The Cross March Test for midline awareness and body imagery was a test I developed about 20 years ago. I modeled it after the Fukuda Step Test. This test challenges someone’s ability relating to two midlines in the upright position.

It has proved to be a very useful screening test over the years (e.g., high sensitivity, but less than ideal specificity). I still use it clinically every now and then, but we have learned so much more during this time frame that there are more important and better things to focus on (this video was taken about 15 years). It would seem better for children since the newer research requires some higher level awareness.

Like the Fukuda Step Test, there are other reasons people can seem to be positive, however when it is severely positive, we can interpret it the way it was intended.

This chap is a nice example of the Cross March Test (screening before the test). The test was demonstrated to him and he was to replicate the movement (see correct movement below). He’s very confident and believes that he is replicating the correct movement. I do hope you can see that he is no actually performing the same movement!

This young chap came in quite disabled from an uncomplicated left sprained ankle (e.g., no signs of instability or neuropathic pain / sensory loss). He scored 118 on the Motor Control Abilities Questionnaire and struggled in school. He was not aware of an atypical birth history, but has signs of FASD. He drank upwards of 18 cups of coffee a day to deal with his fatigue. He had moderate anxiety and moderate kinesiophobia. He had no awareness of his ankle.

He was previously given some basic exercises (e.g., postural stability, non specific strengthening), but did not respond.

He did not respond to any form of education and could not remember anything. He did not like to read instructions.

Given these characteristics, he was not suitable for motor control or sensory motor based rehab.

After several sessions of primitive reflex inhibition and postural reflex facilitation, his postural stability improved and he started getting awareness of his ankle. His symptoms cleared and he returned to work. Doing the cross march exercise calmed his anxiety and helped his fatigue for a few hours. His kinesiophobia dropped considerably from doing the rehabilitation. It felt it made his mind “clearer”. His coffee dropped to 3/ day.

Midline awareness is critical for general coordination, motor imagery and growing evidence suggests aspects of cognitive function. Anxiety and gastrointestinal symptoms are provoked in about 25% of subjects. Midline awareness should be investigated in the possible causation of various behavioral conditions.

How many functional tasks require us to cross midline or coordinate midline? A lot is the answer. It is important to know how to screen for, and rehabilitate this.

Note: This is a pretty extreme example. Most midline awareness examples are not as bad as this. Patients like this DO NOT respond to simple strengthening, specific motor control and / or educational strategies. This is a mild neurological presentation and should be treated as one. Mild Neurological Factors should be considered a a possible cause of kinesiophobia and other behavioral conditions.

Figure 1: The correct midline pattern involves reaching the arm”across the midline” to touch the distal thigh with approximately 90 degrees hip flexion