Life-Span Development in Functional Tasks - CiteSeerX

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Life-Span Development in Functional Tasks

A life-span concept of motor development is presented as a framework for interpretation of a series of studies of righting tasks. Beginning with the task of rising from the poor, the use of a component approach for movement pattern description and for the identijication of developmental sequences of motor pattern is reviewed. Studies applying this approach to a wide range of age groups and to variousfunctional righting tasks are discussed. Recent studies investigatingfactors related to movement patterns used to perj40v-n one of the nghting tasks are also reviewed. Suggestions concerning the ways in which this infomtion could be applied to physical therapy practice are included. pansant AE Life-span development in functional tasks. Phys Ther. 1990;70:788-798.1

Ann F VanSant

Key Words: Functional training and activities; Kinesiologylbiomechanics, general; Motor activity;Motor skills; Movement.

A LIfeSpan Concept of Motor Development Developmentalists bring to the study of human movement unique sets of assumptions that influence their approach to research. Although theoretical diversity exists within developmental science and among motor development researchers,' there is a unifying interest in age-related change in motor behavior. Physical therapy practice has been influenced by classic motor development theory2,3 through the writing of Stockmeyer,*,5 the B ~ b a t h sKnott , ~ and Voss,' and Voss." These individuals brought to the forefront of our profession the notions of developmental sequences, and they incorporated behaviors that are the product of early motor development into treatment programs. Integral to these sequences are the theoretical underpinnings that explained the process of motor skill acquisition early in the life span. According to classical theory,2.3 motor development is primarily caused by the process of

maturation of the central nervous system (CNS). As a corollary to this theory, when neural maturation is complete, the developmental process terminates.*:;step 3 = relationship between pelvis and shoulder girdle changes; step 4 = right shoulder girdle leads. Factors Related to Movement Patterns Used to Perform Righting Tasks Body Dimensions Rising from a bed and getting up from a chair require that the individual execule movements that are shaped by the relative size of the bed or chair and one's body. Small children can "drop down" off the bed onto the floor, extending their LEs, whereas adults "get up from sitting" by flexing forward and then extending to the vertical. When considering the need to execute movements that are congruent with objects such as beds and chairs, it is easy to see how the size arid dimensions of the body might influence developmental change. It is somewhat more difficult to predict relationships among body dimensions and movement patterns when one thinks of a task that is a bit more environmentally neutral, such as

rolling on a flat surface or rising from the floor. McGraw2 originally proposed that the body dimensions might influence the developmental change in body movements used to stand up from the floor. She specifically proposed that the ratio between leg length and body length might be a meaningful factor contributing to the change in movement patterns. My colleagues and I have followed up this lead by obtaining a set of body measurements on all of the subjects who have participated in our studie~~9.~~-30 of rising from the floor. The findings of VanSant and colleagues49 indicate there is a relationship between body dimensions and movement patterns in the task of rising from the floor. The strength of the relationship varied with age and gender within each component. In subjects 4 through 25 years of age, a

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ponderal index accounted for 20% to 30% of the variability in the female subjects' component patterns and for 25% to 35% of the variability in the male subjects' component patterns. Specifically, the taller and lighter subjects demonstrated more advanced patterns compared with the shorter and heavier subjects. In the older female subjects, an androgyny index and age accounted for 30% to 40% of the variability in component patterns. Those women with more masculine body builds, wider biacromial widths, and narrower bicristal widths were more likely to demonstrate advanced movement patterns. Age was also a significant factor in the adult women, with younger women more likely than older women to demonstrate advanced patterns. In men, only age was found to be a significant variable, accounting for approximately 20% of the variability in component patterns. As with the female subjects, youth was

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also associated with the more advanced patterns in the male subjects. Kugler (P Kugler, personal communication, October 1988) has suggested that body topography, rather than body mass, might be a factor affecting movement patterns in the rising task. His suggestion seems most plausible if one considers, for example, an individual who is overweight. When attempting to flex the LEs to bring the feet to the buttocks and to flex the trunk to move toward sitting, the calves may abut the thighs and prevent the feet from approaching the buttocks, and the abdomen may approximate the thighs and prevent forward progression of the trunk toward the feet. The individual must then use a different pattern of movement that involves rotating the trunk toward one side in order to transfer weight to the LEs. We (AJ? VanSant, P Verma, J McDonald, L Dehadrai; unpublished data) have recently asked the question: Does adding weight to the body affect the movement pattern used to rise to a standing position from a supine position? We videotaped young adults, first while they were loaded with two different percentages of their body weight and then without the weights. Our preliminary results suggest that carrying an extra 10% of body weight does affect the rising pattern. In those subjects who demonstrated a symmetrical form of rising, the added weight resulted in asymmetrical patterns. In those subjects with asymmetrical patterns, the effect was less obvious and represented a more subtle change within a movement-pattern category. Thus, we have begun to explore the factors that are related to righting movements and that might help explain age-related change in these movements. Activity Level Another factor that researchers are beginning to explore is the individual's level of physical activity. Luehring3O asked the question: Does activity level affect the movement patterns used to stand up from a su-

