.Onlyonestudy58concernedtheinfluenceof

jointfixationon


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thelevelofcontrolofSTSmovement

performanceusingtheso-calleduncontrolledmanifoldconcept(acyberneticconcepttodescribe

results).Thisanalysisshowedthatthepositionofthecenterofmassin

thesagittalplaneiscontrolled.Nodataonjointangleorangularvelocityweregiven.Anotherstudy36analyzedtherelationshipbetweentheactivelimitationin

rangeofmotion


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ofthekneefollowingtotalkneearthroplasty

andtheheightoftheseatwhenrisingfromaseatedposition.

Thesubjectswithlargerlimitationsinactivekneeflexion(#100ofkneeflexion)

requiredahigherangularvelocityofthehiptoliftthetrunkforwardthandidthosewithlesslimitationofkneeflexion($100ofknee

flexion).36


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Kneeposition.Positioningthekneeinmore

extensionthanpreferredpriortotheSTSmovementappearedtoleadto

anincreaseofthehipjointangulardisplacement,withanincreaseofhip

extensionmomentsof77%.59Thisexperimentalsetupistosomeextentcomparabletothefoot-forwardsetupasusedbyShepherdandKoh17becausefootforward

willresultin


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morekneeextension.

Attention.No

experimentalstudyaddressingtheinfluenceofattentionontheperformanceofthe

STSmovementinsubjectswithoutimpairmentscouldbefound.

Training.Training

canbeadeterminantinanexperimentalstudy.Hesseetal60studiedtheinfluenceof4weekstraining(4-weekinpatientrehabilitationprogram;thephysicaltherapists

trainedthepatients


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todistributeequalweightonbothlegs

andtoavoidlateralcompensatorytiltofthetrunk)onthetemporal

andspatialvariablesoftheSTSmovement.Onlyinasubgroupofpeople

withlefthemipareticstrokeswasadifferencenoted.

PhysicalTherapy.Volume82.Number9.September2002Janssenetal.

875


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DiscussionandConclusions

Method

General.Inourreview,weincludedonlyexperimentalstudies.In

anexperimentalstudyoftheSTSmovement,thedeterminantsaremanipulatedinorder

toexploretheirinfluenceonperformance.Notallofthestudiesreviewed,however,werecompletelyexperimental.Somearticlesincludedcomparativeordescriptivedata.Webelieve

thatexperimentalstudies


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areimportantbecausetheyprovidethestrongest

evidenceconcerningtheinfluenceofthedeterminants.Inthesestudies,onlyone

determinantisusuallymanipulatedwhileothersarekeptconstant.Incomparativestudies,we

believeconclusionsaredifficulttomakebecauseofthenonexperimentaldesign.Therelationshipbetweensubject-relateddeterminants(eg,age,muscleforce)andSTSmovementperformance,in

ourview,is


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seldomunambiguousbecausesubject-relateddeterminantsaregenerally

examinedinnonexperimentalstudies.Forexample,theinfluenceofageonthe

abilitytodoanSTSmovementisoftenstudied,46,48,51,53,6163withageaccountingfor

smalldifferencesinSTSmovementperformanceandadecreasedabilitytodecreasemovementtime.WhetherthesedifferencesintheSTSmovementaretheresultof

increasedageor


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ofcovariatessuchasmuscleforce,balance

disturbances,neuromusculoskeletalchanges,orchangedmotorcontrolisnotclear.Anotherexample

concernsmuscularforceasadeterminantofSTSmovementperformance.Lessquadricepsfemoris

muscleforcewillaffecttheperformanceoftheSTSmovement,andthetimetodotheSTSmovementwillincrease.32,50,61,64Relatedneuromusculoskeletalchanges(eg,loss

oftrunkmuscle


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force,lossofbalance)mayinfluencethe

performanceoftheSTSmovementtothesamedegree.Whentheserelated

changescannotbecontrolledforinastudy,theycanbecomeconfoundingfactors

influencingtheconclusionstobedrawnfromthesestudies.

