Five-repetition sit-to-stand test: usefulness for older patients in a home-care setting

The usefulness of the five-repetition sit-to-stand (FRSTS) test was assessed with older patients in a home-care setting. Records of 45 patients (> or = 65 years old) were examined for information on FRSTS test performance. 5 patients were excluded. 23 patients were unable to complete the test. For the 17 able to complete the FRSTS test, the time required was statistically significantly greater than age-stratified norms. For patients treated in a home-care setting, inability to complete the FRSTS test clearly underscores the test's limitations and the need for alternatives.     

Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders

This meta-analysis was conducted to generate normative values for the 5-repetition sit-to-stand (STS) test suitable for application to individuals at least 60 years of age. A thorough review of the literature yielded 13 papers (14 studies) relevant to this purpose. After the exclusion of potentially unrepresentative data, meta-analysis of these 13 papers indicated that judgments about normal performance should be based on age. Analysis demonstrated that individuals with times for 5 repetitions of this test exceeding the following can be considered to have worse than average performance: 11.4 sec (60 to 69 years), 12.6 sec. (70 to 79 years), and 14.8 sec. (80 to 89 years).     

Challenging horizontal movement of the body during sit-to-stand: impact on stability in the young and elderly

There are 3 significant challenges to sit-to-stand: (a) bringing the center of mass forward, (b) vertically raising the center of mass from the sitting to standing position, and (c) transition from a relatively large and stable base of support in sitting to a considerably smaller base of support when standing. The authors explored the challenges to stability control following sit-to-stand when the requirement for horizontal movement of the center of mass was influenced by foot position and their potential effect on the preceding phases of sit-to-stand. Eleven healthy young and 11 healthy elderly individuals performed the sit-to-stand with their feet further away and closer to the chair. Kinetic and kinematic data were recorded. Regardless of foot position, challenges in stability were greater in elderly participants than young participants despite their similar movement time and shear forces. The greater instability in elderly participants, despite their comparable movement characteristics, emphasizes the importance of stability control following sit-to-stand performance. For both young and elderly participants, the sit-to-stand duration and the shear forces were greater in the far condition. However, foot position did not affect the stability measures (i.e., duration of the stabilization phase and the total center of pressure path during the 1st second of the stabilization phase).     

Effects of visual-motor illusions with different visual stimuli on the sit-to-stand of people with hemiplegia following stroke: A randomized crossover controlled trial

BackgroundThe objective of this study was to determine the effects of different visual stimuli during visual-motor illusion on sit-to-stand in people with hemiplegia following stroke.MethodsThis was a randomized crossover controlled trial. Twenty people with hemiplegia following stroke were randomly divided into groups. The video images used for visual-motor illusion were ankle dorsiflexion without resistance (standard visual-motor illusion [standard illusion]) and maximum effort dorsiflexion with resistance (power visual-motor illusion [power illusion]). People with hemiplegia following stroke underwent both illusion interventions with a 1-week washout period in between; group A started with the standard illusion intervention and group B started with the power illusion intervention. Outcomes included the sit-to-stand duration, maximum weight-bearing value, trunk movement during sit-to-stand, ankle joint movement during sit-to-stand, and active ankle dorsiflexion movement on the paralyzed side.ResultsThe angular velocity of the trunk and ankle joints increased significantly during sit-to-stand, and sit-to-stand duration decreased significantly in response only to power illusion. In addition, the change in angular velocity of active ankle dorsiflexion was significantly greater in response to power illusion than was the change in response to standard illusion.ConclusionPower illusion induces a greater improvement in paralyzed ankle dorsiflexion function than standard illusion, resulting in shorter sit-to-stand duration.     

Compensatory relationship of mechanical energy in paretic limb during sit-to-stand motion of stroke survivors

The sit-to-stand motion is a prerequisite for walking and is therefore frequently performed in daily life. Diseases such as stroke often make performing it challenging. Even the stroke survivors who can stand up, the number of sit-to-stand motions they perform each day is lower than that of healthy adults. The inability of stroke survivors to stand up many times might be due to uneven distribution of mechanical energy expenditure across body parts. However, it was unclear in which body part this mechanical energy expenditure was concentrated, i.e., whether it was due to co-contraction of the paretic limb or compensation by the sound limb. Thus, this study aims to identify which body parts are responsible for mechanical energy expenditure in stroke survivors. Ten stroke survivors and ten healthy adults performed sit-to-stand motion recorded using motion capture cameras. We created a 3-D human model and calculated the mechanical energy expenditure for each joint and segment. The stroke survivors expended more mechanical energy in the affected hip and waist in contrast to the affected knee. Notably, a compensatory relationship for mechanical energy expenditure was observed between adjacent joints on the affected side and not between the affected and sound limbs. This is because stroke survivors may have achieved the sit-to-stand motion by compensating for the distal part with the less impaired proximal part. In addition, the more severe the movement disorders, the more mechanical energy must be expended in the paretic hip to achieve the sit-to-stand motion. These results could contribute to fundamental knowledge about more comfortable daily living in stroke survivors.     

