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Sit-to-Stand Movement Pattern


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									                                   Sit-to-Stand Movement Pattern : A Kinematic Study
                                   Sharon Nuzik, Robert Lamb, Ann VanSant and Susanne
                                   PHYS THER. 1986; 66:1708-1713.

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Sit-to-Stand Movement Pattern
A Kinematic Study

                           A visual model of the sit-to-stand movement pattern was developed from the film
                           data of 38 women and 17 men as they assumed standing from a seated position.
                           We used the data from these film records to identify a representative initial
                           starting position and displacements of body segments for each of 20 equal
                           intervals throughout the movement cycle. Trajectories of data points on the head,
                           acromion, midiliac crest, hip, and knee also were plotted. These diagrams
                           demonstrate the time-space relationships of various body parts during the task.
                           This normalized model may be used by physical therapists as a standard to
                           which they can compare the movement pattern of a patient.
                           Key Words: Biomechanics, Movement, Physical therapy.

   Standing from a seated position is an activity most people                    condition. In a recent study, Wheeler et al used two groups
perform many times daily. Despite its frequency of occurrence                    of female subjects to study the influences of age and chair
and importance to functional activities, reports in the litera-                  design in rising from a chair.6 Electromyographic activity of
ture are few and do not permit clinicians to generalize their                    the vastus lateralis muscle and medial head of the triceps
findings easily to the observed movement characteristics of a                    surae muscle was recorded, as were goniometric measure-
patient. Based on observation and clinical experience, the                       ments of elbow and knee flexion and forward angle of incli-
physical therapist develops a concept of a normal movement                       nation of the trunk. In another recent report, Burdett et al
pattern, assesses the quality of the patient's movement, and                     compared joint moments and range of motion of the hip,
trains the patient according to the idealized model. Although                    knee, and ankle in 10 healthy male subjects and in 4 patients
such conceptualized models approach reality, therapists disa-                    with various diagnoses as they stood from two types of chairs.7
gree about their various components (eg, initial position or                        Because information from these reports was inadequate to
postural set, maximal joint excursion, and most efficient                        develop a clinically relevant visual model of the body rising
pattern of movement). Quantitative data derived from a large                     from a seated position, we undertook a descriptive study of
sample may provide a realistic model of the movement pat-                        this movement pattern. The model generated from this study
tern, a baseline from which further comparisons may be made.                     provides a foundation for the evaluation of patients perform-
The physical therapist then might be more certain about the                      ing this task, determination of treatment effectiveness, and
excursion of each joint, the sequence of action, and the                         implications for further research.
components of movement. A patient's movement pattern,
thus, may be compared to this norm, and treatment may be
aimed at normalizing movement with respect to this model.                        METHOD
   Jones and associates1-4 and Kelley et al5 have studied se-                    Subjects
lected aspects of the sit-to-stand movement pattern in healthy
adults. Jones and associates described the trajectory of the                        The protocol for this study was approved by the Committee
head in space and the effects of various postural sets on this                   on Human Research, and informed consent was obtained
trajectory. Kelley et al described the kinetic characteristics of                from the 55 healthy adults (38 women and 17 men) who
the lower extremities of six subjects under a controlled speed                   participated in the study. This group, representing a sample
                                                                                 of convenience, was composed of graduate and undergraduate
                                                                                 physical therapy students, faculty members, and clinicians at
   Ms. Nuzik is Supervisor, Neuroscience-Pediatrics Team, Physical Therapy       the Medical College of Virginia, Virginia Commonwealth
Department, Medical College of Virginia Hospitals, Virginia Commonwealth
University, Richmond, VA 23298 (USA). She was a graduate student at the
                                                                                 University. The ages of the subjects ranged from 20 to 48
Medical College of Virginia, Virginia Commonwealth University, when this         years ( = 26.4 ± 5.1 yr). We filmed these subjects in the
project was undertaken.                                                          sagittal plane as they stood from an armless wooden chair
  Dr. Lamb is Associate Professor and Director of Graduate Studies, Depart-
ment of Physical Therapy, School of Allied Health Professions, Medical College   with a seat height of 46 cm (18.1 in).
of Virginia, Virginia Commonwealth University.
  Dr. VanSant is Associate Professor, Department of Physical Therapy, School     Instrumentation
of Allied Health Professions, Medical College of Virginia, Virginia Common-
wealth University.
  Ms. Hirt is Professor Emeritus, Department of Physical Therapy, School of       A spring-wound 16-mm Bolex* camera equipped with a 26-
Allied Health Professions, Medical College of Virginia, Virginia Common-         mm Macro-Switar† lens was positioned 7.32 m (24.01ft)from
wealth University.
  This study was completed in partial fulfillment of Ms. Nuzik's master's
degree, Medical College of Virginia, Virginia Commonwealth University.
   This article was submitted March 7, 1985; was with the authors for revision    * Model H-16, Rex 5, Bolex International SA, Sante-Croix, Switzerland.
30 weeks; and was accepted March 19, 1986. Potential Conflict of Interest: 4.     † Kern and Co, Ltd, Aarau, Switzerland.

