Description of Adult Rolling Movements and Hypothesis

of Developmental Sequences

Physical therapists frequently evaluate and teach patients to roll from a supine to Randy R Richter
a prone position. The purposes of this study were 1) to describe the rolling Ann F VanSant
movements of adults and 2) to determine whether the movement patterns used to Roberta A Newton
roll might represent different developmental steps within three body regions.
Thirty-six healthy adult subjects were videotaped during 10 trials of rolling from a
supine to a prone position. Written descriptions of each subject's movements were
reduced to general categorical descriptions of movement patterns for three body
regions (upper extremities, lower extremities, and head and trunk). Stage theory
criteria were used in an attempt to order the movement patterns into
developmental sequences. The most common combination of movement patterns
was used to describe adults' rolling action. Although stage theory criteria were not
met, developmental sequences of movement patterns were proposed for the three
body regions. Subjects were quite variable in their rolling movements. The most
common form of rolling occurred in less than 12% of the subjects' trials. The
descriptions of adults' rolling action gathered in this study provide physical
therapists with a variety of movement patterns for teaching patients to roll. [Richter
RR, VanSant AF, Newton RA: Description of adult rolling movements and
hypothesis of developmental sequences. Phys Ther 69:63-71, 1989]

Key Words: Functional training and activities, Motor skills, Movement.

Physical therapy for patients with some standard or norm. To date no movements are valid representations of
neurologic dysfunction often includes reported research exists describing the healthy individuals' movements is
the evaluation and teaching of rolling movement patterns that adults use to unknown. The purposes of this study
movements.1-3 To determine the roll. Although specific rolling were 1) to describe movement patterns
"quality" of the rolling pattern, rolling movements have been recommended used by adults to roll from a supine to
movements must be evaluated against for use in treatment,3-5 whether these a prone position and 2) to determine
whether different movement patterns
seen in three regions of the body
might represent developmental steps
R Richter, MS, PT, is Instructor, Department of Physical Therapy, School of Allied Health Professions, St within this rolling task.
Louis University, 1504 S Grand Blvd, St Louis, MO 63104 (USA). He was a student in the master's
degree program, Department of Physical Therapy, School of Allied Health Professions, Medical College
of Virginia, Virginia Commonwealth University, Richmond, VA, when this study was conducted. Background
A VanSant, PhD, PT, is Associate Professor, Department of Physical Therapy, School of Allied Health
Professions, Medical College of Virginia, Virginia Commonwealth University, PO Box 224, MCV Station, Gesell and Amatruda defined motor
Richmond, VA 23298-0001. development as a continuous process
that proceeds stage by stage in a
R Newton, PhD, PT, is Associate Professor, Department of Physical Therapy, School of Allied Health
Professions, Medical College of Virginia, Virginia Commonwealth University. systematic order.6 McGraw used the
term "phase" to indicate observable,
This study was completed in partial fulfillment of Mr Richter's master's degree, Medical College of definable behaviors occurring during a
Virginia, Virginia Commonwealth University. The results of this study were presented in poster format
at the Sixty-Third Annual Conference of the American Physical Therapy Association, San Antonio, TX, specific period of time.7 More recently,
June 28-July 2, 1987, and were presented at the Fall Meeting of the Missouri Chapter of the American the term "stage" has been used as a
Physical Therapy Association, Springfield, MO, September 19-21, 1986. more formal theoretical construct in
8,9
This article was submitted August 3, 1987; was with the authors for revision for 26 weeks; and was motor-development literature. In this
accepted June 9, 1988.