Effect of movement speed on lower and upper body biomechanics during sit-to-stand-to-sit transfers: Self-selected speed vs. fast imposed speed

Preferred and fast speed sit-to-stand and stand-to-sit (STS) tests are prevalent in literature, but biomechanical changes between the different speeds of STS have never been studied. Understanding differences between these STS techniques will better inform experimental design for research assessing functional ability in clinical populations. The purpose of this study was to investigate the effect of different speeds of STS transfers on lower body and trunk kinematics and kinetics in healthy adults. Nineteen healthy middle-aged and older adults participated in this study. Two different speeds of STS were tested: self-selected speed and fast speed (as quickly as possible). Ten Vicon cameras and two AMTI force platforms were used to collect three-dimensional kinematic and kinetic data. During sit-to-stand transfer, peak knee extension velocity and knee extension moment were significantly increased for the fast speed STS as compared to the preferred speed STS. During stand-to-sit transfer, peak knee extension moment and lower back moment were significantly increased while STS time was decreased for the fast speed STS as compared to the preferred speed STS. Our results indicate that the fast speed STS could be more challenging for participants compared to the preferred speed STS evidenced by greater knee and lower back joint movements. Therefore, fast STS tests should be reconsidered when testing middle-aged and older adults with chronic low back pain and knee joint problems.     

Reliability of 16 balance tests in individuals with Down syndrome

To assess test-retest reliability scores on 16 balance tests of 21 individuals with Down syndrome whose ages ranged from 5 to 31 yr., participants performed a standing test on firm and soft surfaces with the eyes open and closed, the balance subset of the Bruininks-Oseretsky test, full turn, timed-up-and-go test, forward reach, and sit-to-stand. Each participant completed all 16 tests twice in one day and then again on a subsequent day for a total of 4 sessions. The interclass reliability correlation coefficients (ICC) value for each measure of balance varied considerably by age and sex. Based on having an ICC > .50, only 3 tests were reliable in young males and young females, whereas 5 tests could reliably be used in adult females and 9 tests could reliably be used in adult males. The results of this study raise suspicions as to the reliability of tests commonly used to assess balance and differences in reliability due to age and sex. Results of balance tests should be interpreted with caution in males and females with Down syndrome across the age span.     

Form and variability during sit-to-stand transitions: children versus adults

In performing the sit-to-stand transition, young children (6- to 7-year-olds) were expected to display a movement form similar to that of adults. However, movement consistency was predicted to be poorer in children than in adults because they lack refinement of motor control processes. Kinematic analysis of 10 repetitions of the sit-to-stand movement was carried out for 6 typically developing children and 6 adults. Supporting the authors' prediction of comparable form, no differences were evident between age groups for sequence of joint onsets, proportional duration of segmental motion, or in angle-angle plots of displacement at 2 segments. In contrast, within-participant variability was found to be higher for children: Coefficients of variation for most kinematic measures were twice those seen for adults. The authors interpret the children's lack of movement consistency as a reflection of inadequate stabilization of an internal model of intersegmental dynamics. Whereas adults have attained a skill level associated with refinement of that model, children have not. Children have an additional control problem because changes in body morphology throughout childhood require ongoing updating of the internal model that controls intrinsic dynamics.     

Form and Variability During Sit-to-Stand Transitions: Children Versus Adults

In performing the sit-to-stand transition, young children (6- to 7-year-olds) were expected to display a movement form similar to that of adults. However, movement consistency was predicted to be poorer in children than in adults because they lack refinement of motor control processes. Kinematic analysis of 10 repetitions of the sit-to-stand movement was carried out for 6 typically developing children and 6 adults. Supporting the authors' prediction of comparable form, no differences were evident between age groups for sequence of joint onsets, proportional duration of segmental motion, or in angle-angle plots of displacement at 2 segments. In contrast, within-participant variability was found to be higher for children: Coefficients of variation for most kinematic measures were twice those seen for adults. The authors interpret the children's lack of movement consistency as a reflection of inadequate stabilization of an internal model of intersegmental dynamics. Whereas adults have attained a skill level associated with refinement of that model, children have not. Children have an additional control problem because changes in body morphology throughout childhood require ongoing updating of the internal model that controls intrinsic dynamics.     

Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group

Abstract

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.

Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master^® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.

Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.

Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.     