pine position? She videotaped both active and inactive elderly subjects. Those subjects who were active had a history of participating three or more times per week in physical activity classes offered at the University of Missouri (St Louis, Mo). Luehring found the two groups used different movement patterns to get up from the floor. Those subjects who were active used patterns that represented laterappearing developmental steps, as compared with the inactive group, who demonstrated a greater degree of regression to earlier patterns of rising. Greens0 has extended Luehring's3O line of research by asking whether physically active adults would demonstrate more developmentally advanced movement patterns than less physically active adults. She studied individuals in their thirties who were grouped according to their level of physical activity: (1) those who exercised daily. (2) those who exercised once o r twice a week, and (3) those who rarely exercised. Green found that the more active subjects, who exercised daily o r once o r twice a week, demonstrated more developmentally advanced movement patterns than those who rarely exercised. She suggested that general activity level may be a factor that causes the differences in movement patterns observed among healthy adults.

Clinical Considerations and Summary As a physical therapist, this newfound

knowledge profoundly affects the way I think about patients. First, I assess the movement patterns my patients use to perform these tasks and compare the observed patterns with the expected patterns for their age groups. I am reluctant to prescribe a single set of movement patterns to be used in the performance of a task. I consider age, gender, body size, and body shape as well as activity level when selecting a set of movement patterns to teach. I am concerned with the selection of each set of movement patterns, be-

cause I have also developed a strong appreciation for variability in human performance. With the exception of adults who tend to perform consistently, other age groups vary their performance by using various combinations of UE, AX, and LE movement patterns. Although adults may be consistent in their performance, they can vary the patterns they use if asked o r if the situation demands the use of an alternate form of movement in order to accomplish the task. It is the potential for variability that characterizes normalcy. Varying the situational demands seems a most natural way to introduce variability into patient performance. I search the environment for objects that might be used to bring out a specific pattern. Varying the heights of objects, such as chair seats, is just one example of the creative ways in which we are able to assist patients in adding to their behavioral repertoire. Through this research program, the movement patterns used to perform common righting tasks are being described and defined. Age differences in the incidence of movement patterns used to perform the tasks are being documented, and sequences of development of movement patterns within body regions are beginning to be revealed and examined in longitudinal studies. I have begun to study atypical populations, beginning with a study of head-injured patients. Again, the first question is: Are the movement-pattern categories accurate and comprehensive descriptors of the movement patterns used by headinjured individuals to perform the task? It is possible that new descriptive categories might evolve in the study of patient populations to characterize their unique patterns of movement. We are also beginning to identify factors that are related to movement patterns in various age groups and to manipulate them in quasiexperimental and experimental studies. Two of these factors are body dimension and activity level. These factors hold a great deal of promise

