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Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke.

date: 08/01/2002
author: Eng JJ, Chu KS.
publication: Arch Phys Med Rehabilitation. 2002 Aug;83(8):1138-44.
pubmed_ID: 12161837

OBJECTIVES: To determine the test-retest reliability over 2 separate days for weight-bearing ability during standing tasks in individuals with chronic stroke and to compare the weight-bearing ability among 5 standing tasks for the paretic and nonparetic limbs. DESIGN: Prospective study using a convenient sample. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: Fifteen community-dwelling stroke individuals with moderate motor deficits; volunteer sample. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Weight-bearing ability as measured by the vertical ground reaction force during 5 standing tasks (rising from a chair, quiet standing, weight-shifting forward, backward, laterally). RESULTS: The weight-bearing ability was less for the paretic limb compared with the nonparetic limb, but the intraclass correlation coefficients were high (.95-.99) for both limbs between the 2 sessions for all 5 tasks. The forward weight-shifting ability was particularly low in magnitude on the paretic side compared with the other weight-shifting tasks. In addition, the forward weight-shift ability of the nonparetic limb was also impaired but to a lesser extent. Large asymmetry was evident when rising from a chair, with the paretic limb bearing a mean 296N and the nonparetic side bearing a mean 458N. The weight-bearing ability during all 5 tasks correlated with one another (r range,.56-.94). CONCLUSIONS: Weight-bearing ability can be reliably measured and may serve as a useful outcome measure in individuals with stroke. We suggest that impairments of the hemiparetic side during forward weight shifting and sit-to-stand tasks presents a challenge to the motor systems of individuals with stroke, which may account for the poor balance that is often observed in these individuals. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

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Effects of prolonged muscle stretch on reflex and voluntary muscle activations in children with spastic cerebral palsy.

date: 01/01/1990
author: Tremblay F, Malouin F, Richards CL, Dumas F.
publication: Scand J Rehabilitation Medicine. 1990;22(4):171-80.
pubmed_ID: 2263918

We studied the short term effects of a single session of prolonged muscle stretch (PMS) on reflex and voluntary muscle activations in 22 children with spastic cerebral palsy (CP) assigned to an experimental (n = 12) and a control group (n = 10). Children of the experimental group underwent PMS of the triceps surae (TS) by standing with the feet dorsiflexed on a tilt-table for 30 min, whereas children of the control group were kept at rest. The effects were determined by measuring the associated changes in torque and in electromyographic (EMG) activity of the TS and tibialis anterior (TA) muscles during both passive ankle movements and maximal static voluntary contractions. The results indicate that PMS led to reduced spasticity in ankle muscles as demonstrated by the significant reductions (p less than 0.05) of the neuromuscular responses (torque and EMG) to passive movement. These inhibitory effects lasted up to 35 min after cessation of PMS. In addition, the capacity to voluntarily activate the plantar flexors was significantly (p less than 0.05) increased post-PMS, but the capacity to activate the dorsiflexors was apparently not affected. These findings suggest that repeated sessions of PMS may have beneficial effects in the management of spasticity in children with CP.

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Use of prolonged standing for individuals with spinal cord injuries.

date: 08/01/2001
author: Eng JJ, Levins SM, Townson AF, Mah-Jones D, Bremner J, Huston G.
publication: Phys Ther. 2001 Aug;81(8):1392-9.
pubmed_ID: 11509069

BACKGROUND AND PURPOSE: Prolonged standing in people with spinal cord injuries (SCIs) has the potential to affect a number of health-related areas such as reflex activity, joint range of motion, or well-being. The purpose of this study was to document the patterns of use of prolonged standing and their perceived effects in subjects with SCIs. SUBJECTS: The subjects were 152 adults with SCIs (103 male, 49 female; mean age=34 years, SD=8, range=18-55) who returned mailed survey questionnaires. METHODS: A 17-item self-report survey questionnaire was sent to the 463 members of a provincial spinal cord support organization. RESULTS: Survey responses for 26 of the 152 respondents were eliminated from the analysis because they had minimal effects from their injuries and did not need prolonged standing as an extra activity. Of the 126 remaining respondents, 38 respondents (30%) reported that they engaged in prolonged standing for an average of 40 minutes per session, 3 to 4 times a week, as a method to improve or maintain their health. The perceived benefits included improvements in several health-related areas such as well-being, circulation, skin integrity, reflex activity, bowel and bladder function, digestion, sleep, pain, and fatigue. The most common reason that prevented the respondents from standing was the cost of equipment to enable standing. DISCUSSION AND CONCLUSION: Considering the many reported benefits of standing, this activity may be useful for people with SCI. This study identified a number of body systems and functions that may need to be investigated if clinical trials of prolonged standing in people with SCI are undertaken.

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The vertical wheeler: a device for ambulation in cerebral palsy.

date: 10/01/1985
author: Manley MT, Gurtowski J.
publication: Arch Phys Med Rehabilitation. 1985 Oct;66(10):717-20.
pubmed_ID: 4051716
The vertical wheeler is a new mobility aid that was specifically designed to help improve the quality of life for the handicapped child by providing mobility while standing. Results of a clinical trial in a population of patients with cerebral palsy are presented. Criteria were selected to allow evaluation of the rehabilitative effect of the device on the population. Results showed that the children in this cerebral palsy group all benefited from ambulation with the wheeler. Patients with spastic quadriparesis seemed to gain the most immediate benefit. The device contributed to improved mobility, posture, and self-image. The wheeler was safe and fun for the children. It has the potential for improving the psychologic and medical status of the child with severe locomotion impairment.

