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Sit-to-Stand and Sit-to-Walk
Abstracts
437
Sit-to-Stand and Sit-to-Walk A Kerr Glasgow Caledonian University K M Kerr Nottingham University Rationale Walking can be initiated from a variety of positions and postures. Walking from sitting is probably one of the most common and yet sit-to-walk is rarely investigated. Sit-to-stand has been divided into phases based on kinematic and kinetic events (Schenkman et al, 1990). This framework is used to define and compare sit-to-walk. This study compared the duration of the initial flexion momentum phase in sit-to-stand and sit-to-walk. Method Following ethical approval healthy subjects were recruited. They sat on a stool adjusted vertically to leg height with their feet resting on a forceplate. Foot position was kept constant and arms folded. A CODA® motion analysis system was used with markers placed on anatomical points to define four segments (trunk, thigh, leg and foot). This protocol allowed the measurement of kinetic and kinematic variables. Subjects then carried out sit-to-stand and sit-to-walk (× 5) at their customary speed. Analysis Four phases of sit-to-stand (flexion momentum, extension, deceleration and stabilisation) and two additional sit-to-walk phases (unloading and stance) were defined. Flexion momentum phase was defined as the period between initiation and seat-off and is therefore
comparable between the movements. The five trials were averaged for each subject and tested for differences between the movements using a paired t-test. Results Fourteen subjects participated, mean age 39.8 years (SD 11.8), weight 80.9 kg (SD 15.8), height 1.76 m (SD 0.11). The mean duration of phase 1 in sit-to-stand was 0.92 seconds (SD 0.08) compared to 0.81 seconds (SD 0.06) in sit-to-walk. This difference was statistically significant (p = 0.001). Conclusions There was a statistically longer period of pre-seat-off momentum generation in sit-to-stand. The more rapid phase 1 seen in sit-to-walk probably reflects the need for greater horizontal momentum to initiate gait. Understanding that sit-to-walk requires a faster pre-seat-off flexion movement than sit-to-stand may help guide the rehabilitation of individuals with movement disorders such as Parkinson’s disease. These results may also explain the loss of a smooth sit-to-walk movement in subjects with a prolonged duration of the flexion momentum phase. Future research may consider how the phases in sit-to-stand and sit-to-walk vary with age and disease.
Reference Schenkman, M, Berger, R A, O’Riley, P, Mann, R W and Hodge, W A (1990). ‘Whole-body movements during rising to standing from sitting’, Physical Therapy, 70, 638-648.
Health Technology Assessment Outline proposals for primary research and full proposals for secondary research are invited by the NHS Research and Development Programme for priority areas in health technology assessment. A new series of priority areas has been identified for assessment of the costs, effectiveness and broader impact of any method used by health professionals to promote health; prevent, diagnose or treat disease; or improve rehabilitation and long-term care. One of particular relevance to physiotherapists is in primary research:
Interventions for treating proximal humeral fractures in adults Proposal application forms, commissioning briefs and associated guidance notes may be downloaded from the website at the following address: http://www.ncchta.org/advert.htm Alternatively, paper copies of the proposal application pack are available from the NCCHTA Commissioning Manager, Mailpoint 728, Boldrewood, University of Southampton, Southampton SO16 7PX. Tel 023 8059 5621 (24-hour answer service), fax 023 8059 5639. Please quote reference MA7. The proposal quoted here is ∑ 02/13.
Closing time and date for completed proposals is 5 pm on Thursday, July 18, 2002.
Physiotherapy July 2002/vol 88/no 7
437
Sit-to-Stand and Sit-to-Walk A Kerr Glasgow Caledonian University K M Kerr Nottingham University Rationale Walking can be initiated from a variety of positions and postures. Walking from sitting is probably one of the most common and yet sit-to-walk is rarely investigated. Sit-to-stand has been divided into phases based on kinematic and kinetic events (Schenkman et al, 1990). This framework is used to define and compare sit-to-walk. This study compared the duration of the initial flexion momentum phase in sit-to-stand and sit-to-walk. Method Following ethical approval healthy subjects were recruited. They sat on a stool adjusted vertically to leg height with their feet resting on a forceplate. Foot position was kept constant and arms folded. A CODA® motion analysis system was used with markers placed on anatomical points to define four segments (trunk, thigh, leg and foot). This protocol allowed the measurement of kinetic and kinematic variables. Subjects then carried out sit-to-stand and sit-to-walk (× 5) at their customary speed. Analysis Four phases of sit-to-stand (flexion momentum, extension, deceleration and stabilisation) and two additional sit-to-walk phases (unloading and stance) were defined. Flexion momentum phase was defined as the period between initiation and seat-off and is therefore
comparable between the movements. The five trials were averaged for each subject and tested for differences between the movements using a paired t-test. Results Fourteen subjects participated, mean age 39.8 years (SD 11.8), weight 80.9 kg (SD 15.8), height 1.76 m (SD 0.11). The mean duration of phase 1 in sit-to-stand was 0.92 seconds (SD 0.08) compared to 0.81 seconds (SD 0.06) in sit-to-walk. This difference was statistically significant (p = 0.001). Conclusions There was a statistically longer period of pre-seat-off momentum generation in sit-to-stand. The more rapid phase 1 seen in sit-to-walk probably reflects the need for greater horizontal momentum to initiate gait. Understanding that sit-to-walk requires a faster pre-seat-off flexion movement than sit-to-stand may help guide the rehabilitation of individuals with movement disorders such as Parkinson’s disease. These results may also explain the loss of a smooth sit-to-walk movement in subjects with a prolonged duration of the flexion momentum phase. Future research may consider how the phases in sit-to-stand and sit-to-walk vary with age and disease.
Reference Schenkman, M, Berger, R A, O’Riley, P, Mann, R W and Hodge, W A (1990). ‘Whole-body movements during rising to standing from sitting’, Physical Therapy, 70, 638-648.
Health Technology Assessment Outline proposals for primary research and full proposals for secondary research are invited by the NHS Research and Development Programme for priority areas in health technology assessment. A new series of priority areas has been identified for assessment of the costs, effectiveness and broader impact of any method used by health professionals to promote health; prevent, diagnose or treat disease; or improve rehabilitation and long-term care. One of particular relevance to physiotherapists is in primary research:
Interventions for treating proximal humeral fractures in adults Proposal application forms, commissioning briefs and associated guidance notes may be downloaded from the website at the following address: http://www.ncchta.org/advert.htm Alternatively, paper copies of the proposal application pack are available from the NCCHTA Commissioning Manager, Mailpoint 728, Boldrewood, University of Southampton, Southampton SO16 7PX. Tel 023 8059 5621 (24-hour answer service), fax 023 8059 5639. Please quote reference MA7. The proposal quoted here is ∑ 02/13.
Closing time and date for completed proposals is 5 pm on Thursday, July 18, 2002.
Physiotherapy July 2002/vol 88/no 7