Physical Therapy/Volume 69, Number 1/January 1989 63/77

latter sense, stage refers to generalities
of behavior that are observed across
several motor tasks. During a specific
time period, for example, some general
characteristics of a stage might be
observed in the tasks of rolling, rising
to a standing position, or getting out of
bed.
According to formal stage theory, stages
are intransitive. Stage 1 always precedes
stage 2, stage 2 always precedes stage 3,
and so forth.10 Stages are also universal;
given proper circumstances and
enough time, all individuals will pass
through the same sequence of stages.11
If stages were not universal, some
stages could be skipped during the
process of development.
VanSant used stage theory constructs to
study the motor task of rising from a
supine to a standing position.12 She
assumed that motor behavior in the
rising task developed in a universal and
invariant order. Individuals were
expected to demonstrate behavior
characteristic of their developmental
stage, and individuals in transition
between stages were expected to
demonstrate behavior of adjacent
stages. Adopting a life-span perspective
of development, VanSant applied these
stage theory constructs in a study of
adult subjects ranging in age from 20 to
35 years. The behaviors assumed to
undergo developmental change were
the movement patterns of different
body regions. The movement patterns
observed in the sample of adults were
initially described for three body
regions: 1) the upper extremities, 2)
the axial region, and 3) the lower
extremities. Descriptive categories of
movement patterns were formed and
then ordered into developmental
sequences for each body region by
examining the variability of the subjects
when they performed several trials of
the rising task.
A subsequent study of children
performing the same task demonstrated
that the results of the study of adults
were useful for hypothesizing the
*Panasonic Co, Div of Matsushita Electric Corp of America, One Panasonic Way, Secaucus, NJ 07094.
†
Everex Hatachi Denshi America, Ltd, 175 Crossways Park W, Woodbury, NY 11797.
78/64
developmental sequences of movement
patterns for the rising task.13 By first
studying adults, VanSant was able to
approach the more time-consuming
study of children with clearly defined
hypotheses of developmental
sequences.
Gesell and Amatruda,6 McGraw,7 and
Shirley14 have described development
within the task of rolling, but their
developmental sequences do not
completely describe the movement
patterns used to roll. Their reports are
also limited to descriptions of the
rolling movements of infants and very
young children.
Method
Subjects
The 7 men and 29 women participating
in this study ranged in age from 20 to
29 years. The study sample consisted
primarily of students at the Medical
College of Virginia, Virginia
Commonwealth University. Individuals
who had exposure to physical therapy
techniques that prescribe the form of
rolling movements were not included in
this study. Individuals who reported any
orthopedic or neurological conditions
(eg, pain or muscle soreness) that
would interfere with rolling were
excluded from the study. Each subject
signed an informed consent form.
Equipment
To collect the data, the first author
(R.R.R) used a 1.22 × l.83-m exercise
mat, a videocamera* mounted on a
tripod, and a videocassette recorder
and tuner.† The camera was elevated to
a position about 1.8 m above the floor
and was located about 33 m from the
center of the exercise mat. The camera
was positioned such that the optical
axis was at a 61-degree angle with
respect to the horizontal plane and at a
55-degree angle with respect to a line
bisecting the mat longitudinally (Fig. 1).
This configuration of camera and mat
was used to obtain an overall view of
Phvsical Theraov/Volume 69, Number 1/January 1989
the subjects' movement with just one
camera.
Procedure
The first author collected all data. He
asked subjects to lie on the mat and
then gave the following instructions:
"Lie on your back with your arms at
your side and roll to your stomach as
fast as you can. Ten trials will be
videotaped. I will say, 'Ready, go!' When
I say 'Go,' roll to your stomach as fast
as you can." All subjects were
requested to roll toward and over their
left side because of the camera
location. No effort was made to
determine handedness of the subjects
or to hypothesize or study the effect of
