Author: easystandleader

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A systematic review of supported standing programs

date: 2010;3(3):197-213. doi: 10.3233/PRM-2010-0129.
author: Glickman LB1, Geigle PR, Paleg GS.
publication: J Pediatr Rehabil Med.
pubmed_ID:PMID:21791851

 

The routine clinical use of supported standing in hospitals, schools and homes currently exists. Questions arise as to the nature of the evidence used to justify this practice. This systematic review investigated the available evidence underlying supported standing use based on the Center for Evidence-Based Medicine (CEBM) Levels of Evidence framework.

DESIGN:

The database search included MEDLINE, CINAHL, GoogleScholar, HighWire Press, PEDro, Cochrane Library databases, and APTAs Hooked on Evidence from January 1980 to October 2009 for studies that included supported standing devices for individuals of all ages, with a neuromuscular diagnosis. We identified 112 unique studies from which 39 met the inclusion criteria, 29 with adult and 10 with pediatric participants. In each group of studies were user and therapist survey responses in addition to results of clinical interventions.

RESULTS:

The results are organized and reported by The International Classification of Function (ICF) framework in the following categories: b4: Functions of the cardiovascular, haematological, immunological, and respiratory systems; b5: Functions of the digestive, metabolic, and endocrine systems; b7: Neuromusculoskeletal and movement related functions; Combination of d4: Mobility, d8: Major life areas and Other activity and participation. The peer review journal studies mainly explored using supported standers for improving bone mineral density (BMD), cardiopulmonary function, muscle strength/function, and range of motion (ROM). The data were moderately strong for the use of supported standing for BMD increase, showed some support for decreasing hypertonicity (including spasticity) and improving ROM, and were inconclusive for other benefits of using supported standers for children and adults with neuromuscular disorders. The addition of whole body vibration (WBV) to supported standing activities appeared a promising trend but empirical data were inconclusive. The survey data from physical therapists (PTs) and participant users attributed numerous improved outcomes to supported standing: ROM, bowel/bladder, psychological, hypertonicity and pressure relief/bedsores. BMD was not a reported benefit according to the user group.

CONCLUSION:

There exists a need for empirical mechanistic evidence to guide clinical supported standing programs across practice settings and with various-aged participants, particularly when considering a life-span approach to practice.

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Thirty-Degree Prone Positioning Board for Children with Gastroesophageal Reflux: Suggestion from the Field

date: 1984 Aug;64(8):1240-1.
author:Bubenko S, Flesch P, Kollar C.
publication: Phys Ther
pubmed_ID:6463113

 

 

This excerpt was created in the absence of an abstract.

Gastroesophageal reflux (GER) or chalasia in infants can be defined simply as the regurgitation of gastric contents from the abdominal stomach into the thoracic esophagus.1 Chief among its clinical manifestations is recurrent emesis during and after feedings.1,2 This symptom is present in up to 95 percent of reported cases.2 In addition, any or all of the following disorders may be present: anemia, failure to thrive, nocturnal wheeze or cough, recurrent pneumonia because of aspiration, recurrent bronchitis, near-miss sudden infant death syndrome, and abnormal head positioning (Sandifer syndrome).1,2

An important aspect of the treatment regimen for these patients is positioning during and after feeding. Numerous reports in the literature suggest an upright posture in an infant seat at 45 to 60 degrees after feeding will decrease the incidence of GER.3 Other references suggest a prone posture at 30 degrees after feeding will also decrease the incidence of GER in infants.2,4,5

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Functional status of adults with cerebral palsy and implications for treatment of children

date:  2001 Aug;43(8):516-28.
author: Bottos M1, Feliciangeli A, Sciuto L, Gericke C, Vianello A.
publication: Dev Med Child Neurol.
pubmed_ID:11508917

Abstract

This study examined the evolution of individuals with cerebral palsy (CP) from childhood to adulthood. Seventy-two adults with a diagnosis of CP born between 1934 and 1980 were studied. Individuals were recruited and data comprehensively collected using case notes and through direct assessments of the majority of participants from three rehabilitation units in Bologna, Padua, and Rovigo in Italy. The main findings can be summarized as follows: contact with health and rehabilitation services was radically reduced once individuals reached adulthood; more individuals who were integrated into mainstream schools achieved and maintained literacy than those who had attended special schools; in a high number of participants, motor performance deteriorated once into adulthood. Independent walking or other forms of supported locomotion were lost in many on reaching adulthood. Of those who continued to walk, walking deteriorated in terms of distance. It was concluded that even though CP has been considered as predominantly a childhood pathological condition, the evolution of the effects of CP do not stop at 16 or 18 years of age. For this reason, the traditional child- (or infant-) oriented approach concentrating mainly or exclusively on the achievement of independent walking, may not be an ideal approach to children with CP. Instead a more independence-oriented therapeutic approach would be appropriate.