Physical Therapy / Volume 70, Number 12 /December 1990

for further understanding of lifelong change in motor behavior. In summary, the life-span approach to motor development provides a theoretical framework to examine the continual development of motor abilities. The broadened perspective provided by life-span theory suggests factors that have not traditionally been considered to cause age-related change in behavior. The component approach to movement.-pattern description has been a vely useful initial step in describing tasks of interest to physical therapists and in identifying what appear to be developmental sequences of movement patterns for these tasks. The component approach also reveals the natural variability in movement patterns among and between individuals, both at a single point in and across developmental time. References 1 Williams K. What is motor development? Quest. 1989;.41:179-182. 2 McGraw h4B. The Neuromuscular Maturation of the fluman Infant. New York. NY: Hafner; 1962. 3 Gesell A. The ontogenesis of infant behavior. In: Carmichael L, ed. Manual of Child Psychology. 2nd ed. New York, NY: John Wiley & Sons Inc; 1954:335-373. 4 Stockmey-r SA. An interpretation of the approach of Rood to the treatment of neuromuscular dysfunction. Atn J Ph-ys Med. 1967;46:90& 956. 5 Stockmeyer SA. A sensorimotor approach to treatment. 111: Pearson PH, Williams CE, eds. Physcal Therapy Services in the Developmental Disabilities Springfield, 111: Charles C Thomas, Publisher; 11>72:186-222. 6 Bobath K, Bobath B. Cerebral palsy, parts 1 and 11. In: Pearson PH, Williams CE, eds. Physical Therapy Services in the Developmental Disabilities. Springfield, 111: Charles C Thomas, Publisher; 18272:31-185. 7 Knott M, Voss DE. Pmprioceptitle Neuromuscular Facilitation. New York, NY: Harper & Row, Publishers Inc; 1968. 8 Voss DE. Proprioceptive neuromuscular facilitation: th't PNF method. In: Pearson PH, Williams CE, eds. Physical Therapy Services in the Developmental Disabilities. Springfield, Ill: Charles C Thomas, Publisher; 1972:223-282. 9 Haywcmd KM. Lfispan Motor Development. Champaign. Ill: Human Kinetics Publishers Inc; 1986. 10 Payne VG, Isaacs LD. Iluman Motor Development: A Lifepan Appmach. Mountain View, CaliE Mayfield Publishing Co; 1987. 11 Woollacott MH, Shumway-Cook A. Development of I'mure and Gait Acros the Lqe Span. Columbia, SC: South Carolina Press; 1989.

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12 Schaltenbrand G. The development of human motility and motor disturbances. Arch Neurol Psychiatry. 1928;20:72&730. 13 Wyke B. The neurological basis of movement: a developmental review. In: Holt KS, ed. Movement and Child Development. Philadelphia, Pa: JB Lippincott Co; 1975:19-33. 14 VanSant AF. A life span concept of motor development. Quest. 1989;41:224235, 15 Oppenheim RW. Ontogenetic adaptions and retrogressive processes in the development of the nervous system and behaviour: a neuroembryological perspective. In: Connolly KJ, Prechtl HFR, eds. Maturation and Development: Biological and Psychological Perspectitles. Philadelphia, Pa: JB Lippincott Co; 1981:73-109. 16 Shirley MM. The First Two Years: A Study of Twenly-FiveBabies. Volume I , Postural and Locomotor Deoelopment. Minneapolis, Minn: University of Minnesota Press; 1931. 17 Bobath B. Abnonrual Postural Reflex Actizrity Caused by Bruin Lesions. London, England: William Heinemann Medical Books Ltd; 1965. 18 Paine RS. The evolution of infantile postural reflexes in the presence of chronic brain syndromes. Dev Med Child Neurol. 1964;6:345 361. 19 VanSant AF. Rising from a supine position to erect stance: description of adult movement and a developmental hypothesis. Phvs Ther. 1988;68:185-192. 20 Richter RR, VanSant AF, Newton RA. Description of adult rolling movements and hypothesis of developmental sequences. Phys Ther. 1989;69:63-71. 21 Lawrence DG, Kuypers HGJM. The functional organization of the motor system in the monkey, I: the effects of bilateral pyramidal lesions. Brain. 1968;91:1-14. 22 Lawrence DG, Kuypers HGJM. The functional organization of the motor system in the monkey, 11: the effects of lesions of the descending brainstem pathways. Brain. 1968;91:15-36. 23 Lawrence DG, Hopkins DA. The development of motor control in the rhesus monkey: evidence concerning the role of corticomotoneuronal connections. Brain. 1976;99:235254. 24 Kuypers HGJM. Anatomy of the descending pathways. In: Brooks VB, ed. Ifandbook of P h y s i o l ~Motor : Control. Bethesda, Md: American Physiological Society; 1981;2:597666. 25 Roberton MA. Stability of stage categorizations across trials: implications for the "stage theory" of overarm throw development. Journal of lluman Movement Studies. 1977;3: 49-59. 26 Roberton MA. Stages in motor development. In: Ridenour MV, ed. Motor Development: Issues and Applications. Princeton, NJ: Princeton Book Co Publishers; 1978:6341. 27 VanSant AF. Age differences in movement patterns used by children to rise from a supine position to erect stance. Ph)~sTher. 1988;68:133G1338. 28 Sabourin PT. Rising from a Supine to a Standing Position: A Siudy of Adolescents. Richmond, Va: Virginia Commonwealth University; 1989. Master's thesis. 29 VanSant AF, Cromwell S, Deo A, et al. Rising from supine to standing: a study across