handedness on performance of the
rolling task.
Videotaping began about three to five
seconds before saying, "Ready, go!" and
stopped just after the subject reached
the prone position. A rest interval of
one minute or less between trials gave
the rater sufficient time to change
trial-number indicators.
Data Reduction
Movement pattern description.
The videotape was played back through
the videocassette recorder and a
television monitor. About 30 images
per second were available for analysis.
The videocassette recorder had
single-frame advance, slow-speed, and
stop-action capabilities. We used all of
these modes to analyze subjects'
movements. The first author described
movements across all trials and subjects
for each of three body regions: 1)
upper extremities (UEs), 2) head and
trunk (HT), and 3) lower extremities
(LEs). We then examined the written
descriptions of the movement of the
UEs during the 8th, 9th, and 10th trials,
looking for similarities and differences
in the written descriptions. Based on
these comparisons, we developed
preliminary descriptive categories of
movement patterns for the UEs. These
preliminary categories were refined by
reviewing the videotapes of all subjects
and trials. After refining the categorical
descriptions of the UE movement
patterns, the first author reviewed the
videotapes and classified the UE
movement patterns for all subjects and
trials into an appropriate category. This
same process was repeated to identify
movement patterns and reduce the data
for the HT and LE regions.
Fig. 1. Configuration of camera and mat at taping site.
Physical Therapy/Volume 69, Number 1/January 1989
Objectivity procedures. The second
author (AFV) independently
categorized movement patterns of each
body region in a set of 36 randomly
selected trials. The results of her
classification were compared with the
first author categorization of the same
trials to determine the percentage of
exact agreement between raters. If less
than 85% of exact agreement was
obtained within a body region, we
refined the movement pattern
descriptions to resolve any possible
ambiguities. Another set of 36 trials was
selected, and we repeated the process
until we attained at least 85% of exact
agreement for classifying the
movement patterns of each body
region. The first author determined his
intrarater exact agreement after
attaining a minimum of 85% of exact
agreement with the second author.
Data Analysis
Developmental sequences. We used
the following procedure to hypothesize
a developmental order of movement
patterns for each body region within
the rolling task. As with VanSant's
study,12 the movement pattern
categories were assumed to represent
developmental elements or steps.
Concentrating on a single body region,
we analyzed the data from subjects
who had varied their movement
patterns during the 10 trials. We
searched for an ordering of the
patterns in which subjects varied only
among adjacent patterns. An ordering
that met this criterion could be
hypothesized as an invariant and
universal developmental sequence of
movement patterns for that body
region.8
Description of adults9 rolling
action. A table was constructed to
record the combinations of UE, HT,
and LE movement patterns used by
each subject during each trial. From
these data, the most common
combination of UE, HT, and LE action
across all subjects and trials was
determined. The percentage of
occurrence of each movement pattern
was also determined for each body
region across all subjects and trials.
Results
Movement Pattern Categories
Four movement patterns were
identified for each body region. The
UE movement patterns were "Lift and
Reach Below Shoulder Level," "Lift and
65/79
Reach Above Shoulder Level," "Push
and Reach," and "Push." Thefirsttwo
patterns are characterized by lifting and
reaching of the right UE as the subject
rolls over the left side. The major
difference between these two patterns
is the position the right hand reaches
with respect to the left shoulder. The
Push-and-Reach and Push movement
patterns are characterized initially by
maintained contact of the right UE
against the support surface as the
subject rolls. Later during the
movement, these two UE patterns can
be differentiated by the position of the
right arm at side lying. In the Push-and-
Reach pattern, the right arm is parallel
to or in front of the body by the time
the subject reaches side lying. In the
