Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries?

date: 2005;51(4):251-6.
author: Ben M.
publication: Aust J Physiother.
PubMed ID:16321132



The purpose of this study was to determine the effects of a 12-week standing program on ankle mobility and femur bone mineral density in patients with lower limb paralysis following recent spinal cord injury. An assessor-blinded within-subject randomised controlled trial was undertaken. Twenty patients with lower limb paralysis following a recent spinal cord injury were recruited. Subjects stood weight-bearing through one leg on a tilt-table for 30 minutes, three times each week for 12 weeks. By standing on one leg a large dorsiflexion stretch was applied to the ankle and an axial load was applied to the bones of the weight-bearing leg. Ankle mobility and femur bone mineral density of both legs were measured at the beginning and end of the study. Ankle mobility (range of motion) was measured with the application of a 17 Nm dorsiflexion torque. Femur bone mineral density was measured using dual energy X-ray absorptiometry (DEXA). The effect of standing was estimated from the difference between legs in mean change of ankle mobility and femur bone mineral density. The results indicated a mean treatment effect on ankle mobility of 4 degrees (95% CI 2 to 6 degrees) and on femur bone mineral density of 0.005 g/cm(2) (95% CI -0.015 to 0.025 g/cm(2)). Tilt-table standing for 30 minutes, three times per week for 12 weeks has a small effect on ankle mobility, and little or no effect on femur bone mineral density. It is unclear whether clinicians and patients would consider such effects to be clinically worthwhile.

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.

Passive ankle dorsiflexion increases in patients after a regimen of tilt table-wedge board standing. A clinical report.

date: 1985 Nov;65(11):1676-8.
author: Bohannon RW, Larkin PA.
publication: Phys. Ther.

 pubmed_ID: 4059330



We monitored the result of a tilt table-wedge board routine on the passive ankle dorsiflexion of 20 patients consecutively to determine the effectiveness of the treatment. The calculated frequency of the treatment, which was applied for 30 minutes on each of 5 to 22 treatment days, ranged from 2.3 to 6.4 treatments a week. All patients demonstrated increased passive ankle dorsiflexion. The increases ranged from 3 to 17 degrees and occurred at a calculated rate of 0.11 to 1.0 degrees a day. We believe the treatment is an effective clinical method for increasing passive ankle dorsiflexion in neurologically involved patients.

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.

Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy

date:2015 Fall;27(3):243-9.
author:Macias-Merlo L1, Bagur-Calafat C, Girabent-Farrés M, Stuberg WA.

publication: Pediatr Phys Ther.
pubmed_ID: 26020594




To investigate the effects of a standing program on the range of motion (ROM) of hip abduction in children with spastic diplegic cerebral palsy.


The participants were 13 children, Gross Motor Functional Classification System level III, who received physical therapy and a daily standing program using a custom-fabricated stander from 12 to 14 months of age to the age of 5 years. Hip abduction ROM was goniometrically assessed at baseline and at 5 years.


Baseline hip abduction was 42° at baseline and 43° at 5 years.


This small difference was not clinically significant, but did demonstrate that it was possible to maintain hip abduction ROM in the spastic adductor muscles of children with cerebral palsy with a daily standing program during the children‘s first 5 years of development.

Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home.

date:2007 Jan;2(1):43-9.
author: Netz Y1, Argov E, Burstin A, Brown R, Heyman SN, Dunsky A, Alexander NB.
publication: Disabil Rehabil Assit Technol





To demonstrate the feasibility of an innovative program of physical activity using a standingsupport device targeted towards adult residents of a nursing home who are unable to transfer or stand independently.


Intervention study.


Thirteen residents, age 82 +/- 11 years, at the Beit Bayer Nursing Home, Jerusalem, Israel, who were unable to transfer or stand independently.


Eight-week observational period followed by 12-week physical activity performed while standing in a StandingSupport Device.


Manual Muscle Testing, joint range of motion, forward and lateral reach, time to stand independently, distance walked with a walker, Functional Independence Measure.


Compared to the observational period, significant post-intervention improvements were noted particularly in lower extremity muscle strength. Improvements in the Functional Independence Measure were noted in sphincter control, locomotion, mobility, motor score, and total score. Over 60% of those previously requiring assistance in standing became able to stand for an average of 1 min unassisted and walk an average of 14 m with a walker.


A pilot program of physical activity using a StandingSupport Device is feasible in selected stance-disabled older adult nursing home residents. Participants showed evidence of muscle strength and functional improvement. Future studies of the device with a concurrent examination of healthcare costs, functional improvement, and staff burden, are recommended.

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.


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.


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.


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.


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.

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


Measurement of growth in children with developmental disabilities.

date: 09/01/1996
author: Stevenson RD.
publication: Dev Med Child Neurol. 1996 Sep;38(9):855-60.
pubmed_ID: 8810718

The clinical assessment of growth is a challenging, but essential, aspect of managing the health care of children with developmental disabilities. However, with standard equipment, modest training and some patience, almost all children can be measured reliably. Once reliable measurements are obtained, the interpretation or ‘clinical meaning’ of the measurements depends on their comparison with reference data from normal populations or, when available, with condition-specific reference data. More research is needed to improve our understanding of the clinical meaning of obtained measurements. The range of normal growth for some children with disabilities, particularly CP, remains to be defined. Research in the next ten years will, hopefully, lead to the development of growth charts for children with CP, and perhaps children with other conditions, which will facilitate the clinical interpretation of growth data and lead to improved management of health care for children with developmental disabilities.

Will whole-body vibration training help increase the range of motion of the hamstrings?

date: 02/20/2006
author: van den Tillaar R.
publication: J Strength Cond Res. 2006 Feb;20(1):192-6.
pubmed_ID: 16503680
Muscle strain is one of the most common injuries, resulting in a decreased range of motion (ROM) in this group of muscles. Systematic stretching over a period of time is needed to increase the ROM. The purpose of this study was to determine if whole-body vibration (WBV) training would have a positive effect on flexibility training (contract-release method) and thereby on the ROM of the hamstring musculature. In this study, 19 undergraduate students in physical education (12 women and 7 men, age 21.5 +/- 2.0 years) served as subjects and were randomly assigned to either a WBV group or a control group. Both groups stretched systematically 3 times per week for 4 weeks according to the contract-release method, which consists of a 5-second isometric contraction with each leg 3 times followed by 30 seconds of static stretching. Before each stretching exercise, the WBV group completed a WBV program consisting of standing in a squat position on the vibration platform with the knees bent 90 degrees on the Nemes Bosco system vibration platform (30 seconds at 28 Hz, 10-mm amplitude, 6 times per training session). The results show that both groups had a significant increase in hamstring flexibility. However, the WBV group showed a significantly larger increase (30%) in ROM than did the control group (14%). These results indicate that WBV training may have an extra positive effect on flexibility of the hamstrings when combined with the contract-release stretching method.