Validity.OurreviewofstudiesonthedeterminantsofwhatmakestheSTSmovement

possibleledus


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tobelievethatmanystudieshavegood

internalvalidity,butwedidnotuseevaluativecriteriaorexaminationby

multipleauthors.Thereis,inourview,alsoevidenceforconstructvalidityfor

themeasuresused,becauseclinicaltestsforSTSmovementperformanceappeartoustobehighlycorrelatedwithphysicalfunctioninginelderlypeople.2,3Wequestion,

however,whetherthe


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reviewedstudiesareexternallyvalidforpredicting

changesinstandingup.Standingupfromachairisalmostnever

aimedatstandingalonebutispartofagoal-orientedbehavior,suchas

goingforawalkorpickingupanobject.Nevertheless,thereareexamplesinwhichstandingupis

aimedatsimplestanding(eg,

inchurch,watching


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sports).

Variability.Thereisintrasubject

andintersubjectvariabilityintheperformanceoftheSTSmovement.Variabilitycan

betheresultofproblemsindefiningtheSTSmovementevents,technicalproblems,

oranalysisofalownumberofSTSmovements,oritcanbeconsideredasasignofflexibilityofperformanceduringtheSTSmovement.

Tolowervariability


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andtoeaseanalysisofthedeterminants,

manyconstraintswereusedintheSTSmovementstudiesthatwereviewed

(Tab.2).Wecontendthatonlyinclinicalphysicalperformanceistestingof

thenaturalSTSmovementimitated(withself-selectedspeedandstrategy).9,23,24OtherexplanationsforvariabilitymayincludealearningeffectduringperformanceoftheSTSmovement,

fatigueinrepeating


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fastandfrequentSTSmovements,anderroneous

instructionsleadingtomisinterpretation.

GeneralConclusions

Inour

review,wefoundthatinmoststudies(27ofthe39studies),a

combinationofforceplate(s)andamotionanalysissystem(varyingfromvideotoatypeofoptoelectronicsystem)wasused.SurfaceEMGanalysiswasused

in10of


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the39studies.Thenumberofanalyzed

STSmovementspersubjectrangedfrom1to15.In7of

the39studies,onlyonetrialwasusedforstatisticalanalysis.Thenumber

ofsubjectsstudiedrangedfrom2to51.Webelieve,however,thatgeneralconclusionscanbedrawn.Theheightofthechairseat,theuse

ofarmrests,and


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footpositioninghaveamajorinfluenceon

STSmovementperformance.Ahigherchairseatresultsinlowermomentsat

hipandkneelevel(upto60%and50%,

respectively).10,14,30,39,40,42

44Loweringthechairseatwillincreasetheneedforgenerationofmomentumorrepositioningofthefeettolowerthemomentsneeded.14Comparison

oftheresults


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ofthestudiesisdifficultbecauseof

differencesinstudydesignandthefactthatchairseatheightis

notalwaysbasedonlower-extremitylength.Usingarmrestswilllowerthemomentsneeded

atthekneeby50%,probablywithoutinfluencingtherangeofmotionofthejoints.40,44,46Therewerenoreportsontheinteractionbetweentheheight

ofthearmrests,


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chairseatheight,orhandpositioningand

theircumulativeeffectonSTSmovementperformance.Repositioningoffeetappearsto

influencetheSTSmovementstrategy,enablinglowerpeakmomentsatthe

hipandknee.17,19,39,55,65

Noexperimentalstudywasfoundthataddressedtheinfluenceoftheuseofabackrest.Theinfluenceoftrunkposition

hasbeenstudied;


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however,trunkpositioncannotberelatedto

backrestposition,becausethestudiedtrunkpositionisnotcomparabletothe

trunkpositionusingabackrest.31


Therapy.Volume82.Number9.September2002


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########################.