Push pattern, the right arm remains
behind the body at side lying. Detailed
descriptions of each UE movement
pattern are provided in the Appendix.
The HT movement patterns were
"Aligned Pelvis and Shoulder Girdle,"
"Pelvis Leads," "Relationship Between
Pelvis and Shoulder Girdle Changes,"
and "Shoulder Girdle Leads." In all
four HT movement patterns, the head
and trunk turn to the left, and the head
may be raised from the support
surface. The four patterns can be
differentiated by the positions of the
right shoulder girdle and pelvis during
the movement. During two of the
movement patterns, Pelvis Leads and
Shoulder Girdle Leads, either the right
pelvis or the shoulder girdle leads the
other as the subject rolls past side
lying. Of the remaining movement
patterns, Aligned Pelvis and Shoulder
Girdle is characterized by the right
pelvis and shoulder girdle remaining
aligned with each other as the subject
rolls beyond side lying. The
Relationship-Between-Pelvis-and-
Shoulder-Girdle-Changes movement
pattern is characterized by a change in
the relative position of the right pelvis
and shoulder girdle before the subject
reaches side lying. Detailed
descriptions of each HT movement
pattern are presented in the Appendix.
The LE movement patterns are
"Bilateral Lift," "Unilateral Lift,"
"Unilateral Push," and "Bilateral Push."
An initial flexion of the LEs occurs in
each pattern. One or both LEs are lifted
80/66
from the support surface enabling
differentiation of the Bilateral-Lift and
Unilateral-Lift movement patterns.
During Bilateral Lift both LEs are flexed
and lifted off of the support surface,
whereas in Unilateral Lift only one LE is
lifted off of the support surface. The
Unilateral-Push and Bilateral-Push
movement patterns are defined by
whether one or both LEs push against
the support surface. Complete
descriptions of the LE movement
patterns are provided in the Appendix.
Objectivity of Movement Patterns
We achieved 92% of exact agreement
between the first and second authors
for classifying movement patterns of
the UE and HT regions. We attained
88% of exact agreement for the LE
region. Intrarater objectivity for the UE,
HT, and LE components was 94%, 91%,
and 86% of exact agreement,
respectively.
Developmental Sequences
Upper extremity sequence. Analysis
of the UE categorization indicated that
only 18 of the 36 subjects varied their
UE movement pattern during their 10
trials of rolling. The other 18 subjects
did not vary their UE movement pattern.
No ordering of the UE movement
pattern categories was found in which
all subjects varied only among adjacent
Table 1. Most Common Movement Pattern Combinations Observed Across 360 T
(N = 36)
11
Upper
1
Extremity
Patterna
B D
B C
B D
B D
C C
D B
C B
a
B-Lift and Reach Above Shoulder Level, C-Push and Reach, D-Push.
b
B-Pelvis Leads, C-Relationship Between Pelvis and Shoulder Girdle Changes, D-Shoulder Girdle Leads.
c
A-Bilateral Lift, B-Unilateral Lift, C-Unilateral Push.
Physical Therapy/Volume 69, Number 1/January 1989
patterns. Two orders were identified in
which only one individual varied
between nonadjacent steps: 1) Lift and
Reach Below Shoulder Level, Lift and
Reach Above Shoulder Level, Push and
Reach, and Push and 2) Push, Push and
Reach, Lift and Reach Above Shoulder
Level, and Lift and Reach Below
Shoulder Level. To determine whether
either of these two permutations might
approximate a developmental sequence,
we consulted McGraw's research.7 Line
drawings accompanying McGraw's
description of the first developmental
phase of rolling indicate that the
extremities on the occiput side are lifted
and carried over toward the chin side.
In one of the two permutations being
considered, lifting movements preceded
pushing movements. Because a
developmental sequence in which
pushing movements were common
before lifting movements would be
inconsistent with McGraw'sfindings,we
hypothesized that the developmental
sequence for UE movement patterns
from earliest to latest steps was 1) Lift
and Reach Below Shoulder Level, 2) Lift
and Reach Above Shoulder Level, 3)
Push and Reach, and 4) Push.
Head and trunk sequence.
Seventeen of the 36 subjects
demonstrated variability in HT action
across their 10 trials of rolling. The
remaining 19 subjects demonstrated no
variability in HT action across their 10
Lower
Extremity Occurrence
Patternc (%)
B 11.9
C 11.4
A 10.8
C 10.5
C 9.7
C 7.5
C 6.1