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Follow-up assessment of standing mobility device users.

date: 10/01/1998
author: Dunn RB, Walter JS, Lucero Y, Weaver F, Langbein E, Fehr L, Johnson P, Riedy L.
publication: Assistive Technology. 1998;10(2):84-93.
pubmed_ID: 10339284

The use of standing devices by spinal cord-injured subjects was investigated through a national survey of a sample of individuals who returned their manufacturer’s warranty card to two companies. We obtained a 32% response rate (99/310). The majority of respondents were male (87%) with a median age between 41 and 50 years. Seventy-seven percent were paraplegic and 21% were quadriplegic. Forty percent had between 1 and 5 years experience with their device, and 84% of those responding were currently using their standing device. Forty-one percent used their standing device one to six times a week; two-thirds stood between 30 minutes and 1 hour for each use. Less than 10% of subjects experienced any side effects, such as nausea or headaches, from standing. Twenty-one percent of subjects reported being able to empty their bladder more completely. There was also a favorable response by some individuals on the effects of the standing devices on bowel regularity, reduction of urinary tract infections, leg spasticity, and number of bedsores. Finally, 79% of subjects highly recommended use of standing devices to other people with spinal cord injury. The positive responses of individuals using standing devices is a strong recommendation for the assistive technology community to make these devices more available to individuals with spinal cord injury.

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Effects of a dynamic versus a static prone stander on bone material density and behavior in four children with severe cerebral palsy.

date: 03/01/2002
author: Gudjonsdottir, Bjorg MS/PT, Vicki Stemmons Mercer, PhD, PT
publication: Pediatric Physical Therapy 2002;14:38-46.
pubmed_ID: 17053680

PURPOSE: in this case series, we examined how two types of prone standers affected bone material density and behavioral variables in four children of preschool age with severe cerebral palsy. METHODS: In phase one, four children of preschool age participated in an eight-week standing program, standing for 30 minutes a day, five days a week. Two children stood in a conventional stander, and two stood in a new type of motorized (dynamic) stander that provides intermittent weight bearing. Measurements of bone material density before and after the program revealed increases in bone material density in both children who used a dynamic stander and one child who used a static stander. In phase two, all four subjects stood in both types of stander during three separate test sessions. RESULT: Measures of behavioral variables, including behavioral state, reactivity, goal directedness, and attention span, indicated little or no effect of type of stander on behavior. CONCLUSIONS: These results suggest there is potential value in additional research concerning the effects of static and dynamic standers on bone material density and behavior in children with cerebral palsy.

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Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee.

date: 01/01/2000
author: Trudel G, Uhthoff HK.
publication: Arch Phys Med Rehabilitation. 2000 Jan;81(1):6-13.
pubmed_ID: 10638868

OBJECTIVES: To measure articular structures’ contribution to the limitation of range of motion after joint immobility. STUDY DESIGN: Experimental, controlled study involving 40 adult rats that had one knee joint immobilized in flexion for durations of 2, 4, 8, 16, and 32 weeks; 20 rats underwent a sham procedure. The angular displacement was measured both in flexion and extension at three different torques. Myotomy of transarticular muscles allowed isolation of the arthrogenic component of the contracture. RESULTS: A contracture developed in all immobilized knees. The articular structures were incrementally responsible for the limitation in range of motion (from 12.6 degrees +/-6.7 degrees at 2 weeks to 51.4 degrees +/-5.4 degrees at 32 weeks). The myogenic restriction proportionately decreased over time (from 20.1 degrees +/-8.4 degrees at 2 weeks to only 0.8 degrees +/-7.2 degrees at 32 weeks). The increase in the arthrogenic component of contracture was predominant in extension. CONCLUSION: This study quantified the increasing role of arthrogenic changes in limiting the range of motion of joints after immobility, especially as the period of immobility extended past 2 weeks. These data provide a better understanding of joint contracture development and can be used to guide therapeutic approaches.

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Regulation of bone mass by mechanical strain magnitude.

date: 08/01/1985
author: Rubin CT, Lanyon LE.
publication: Calcif Tissue Int. 1985 Jul;37(4):411-7.
pubmed_ID: 3930039

The in vivo remodeling behavior within a bone protected from natural loading was modified over an 8-week period by daily application of 100 consecutive 1 Hz load cycles engendering strains within the bone tissue of physiological rate and magnitude. This load regime resulted in a graded dose:response relationship between the peak strain magnitude and change in the mass of bone tissue present. Peak longitudinal strains below 0.001 were associated with bone loss which was achieved by increased remodeling activity, endosteal resorption, and increased intra-cortical porosis. Peak strains above 0.001 were associated with little change in intra-cortical remodeling activity but substantial periosteal and endosteal new bone formation.

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Tilt table standing for reducing spasticity after spinal cord injury.

date: 10/01/1993
author: Bohannon RW
publication: Arch Physical Medicine Rehabilitation. 1993 Oct;74(10):1121-2.
pubmed_ID: 8215868

A patient with a T12 spinal cord injury and intractable extensor spasms of the lower extremities participated in tilt table standing trial on 5 nonconsecutive days to determine if the intervention would affect his spasticity and spasms. Each day’s standing trial was followed by an immediate reduction in lower extremity spasticity (measured using the modified Ashworth scale and pendulum testing). Standing was also accompanied by a reduction in spasms that lasted until the following morning. The reduction of spasms was particularly advantageous to the performance of car transfers. Tilt table standing merits further examination as a physical treatment of spasms that accompany central nervous system lesions.