1708                                                                                                                           PHYSICAL THERAPY
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                                       Mean Angular Positions Computed at Five-Percent Intervals of the Sit-to-Stand Movement Pattern (in Degrees)

                                                         Movement             Anklea                Kneea                    Hipa                  Pelvisb               Trunkb               Neckb              Frankfortb
                                             Interval     Pattern                                                                                                                                                  Plane
                                                             (%)                        s                    s                        s                                                                               ie
                                                                                                                                                               s                    s                   s                     s

                                              Start            0         105.75        6.59    94.61        5.83    135.25          11.55     116.25         10.51   79.78         6.46   62.63        7.94   -2.10     11.94
                                                1              5         105.56        6.72    94.53        5.79    134.57          11.65     115.62         10.56   79.15         6.52   61.93        7.94   -2.61     11.78

Volume 66 / Number 11, November 1986
                                               2              10         105.23        6.79    94.56        5.81    133.24          11.62     114.28         10.48   77.66         6.55   60.81        8.06   -3.25     11.81
                                               3              15         104.75        6.75    94.57        5.84    130.87          11.53     111.79         10.31   74.83         6.62   59.14        8.28   -4.03     11.95
                                               4              20         104.10        6.63    94.68        5.89    126.94          11.40     107.53         10.14   70.39         6.80   57.09        8.65   -4.80     12.30
                                               5              25         103.26        6.51    95.06        5.94    121.54          11.18     101.33          9.92   64.77         7.21   55.19        9.33   -5.51     12.82
                                               6              30         102.21        6.42    96.02        5.96    115.70          10.80      93.80          9.46   58.62         7.82   53.93       10.37   -5.84     13.59
                                               7             35          101.03        6.35    97.89        5.99    111.60          10.28      86.75          8.59   53.20         8.77   53.40       11.54   -5.71     14.36
                                               8             40           99.93        6.26   101.08        6.20    110.88          10.28      81.65          7.95   49.52         9.90   53.47       12.47   -5.27     14.95
                                               9             45           99.31        6.13   105.90        6.61    113.73          10.64      78.88          7.52   48.22        11.00   54.18       12.88   -4.52     15.09
                                              10             50           99.44        5.98   112.47        7.26    119.39          11.21      77.89          7.33   49.40        11.75   55.64       12.68   -3.38     14.74
                                              11             55          100.28        5.83   120.32        7.75    126.81          11.46      78.11          7.16   52.66    11.90       57.76       11.98   -1.87     13.92
                                              12             60          101.68        5.79   129.07        8.35    135.35          11.41      79.13          6.90   57.55    11.53       60.36       10.99   -0.13     12.87
                                              13             65          103.44        5.78   138.21        8.94    144.33          10.97      80.62          6.53   63.44    10.60       62.98        9.86    1.49     11.79
                                              14             70          105.30        5.79   147.20        9.15    153.19          10.04      82.30          6.12   69.72         9.22   65.27        8.91    2.73     10.95
                                              15             75          107.19        5.63   155.75        9.01    161.49           9.25      83.95          5.84   75.90         7.61   66.94        8.28    3.36     10.39
                                              16             80          108.87        5.31   163.11        8.08    168.60           8.24      85.41          5.61   81.33         6.06   68.08        7.79    3.55       9.91
                                              17             85          110.21        4.94   169.06        6.86    174.32           7.54      86.59          5.45   85.65         4.95   68.88        7.45    3.59       9.56
                                              18             90         111.12         4.67   173.46        5.78    178.68           7.01     87.53           5.30   88.86         4.25   69.54        7.22    3.71       9.43
                                              19             95         111.59         4.51   176.22        5.17    181.56           6.77     88.17           5.18   91.00         3.88   70.09        7.15    3.78       9.31
                                              20            100         111.74         4.45   177.86        4.98    183.40           6.74     88.58           5.13   92.49         3.65   70.06        7.21    3.67       9.28

                                            Values define the angular measurements between body segments as delineated by data points.
                                            Angular measurements reflect the relationship of the body segment to the positive x axis.