Arm Pattern • Lift and reach above shoulder level
Head-Trunk Pattern • Shoulder girdle leads
Leg Pattern • Unilateral lift
Fig. 2 . A common form of rolling. Read from lower right-hand corner to upper
left-hand corner.
trials. No permutation was found in
which all 17 subjects varied only
among adjacent movement patterns.
Two orderings of the patterns had only
two individuals who did not meet this
criterion: 1) Aligned Pelvis and
Shoulder Girdle, Pelvis Leads,
Relationship Between Pelvis and
Shoulder Girdle Changes, and
Shoulder Girdle Leads and 2) Shoulder
Girdle Leads, Relationship Between
Pelvis and Shoulder Girdle Changes,
Pelvis Leads, and Aligned Pelvis and
Shoulder Girdle. We again consulted
McGraw's research report 7 to ascertain
whether either permutation
corresponded to her findings. One of
the possible developmental orders
paralleled McGraw's developmental
sequence. The Aligned-Pelvis-
and-Shoulder-Girdle pattern was
similar to McGraw's description of the
earliest rolling pattern to develop.7
Movement between upper and lower
spinal segments did not appear to be
characteristic of this early phase. Our
HT categorical description, Pelvis Leads,
was similar to McGraw's description of
the second, or "spinal extension,"
phase; in both instances, spinal or
trunk extension is a characteristic
feature. We hypothesized, therefore,
that the developmental sequence for
HT movement patterns was 1) Aligned
Physical Therapy/Volume 69, Number 1/January 1989
Pelvis and Shoulder Girdle, 2) Pelvis
Leads, 3) Relationship Between Right
Pelvis and Shoulder Girdle Changes,
and 4) Shoulder Girdle Leads.
Lower extremity sequence.
Thirty-one subjects varied among the
LE movement pattern used during their
10 trials. The remaining 5 subjects did
not vary in LE action across their 10
trials. As with the other two body
regions, no permutation was found in
which all subjects varied between
adjacent LE movement patterns. Two
permutations were found in which only
one individual varied among non-
adjacent categories: 1) Bilateral Lift,
Unilateral Lift, Unilateral Push, and
Bilateral Push and 2) Bilateral Push,
Unilateral Push, Unilateral Lift, and
Bilateral Lift. In the line drawing of
McGraw's earliest step in the
development of rolling,7 the lower
extremities appear to be flexing on the
trunk. During the second phase of
development, the foot on the occiput
side pushes and moves into an
extension pattern. Our Unilateral-Push
movement pattern category describes a
similar extension pattern. We selected
the ordering of patterns that was most
consistent with McGraw'sfindingsand
hypothesized that the developmental
sequence of movement patterns for the
LEs was 1) Bilateral Lift, 2) Unilateral
Lift, 3) Unilateral Push, and 4) Bilateral
Push.
Description of Adults' Rolling
Thirty-two different combinations of
UE, HT, and LE movement patterns
were exhibited by the 36 subjects. Eight
of these movement-pattern
combinations were seen in only one
trial. Table 1 reports the percentage of
occurrence of the most common
combinations, or "profiles," of body
action observed across trials. Only
combinations appearing on more than
5% of the trials are included. Four
combinations of UE, HT, and LE
movement patterns appeared in at least
10% of the 360 trials. Three of these
four combinations involved the same
UE and HT patterns and differed only
in LE action. This common set of UE
and HT action was characterized by the
right UE being lifted off of the support
surface and the hand being brought up
above shoulder level as the right
shoulder girdle led the trunk to side
lying. This form of UE and HT action
was combined with either a
Unilateral-Lift, Bilateral-Lift, or
Unilateral-Push pattern in the LEs.
Figures 2 through 4 illustrate these
three common forms of rolling. The
fourth common pattern (Fig. 5) differed
from the other three patterns in HT
action, because the relationship
between the shoulder girdle and pelvis
changed before the subjects reached
side lying. In this latter combination, LE
action was characterized by a
Unilateral-Push pattern.
The frequency with which each
movement pattern category was
observed across the 360 trials is
reported in Table 2. The UE and HT
movement patterns observed most
frequently were also elements of three
of the common combinations of
movement patterns. The most common
LE pattern was the Unilateral Push.
Discussion
Forming Developmental
Sequences
The theoretical model used to form
sequences was based on stage theory
67/81
constructs. According to these
constructs, for a sequence to be valid,
all individuals who show across-trial
variation in their movements should
vary only to adjacent steps in the
proposed sequence.10 Roberton found
that developmental sequences that
withstood this criterion, called an
adjacency criterion, were validated in a
later longitudinal study.9 Sequences of
development in which individuals
varied to nonadjacent steps were not
validated in later longitudinal studies.

