Category: Research and Articles

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Quantifying weight-bearing by children with cerebral palsy while in passive standers.

date:  2007 Winter;19(4):283-7
author: Herman D.
publication:Pediatr Phys Ther.
pubmed_ID:18004195

Abstract

PURPOSE:

Children who are nonambulatory are placed into standers with the goal of providing benefits from weight-bearing. The purpose of this study was to quantify weight-bearing loads by children with cerebral palsy while in standers.

METHODS:

Electronic load-measuring footplates were fabricated specifically for this study. Weight-bearing loads were continuously measured in 19 children who were nonambulatory during routine 30-minute standing sessions (3-6 sessions/child, total 110 sessions).

RESULTS:

Weight-bearing ranged widely (23%-102%) with a mean of 68% of body weight. There was some variation over the course of a session and between different sessions, but more variance was noted between subjects.

CONCLUSIONS:

Actual weight borne in a stander is quite variable, and in some instances only a fraction of actual body weight. Further studies are required to delineate relevant factors and identify ways to maximize weight-bearing loads while in a stander.

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Trochanteric girdle to prevent hip dislocation in standing. Suggestion from the field

date: 1988 Feb;68(2):226-7.
author:Ruys EC1.
publication: Phys Ther
pubmed_ID:3340662

Excerpt

This article describes the use of a trochanteric girdle on a child with acetabular dysplasia to prevent hip displacement during weight-bearing. The patient was a boy 12 years of age with hypotonic athetosis and such severe acetabular dysplasia that his hips dislocated laterally with the slightest adduction beyond neutral. The patient’s hips subluxated proximally with weight-bearing or joint compression with only 20 degrees of abduction.

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Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy.

date: 2006 Sep;38(5):302-8.
author: Ahlborg L1, Andersson C, Julin P.
publication: J Rehabil Med.
pubmed_ID: 16931460

Abstract

OBJECTIVE:

The aim of this study was to evaluate the effect on spasticity, muscle strength and motor performance after 8 weeks of whole-body vibration training compared with resistance training in adults with cerebral palsy.

METHODS:

Fourteen persons with spastic diplegia (21-41 years) were randomized to intervention with either whole-body vibration training (n=7) or resistance training (n=7). Pre- and post-training measures of spasticity using the modified Ashworth scale, muscle strength using isokinetic dynamometry, walking ability using Six-Minute Walk Test, balance using Timed Up and Go test and gross motor performance using Gross Motor Function Measure were performed.

RESULTS:

Spasticity decreased in knee extensors in the whole-body vibration group. Muscle strength increased in the resistance training group at the velocity 30 degrees /s and in both groups at 90 degrees /s. Six-Minute Walk Test and Timed Up and Go test did not change significantly. Gross Motor Function Measure increased in the whole-body vibration group.

CONCLUSION:

These data suggest that an 8-week intervention of whole-body vibration training or resistance training can increase muscle strength, without negative effect on spasticity, in adults with cerebral palsy.

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Vibration therapy

date:2009 Oct;51 Suppl 4:166-8
author:Rauch F1.
publication: Dev Med Child Neurol.
pubmed_ID:19740225

Abstract

Whole-body vibration training is a method for muscle strengthening that is increasingly used in a variety of clinical situations. Key descriptors of vibration devices include the frequency, the amplitude, and the direction of the vibration movement. In a typical vibration session, the user stands on the device in a static position or performs dynamic movements. Most authors hypothesize that vibrations stimulate muscle spindles and alpha-motoneurons, which initiate a muscle contraction. An immediate effect of a non-exhausting vibration session is an increase in muscle power. Most studies of the longer term use of vibration treatment in various disorders have pursued three therapeutic aims: increasing muscle strength, improving balance, and increasing bone mass. In a small pilot trial in children we noted improvements in standing function, lumbar spine bone mineral density, tibial bone mass, and calf muscle cross-sectional area.