ClinicalSignificance

TheabilitytoperformanSTSmovementisanimportant

skill.Inelderlypeople,theinabilitytoperformthisbasicskillcanlead

toinstitutionalization,impairedADLfunctioning,andimpairedmobility.2,3Consequently,thismovementisfrequentlyassessedinclinicalpractice.KnowledgeofdeterminantsoftheSTSmovement,therefore,

isimportantfor


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cliniciansinterestedinevaluatingtheabilityto

doanSTSmovement.ForaproperevaluationoftheSTSmovement

inaclinicalsetting,wecontendthatstandardizationoftheevaluationshouldbe

doneinregardtotypeofchair,chairseatheight,positioningoffeet,andtheuseofarmrests.Resultsofexperimentalstudiesshowthatthese

variablesinfluencethe


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performanceoftheSTSmovement.Neglectingthese

variablesmayresultinaninabilitytomeasureactualchangesinSTS

movementperformanceofapatient.Furthermore,problemsinSTSmovementperformancemaybe

obscuredwithoutstandardization.Anotherconsequencemaybethatapparentchangesordiscrepanciesmaynotactuallybepresent.Allofthesefactorscanleadtosuboptimal

choicesanddecisions


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withrespecttoprognosis,planning,andtherapy.

Recommendations

Webelievethatinbothexperimentaland

comparativeSTSmovementstudies,thereneedstobecontrolofvariablesthatcan

influenceSTSmovementperformance.Somedeterminants(eg,chairseatheight,speed,positionoffeet)havebeenstudiedextensively.Others(eg,theeffectsoffootwearon

STSmovementperformance)


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havenotbeenwellstudied(althoughthe

footweartypedoesinfluencetheperformanceoftheTimedUp&Go

Test66).Theinteractionamongdeterminants

extent.19,30,48,53,55

hasbeenstudiedto

someMoreresearchisneeded,however,ontheinteractionofvariablessuchasuseofarmrests,chairseatheight,andfootpositioning.

All

ofthestudies


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weexaminedweredirectedatthelevel

ofimpairment.Studyingfunctionalperformance,inouropinion,shouldalsoincludetesting

atthelevelofskills.67,68Toanalyzetheskillofasubjectto

performtheSTSmovement,itmaybenecessarytoevaluatetheabilitiesofthatsubjecttocopewithchangingconstraints(eg,STSmovementatdifferent

speeds,atdifferent


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chairseatheights,STSmovementversussit-to-walk

movement,lightversusdarkness).Togaininsightintotheinfluenceofthe

determinantsontheSTSmovementmayentailusingotherbiomechanicalmodelsorparadigms.68,69

Newtechniques(eg,ambulatorytechniquesthatregisterbodypostureandmovementsinthereal-lifeenvironmentofthesubject)raisenewresearchquestions.Toenhancethe

validityofdata


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obtainedinfuturestudiesandthegeneralizability

oftheresults,newmethodsof

PhysicalTherapy.Volume

82.Number9.September2002

research(whichcanbe

usedoutsidethegaitlaboratory70),webelieve,shouldbeevaluated.

References

1OddingE.LocomotorDisabilityintheElderly:AnEpidemiological

StudyofIts


117/150

OccurrenceandDeterminantsinaGeneralPopulation

of55YearsandOver

[thesis].Rotterdam,theNetherlands:Erasmus

UniversityRotterdam;1994.

2GuralnikJM,SimonsickEM,FerrucciL,et

al.Ashortphysicalperformancebatteryassessinglowerextremityfunction:associationwithself-reporteddisabilityandpredictionofmortalityandnursinghomeadmission.JGerontol.1994;49:M85M94.

3


118/150

GuralnikJM,FerrucciL,SimonsickEM,et

al.Lower-extremityfunctioninpersonsovertheageof70yearsas

apredictorofsubsequentdisability.NEnglJMed.1995;332:556561.

4

CoghlinSS,McFadyenBJ.Transferstrategiesusedtorisefromachairinnormalandlowbackpainsubjects.ClinBiomech.1994;9:8592.

5

HesseS,Schauer


119/150

M,MalezicM,etal.Quantitativeanalysis

ofrisingfromachairinhealthyandhemipareticsubjects.ScandJ

RehabilMed.1994;26:161166.

6EngardtM,OlssonE.Bodyweight-bearingwhile

risingandsittingdowninpatientswithstroke.ScandJRehabilMed.1992;24:6774.

7YoshidaK,IwakuraH,InoueF.Motionanalysisin

themovementsof


120/150

standingupfromandsittingdownon

achair:acomparisonofnormalandhemipareticsubjectsandthedifferences

ofsexandageamongthenormals.ScandJRehabilMed.1983;15:133140.