A major difference between our work

and that of Roberton8,9 is the age of the
subjects. Roberton used children as Arm Pattern • Lift and reach above shoulder level
subjects when identifying developmental Head-Trunk Pattern • Shoulder girdle leads
sequences. Since Roberton's initial Leg Pattern • Unilateral push
work,8,9 however, VanSant13 identified
developmental sequences of movement
patterns using stage theory criteria with Fig. 3 . A second common form of rolling. Read from lower right-hand corner to up
a group of adult subjects. Before left-hand corner.
undertaking that study, she postulated,
however, that it may not be possible to
use the adjacency criterion for adult
subjects. VanSant hypothesized that
adults may have developed all of the
possible movement patterns and,
therefore, may vary among all
movement patterns. Because in this
study a developmental sequence could
not be identified in which all subjects
varied among adjacent steps, it is
possible that our subjects also varied
among any of the patterns identified, as
proposed by VanSant. If adults vary Arm Pattern • Lift and reach above shoulder level
among all movement patterns, however, Head-Trunk Pattern • Shoulder girdle leads
then it is curious that possible Leg Pattern • Bilateral lift
sequences were identified in which
such small numbers of subjects varied
among nonadjacent patterns. The Fig. 4. A third common form of rolling. Read from lower right-hand corner to upp
sequences identified in this study may left-hand corner.
represent the common, if not universal,
orders of development of movement developmental sequences proposed developmental nature of the movement
patterns for this task. That is, they may should undergo further study. A patterns is a longitudinal study, which
represent a developmental order seen cross-sectional design sampling several could document changes in movement
in a majority of, but not all, individuals. different age groups would be the most patterns as they occur over time.
practical next step. Such a study would
provide data to support or refute the Clinical Implications
Validating Developmental developmental nature of the movement
Sequences pattern categories by determining The high number of movement pattern
whether the incidence of these patterns combinations appearing in our study
Roberton proposed that developmental varies with age. In addition, the sample should alert physical therapists
sequences not meeting the criterion developmental sequences we proposed to the great variability of movement
used in this study may need further could undergo preliminary screening patterns that can be used to roll. This
revisions before beginning a by studying the order in which the knowledge gives therapists more
longitudinal study of the development options to use when training or
patterns predominate with respect to
of movement patterns in the task.9 Our
age.15 The ultimate method of retraining adults in the task of rolling.
results indicate that the movement
supporting or reflating the The categorical descriptions of
patterns we identified and the

82/68 Physical Therapy/Volume 69, Number 1/January 1989

 described by Knott and Voss in their
text on proprioceptive neuromuscular
facilitation.4 For example, in the PNF
description of rolling from a supine to a
prone position while stressing UE
movement, the leading UE moves in a
pattern incorporating shoulder
extension, adduction, and medial
(internal) rotation. The Lift-and-Reach-
Below-Shoulder-Level UE movement
pattern is similar to this PNF diagonal
pattern of extension, adduction, and
medial rotation. The Lift-and-Reach-
Above-Shoulder-Level UE movement
pattern and the UE PNF pattern of
flexion, adduction, and lateral (external)
rotation are also similar to one another.
This similarity is most apparent in the
description of the flexion, adduction,
and lateral rotation pattern during a
Arm Pattern • Lift and reach above shoulder level
procedure to facilitate head, neck, and
Head-Trunk Pattern • Relationship between pelvis and
shoulder girdle changes trunk rotation while rolling.4
Leg Pattern • Unilateral push

In summary, we believe that the wide

variability in movement patterns used by
Fig. 5 . A fourth common form of rolling. Read from lower right-hand corner to upper
adults to roll from a supine to a prone
left-hand corner.
position should be considered when
teaching patients to roll. Future studies
should be undertaken to determine
Table 2. Proposed Sequences of Movement Pattern Development for Each Body whether the different movement
Region with Percentage of Occurrence of Each Movement Pattern Across Trials (N -patterns
360) identified in this study present
different developmental steps within the
task of rolling and whether the
Sequence Occurrence sequences proposed here are valid.
Body Region Order Pattern (%)
Conclusions
Upper extremity 1 Lift and Reach Below Shoulder 5.0
Level Adults show great variability in the
2 Lift and Reach Above Shoulder 62.5 movement patterns used to roll. We
Level hypothesize that the movement
3 Push and Reach 24.2 patterns identified in this study are
4 Push 8.3 developmental; that is, we propose that
these movement patterns vary with age.
Head-trunk 1 Aligned Pelvis and Shoulder Girdle 3.6 Finally, we do not believe that the
2 Pelvis Leads 27.2
sequences of movement pattern
development hypothesized for each
3 Relationship Between Pelvis and 30.3
Shoulder Girdle Changes
body region will be seen in all
individuals. Rather, we believe that the
4 Shoulder Girdle Leads 38.9
sequences represent a common order
of development demonstrated by most,
Lower extremity 1 Bilateral Lift 13.3 but not all, individuals.
2 Unilateral Lift 15.6
3 Unilateral Push 51.4
4 Bilateral Push 19.7
References
1 Bobath B: Adult Hemiplegia: Evaluation and
Treatment, ed 2. London, England, Heinemann
Medical Books Ltd, 1978, pp 43-48
movement patterns presented in this The movement pattern descriptions
2 Voss DE: Proprioceptive neuromuscular
article can be used as models when developed in this study are somewhat facilitation. Am J Phys Med 46:838-898, 1967
instructing patients. similar to the patterns of movement