A field study of step-up exercises with touch for elderly people

This study assessed step-up exercises appropriate for elderly persons (M age=70.7 yr., SD=7.0). The group did several exercises in 7 sessions per month (average participants per session was 14, SD=3). A 30-sec. chair-stand test (sit-to-stand), questionnaires on activities of daily living, and impressions of the exercises were examined. Activities of daily living were expected to differ on cluster analysis before and after exercise sessions. Each cluster was classified by basic and instrumental activities. The 30-sec. chair-stand test did not significantly improve. Subjects enjoyed doing exercises with touch. Appropriate exercises for elderly persons should promote activities of daily living. Functional movements with touch seem appropriate for maintaining physical fitness and social interaction.     

The effects of unilateral grab rail assistance on the sit-to-stand performance of older aged adults

This study investigated the effects of unilateral grab rail assistance during the sit-to-stand transfer to develop an understanding of lower limb joint mechanics and whole body movement patterns. External reaction forces at the grab rail and floor interfaces were also investigated to understand the nature of the assistance provided by the introduction of unilateral upper body assistance. While 12 older aged adults performed the sit-to-stand, three-dimensional body segment kinematics were recorded to determine lower body joint motion and whole body centre of mass motion. Grab rail reaction forces and bilateral ground reaction forces were recorded to determine external reaction forces and lower body joint kinetics. Grab rail assisted conditions were compared with unassisted transfers. During grab rail assistance, a systematic asymmetry was introduced to lower limb joint kinetics, without noticeable alterations to peak lower body joint motion and whole body movement patterns. Ipsilateral net joint moments and powers decreased in the ankle and hip and increased in the knee, while the contralateral net joint moments and powers increased in the hip and decreased in the knee. Joint kinetic and kinematic responses suggest a motor control strategy that maintains symmetric sit-to-stand movement patterns by adjusting bilateral muscle control when a unilateral external reaction force is provided. Understanding the mechanical assistance that is generated during the sit-to-stand will facilitate optimal design of grab rails for older aged adults and may contribute to design for specific pathologies. Such design implementation will influence the ability of older aged adults to remain independent in the community.     

Sit-to-stand: Functional relationship between upper body and lower limb segments

The behaviour of linked body segments during sit-to-stand was the subject of this study which investigated the relationship between the trunk and lower limb segments by varying the initial position of the trunk. Six subjects were videotaped as they stood up with feet on a forceplate from three initial positions: erect sitting, trunk flexed forward 30 deg, and 60 deg. When subjects actively flexed the trunk in the pre-extension phase, the order in which lower limb joints extended was knee, hip, ankle. However, when there was no active flexion, the order of onsets changed, the hip extending first followed by the knee and ankle. An extensor support moment (SM), a summation of extensor moments at hip, knee and ankle, occurred throughout the extension phase. The mean peak value of SM remained invariant in all three conditions despite variability in individual hip, knee and ankle moments. When active trunk flexion was absent, the duration of the extension phase was longer and a high value of SM was sustained for a longer proportion of the phase, indicating that more muscle force was required. The findings support the view that biomechanical characteristics emerge naturally from a functional coupling between segments, according to the demands of the action.     

"Perceptual scotomas": a functional account of motion-induced blindness

ABSTRACT— In motion-induced blindness (MIB), salient objects in full view can repeatedly fluctuate into and out of conscious awareness when superimposed onto certain global moving patterns. Here we suggest a new account of this striking phenomenon: Rather than being a failure of visual processing, MIB may be a functional product of the visual system's attempt to separate distal stimuli from artifacts of damage to the visual system itself. When a small object is invariant despite changes that are occurring to a global region of the surrounding visual field, the visual system may discount that stimulus as akin to a scotoma, and may thus expunge it from awareness. We describe three experiments demonstrating new phenomena predicted by this account and discuss how it can also explain several previous results.     

Spatial and Temporal Adaptations That Accompany Increasing Catching Performance During Learning

During stance, head extension increases postural sway, possibly due to interference with sensory feedback. The sit-to-stand movement is potentially destabilizing due to the development of momentum as the trunk flexes forward and the body transitions to a smaller base of support. It is unclear what role head orientation plays in the postural and movement characteristics of the sit-to-stand transition. The authors assessed how moving from sitting to standing with head-on-trunk extension compared with moving with the head neutral or flexed, or with moving with the head facing forward in space (which would involve head-on-trunk extension, but not head-in-space extension) in healthy, young participants. Head-on-trunk extension increased center of pressure variability, but decreased movement velocities, movement duration, and trunk flexion compared with flexed and neutral head-on-trunk orientations. Similarities in movement characteristics between head-on-trunk extension and the forward head-in-space orientation suggest that stabilizing the head in space does not fully counteract the postural and movement changes due to head-on-trunk extension. Findings suggest that proprioceptive feedback from the neck muscles contributes to the regulation of posture and movement, and therefore should not be overlooked in research on the role of sensory feedback in postural control.     