middle adulthood. Presented at the Joint Congress of the American Physical Therapy Association and the Canadian Physiotherapy Association: June 12-16, 1988; las Vegas, Nev. 30 Luehring SK. Component Movement Patterns of Two Cmups of Older Adults in the Task of Rising to Standing from the Flmr. Richmond, Va: Virginia Commonwealth IJniversity; 1989. Master's thesis. 31 VanSant AF. A life-span perspective of age differences in righting movements. In: Roberton MA, ed. Advances in Motor Development Research, Volume 4 New York, NY: AMS Press Inc. In press. 32 Richter RR. Developmental Sequences for Rolling from Supine to Prone: A Prelongitudinal stud)^. Richmond, Va: Virginia Commonwealth University; 1985. Master's thesis. 33 Lewis AM. Age-related Dijiv-ences in Component Action During Rolling in Children. Richmond, Va: Virginia Commonwealth Llniversity; 1987. Master's thesis. 34 Boucher JS. Age-related Differences in Adolescent Movement Patterns During Rolling from Supine to Prone. Richmond, Va: Virginia Commonwealth University; 1988. Master's thesis. 35 VanSant AF. Developmental Sequences for Righting from Supine to Erect Stance: A Prelongitudinal Screening. Madison, Wis: University of Wisconsin; 1983. Doctoral dissertation. 36 VanSant AF, Richter RR, Lewis AM, Boucher JS: Age differences in rolling from supine to prone in children, adolescents and young adults. Poster presentation at the 63rd Annual Conference of the American Physical Therapy Association;June 2t?-July 2, 1987; San Antonio, Tex. 37 Sarnacki SJ. Rising fiom Supine o n a Bed. A Description of Adult Movement and Fiypothesis of Developtnental Sequences. Richmond, Va: Virginia Commonwealth Ilniversity; 1985. Master's thesis. 38 McCoy JO. Age-related Dtjhrmces in the Movement Pattems of Adolescents 11. 14. and 17 Years of 4ge Rising to Standing,f'rom Supine o n a Bed. Richmond, va: Virginia Commonwealth University; 1989. Master's thesis. 39 Ford-Smith CD. Age Dzyerences in Mocetnent Patterns Used to Rise from a Bed. A Stu* of Middle Adulthood Richmond, Va: Virginia Commonwealth University; 1989. Master's thesis. 40 Francis ED, VanSant AF. Description of the sit-to-stand motion in children and young adults: hypothesis of developmental sequences. Poster presentation at the Joint Congress of the American Physical Therapy Association and the Canadian Physiotherapy Association;June 12-16, 1988; Las Vegas, Nev. 41 Nusik S, lamb RL, VanSant AF, Hirt S. Sitto-stand m~vement'~attern: a kinematic study. Phys Ther. 1986;11:1708-1713. 42 Jones FP. The influence of postural set on pattern of movement in man, lnt J Neurol. 1963;4:60-71. 43 Jones FP, Gray FE, Hanson JA, et al. An experimental study of the effect of head balance on patterns of posture and movement in man. J Psychol. 1959;47:247-258. 44 Jones FP, Hanson JA. Time-space pattern in a gross body movement. Percept Mot Skills. 1961;12:3541.

45 Kelley DL, Dainis A, Wood GK. Mechanics and muscular dynamics of rising from a seated position. In: Komi PV, ed, International Series of Biomechanics, V-B.Baltimore, Md: University Park Press; 1976:127-133. 46 Wheeler J, Woodward C, Ucovich RL, et al. Rising from a chair: influence of age and chair design. Phys Ther 1985;65:22-26.

47 Burdett RG, Habasevich R, Pisciotta J, Simon SR. Biomechanical comparison of rising from two types of chairs. Phys Ther 1985; 65:1177-1183. 48 Roberton MA, Williams K, Langendorfer S. Prelongitudinal screening of motor development sequences. Research Quarterly. 1980;51:724-731,

49 VanSant AF, Sabourin PT, Luehring SK, et al. Relationships among age, gender, body dimensions and movement patterns in a righting task. Poster presentation at the 64th Annual Conference of the American Physical Therapy Association; June 11-15, 1989; Nashville, Tenn. 50 Green LN. The Relationship Between Actiuity Le~jeland the hfovement Patterns of Supine to Standing Manhattan, Kan: Kansas State University; 1989. Master's thesis.

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Physical Therapy /Volume 70, Number 12 /December 1990