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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 developmental sequences of movement the subjects' movement with just one
of behavior that are observed across patterns for the rising task.13 By first camera.
several motor tasks. During a specific studying adults, VanSant was able to
time period, for example, some general approach the more time-consuming Procedure
characteristics of a stage might be study of children with clearly defined
observed in the tasks of rolling, rising hypotheses of developmental The first author collected all data. He
to a standing position, or getting out of sequences. asked subjects to lie on the mat and
bed. then gave the following instructions:
Gesell and Amatruda,6 McGraw,7 and "Lie on your back with your arms at
According to formal stage theory, stages Shirley14 have described development your side and roll to your stomach as
are intransitive. Stage 1 always precedes within the task of rolling, but their fast as you can. Ten trials will be
stage 2, stage 2 always precedes stage 3, developmental sequences do not videotaped. I will say, 'Ready, go!' When
and so forth.10 Stages are also universal; completely describe the movement I say 'Go,' roll to your stomach as fast
given proper circumstances and patterns used to roll. Their reports are as you can." All subjects were
enough time, all individuals will pass also limited to descriptions of the requested to roll toward and over their
through the same sequence of stages.11 rolling movements of infants and very left side because of the camera
If stages were not universal, some young children. location. No effort was made to
stages could be skipped during the determine handedness of the subjects
process of development. Method or to hypothesize or study the effect of
handedness on performance of the
VanSant used stage theory constructs to Subjects rolling task.
study the motor task of rising from a
supine to a standing position.12 She The 7 men and 29 women participating Videotaping began about three to five
assumed that motor behavior in the in this study ranged in age from 20 to seconds before saying, "Ready, go!" and
rising task developed in a universal and 29 years. The study sample consisted stopped just after the subject reached
invariant order. Individuals were primarily of students at the Medical the prone position. A rest interval of
expected to demonstrate behavior College of Virginia, Virginia one minute or less between trials gave
characteristic of their developmental Commonwealth University. Individuals the rater sufficient time to change
stage, and individuals in transition who had exposure to physical therapy trial-number indicators.
between stages were expected to techniques that prescribe the form of
demonstrate behavior of adjacent rolling movements were not included in Data Reduction
stages. Adopting a life-span perspective this study. Individuals who reported any
of development, VanSant applied these orthopedic or neurological conditions Movement pattern description.
stage theory constructs in a study of (eg, pain or muscle soreness) that The videotape was played back through
adult subjects ranging in age from 20 to would interfere with rolling were the videocassette recorder and a
35 years. The behaviors assumed to excluded from the study. Each subject television monitor. About 30 images
undergo developmental change were signed an informed consent form. per second were available for analysis.
the movement patterns of different The videocassette recorder had
body regions. The movement patterns Equipment single-frame advance, slow-speed, and
observed in the sample of adults were stop-action capabilities. We used all of
initially described for three body To collect the data, the first author these modes to analyze subjects'
regions: 1) the upper extremities, 2) (R.R.R) used a 1.22 × l.83-m exercise movements. The first author described
the axial region, and 3) the lower mat, a videocamera* mounted on a movements across all trials and subjects
extremities. Descriptive categories of tripod, and a videocassette recorder for each of three body regions: 1)
movement patterns were formed and and tuner.† The camera was elevated to upper extremities (UEs), 2) head and
then ordered into developmental a position about 1.8 m above the floor trunk (HT), and 3) lower extremities
sequences for each body region by and was located about 33 m from the (LEs). We then examined the written
examining the variability of the subjects center of the exercise mat. The camera descriptions of the movement of the
when they performed several trials of was positioned such that the optical UEs during the 8th, 9th, and 10th trials,
the rising task. axis was at a 61-degree angle with looking for similarities and differences
respect to the horizontal plane and at a in the written descriptions. Based on
A subsequent study of children 55-degree angle with respect to a line these comparisons, we developed
performing the same task demonstrated bisecting the mat longitudinally (Fig. 1). preliminary descriptive categories of
that the results of the study of adults This configuration of camera and mat movement patterns for the UEs. These
were useful for hypothesizing the was used to obtain an overall view of preliminary categories were refined by
reviewing the videotapes of all subjects
and trials. After refining the categorical
descriptions of the UE movement
*Panasonic Co, Div of Matsushita Electric Corp of America, One Panasonic Way, Secaucus, NJ 07094. patterns, the first author reviewed the

Everex Hatachi Denshi America, Ltd, 175 Crossways Park W, Woodbury, NY 11797. videotapes and classified the UE