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Nonoperative treatment of osteogenesis imperfecta: orthotic and mobility management.

date: 1981 Sep;(159):111-22
author: Bleck E E
publication: Clinical Orthopedic Relat Re
pubmed ID: 7285447

Abstract

The problem of osteoporosis superimposed on the basic collagen defect of osteogenesis imperfecta has been approached by the use of plastic containment orthoses for the lower limbs, in addition to developmentally staged mobility devices that assist early standing and walking. The purpose of forcing early weight-bearing is to provide stress to the lower limb bones in order to minimize osteoporosis, prevent refracture and deformity, and curb subsequent immobilization osteoporosis, thus breaking a vicious cycle. Management goals are based upon adult needs for independence: efficiency in daily living activities and in mobility. These goals were reached in most of our patients via use of plastic orthoses, early weight-bearing, and electrically powered wheelchairs. Manual osteoclasis of the tibia followed by plastic orthoses utilizing principles of fluid compression to support fractured or structurally weak bones appeared successful at the time of follow-up. Intramedullary rodding of the femur was necessary in most of the 12 children with osteogenesis imperfecta congenita. Supplementary plastic orthoses have reduced the refracture rate in both the tibia and the femur. Social integration of the children was reflected by the fact that among the 12 OI congenita cases, ten were attending regular educational institutions. Twelve OI tarda children fared well, all attaining complete independence in daily living, mobility and ambulation. Seven of this group were treated with intramedullary rodding of the femur or tibia and with plastic orthoses. Five patients required no treatment.

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EFFECT OF EXERCISE, STANDING, NEGATIVE TRUNK AND POSITIVE SKELETAL PRESSURE ON BED REST-INDUCED ORTHOSTATIS AND HYPERCALCIURIA.

date: JAN 1966

author: Birkhead,N. C. ; Blizzard,J. J. ; Issekutz,B. ,Jr. ; rodahl,K.

publication:
pubmed_ID:
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Abstract : Tilt intolerance and hypercalciuria were induced in healthy subjects fed weighed diets by 18-32 days continuous bed rest in a Metabolic Ward. The effect of supplementing bed rest with daily supine bicycle exercise (2 or 4 hours), quiet standing (3 hours), or longitudinal supine skeletal pressure on orthostasis and urinary calcium was determined. Tilt tolerance was evaluated by blood pressure and heart rate response to 10 minutes of 70? head-up body tilt and urinary calcium excretion by analysis of 3- or 6-day urine collections. Supine bicycle exercise was ineffective in significantly reducing tilt intolerance or hypercalciuria. Standing decreased orthostasis in 3 of 5 subjects and decreased urinary calcium in 4 of 5 subjects. Longitudinal skeletal pressure decreased hypercalciuria in 1 of 2 subjects but did not improve tilt tolerance. Intermittent lower body negative pressure during bed rest in one subject impeded development of orthostasis but increased urine calcium. Three hours daily standing is the minimum effective duration for reversing bed rest-induced tilt intolerance and hypercalciuria while supine bicycle exercise is not a practical method for obtaining similar effects. (Author)

Descriptors :   (*CALCIUM, EXCRETION), (*RELAXATION(PHYSIOLOGY), METABOLISM), EXERCISE(PHYSIOLOGY), SKELETON, BONES, PRESSURE, URINE, TOLERANCES(PHYSIOLOGY), BLOOD, PULSE RATE, POSTURE(PHYSIOLOGY), TABLES(DATA)

Subject Categories : ANATOMY AND PHYSIOLOGY

Distribution Statement : APPROVED FOR PUBLIC RELEASE

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Physical rehabilitation as an agent for recovery after spinal cord injury.

date: 2007 May;18(2):183-202
author: Behrman AL1, Harkema SJ
publication: Phys Med Rehabil Clin N Am

 

PubMed ID:  17543768

Abstract

The initial level of injury and severity of volitional motor and clinically detectable sensory impairment has been considered the most reliable for predicting neurologic recovery of function after spinal cord injury (SCI). This consensus implies a limited expectation for physical rehabilitation interventions as important in the facilitation of recovery of function. The development of pharmacologic and surgical interventions has always been pursued with the intent of altering the expected trajectory of recovery after SCI, but only recently physical rehabilitation strategies have been considered to improve recovery beyond the initial prognosis. This article reviews the recent literature reporting emerging activity-based therapies that target recovery of standing and walking based on activity-dependent neuroplasticity. A classification scheme for physical rehabilitation interventions is also discussed to aid clinical decision making.

