Category: Research and Articles

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Effects of prolonged standing on gait in children with spastic cerebral palsy.

date: 2010 Feb;30(1):54-65
author: Salem Y1, Lovelace-Chandler V, Zabel RJ, McMillan AG.
publication: Phys Occup Ther Pediatr.
pubmed_ID: 20170432

 

 

Abstract

The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. 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. Gait analysis and clinical assessment of spasticity were performed before and after each phase. Analysis of variance (ANOVA) for repeated measurements was used to test for changes in gait measures across the four measurement sessions. Friedman’s was used to test for changes in muscle tone (Modified Ashworth Scale) across the four measurement sessions. Stride length (p <.001), gait speed (p <.001), stride time (p <.001), stance phase time (p <.001), double support time (p <.003), muscle tone (p <.02), and peak dorsiflexion angle during midstance (p <.004) improved significantly following the intervention phase. The results of this study demonstrate that the gait pattern of children with cerebral palsy classified as level II or III on the Gross Motor Functional Classification System (GMFCS) improved by a prolonged standing program. However, these improvements were not maintained at 3 weeks. Further research is necessary with larger sample sizes to replicate these findings and determine specific “dosing” for standing programs to create long-lasting functional effects on gait.

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Effect of weight-bearing in abduction and extension on hip stability in children with cerebral palsy.

date: 2011 Summer;23(2):150-7
author: Martinsson C1, Himmelmann K.
publication:Pediatr Phys Ther.
pubmed_ID: 21552077

 

Abstract

PURPOSE:

: To study the effect of 1 year of daily, straddled weight-bearing on hip migration percentage (MP) and muscle length in children with cerebral palsy who were nonambulatory.

METHODS:

: Participants stood upright in maximum tolerated hip abduction and hip and knee extension ½ to 1½ hours per day for 1 year. Controls, matched for age, motor ability, and surgery, were derived from a national cerebral palsy follow-up program.

RESULTS:

: Participants using straddled weight-bearing after surgery had the largest decrease in MP (n = 3, 20 controls; P = .026). Children using straddled weight-bearing at least 1 hour per day for prevention also improved (n = 8, 63 controls; P = .029). Hip and knee contractures were found only in controls.

CONCLUSION:

: Straddled weight-bearing, 1 hour per day, may reduce the MP after adductor-iliopsoas-tenotomies or prevent an MP increase and preserve muscle length in children with cerebral palsy who did not need surgery. Larger studies are needed to confirm the results.

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The use of standing frames for contracture management for nonmobile children with cerebral palsy.

date: 2009 Dec;32(4):316-23
author: Gibson SK1, Sprod JA, Maher CA.
publication: Int J Rehabil Res.
pubmed_ID:19901618

 

Abstract

The objective of this study was to determine whether static weight-bearing in a standing frame affected hamstring length and ease of activities of daily living (ADLs) in nonambulant children with cerebral palsy (CP). A convenient sample of nonambulant children with CP was recruited for this one-group quasi-experimental study. Participants stood in a standing frame for 1 h, 5 days per week, for 6 weeks, followed by 6 weeks of not using a standing frame; each phase was repeated. Popliteal angle measurements were made at baseline and weekly throughout the study period. Carers provided written feedback regarding ease of ADLs at the end of each standing and nonstanding phase. Five children were recruited (age range 6-9 years, mean age 7 years 2 months, SD 1 year 4 months). High compliance with the standing regime was achieved (85% of intended sessions completed). Repeated-measures analysis of variance and t-tests showed hamstrings significantly lengthened during standing phases (mean improvement 18.1 degrees , SD 5.5, P<0.01 for first standing phase; mean improvement 12.1 degrees , SD 7.7, P=0.03 for second standing phase). A trend for hamstrings to shorten during nonstanding phases was observed (mean change -14.0 degrees , SD 4.2, P=0.02 for first nonstanding phase; mean change -7.3 degrees , SD 6.5, P=0.20 for second nonstanding phase). Feedback from carers suggested that transfers and ADLs became slightly easier after phases of standing frame use. Preliminary evidence that 6 weeks of standing frame use leads to significant improvements in hamstring length in nonambulant children with CP, and may increase ease of performance of ADLs was found.

 

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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

pubmed_ID:19263553

 

Abstract

PURPOSE:

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

METHOD:

Intervention study.

PARTICIPANTS:

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

INTERVENTION:

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

MEASUREMENTS:

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

RESULTS:

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.