Physical Therapy/ Volume 69, Number 1/January 1989 69/83

Appendix. Adult Rolling Movement Patterns

Upper Extremity
Lift and Reach Below Shoulder Level
The right upper extremity (UE) is lifted off of the support surface and reaches across the body with the right hand at or below shoulder level.
The left arm stays at the side of the body, abducts, or may be lifted off of the mat. The left shoulder or UE contacts the support surface as the
subject rolls over the left shoulder or UE.
Lift and Reach Above Shoulder Level
The right UE is lifted off of the support surface. The right hand is brought above shoulder level. The left arm may stay at the side of the body. The
subject rolls over the left UE or shoulder.
Push and Reach
At the start of the movement, part of the right UE appears to push while in contact with the support surface. The right UE is lifted from the support
surface as the right shoulder flexes, reaching toward a position parallel to or in front of the body when the subject is side lying. The left arm may
stay at the side of the body, and the left shoulder or UE remains in contact with the surface as the subject rolls.
Push
The right UE maintains contact with the support surface as the right shoulder extends. The right arm remains behind the body until the subject
reaches side lying. The left arm may stay at the side of the body, abduct, or flex. The left shoulder or UE remains in contact with the support surface
as the subject rolls past side lying.

Head and Trunk

Aligned Pelvis and Shoulder Girdle
The head and trunk turn to the left. The head may be raised from the support surface, and the trunk may flex as the subject rolls. The right pelvis
and shoulder girdle remain aligned with each other beyond the side-lying position.
Pelvis Leads
The head may be raised off of the support surface and may turn to the left. The trunk turns to the left. The right pelvis leads the right shoulder girdle,
and this relationship stays the same beyond side lying. The trunk becomes extended before side lying.
Relationship Between Pelvis and Shoulder Girdle Changes
The head may be raised off of the support surface and may turn as the trunk rotates to the left. The right shoulder or pelvis may initially lead the movement
toward side lying and may be aligned with each other. Before side lying, the relative position of the right pelvis and right shoulder girdle changes.
Shoulder Girdle Leads
The head may be raised from the support surface and may turn to the left. The trunk rotates to the left and may flex before side lying. The right shoulder
girdle leads the right pelvis, and this relationship stays the same beyond side lying.

Lower Extremity
Bilateral Lift
Both of the lower extremities (LEs) are flexed and lifted off of the support surface with the right pelvis remaining on the support surface. The LEs may be
carried to the left and may not reach full extension.
Unilateral Lift
One or both LEs may flex and assume a position as if to push. One LE may be lifted off of the support surface. If the right LE is lifted off of the support
surface, this movement occurs before any part of the right pelvis loses contact with the support surface. Neither extremity, although contacting the support
surface, maintains a fixed point of contact against which to push.
Unilateral Push
The right LE is pulled up toward the chest, remaining partly in contact with the support surface. One foot maintains a fixed point of contact on the support
surface and appears to push.
Bilateral Push
Both LEs are pulled up toward the chest. Both feet simultaneously maintain a fixed point of contact with the support surface and appear to push. As the
subject rolls to side lying, the right leg or thigh may remain behind the left LE.

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