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Fig. 1. Angles between body segments: the ankle (Angle 1), the       Fig. 2. Angles of inclination: the pelvis (Angle 4), the trunk (Angle
knee (Angle 2), and the hip (Angle 3).                               5), the neck (Angle 6), and the Frankfort plane (Angle 7).

the subject. An electronic digital timer visible in the photo-       defined by the lateral femoral epicondyle, the greater trochan-
graphic field provided accurate time measurement. The cam-           ter, and the midiliac crest. The greater trochanter was the
era was operated at a film speed of 32 Frames per second.            vertex of this angle. Figure 1 identifies these angles.
Additional details of the filming method are described in a             The angular values we recorded reflect the relationships
previous report.8                                                    among the body landmarks identified by the data points
Procedure                                                            (Table). These landmarks, however, are not always analogous
                                                                     to the clinical measurements. For example, because of the
   Data points were established over the following body land-        increased objectivity permitted by photographic measurement
marks: the fifth metatarsal head, lateral malleolus, lateral         and data reduction, the data points of the ankle angle were
femoral epicondyle, greater trochanter, midiliac crest, acro-        not analogous to the bony landmarks used by the clinician to
mion process, tragus, and the mid-Frankfort plane. (The              obtain goniometric measurements. Our ankle values, there-
Frankfort plane, the center of which approximates the head's         fore, reflect a greater degree of plantar flexion than would be
center of gravity, is located between the tragus and the lowest      recorded by clinical measurement.
point of the orbit.) These data points defined the angles of            In addition to these three lower extremity angles, we also
interest of our study (Figs. 1,2).                                   were interested in the movements of other body segments.
   The data points on the fifth metatarsal head, the lateral         These body segments, defined by a line connecting two data
malleolus, and the lateral femoral epicondyle were used to           points, were 1) the pelvis, between the greater trochanter and
measure the angle of the ankle joint (Angle 1). The lateral          the midiliac crest; 2) the trunk, between the midiliac crest and
malleolus was located at the vertex of this angle. The lateral       the acromion; 3) the neck, between the acromion and the
malleolus, the lateral femoral epicondyle, and the greater           mid-Frankfort plane; and 4) the Frankfort plane, between the
trochanter defined the knee angle (Angle 2), with the lateral        mid-Frankfort plane and the tragus. The relationship of each
femoral epicondyle at the vertex. The hip angle (Angle 3) was        body segment to the horizontal plane was computed, and

1710                                                                                                            PHYSICAL THERAPY