CONCLUSION:

A pilot program of physical activity using a Standing–Support 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.

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Cardiovascular and haemodynamic responses to tilting and to standing in tetraplegic patients: a review

date:1984 Apr;22(2):99-109
author: Figoni SF.
publication: Paraplegia.
pubmed_ID:6379566

Abstract

This paper has reviewed the acute and long-term responses to changes in vertical posture in normal and tetraplegic subjects. It has discussed physiological mechanisms causing orthostatic hypotension in acute cervical spinal cord injured patients, and subsequent factors contributing to its amelioration over time. The long-term adaptive mechanisms are still controversial, probably involving multiple neurological, endocrine, renal, cardiovascular and haemodynamic factors. These factors include inhibition of vagal tone, plasma catecholamine levels, sensitivity of vascular beds to catecholamines, stretch reflexes in blood vessels, spinal BP reflexes, renin-angiotensin system, aldosterone and plasma volume changes. Individual differences may also interact with these various mechanisms, further complicating the issues. Although the fact that most tetraplegics do improve their orthostatic tolerance over time with repeated tilting is manifest, the precise mechanisms allowing this improvement are not. Research is needed to clarify these adaptive mechanisms, as well as to investigate the physiological effects of long-term therapeutic standing in devices such as standing frames.

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Physiologic responses to electrically assisted and frame-supported standing in persons with paraplegia

date: 2003 Winter;26(4):384-9.
author: Jacobs PL1, Johnson B, Mahoney ET.
publication: J Spinal Cord Med.
pubmed_ID:14992341

assisted

Abstract

BACKGROUND:

Systems of functional electrical stimulation (FES) have been demonstrated to enable some persons with paraplegia to stand and ambulate limited distances. However, the energy costs and acute physiologic responses associated with FES standing activities have not been well investigated.

OBJECTIVE:

To compare the physiologic responses of persons with paraplegia to active FES-assisted standing (AS) and frame-supported passive standing (PS).

METHODS:

Fifteen persons with paraplegia (T6-T11) previously habituated to FES ambulation, completed physiologic testing of PS and AS. The AS assessments were performed using a commercial FES system (Parastep-1; Altimed, Fresno, Calif); the PS tests used a commercial standing frame (Easy Stand 5000; Altimed, Fresno, Calif). Participants also performed a peak arm-cranking exercise (ACE) test using a progressive graded protocol in 3-minute stages and 10-watt power output increments to exhaustion. During all assessments, metabolic activity and heart rate (HR) were measured via open-circuit spirometry and 12-lead electrocardiography, respectively. Absolute physiologic responses to PS and AS were averaged over 1-minute periods at 5-minute intervals (5, 10, 15, 20, 25, and 30 minutes) and adjusted relative to peak values displayed during ACE to determine percentage of peak (%pk) values. Absolute and relative responses were compared between test conditions (AS and PS) and across time using two-way analysis of variance.

RESULTS:

The AS produced significantly greater values of VO2 (43%pk) than did PS (20%pk). The mean HR responses to PS (100-102 beats per minute [bpm] throughout) were significantly lower than during AS, which ranged from 108 bpm at 5 minutes to 132 bpm at test termination.

CONCLUSION:

Standing with FES requires significantly more energy than does AS and may provide a cardiorespiratory stress sufficient to meet minimal requirements for exercise conditioning.

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Comparison of orthostatic reactions of patients still unconscious within the first three months of brain injury on a tilt table with and without integrated stepping. A prospective, randomized crossover pilot trial

date: 2008 Dec;22(12):1034-41.
author: Luther MS1, Krewer C, Müller F, Koenig E.
publication:Clin Rehabil.
pubmed_ID:19052242

 

Abstract

OBJECTIVE:

To determine whether passive leg movement during tilt table mobilization reduces the incidence of orthostatic dysfunction in mobilization of patients being comatose or semi-comatose early after brain injury.

DESIGN:

Randomized crossover pilot trial using sequential testing.

SETTING:

Neurorehabilitation hospital.

SUBJECTS:

Nine patients still unconscious within the first three months of brain injury (5 men, 4 women; age 51 +/- 20 years).

INTERVENTION:

Patients were subjected once to a conventional tilt table and once to a tilt table with an integrated stepping device.

MAIN OUTCOME MEASURE:

The number of syncopes/presyncopes (orthostatic hypotension, tachypnoea, increased sweating) during interventions.