78/64 Phvsical Theraov/Volume 69, Number 1/January 1989


movement patterns for all subjects and Objectivity procedures. The second trials to determine the percentage of
trials into an appropriate category. This author (AFV) independently exact agreement between raters. If less
same process was repeated to identify categorized movement patterns of each than 85% of exact agreement was
movement patterns and reduce the data body region in a set of 36 randomly obtained within a body region, we
for the HT and LE regions. selected trials. The results of her refined the movement pattern
classification were compared with the descriptions to resolve any possible
first author categorization of the same 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
Fig. 1. Configuration of camera and mat at taping site. Reach Below Shoulder Level," "Lift and

Physical Therapy/Volume 69, Number 1/January 1989 65/79


Reach Above Shoulder Level," "Push from the support surface enabling patterns. Two orders were identified in
and Reach," and "Push." Thefirsttwo differentiation of the Bilateral-Lift and which only one individual varied
patterns are characterized by lifting and Unilateral-Lift movement patterns. between nonadjacent steps: 1) Lift and
reaching of the right UE as the subject During Bilateral Lift both LEs are flexed Reach Below Shoulder Level, Lift and
rolls over the left side. The major and lifted off of the support surface, Reach Above Shoulder Level, Push and
difference between these two patterns whereas in Unilateral Lift only one LE is Reach, and Push and 2) Push, Push and
is the position the right hand reaches lifted off of the support surface. The Reach, Lift and Reach Above Shoulder
with respect to the left shoulder. The Unilateral-Push and Bilateral-Push Level, and Lift and Reach Below
Push-and-Reach and Push movement movement patterns are defined by Shoulder Level. To determine whether
patterns are characterized initially by whether one or both LEs push against either of these two permutations might
maintained contact of the right UE the support surface. Complete approximate a developmental sequence,
against the support surface as the descriptions of the LE movement we consulted McGraw's research.7 Line
subject rolls. Later during the patterns are provided in the Appendix. drawings accompanying McGraw's
movement, these two UE patterns can description of the first developmental
be differentiated by the position of the Objectivity of Movement Patterns phase of rolling indicate that the
right arm at side lying. In the Push-and- extremities on the occiput side are lifted
Reach pattern, the right arm is parallel We achieved 92% of exact agreement and carried over toward the chin side.
to or in front of the body by the time between the first and second authors In one of the two permutations being
the subject reaches side lying. In the for classifying movement patterns of considered, lifting movements preceded
Push pattern, the right arm remains the UE and HT regions. We attained pushing movements. Because a
behind the body at side lying. Detailed 88% of exact agreement for the LE developmental sequence in which
descriptions of each UE movement region. Intrarater objectivity for the UE, pushing movements were common
pattern are provided in the Appendix. HT, and LE components was 94%, 91%, before lifting movements would be
and 86% of exact agreement, inconsistent with McGraw'sfindings,we
The HT movement patterns were respectively. hypothesized that the developmental
"Aligned Pelvis and Shoulder Girdle," sequence for UE movement patterns
"Pelvis Leads," "Relationship Between Developmental Sequences from earliest to latest steps was 1) Lift
Pelvis and Shoulder Girdle Changes," and Reach Below Shoulder Level, 2) Lift
and "Shoulder Girdle Leads." In all Upper extremity sequence. Analysis and Reach Above Shoulder Level, 3)
four HT movement patterns, the head of the UE categorization indicated that Push and Reach, and 4) Push.
and trunk turn to the left, and the head only 18 of the 36 subjects varied their
may be raised from the support UE movement pattern during their 10 Head and trunk sequence.
surface. The four patterns can be trials of rolling. The other 18 subjects Seventeen of the 36 subjects
differentiated by the positions of the did not vary their UE movement pattern. demonstrated variability in HT action
right shoulder girdle and pelvis during No ordering of the UE movement across their 10 trials of rolling. The
the movement. During two of the pattern categories was found in which remaining 19 subjects demonstrated no
movement patterns, Pelvis Leads and all subjects varied only among adjacent variability in HT action across their 10
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
Table 1. Most Common Movement Pattern Combinations Observed Across 360 T
patterns, Aligned Pelvis and Shoulder
(N = 36)
Girdle is characterized by the right
pelvis and shoulder girdle remaining
aligned with each other as the subject
11

Upper Lower
1

rolls beyond side lying. The Extremity Extremity Occurrence


Patterna Patternc (%)
Relationship-Between-Pelvis-and-
Shoulder-Girdle-Changes movement
pattern is characterized by a change in B D B 11.9
the relative position of the right pelvis B C C 11.4
and shoulder girdle before the subject B D A 10.8
reaches side lying. Detailed
B D C 10.5
descriptions of each HT movement
C C C 9.7
pattern are presented in the Appendix.
D B C 7.5
C B C 6.1
The LE movement patterns are
"Bilateral Lift," "Unilateral Lift," a
"Unilateral Push," and "Bilateral Push." B-Lift and Reach Above Shoulder Level, C-Push and Reach, D-Push.
b
An initial flexion of the LEs occurs in B-Pelvis Leads, C-Relationship Between Pelvis and Shoulder Girdle Changes, D-Shoulder Girdle Leads.
each pattern. One or both LEs are lifted c
A-Bilateral Lift, B-Unilateral Lift, C-Unilateral Push.