Is head-on-trunk extension a proprioceptive mediator of postural control and sit-to-stand movement characteristics?

During stance, head extension increases postural sway, possibly due to interference with sensory feedback. The sit-to-stand movement is potentially destabilizing due to the development of momentum as the trunk flexes forward and the body transitions to a smaller base of support. It is unclear what role head orientation plays in the postural and movement characteristics of the sit-to-stand transition. The authors assessed how moving from sitting to standing with head-on-trunk extension compared with moving with the head neutral or flexed, or with moving with the head facing forward in space (which would involve head-on-trunk extension, but not head-in-space extension) in healthy, young participants. Head-on-trunk extension increased center of pressure variability, but decreased movement velocities, movement duration, and trunk flexion compared with flexed and neutral head-on-trunk orientations. Similarities in movement characteristics between head-on-trunk extension and the forward head-in-space orientation suggest that stabilizing the head in space does not fully counteract the postural and movement changes due to head-on-trunk extension. Findings suggest that proprioceptive feedback from the neck muscles contributes to the regulation of posture and movement, and therefore should not be overlooked in research on the role of sensory feedback in postural control.     

Perception of weight-bearing distribution during sit-to-stand task in healthy young and elderly individuals

The first objective was to assess whether healthy individuals could accurately estimate their weight-bearing distribution in sit-to-stand transfers. The second was to evaluate the effect of age on weight-bearing perception. 16 young participants (11 women, 5 men; M age 29 yr., SD = 8.7) and 15 elderly participants (7 women, 8 men; M age 65 yr., SD = 3.8) were recruited. Verbal instructions and visual feedback referring to different percentages of weight-bearing distribution to execute were used to quantify weight-bearing perception in sit-to-stand tasks. For the feedback approach, the perception was assessed with a visual analog scale. For the verbal task, the weight-bearing distribution produced was assessed with force plates. Both young and elderly participants had good perception of weight-bearing distribution, with mean absolute errors of 6.4%. Moreover, their perceived and real weight-bearing distribution showed good agreement (ICC > or = .79).     

The validity of functional assessment with neuropsychological tests in aphasic stroke patients

The study describes a battery of clinical neuropsychological tests, and aims to show that inferences about underlying functions can be drawn from the results. The test battery is applied to a sample of 108 aphasic patients, and is shown to measure performances with acceptable stability across testing sessions and relatively independently of general background factors. The results of factor analysis show that five underlying functions can be assessed. A functional model is described and the factors are interpreted as reflecting the functions of Praxis, Attention, Language, Motor Deficit, and Perceptual Integration. Although aphasia is defined as a disturbance of language, the aphasic patient is best described by a functional profile with dimensions based on the factors isolated.     

Beyond "objective" and "projective": a logical system for classifying psychological tests: comment on Meyer and Kurtz (2006)

I present a formal system that accounts for the misleading distinction between tests formerly termed objective and projective, duly noted by Meyer and Kurtz (2006). Three principles of Response Rightness, Response Latitude and Stimulus Ambiguity are shown to govern, in combination, the formal operating characteristics of tests, producing inevitable overlap between "objective" and "projective" tests and creating at least three "types" of tests historically regarded as being projective in nature. The system resolves many past issues regarding test classification and can be generalized to include all psychological tests.     

Instruction in reliability and magnitude of evaluation parameters at each phase of a sit-to-stand movement

The sit-to-stand movement strategy of each subject is different depending on whether the subjects perform voluntary movements or have concrete instructions (i.e., stand quickly), which is strongly reflected in the performance of each sit-to-stand movement phase. Thirty young-adult male subjects participated in this study (M age=20.7 yr; SD=2.6). Subjects performed the two movements from a chair height adjusted to the subject's lower thigh length. In the self-administered (SA) condition, subjects voluntarily stood up from the chair without instruction, and in the assigned-ordered (AO) condition subjects stood up from the chair as fast as possible. Vertical floor reaction force and electromyograms of the rectus femoris and tibialis anterior muscles were measured, and 15 parameters were selected. The parameters in the phase between the peak value of the floor reaction force and completion of the movement was highly reliable regardless of instruction. However, other parameters had different reliabilities between the instruction conditions. In particular, the parameters in the phase between starting the movement and the peak value of the floor reaction force under the assigned-order were higher than those of the self-administered condition. Moreover, the sit-to-stand movement was conducted faster in the assigned-order condition during the phase between starting the movement and buttocks-syneresis, and the peak value of the floor reaction force and completion of the movement. From the above, in the assigned-order condition "as fast as possible," the anteflexion bending movement and extension of knee and trunk joints were faster, and anteflexion movement was repeated more similarly under a concrete instruction such as moving as fast as possible.