8AdaL,WestwoodP.Akinematicanalysisofrecoveryoftheabilitytostandupfollowingstroke.AustralianJournalofPhysiotherapy.1992;38:135142.

9


121/150

ButlerPB,NeneAV,MajorRE.Biomechanics

oftransferfromsittingtothestandingpositioninsomeneuromusculardiseases.

Physiotherapy.1991;77:8188.

10MuntonJS,EllisMI,WrightV.Useof

electromyographytostudylegmuscleactivityinpatientswitharthritisandinnormalsubjectsduringrisingfromachair.AnnRheumDis.1984;43:6365.

11IkedaER,


122/150

SchenkmanML,RileyPO,HodgeWA.Influence

ofageondynamicsofrisingfromachair.PhysTher.1991;71:473481.

12EngardtM.Risingandsittingdowninstrokepatients:auditory

feedbackanddynamicstrengthtrainingtoenhancesymmetricalbodyweightdistribution.ScandJRehabilMedSuppl.1994;31:157.

13PaiYC,RogersMW.Speed

variationandresultant


123/150

jointtorquesduringsit-to-stand.ArchPhysMed

Rehabil.1991;72:881885.

14SchenkmanML,RileyPO,PieperC.Sit

tostandfromprogressivelylowerseatheights:alterationsinangularvelocity.ClinBiomech.

1996;11:153158.

15HughesMA,SchenkmanML.Chairrisestrategyinthefunctionallyimpairedelderly.JRehabilResDev.1996;33:409412.

16

DurwardBR.The


124/150

BiomechanicalAssessmentofStrokePatientsinRising

toStandandSittingDown[thesis].Glasgow,Scotland:StrathclydeUniversity;1994.

17ShepherdRB,KohHP.Somebiomechanicalconsequencesofvaryingfootplacement

insit-to-standinyoungwomen.ScandJRehabilMed.1996;28:7988.

18RoebroeckME,DoorenboschCA,HarlaarJ,etal.Biomechanicsandmuscularactivity

duringsit-to-standtransfer.


125/150

ClinBiomech.1994;9:235244.

Janssen

etal.877


126/150

19VanderLindenDW,BruntD,

McCullochMU.Variantandinvariantcharacteristicsofthesit-to-standtaskinhealthy

elderlyadults.ArchPhysMedRehabil.1994;75:653660.

20KraljA,Jaeger

RJ,MunihM.Analysisofstandingupandsittingdowninhumans:definitionsandnormativedatapresentation.JBiomech.1990;23:11231138.

21SchenkmanML,

BergerRA,Riley


127/150

PO,etal.Whole-bodymovementsduringrising

tostandingfromsitting.PhysTher.1990;70:638648;discussion:648651.

22

KotakeT,DohiN,KajiwaraT,etal.Ananalysisofsit-to-standmovements.

ArchPhysMedRehabil.1993;74:10951099.

23MathiasS,NayakUS,IsaacsB.Balanceinelderlypatients:theget-upandgotest.ArchPhys

MedRehabil.1986;67:387389.


128/150

24PodsiadloD,RichardsonS.

ThetimedUp&Go:atestofbasicfunctionalmobilityfor

frailelderlypersons.JAmGeriatrSoc.1991;39:142148.

25Roorda

LD,RoebroeckME,LankhorstGJ,etal.Measuringfunctionallimitationsinrisingandsittingdown:developmentofaquestionnaire.ArchPhysMedRehabil.1996;77:663669.

26Thorbahn


129/150

LD,NewtonRA.UseoftheBerg

BalanceTesttopredictfallsinelderlypersons.PhysTher.1996;76:576583;discussion:

584575.

27SeemanTE,CharpentierPA,BerkmanLF,etal.Predicting

changesinphysicalperformanceinahigh-functioningelderlycohort:MacArthurstudiesofsuccessfulaging.JGerontol.1994;49:M97M108.

28BergK,Wood-DauphineeS,Williams

JI,GaytonD.


130/150

Measuringbalanceintheelderly:preliminarydevelopment

ofaninstrument.PhysiotherapyCanada.1989;41:304311.