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these angles are referred to in this article as the angles of
inclination (Fig. 2).
   The trunk and neck angles of inclination also are relative
and should not be construed as the true reflection of trunk or
neck movement. First, the data point on the acromion is on
the appendicular skeleton. Second, no attempt was made to
assess specific spinal mobility.
   The subjects were asked to assume a seated position of
readiness. Verbal commands were standardized: "I want you
to get ready to stand up. Scoot as far forward in the chair and
bring your feet as far back as you need to stand up comfort-
ably. Rest your hands lightly on your thighs but do not push
with them when you stand up. Do not stand up until you
hear me say, 'Stand.'" No further attempts were made to
control the subjects' postural set. After three to five trial
movements, we filmed the subjects as they stood up from a
sitting position in their usual manner and at their usual speed.
Three consecutive trials for each subject were recorded on
   One trial from each subject was selected for analysis. The
criteria for trial selection, in order of their importance, were
 1) ability to view all data points on each frame, 2) subjective
appearance of the movement as smooth and natural, 3) feet
flat at the beginning of the movement, 4) feet symmetrical at
the beginning of the movement, and 5) a clearly defined
completion of motion. The frame preceding the first discern-
ible body movement was the first to be reduced. If the subject
exhibited postural sway, the end of motion was represented               Fig. 3. Left diagram depicts a representative movement pattern.
by that frame in which no further forward displacement of                Data points are joined by lines to form 21 stick figures (sampling
                                                                         rate), Enhanced line on the left indicates the initial position; the
the pelvis occurred. Data were reduced from each frame up                enhanced line on the right indicates the final position. Right diagram
to, and including, this last frame.                                      depicts trajectories of data points at the tragus, acromion, midiliac
                                                                         crest, hip, and knee.
Data Reduction
   An electronic graphics calculator‡ was used to place the              reflected angular deviations occurring in a clockwise direction
projected film image in a two-dimensional, Cartesian-coor-               from the positive x axis (ie, below the horizontal axis).
dinate system and to assign each data point x and y spatial
coordinates. The calculator was interfaced with a Texas In-              Data Analysis
struments Silent 700 ASR§ electronic data terminal, which
recorded x and y coordinates on digital magnetic tape cas-                 For intersubject comparison, the movement time of each
settes. Data from these tapes were transferred later to magnetic         subject was divided into 5% increments. This division, which
disks and made accessible to a Xerox Sigma 6" computer.                  included the initial starting position, provided for 21 points
   A FORTRAN IV computer program was written to reduce                   of comparison within the movement. For each 5% interval,
the data and allow for additional analyses. Computations                 the mean and standard deviation of each angle were calculated
were made to correct for equipment error and to compensate               across all subjects. The mean horizontal and vertical coordi-
for the distortion inherent in the data. Angles between body             nates of each data point were used to construct a model of
segments (Fig. 1) were calculated using the dot product                  the starting position and a schematic diagram of the entire
method.9 As noted earlier, because these values reflect the              movement cycle (Fig. 3, left diagram). Average x and y
relationships among body segments, they are not always anal-             coordinate values also were used to graph trajectories of body
ogous to clinical measurements. For example, in this study,              landmarks during the movement cycle (Fig. 3, right diagram).
both knee and hip extension approached 180 degrees, not 0
degrees.                                                                 RESULTS
   Numerical values for angles of inclination of the pelvis,               Movement time ranged from 1.3 to 2.5 seconds. The av-
trunk, neck, and Frankfort plane (Fig. 2) were computed with             erage movement time was 1.8 ± 0.3 seconds.
respect to the horizontal x axis. The positive x axis, the
reference line, was 0 degrees; the positive y axis was 90 degrees        Pattern of Movement
with respect to the horizontal axis. Positive angular values
reflected angular deviations occurring in a counterclockwise                Figure 3 (left diagram) illustrates the data from the Table
direction from the positive x axis. Negative angular values              in graphic form. The initial position of the representative
                                                                         movement pattern is indicated by the enhanced line on the
                                                                         left; the final position is indicated by the enhanced line on
 ‡ Numonics Corp, 418 Pierce St, Lansdale, PA 19446.
 § Texas Instruments, Inc, Houston, TX 77011.                            the right. When the model stick figure leaned forward, the
   Xerox Corp, El Segundo, CA 90265.                                     trunk inclined to an angle of 80 degrees counterclockwise