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Effect of a new physiotherapy concept on bone mineral density, muscle force and gross motor function in children with bilateral cerebral palsy.

date: 2010 Jun;10(2):151-8
author: Stark C.
publication: J Musculoskelet Neuronal Interact.
pubmed_ID: 20516632

Abstract

OBJECTIVE:

The purpose of this study was to determine the effect of a new physiotherapy concept on bone density, muscle force and motor function in bilateral spastic cerebral palsy children.

METHODS:

In a retrospective data analysis 78 children were analysed. The concept included whole body vibration, physiotherapy, resistance training and treadmill training. The concept is structured in two in-patient stays and two periods of three months home-based vibration training. Outcome measures were dual-energy x-ray absorption (DXA), Leonardo Tilt Table and a modified Gross Motor Function Measure before and after six months of training.

RESULTS:

Percent changes were highly significant for bone mineral density, -content, muscle mass and significant for angle of verticalisation, muscle force and modified Gross Motor Function Measure after six months training.

CONCLUSIONS:

The new physiotherapy concept had a significant effect on bone mineral density, muscle force and gross motor function in bilateral spastic cerebral palsy children. This implicates an amelioration in all International Classification of Functioning, Disability and Health levels. The study serves as a basis for future research on evidence based paediatric physiotherapy taking into account developmental implications.

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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

 

Abstract

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.

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Characteristics of children with hip displacement in cerebral palsy.

date: 2007 Oct 26;8:101
author: Hägglund G1, Lauge-Pedersen H, Wagner P.
publication:BMC Musculoskelet Disord.

pubmed_ID: 17963501

Abstract

BACKGROUND:

Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme.

METHODS:

In a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9-16 years of age.

RESULTS:

Of the 212 children, 38 (18%) developed displacement with Migration Percentage (MP) >40% and further 19 (9%) MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement. The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40%) was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V.

CONCLUSION:

Hip displacement in CP often occurs already at 2-3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted. We recommend a hip surveillance programme for children with CP with radiographic examinations based on the child‘s age and GMFCS level.

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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

 

Abstract

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.

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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

 

Abstract

PURPOSE:

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

METHODS:

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.

RESULTS:

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

CONCLUSIONS:

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.

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Effects of the standing program with hip abduction on hip acetabular development in children with spastic diplegia cerebral palsy.

date: 2016 Jun;38(11):1075-81
author: Macias-Merlo L1, Bagur-Calafat C2, Girabent-Farrés M3, A Stuberg W4.
publication:Disabil Rehabil.
pubmed_ID: 26517269

 

Abstract

PURPOSE:

Early identification and intervention with conservative measures is important to help manage hip dysplasia in children with a high adductor and iliopsoas tone and delay in weight bearing. The effect of a daily standing program with hip abduction on hip acetabular development in ambulatory children with cerebral palsy was studied.

METHOD:

The participants were 26 children with spastic diplegia cerebral palsy (CP), classified at Level III according to the Gross Motor Function Classification System (GMFCS). Thirteen children stood with hip abduction at least 1 h daily from 12 to 14 months of age to 5 years with an individually fabricated standing frame with hip abduction.

RESULTS:

At the age of 5 years, radiologic results of the study group were compared with a comparison group of 13 children with spastic diplegia CP who had not taken part in a standing program. The migration percentage in all children who stood with abduction remained within stable limits (13-23%) at 5 years of age, in comparison to children who did not stand in abduction (12-47%) (p < 0.01).

CONCLUSIONS:

The results indicate that a daily standing program with hip abduction in the first 5 years may enhance acetabular development in ambulatory children with spastic diplegia CP. Implications for Rehabilitation Abnormal acetabular development is a problem related to mobility problems and spasticity muscles around the hip. The literature suggests that postural management and standing programs could reduce levels of hip subluxation and increase function in children with cerebral palsy. A standing program with hip abduction can be a beneficial to develop more stable hips in children with spastic diplegic GMFCS level III.