29HankeTA,Pai

YC,RogersMW.Reliabilityofmeasurementsofbodycenter-of-massmomentumduringsit-to-standin

healthyadults.PhysTher.1995;75:105113;discussion:113108.

30MunroBJ,SteeleJR,BashfordGM,etal.Akinematicandkineticanalysisofthe

sit-to-standtransferusing


131/150

anejectorchair:implicationsforelderlyrheumatoid

arthriticpatients.JBiomech.1998;31:263271.

31ShepherdRB,GentileAW.

Sit-to-stand:functionalrelationshipbetweenupperbodyandlowerlimbsegments.HumanMovSci.

1994;13:817840.

32HughesMA,MyersBS,SchenkmanML.Theroleofstrengthinrisingfromachairinthefunctionallyimpairedelderly.J

Biomech.1996;29:15091513.


132/150

33PaiYC,NaughtonBJ,Chang

RW,RogersMW.Controlofbodycentreofmassmomentumduringsit-to-stand

amongyoungandelderlyadults.GaitPosture.1994;2:109116.

34PaiYC,

RogersMW.Controlofbodymasstransferasafunctionofspeedofascentinsit-to-stand.MedSciSportsExerc.1990;22:378384.

35Pai

YC,LeeWA.


133/150

Effectofaterminalconstraintoncontrol

ofbalanceduringsit-to-stand.JMotBehav.1994;26:247256.

36Itokazu

M,UemuraS,AokiT,TakatsuT.Analysisofrisingfromachair

aftertotalkneearthroplasty.BullHospJtDis.1998;57:8892.

37GoulartFR,Valls-SoleJ.Patternedelectromyographicactivityinthesit-to-standmovement.ClinNeurophysiol.

1999;110:16341640.


134/150

38KerrKM,WhiteJA,MollanRAB,

BairdHE.Risingfromachair:areviewoftheliterature.Physiotherapy.

1991;77:1519.

39HughesMA,WeinerDK,SchenkmanML,etal.Chair

risestrategiesintheelderly.ClinBiomech.1994;9:187192.

40BurdettRG,HabasevichR,PisciottaJ,SimonSR.Biomechanicalcomparisonofrisingfromtwo

typesofchairs.


135/150

PhysTher.1985;65:11771183.

41

WeinerDK,LongR,HughesMA,etal.Whenolderadultsface

thechair-risechallenge:astudyofchairheightavailabilityandheightmodifiedchair-riseperformance

intheelderly.JAmGeriatrSoc.1993;41:610.

42RodoskyMW,AndriacchiTP,AnderssonGB.Theinfluenceofchairheightonlowerlimb

mechanicsduringrising.


136/150

JOrthopRes.1989;7:266271.

43SuFC,LaiKA,HongWH.Risingfromchairaftertotal

kneearthroplasty.ClinBiomech.1998;13:176181.

44ArboreliusUP,WretenbergP,Lindberg

F.Theeffectsofarmrestsandhighseatheightsonlower-limbjointloadandmuscularactivityduringsittingandrising.Ergonomics.1992;35:13771391.

45

SeedhomBB,Terayama


137/150

K.Kneeforcesduringtheactivityof

gettingoutofachairwithandwithouttheaidofarms.

BiomedEng.1976;11:278282.

46AlexanderNB,SchultzAB,WarwickDN.

Risingfromachair:effectsofageandfunctionalabilityonperformancebiomechanics.JGerontol.1991;46:M91M98.

47WheelerJ,WoodwardC,UcovichRL,

etal.Rising


138/150

fromachair:influenceofageand

chairdesign.PhysTher.1985;65:2226.

48MoureyF,PozzoT,

Rouhier-MarcerI,DidierJP.Akinematiccomparisonbetweenelderlyandyoungsubjectsstanding

upfromandsittingdowninachair.AgeAgeing.1998;27:137146.

49DoorenboschCA,HarlaarJ,RoebroeckME,LankhorstGJ.Twostrategiesof

transferringfromsit-to-stand:


139/150

theactivationofmonoarticularandbiarticularmuscles.

JBiomech.1994;27:12991307.

50GrossMM,StevensonPJ,CharetteSL,

etal.Effectofmusclestrengthandmovementspeedonthebiomechanicsof

risingfromachairinhealthyelderlyandyoungwomen.GaitPosture.1998;8:175185.