Volume 66 / Number 11, November 1986                                                                                                     1711
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from the horizontal axis or 10 degrees to the right of the             DISCUSSION
vertical axis. The neck segment was 63 degrees from the
horizontal axis or inclined forward 27 degrees from the ver-              The sit-to-stand movement pattern can be divided into two
tical axis. The angle of the Frankfort plane from the horizontal       phases. The first phase, theflexionphase, occurred during the
axis was negative, with the head tipped down 2 degrees. The            first 35% of the movement cycle. The second phase, the
pelvic segment was 116 degrees from the horizontal axis or             extension phase, then began at the head and knee. This change
rotated 26 degrees to the left of the vertical axis. The hip was       was evidenced by a reversal of head movement and a rapid
flexed to 135 degrees and the knee to 95 degrees. The relative         increase in knee extension. The reversal of movement spread
ankle measurement was 106 degrees (Table).                             from the head down the trunk to the pelvis. The reversal from
   During the first 35% of the movement cycle, the angle of            flexion to extension appeared to correspond to the lifting of
the Frankfort plane from the horizontal axis indicated the             the buttocks from the chair. Because the chair was not
head was tipping downward. The angle of inclination changed            equipped with either a force transducer or a contact switch,
from an initial —2 degrees to a minimum of —6 degrees, at              however, we were unable to document this relationship.
which time 30% of the movement cycle had been completed.                  The body segment initiating the sit-to-stand movement
Throughout the remainder of the movement cycle, the head               could not be identified in this study because of the distortion
rotated upward from - 6 to +4 degrees.                                 inherent in the kinematic data. This problem, however,
   The neck, trunk, and pelvis followed similar patterns, mov-         prompted our analysis of the initial 20% of the movement
ing first intoflexionand then into extension as the movement           cycle to determine those angles demonstrating the greatest
cycle progressed. The neck angle inclined downward for the             displacement during that part of the cycle. The angle of the
first 35% of the movement cycle and then moved back toward             Frankfort plane with respect to the horizontal axis (Angle 7)
the vertical axis. The trunk began to move toward the vertical         demonstrated the highest frequency of maximal displacement
axis after 45% of the movement cycle was completed. The                for 23 of the 55 subjects. When considering the hip and trunk
pelvis, initially in a position of posterior tilt with respect to      movements together, however, we noted that 25 subjects
the vertical axis, rotated anteriorly from this position through-      exhibited maximal displacement at those angles (Angles 3
out the first half of the movement cycle. This movement                and 5) during the first 20% of the movement cycle. These
reflected a change from 26 degrees behind the vertical axis to         data suggest that substantial individual differences exist during
 12 degrees forward of the vertical axis. During the latter half       the initial phase of the movement cycle. For those individuals
of the movement cycle, the pelvis reversed its direction,              who demonstrate the greatest angular displacement at the
ending in an upright position.                                         Frankfort plane, this displacement may occur because the
   The hip flexed during the first 40% of the sit-to-stand             head is leading the movement. Another possible explanation
movement cycle and extended during the last 60% of the
                                                                       is that the head displacement may be the result of movement
cycle. The knee extended throughout the pattern of motion.
                                                                       caudally to the head (ie, hip or trunk movement effecting
The ankle moved toward dorsiflexion in the first 45% of the
                                                                       displacement at the head).
movement cycle. The remainder of the motion was charac-
terized by movement toward plantarflexion.Across all angles,             When group data are used to describe and to develop a
variability increased from distal to proximal and from caudal         model of the sit-to-stand movement pattern, individual dif-
to cephalic. The variability was smallest for each angle at the       ferences are obscured. Our model, therefore, should not be
termination of the movement cycle.                                    construed as directly applicable to all persons. Examination
                                                                      of individual trajectories, nevertheless, allowed the grouping
Movement Trajectories                                                 of certain body parts. Although we did not analyze these
                                                                      groupings further in this study, they suggest not only individ-
   Trajectories of various anatomical landmarks were con-             ual variation but also common characteristics among individ-
structed to demonstrate the movement of these body parts in           uals. Future studies, thus, should be directed toward clarifying
space during the sit-to-stand task. Figure 3 (right diagram)          these similarities and differences by considering the effects of
plots the movements of the data points on the mid-Frankfort           sex, age, and anthropometric variables on movement among
plane, acromion, midiliac crest, greater trochanter, and lateral      various body segments and the trajectories of body parts in
femoral epicondyle. The trajectories of the data points on the        space.
mid-Frankfort plane and the acromion were similar, but the
excursion of the data point on the head was greater than that           Comparing data acquired in this study to those of earlier
of the acromion. The shapes of the trajectories of the midiliac       reports is limited primarily by differences in methodology.
crest and greater trochanter also were similar. Their ascents         This study solely considered kinematic variables or time-space
were more direct than those of the head or acromion, but still        relationships. No attempt was made to study the forces in-
curvilinear. The dip at the end of the movement of the                volved in the sit-to-stand movement, as did Kelley et al.5
midiliac crest occurred as the pelvis moved from a posterior             Jones and associates1-4 also examined the time-space char-
position to an anterior position with respect to the vertical         acteristics of the sit-to-stand movement, but important differ-
axis. During this same time period, the greater trochanter            ences exist between our approaches, goals, and presentation
moved forward rather than downward.                                   of data. Although Jones and associates considered various
   Horizontal displacement at the knee was much greater than          experimental conditions, they focused their attention on head
vertical displacement. The knee trajectory demonstrated for-          and neck movements. They reported descriptive data of other
ward and slightly downward displacement during earlier por-           body parts but did not document their findings with quanti-
tions of the movement pattern. This movement was followed             tative data. The groups of subjects they used generally were
by backward and minimal upward movement as the knee                   small and exclusively male, and they usually were instructed
extended.                                                             to perform the task as quickly as possible.

