Orthostatic hypotension following spinal cord injury: impact on the use of standing apparatus

date: 2009;24(3):237-42
author: Chelvarajah R.
publication: NeuroRehabilation
PubMed ID19458431




Upright posture confers numerous medical and social benefits to a spinal cord injured (SCI) patient. Doing so is limited by symptoms of orthostatic hypotension. This is a common secondary impairment among tetraplegic sufferers.


Establish the proportion of SCI patients who are restricted from using standing apparatus, such as standing frames and standing wheelchairs, because of inducing symptomatic orthostatic hypotension or the fear of developing these disabling symptoms.


Survey conducted by Internet-accessible electronic questionnaire. Questionnaire validated for reliability and accuracy.


293 respondents. Mean age 44.6; 76% male. Median time from injury: 7 years. 38% suffered with orthostatic hypotension; majority were complete injuries and all (except one – T12) were T5 or above level. 52% replied that they were using standing wheelchairs or frames. Of these, 59 (20% of total) stated that orthostatic hypotension symptoms were limiting the use of their upright apparatus. Of those who did not use standing wheelchairs or frames, 16 (5.5% of total) reported that this was because of the fear of worsening their orthostatic hypotension.


Orthostatic hypotension restricts standing apparatus use in a large proportion (a total of 25.5% of respondents in this survey) of SCI patients.

Prevalence of joint contractures and muscle weakness in people with multiple sclerosis

date: 2014;36(19):1588-93
author: Hoang PD1, Gandevia SC, Herbert RD.
publication: Disabil Rehabil.
pubmed_ID: 24236496




To investigate the prevalence of joint contracture (limited passive range of joint motion) and muscle weakness in a population with multiple sclerosis (MS). A secondary aim was to establish normative data of functional tests of mobility and balance of people with MS who are still ambulant.


Cross-sectional study.


People with MS living in metropolitan Sydney, Australia.


330 people with MS living in metropolitan Sydney, Australia were randomly sampled on 23 July 2009 from the MS Australia register and invited to participate.


Passive range of motion of large joints of the limbs and muscle strength. Tests of walking and balance were also conducted.


156 people (109 females, 47 males; mean age 54.2 years; mean time since diagnosis 14.9 years) agreed to participate and were assessed. Fifty-six per cent (56%) of participants had contracture in at least one major joint of upper or lower limb. The most common site of contracture was the ankle (43.9%). Seventy per cent (70%) of participants had muscle weakness in one or more muscle groups. As muscle weakness, joint contractures were present at early stage of MS and the prevalence was associated with the progression of the disease.


These data show that in addition to muscle weakness joint contractures are highly prevalent among people with MS, especially in the ankle joint. This implicates that prevention of contracture is crucial in providing rehabilitation to people with MS.

The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke

date: 2008 Dec;39(12):3329-34
author: Sackley C1, Brittle N, Patel S, Ellins J, Scott M, Wright C, Dewey ME.
publication: Stroke




Complications after stroke have been shown to impede rehabilitation, lead to poor functional outcome, and increase cost of care. This inception cohort study sought to investigate the prevalence of immobility-related complications during the first year after severely disabling stroke in relation to functional independence and place of residence.


Over a 7-month period, 600 stroke survivors were identified in the hospital through the Nottingham Stroke Register. Those who had a Barthel Index score <or=10 3 months poststroke and did not have a primary diagnosis of dementia were eligible to participate in the study. Assessments of complications were carried out at 3, 6, and 12 months poststroke.


Complications were recorded for 122 stroke survivors (mean age, 76 years; 57% male). Sixty-three (52%) had significant language impairment and of the remaining 59 who were able to complete an assessment of cognitive function, 10 (8%) were cognitively impaired. The numbers of reported complications over 12 months, in rank order, were falls, 89 (73%); contracture, 73 (60%); pain, 67 (55%); shoulder pain, 64 (52%); depression, 61 (50%); and pressure sores, 26 (22%). A negative correlation was found between Barthel Index score and the number of complications experienced (low scores on the Barthel Index correlate with a high number of complications). The highest relative percentages of complications were experienced by patients who were living in a nursing home at the time of their last completed assessment.


Immobility-related complications are very common in the first year after a severely disabling stroke. Patients who are more functionally dependent in self-care are likely to experience a greater number of complications than those who are less dependent. Trials of techniques to limit and prevent complication are required.

Standing and mortality in a prospective cohort of Canadian adults.

date: 2014;46(5):940-6
author:Katzmarzyk PT1.
publication:Med Sci Sports Exerc.





Several studies have documented significant associations between sedentary behaviors such as sitting or television viewing and premature mortality. However, the associations between mortality and other low-energy-expenditure activities such as standing have not been explored. The purpose of this study was to examine the association between daily standing time and mortality among 16,586 Canadian adults 18-90 yr of age.


Information on self-reported time spent standing as well as several covariates including smoking, alcohol consumption, physical activity readiness, and moderate-to-vigorous physical activity was collected at baseline in the 1981 Canada Fitness Survey. Participants were followed for an average of 12.0 yr for the ascertainment of mortality status.