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Preliminary results on the mobility after whole body vibration in immobilized children and adolescents

date: 01/01/2007
author: Semler, O., Fricke, O., Vezyroglou, K., Stark, C., Schoenau, E.
publication: J Musculoskelet Neuronal Interact 2007; 7(1):77-81
pubmed_ID:17396011 
The present article is a preliminary report on the effect of Whole Body Vibration (WBV) on the mobility in long-term immobilized children and adolescents. WBV was applied to 6 children and adolescents (diagnoses: osteogenesis imperfecta, N=4; cerebral palsy, N=1; dysraphic defect of the lumbar spine, N=1) over a time period of 6 months. WBV was applied by a vibrating platform constructed on a tilt-table. The treatment effect was measured by alternations of the tilt-angle of the table and with the “Brief assessment of motor function” (BAMF). All 6 individuals were characterized by an improved mobility, which was documented by an increased tilt-angle or an improved BAMF-score. The authors concluded WBV might be a promising approach to improve mobility in severely motor-impaired children and adolescents. Therefore, the Cologne Standing-and-Walking-Trainer powered by Galileo is a suitable therapeutic device to apply WBV in immobilized children and adolescents.

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Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta

date: 06/01/2008
author: Semler O, Fricke O, Vezyroglou K, Stark C, Stabrey A, Schoenau E.
publication: Clinical Rehabilitation, Vol. 22, No. 5, 387-394 (2008)
pubmed_ID: 18441035
Abstract
Objective: To evaluate the effect of whole body vibration on the mobility of long-term immobilized children and adolescents with a severe form of osteogenesis imperfecta. Osteogenesis imperfecta is a hereditary primary bone disorder with a prevalence from 1 in 10000 to 1 in 20000 births. Most of these children are suffering from long-term immobilization after recurrent fractures. Due to the immobilization they are affected by loss of muscle (sarcopenia) and secondary loss of bone mass.

Subjects: Whole body vibration was applied to eight children and adolescents (osteogenesis imperfecta type 3, N=5; osteogenesis imperfecta type 4, N=3) over a period of six months.

Interventions and results: Whole body vibration was applied by a vibrating platform (Galileo Systems) constructed on a tilting-table. Success of treatment was assessed by measuring alterations of the tilting-angle and evaluating the mobility (Brief Assessment of Motor Function). All individuals were characterized by improved muscle force documented by an increased tilting-angle (median = 35 degrees) or by an increase in ground reaction force (median at start=30.0 [N/kg] (14.48?134.21); median after six months = 146.0 [N/kg] (42.46?245.25).

Conclusions: Whole body vibration may be a promising approach to improve mobility in children and adolescents severely affected with osteogenesis imperfecta.

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Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

date: 03/01/2005
author: Zabel, R J.; McMillan, A G.; Salem, Y
publication: Pediatric Physical Therapy:Volume 17(1)Spring 2005p 93
pubmed_ID:
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PURPOSE/HYPOTHESIS: The purpose of this study was to determine the effects of prolonged standing on several gait variables in ambulatory children with spastic cerebral palsy.
NUMBER OF SUBJECTS: Six children with spastic derebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4 – 9.8).
MATERIALS/METHODS: A reverse baseline design (A-B-A) was used. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Three dimensional gait analysis was performed before and after each phase. The Modified Ashworth Scale was used to measure muscle tone. Anaylsis of variance (ANOVA) for repeated measures was used to test for changes in gait measures across four measurement sessions.
RESULTS: Stride length (P < 0.001), speed (P < 0.001), stride time (P < 0.001), stance phase time (P < 0.005), and muscle tone (P < 0.02) improved significantly following the intervention period. No significant differences were found in swing phase time, double support time, foot angle, knee flexion angle, knee moment or ankle power.
CONCLUSIONS: The results of this study suggest that children with spastic cerebral palsy could benefit from a prolonged standing program to improve their gait.
CLINICAL RELEVANCE: Prolonged standing may improve gait in children with cerebral palsy.