1712                                                                                                           PHYSICAL THERAPY
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   In Burdett et al's comparison of rising from two types of                   al found the hip angle to be the first to demonstrate displace-
chairs, mean maximal flexion values at the hip, knee, and                      ment.5 In our study, the hip angle demonstrated the greatest
ankle were reported.7 Their data points were similar to those                  angular displacement in the initial 20% of the movement
used in our study. They reported the mean maximal hip                          cycle for a total of 21 of the 55 subjects. In 23 subjects, the
flexion angle to be 116.8 degrees when using a standard chair                  angle of the Frankfort plane with respect to the horizontal
and not pushing up with the arms. The knee flexion value                       axis had the greatest initial displacement. As discussed previ-
was 91.5 degrees. Those values in our study are 110.9 and                      ously, whether this displacement is a reflection of hip move-
94.5 degrees, respectively. Because of differences between our                 ment remains to be demonstrated.
studies in data reduction, comparisons of ankle values are not
possible.                                                                      SUMMARY
   Wheeler et al studied 10 healthy young women and 10
healthy elderly women as they stood from two types of chairs.6                    The sit-to-stand movement, similarly to gait, is a funda-
Mean knee flexion when rising from a standard chair was                        mental movement pattern of concern to physical therapists.
reported to be 75.5 degrees for the younger group. The data                    This study represents an initial step toward defining this
points they used were similar to those used in our study and                   movement pattern in healthy individuals. With further re-
in the Burdett et al study. The height of the chair used in                    finement of this model, physical therapists may use such
Wheeler et al's study was only 1 cm higher than that of the                    normalized data to enhance their understanding of normal
chairs used by Burdett et al or us. Other differences among                    and pathological movement patterns and to set treatment
these studies, therefore, probably account for the disparities                 goals. Either by observing or by filming the patient's move-
in knee flexion values.                                                        ment, the therapist then may compare the patient's movement
   Mean trunk forward lean was reported by Wheeler et al as                    sequence, postural set, movement time, and joint and body-
75 degrees and was defined by the data points over the                         segment excursions with this model.
acromion, greater trochanter, and knee.9 To determine for-
ward lean in our study, we used the trunk segment as defined                     Acknowledgment. Grateful appreciation is expressed to Anil
by the acromion and midiliac crest and computed this seg-                      Chatterji, Assistant Director, Academic Computing, East
ment's angle of inclination with respect to the horizontal axis                Campus, Medical College of Virginia, Virginia Common-
of the body; hence, these findings cannot be compared.                         wealth University, whose assistance in data reduction and
   Although movement of the head was not studied, Kelley et                    computer programming was invaluable.

 1. Jones FP, Gray FE, Hanson JA, et al: An experimental study of the effect    6. Wheeler J, Woodward C, Ucovich RL, et al: Rising from a chair: Influence
    of head balance on patterns of posture and movement in man. J Psychol          of age and chair design. Phys Ther 65:22-66, 1985
    47:247-258, 1959                                                            7. Burdett RG, Habasevich R, Pisciotta J, et al: Biomechanical comparison
 2. Jones FP: The influence of postural set on pattern of movement in man.         of rising from two types of chairs. Phys Ther 65:1177-1183, 1985
    Int J Neurol 4:60-71, 1963
 3. Jones FP, Hanson JA: Postural set and overt movement: A force platform      8. Lamb RL, Gross LD, Meydrech EF: Electrical and mechanical correlates
    analysis. Percept Mot Skills 30:699-702, 1970                                  of motor skill development: Triceps and anconeus as antagonists. In:
 4. Jones FP, Hanson JA, Miller JF, et al: Quantitative analysis of abnormal       Proceedings of the Seventh International Congress of the World Confed-
    movement: The sit-to-stand pattern. Am J Phys Med 42:208-218, 1963             eration for Physical Therapy. Montreal, Quebec, Canada, June 1974, pp
 5. Kelley DL, Dainis A, Wood GK: Mechanics and muscular dynamics of rising        124-131
    from a seated position. In Komi PV (ed): Biomechanics V-B. Baltimore,       9. Thomas GB Jr: Calculus and Analytic Geometry. Reading, MA, Addison-
    MD, University Park Press, 1976, pp 127-133                                    Wesley Publishing Co Inc, 1968, p 395

Volume 66 / Number 11, November 1986                                                                                                                1713
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                                  Sit-to-Stand Movement Pattern : A Kinematic Study
                                  Sharon Nuzik, Robert Lamb, Ann VanSant and Susanne
                                  PHYS THER. 1986; 66:1708-1713.

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