80/66 Physical Therapy/Volume 69, Number 1/January 1989


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
Arm Pattern • Lift and reach above shoulder level
movement patterns appeared in at least
Head-Trunk Pattern • Shoulder girdle leads
10% of the 360 trials. Three of these
Leg Pattern • Unilateral lift
four combinations involved the same
UE and HT patterns and differed only
Fig. 2 . A common form of rolling. Read from lower right-hand corner to upper in LE action. This common set of UE
left-hand corner. and HT action was characterized by the
right UE being lifted off of the support
trials. No permutation was found in Pelvis and Shoulder Girdle, 2) Pelvis surface and the hand being brought up
which all 17 subjects varied only Leads, 3) Relationship Between Right above shoulder level as the right
among adjacent movement patterns. Pelvis and Shoulder Girdle Changes, shoulder girdle led the trunk to side
Two orderings of the patterns had only and 4) Shoulder Girdle Leads. lying. This form of UE and HT action
two individuals who did not meet this was combined with either a
criterion: 1) Aligned Pelvis and Lower extremity sequence. Unilateral-Lift, Bilateral-Lift, or
Shoulder Girdle, Pelvis Leads, Thirty-one subjects varied among the Unilateral-Push pattern in the LEs.
Relationship Between Pelvis and LE movement pattern used during their Figures 2 through 4 illustrate these
Shoulder Girdle Changes, and 10 trials. The remaining 5 subjects did three common forms of rolling. The
Shoulder Girdle Leads and 2) Shoulder not vary in LE action across their 10 fourth common pattern (Fig. 5) differed
Girdle Leads, Relationship Between trials. As with the other two body from the other three patterns in HT
Pelvis and Shoulder Girdle Changes, regions, no permutation was found in action, because the relationship
Pelvis Leads, and Aligned Pelvis and which all subjects varied between between the shoulder girdle and pelvis
Shoulder Girdle. We again consulted adjacent LE movement patterns. Two changed before the subjects reached
McGraw's research report 7 to ascertain permutations were found in which only side lying. In this latter combination, LE
whether either permutation one individual varied among non- action was characterized by a
corresponded to her findings. One of adjacent categories: 1) Bilateral Lift, Unilateral-Push pattern.
the possible developmental orders Unilateral Lift, Unilateral Push, and
paralleled McGraw's developmental Bilateral Push and 2) Bilateral Push, The frequency with which each
sequence. The Aligned-Pelvis- Unilateral Push, Unilateral Lift, and movement pattern category was
and-Shoulder-Girdle pattern was Bilateral Lift. In the line drawing of observed across the 360 trials is
similar to McGraw's description of the McGraw's earliest step in the reported in Table 2. The UE and HT
earliest rolling pattern to develop.7 development of rolling,7 the lower movement patterns observed most
Movement between upper and lower extremities appear to be flexing on the frequently were also elements of three
spinal segments did not appear to be trunk. During the second phase of of the common combinations of
characteristic of this early phase. Our development, the foot on the occiput movement patterns. The most common
HT categorical description, Pelvis Leads, side pushes and moves into an LE pattern was the Unilateral Push.
was similar to McGraw's description of extension pattern. Our Unilateral-Push
the second, or "spinal extension," movement pattern category describes a Discussion
phase; in both instances, spinal or similar extension pattern. We selected
trunk extension is a characteristic the ordering of patterns that was most Forming Developmental
feature. We hypothesized, therefore, consistent with McGraw'sfindingsand Sequences
that the developmental sequence for hypothesized that the developmental
HT movement patterns was 1) Aligned sequence of movement patterns for the The theoretical model used to form
sequences was based on stage theory

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

3 Stockmeyer SA: An interpretation of the 4 Knott M, Voss DE: Proprioceptive 5 Bobath B, Bobath K: Cerebral palsy. In
approach of Rood to the treatment of Neuromuscular Facilitation: Patterns and Pearson PH, Williams CE (eds): Physical Therapy
neuromuscular dysfunction. Am J Phys Med 46: Techniques, ed 2. Baltimore, MD, Williams & Services in the Developmental Disabilities.
900-961, 1967 Wilkins, 1968 Springfield, IL, Charles C Thomas, Publisher,
1972, pp 31-185

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