There were 1785 deaths (743 from cardiovascular disease [CVD], 530 from cancer, and 512 from other causes) in the cohort. After adjusting for age, sex, and additional covariates, time spent standing was negatively related to mortality rates from all causes, CVD, and other causes. Across successively higher categories of daily standing, the multivariable-adjusted hazard ratios were 1.00, 0.79, 0.79, 0.73, and 0.67 for all-cause mortality (P for trend <0.0001); 1.00, 0.82, 0.84, 0.68, and 0.75 for CVD mortality (P for trend 0.02); and 1.00, 0.76, 0.63, 0.67, and 0.65 for other mortality (P for trend <0.001). There was no association between standing and cancer mortality. There was a significant interaction between physical activity and standing (P < 0.05), and the association between standing and mortality was significant only among the physically inactive (<7.5 MET·h·wk).


The results suggest that standing may not be a hazardous form of behavior. Given that mortality rates declined at higher levels of standing, standing may be a healthier alternative to excessive periods of sitting.

Sitting time and all-cause mortality risk in 222 497 Australian adults

date: 2012 Mar 26;172(6):494-500.
author: van der Ploeg HP1, Chey T, Korda RJ, Banks E, Bauman A.
publication:Arch Intern Med.




Prolonged sitting is considered detrimental to health, but evidence regarding the independent relationship of total sitting time with all-cause mortality is limited. This study aimed to determine the independent relationship of sitting time with all-cause mortality.


We linked prospective questionnaire data from 222 497 individuals 45 years or older from the 45 and Up Study to mortality data from the New South Wales Registry of Births, Deaths, and Marriages (Australia) from February 1, 2006, through December 31, 2010. Cox proportional hazards models examined all-cause mortality in relation to sitting time, adjusting for potential confounders that included sex, age, education, urban/rural residence, physical activity, body mass index, smoking status, self-rated health, and disability.


During 621 695 person-years of follow-up (mean follow-up, 2.8 years), 5405 deaths were registered. All-cause mortality hazard ratios were 1.02 (95% CI, 0.95-1.09), 1.15 (1.06-1.25), and 1.40 (1.27-1.55) for 4 to less than 8, 8 to less than 11, and 11 or more h/d of sitting, respectively, compared with less than 4 h/d, adjusting for physical activity and other confounders. The population-attributable fraction for sitting was 6.9%. The association between sitting and all-cause mortality appeared consistent across the sexes, age groups, body mass index categories, and physical activity levels and across healthy participants compared with participants with preexisting cardiovascular disease or diabetes mellitus.


Prolonged sitting is a risk factor for all-cause mortality, independent of physical activity. Public health programs should focus on reducing sitting time in addition to increasing physical activity levels.

Standing time and all-cause mortality in a large cohort of Australian adults.

date: 2014 Dec;69:187-91.
author: van der Ploeg HP1, Chey T2, Ding D2, Chau JY2, Stamatakis E3, Bauman AE2
publication: Prev Med.




To determine the association between standing time and all-cause mortality.


Prospective questionnaire data from 221,240 individuals from the 45 and Up Study were linked to mortality data from the New South Wales Registry of Deaths (Australia) from February 1, 2006 to June 17, 2012. Hazard ratios for all-cause mortality according to standing time at baseline were estimated in 2013 using Cox regression modelling, adjusted for sex, age, education, urban/rural residence, physical activity, sitting time, body mass index, smoking status, self-rated health and disability.


During 937,411 person years (mean follow-up=4.2 yr) 8009 deaths occurred. All-cause mortality hazard ratios were 0.90 (95% CI 0.85-0.95), 0.85 (95% CI 0.80-0.95), and 0.76 (95% CI 0.69-0.95) for standing 2-≤5h/d, 5-≤8h/d, or >8h/d respectively, compared to standing two or less hours per day. Further analyses revealed no significant interactions between standing and sex (p=0.93), the presence/absence of cardiovascular disease or diabetes (p=0.22), BMI (p=0.78), physical activity (p=0.16) and sitting time (p=0.22).


This study showed a dose-response association between standing time and all-cause mortality in Australian adults aged 45 years and older. Increasing standing may hold promise for alleviating the health risks of prolonged sitting

Limb contractures in progressive neuromuscular disease and the role of stretching, orthotics, and surgery

date:1998 Feb;9(1):187-211
author: McDonald CM1.
publication: Phys Med Rehabil Clin N Am.
pubmed_ID: 9894140



Contractures are exceedingly common impairments in selected progressive NMD conditions, particularly those with excessive fibrosis and fatty infiltration into muscle (i.e., dystrophic myopathies) and more severe NMD conditions, resulting in significant weakness and wheel-chair reliance, such as SMA. Less than antigravity strength produces an inability to achieve full active range of motion. Static positioning of limbs (generally in flexion) and lack of weight bearing results in fixed contractures. This article has reviewed the prevalence and distribution of contractures in specific NMD conditions. Aggressive rehabilitation strategies, including stretching, positioning, splinting, upright weight bearing, and orthopaedic surgical management may help minimize the degree of disability in NMD patients with contractures.


date: JAN 1966

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



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)



Distribution Statement : APPROVED FOR PUBLIC RELEASE

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
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.

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
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.