RESULTS:

One patient had presyncopes on both devices, six patients had presyncopes on the conventional tilt table but not on the tilt table with integrated stepping, and two patients did not exhibit presyncopal symptoms on either device. There were significantly more incidents on the tilt table without than on the one with an integrated stepping device (P < 0.05) at tilts of 50 or 70 degrees respectively.

CONCLUSION:

Patients tolerate greater degrees of head-up tilt better with simultaneous leg movement.

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The pieces fall into place": the views of three Swedish habilitation teams on conductive education and support of disabled children.

date: 2003 Mar;26(1):11-20.
author: Lind L.
publication: Int J Rehabil Res.
pubmed_ID: 12601263

 

Box 47 308, SE-100 74 Stockholm, Sweden.

Abstract

A survey concerning how Swedish habilitation staff view the support of disabled children and their families was conducted in 2001. It focused on what support the staff knew about, offered and considered good for the children and parents, and on how they viewed conductive education. Interviews were conducted with 25 team members in three habilitation teams in the south of Sweden. The results show that the support habilitation staff most feel children need is the opportunity to investigate their surroundings, play with other children, meet other children in the same situation and try out different activities. The support that parents are felt to need is mainly aid and housing adaptation, relief, financial help, information, medical knowledge, emotional support and to meet others in the same situation. The staff gave information pertaining to different methods of treatment only if the parents specifically asked for it. What the habilitation teams recommended were contracture prophylaxis, motor skills exercises, riding, swimming, splints, standing shells, surgery, injections and medicines. The habilitation staff were of the opinion that conductive education is focused purely on intensive mobility training.

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Whole-body vibration alters blood flow velocity and neuromuscular activity in Friedreich's ataxia.

date: 2011 Mar;31(2):139-44.
author: Herrero AJ1, Martín J, Martín T, García-López D, Garatachea N, Jiménez B, Marín PJ.
publication: Clin Physiol Funct Imaging.
pubmed_ID:21078065

Abstract

The purpose of this study was to investigate the effects of whole–body vibration (WBV) on blood flow velocity and muscular activity after different vibration protocols in Friedreich’s ataxia (FA) patients. After two familiarization sessions ten patients received six 3 min WBV treatments depending on a combination of frequency (10, 20 or 30 Hz) and protocol (constant or fragmented). Femoral artery blood flow velocity, vastus lateralis (VL) and vastus medialis (VM) electromyography (EMG), and rate of perceived exertion were registered. Peak blood velocity was increased with respect to basal values after 1, 2 and 3 min of WBV (14·8%, 18·8% and 19·7%, respectively, P<0·001). Likewise, mean blood velocity was increased with respect to basal values after 1, 2 and 3 min of WBV (17·3%, 19·4% and 16·6%, respectively, P<0·001). EMG amplitude of VL and VM was increased (39% and 23%, respectively, P<0·05) and EMG frequencies decreased during the application of WBV. The results of this study suggest that higher frequencies (30 Hz) produce a greater increase in blood flow velocity and rate of perceived exertion. WBV is an effective method to increase blood flow and to activate muscle mass in patients with Friedreich’s ataxia, and could therefore be considered to be incorporated in rehabilitation programs of this collective.

 

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Factors affecting prescription and implementation of standing-frame programs by school-based physical therapists for children with impaired mobility

date: 2009 Fall;21(3):282-8. doi: 10.1097/PEP.0b013e3181b175cd
author: Taylor K.
publication: Pediatr Phys Ther.
pubmed_ID:19680071

 

Abstract

PURPOSE:

The purpose of this study was to investigate factors considered in the prescription and implementation of standing–frame programs by school–based physical therapists.

METHODS:

A 20-item survey was mailed to 500 members of the APTA Pediatric Section and School–Based Special Interest Group. Survey questions addressed standing–frame program prescription and perceived benefits.

RESULTS:

Response rate was 77.2%. A majority of respondents rated ambulatory status for the prescription of standing–frame programs and a child‘s specific needs in the selection of a specific standing frame as very important. Respondents identified multiple benefits with pressure relief rated very important most frequently. More than 50% of respondents indicated social and educational benefits are very important. A majority of respondents prescribed standing–frame programs for 30-45 minutes daily.

CONCLUSIONS:

Variation does exist, but the majority of school–based physical therapists agree on several key factors in the prescription and implementation of standing–frame programs.