MOVEMENT PATTERN ANALYSIS OF THE FORWARD REACH

Newton RA, King L, Cromwell R. Department of Physical Therapy, Temple University, Philadelphia, PA and Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, [...]
PURPOSE: The purpose of the study was to describe the movement patterns older adults use when performing the forward reach test of balance. SUBJECTS: Sixty community dwelling older adults ranging in age from 60 to 94 years (mean=72.6 yrs, std=8.37 yrs) participated. METHODS: Subjects were videotaped using two cameras. One obtained a front view and the other a side view of each subject performing three trials of forward reaching with the right arm along the length of a yardstick. The yardstick was located on a telescoping tripod positioned at the height of the subject's right acromion process. Subjects were instructed: 'without moving your feet or taking a step, reach as far forward as you can, and try to keep your hand along the yardstick.' ANALYSES: Written descriptions of the movement in each of four body regions were developed and used to form movement pattern categories for each region. Movement pattern categories were developed for the Reach Arm (RA), the Non-Reach Arm (NRA), the Head/Trunk (HT) and the Lower Extremities (LEs). Intra-rater reliability was performed on each category and was greater than 93% agreement. After classifying the movements of all subjects across all trials, the most common combination of RA, NRM, HT and LE movement patterns were determined. RESULTS: Four patterns were described for the RA, 6 for the NRA, 4 for the HT and 5 for the LEs. Thirty-three different combinations of RA, NRA, HT, LE movement patterns were observed. The most common reach pattern observed in 20% of the trials involved reaching with protraction at ruler level; slight extension or oscillation of the shoulder between flexion and extension in the NRA; rotation of the upper trunk with the pelvis tipping forward and the head turned toward the reaching arm; and hip flexion with knee extension and plantar flexion. The second most common reach pattern observed in 16% of the trials differed only in the head-trunk region that demonstrated rotation of the upper trunk with minimal forward inclination of the pelvis. CONCLUSIONS: Older adults use a variety of movement patterns to perform the forward reach test. Therapists should not rely solely on the distance reached but also observe the movement patterns used to accomplish the reach task. The observations can help determine if the individual performs the reach using solely upper extremity protraction and trunk rotation or if the individual is moving the center of mass further forward through trunk and leg action, challenging their limits of stability.