51PapaE,CappozzoA.Sit-to-standmotorstrategiesinvestigated

inable-bodiedyoung


140/150

andelderlysubjects.JBiomech.2000;33:11131122.

52PapaE,CappozzoA.Atelescopicinverted-pendulummodelofthe

musculo-skeletalsystemanditsusefortheanalysisofthesit-to-standmotortask.

JBiomech.1999;32:12051212.

53MoureyF,GrishinA,dAthisP,etal.Standingupfromachairasadynamicequilibriumtask:a

comparisonbetweenyoung


141/150

andelderlysubjects.JGerontolABiol

SciMedSci.2000;55:B425B431.

54HesseS,SchauerM,Jahnke

M.Standing-upinhealthysubjects:symmetryofweightdistributionandlateraldisplacementof

thecentreofmassasrelatedtolimbdominance.GaitPosture.1996;4:287292.

55KawagoeS,TajimaN,ChosaE,etal.Biomechanicalanalysis

ofeffectsof


142/150

footplacementwithvaryingchairheighton

themotionofstandingup.JOrthopSci.2000;5:124133.

56

StevensC,Bojsen-MollerF,SoamesRW.Theinfluenceofinitialpostureonthe

sit-to-standmovement.EurJApplPhysiol.1989;58:687692.

57CarrJH.Balancingthecentreofbodymassduringstandingup.PhysiotherapyTheoryand

Practice.1992;8:159164.


143/150

58ScholzJP,SchonerG.The

uncontrolledmanifoldconcept:identifyingcontrolvariablesforafunctionaltask.ExpBrain

Res.1999;126:289306.

59FleckensteinSJ,KirbyRL,MacLeodDA.Effect

oflimitedkneeflexionrangeonpeakhipmomentsofforcewhiletransferringfromsittingtostanding.JBiomech.1988;21:915918.

878.Janssenet

alPhysicalTherapy


144/150

.Volume82.Number9.

September2002


145/150

########################.

60Hesse

S,SchauerM,PetersenM,JahnkeM.Sit-to-standmanoeuvreinhemipareticpatients

beforeandaftera4-weekrehabilitationprogramme.ScandJRehabilMed.1998;30:8186.

61AlexanderNB,SchultzAB,Ashton-MillerJA,etal.Musclestrengthandrisingfromachairinolderadults.MuscleNerveSuppl.1997;5:S56S59.

62


146/150

BaerGD,AshburnAM.Trunkmovementsin

oldersubjectsduringsit-to-stand.ArchPhysMedRehabil.1995;76:844849.

63

MillingtonPJ,MyklebustBM,ShambesGM.Biomechanicalanalysisofthesit-to-standmotionin

elderlypersons.ArchPhysMedRehabil.1992;73:609617.

64ScarboroughDM,KrebsDE,HarrisBA.Quadricepsmusclestrengthanddynamicstabilityinelderlypersons.

GaitPosture.1999;10:


147/150

1020.

65KhemlaniMM,Carr

JH,CrosbieWJ.Musclesynergiesandjointlinkagesinsit-to-standundertwo

initialfootpositions.ClinBiomech.1999;14:236246.

66ArnadottirSA,MercerVS.

Effectsoffootwearonmeasurementsofbalanceandgaitinwomenbetweentheagesof65and93years.PhysTher.2000;80:1727.

67

RozendalRH.Clinical


148/150

gaitanalysis:problemsandsolutions?HumanMov

Sci.1991;10:555564.

68MulderT,NienhuisB,PauwelsJ.Clinical

gaitanalysisinarehabilitationcontext:somecontroversialissues.ClinRehabil.1998;12:99106.

69RobertsPD,McCollumG.Dynamicsofthesit-to-standmovement.BiolCybern.1996;74:147157.

70BussmannHB,ReuvekampPJ,VeltinkPH,etal.

Validityandreliability


149/150

ofmeasurementsobtainedwithanactivitymonitor

inpeoplewithandwithoutatranstibialamputation.PhysTher.1998;78:989998.

PhysicalTherapy.Volume82.Number9.September2002Janssen

etal.879


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