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RESNA POSITION ON THE APPLICATION OF WHEELCHAIR STANDING DEVICES: 2013 CURRENT STATE OF THE LITERATURE

date: Dec. 23, 2013
author: Dicianno BE, Morgan A, Lieberman J, Rosen L
publication: Assit Technol.
pubmed_ID: 26910615

This article, approved by the Rehabilitation Engineering & Assistive Technology Society of North America Board of Directors on December 23, 2013, shares typical clinical applications and provides evidence from the literature supporting the use of wheelchair standers

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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.
pubmed_ID:PMID:25456805

Outside_URL:https://www.ncbi.nlm.nih.gov/pubmed/25456805

Abstract

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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

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Effects of a standing table on work productivity and posture in an adult with developmental disabilities.

date:1997;9(1):13-20.
author: Nelson DL1, Schau EM1.
publication: Work
pubmed_ID: 24441921

 

Abstract

The standing table is an assistive device designed to encourage occupational performance of the upper extremities while helping the person compensate for limitations in standing posture. We conducted three single-subject studies of a standing table used by a 52-year-old man with spastic cerebral palsy and mental retardation. In the first study, positioning in the standing table resulted in no discernible difference in work output per hour in comparison to his customary seated posture. In the second study, positioning in the standing table resulted in an unexpectedly small increase in work output in comparison to his customary method of standing without special support at the work bench. In the third study, we demonstrated that the standing table dramatically improved the erectness of his posture as measured by an infrared motion detector in comparison to his customary method of standing. Because work productivity depends on multiple factors, improved posture and biomechanical stability do no always result in a proportionate improvement in work output. There remain multiple justifications of equipment such as the standing table in work settings for adults with developmental disabilities

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Low magnitude mechanical loading is osteogenic in children with disabling conditions.

date:2004 Mar;19(3):360-9.
author: Ward K1, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z.
publication: J. Bone Miner Res

pubmed_ID: 15040823

 

Abstract

The osteogenic potential of short durations of low-level mechanical stimuli was examined in children with disabling conditions. The mean change in tibia vTBMD was +6.3% in the intervention group compared with -11.9% in the control group. This pilot randomized controlled trial provides preliminary evidence that low-level mechanical stimuli represent a noninvasive, non-pharmacological treatment of low BMD in children with disabling conditions.

INTRODUCTION:

Recent animal studies have demonstrated the anabolic potential of lowmagnitude, high-frequency mechanical stimuli to the trabecular bone of weight-bearing regions of the skeleton. The main aim of this prospective, double-blind, randomized placebo-controlled pilot trial (RCT) was to examine whether these signals could effectively increase tibial and spinal volumetric trabecular BMD (vTBMD; mg/ml) in children with disabling conditions.

MATERIALS AND METHODS:

Twenty pre-or postpubertal disabled, ambulant, children (14 males, 6 females; mean age, 9.1 +/- 4.3 years; range, 4-19 years) were randomized to standing on active (n = 10; 0.3g, 90 Hz) or placebo (n = 10) devices for 10 minutes/day, 5 days/week for 6 months. The primary outcomes of the trial were proximal tibial and spinal (L2) vTBMD (mg/ml), measured using 3-D QCT. Posthoc analyses were performed to determine whether the treatment had an effect on diaphyseal cortical bone and muscle parameters.

RESULTS AND CONCLUSIONS:

Compliance was 44% (4.4 minutes per day), as determined by mean time on treatment (567.9 minutes) compared with expected time on treatment over the 6 months (1300 minutes). After 6 months, the mean change in proximal tibial vTBMD in children who stood on active devices was 6.27 mg/ml (+6.3%); in children who stood on placebo devices, vTBMD decreased by -9.45 mg/ml (-11.9%). Thus, the net benefit of treatment was +15.72 mg/ml (17.7%; p = 0.0033). In the spine, the net benefit of treatment, compared with placebo, was +6.72 mg/ml, (p = 0.14). Diaphyseal bone and muscle parameters did not show a response to treatment. The results of this pilot RCT have shown for the first time that lowmagnitude, high-frequency mechanical stimuli are anabolic to trabecular bone in children, possibly by providing a surrogate for suppressed muscular activity in the disabled. Over the course of a longer treatment period, harnessing bone’s sensitivity to these stimuli may provide a non-pharmacological treatment for bone fragility in children.

 

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A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy.

date: 2004 Feb;89(2):131-5
author: Caulton J.
publication:Arch Dis Child.
pubmed_ID: 14736627

Abstract

BACKGROUND:

Severely disabled children with cerebral palsy (CP) are prone to low trauma fractures, which are associated with reduced bone mineral density.

AIMS:

To determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular bone mineral density (vTBMD) of non-ambulant children with CP.

METHODS:

A heterogeneous group of 26 pre-pubertal children with CP (14 boys, 12 girls; age 4.3-10.8 years) participated in this randomised controlled trial. Subjects were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to either intervention (50% increase in the regular standing duration) or control (no increase in the regular standing duration) groups. Pre- and post-trial vertebral and proximal tibial vTBMD was measured by quantitative computed tomography (QCT).

RESULTS:

The median standing duration was 80.5% (9.5-102%) and 140.6% (108.7-152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group showed an increase of 8.16 mg/cm3 representing a 6% mean increase in vertebral vTBMD. No change was observed in the mean proximal tibial vTBMD.

CONCLUSION:

A longer period of standing in non-ambulant children with CP improves vertebral but not proximal tibial vTBMD. Such an intervention might reduce the risk of vertebral fractures but is unlikely to reduce the risk of lower limb fractures in children with CP.

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Load redistribution in variable position wheelchairs in people with spinal cord injury.

date: 2010;33(1):58-64
author: Sprigle S.
publication: J Spinal Cord Med.
pubmed_ID::20397444

Abstract

BACKGROUND/OBJECTIVE:

Tilt and recline variable position seating systems are most commonly used for pressure relief to decrease potential for skin breakdown. This study provides quantitative information on the magnitudes of loading on the seat and back during phases of tilt, recline, and standing. The objective of this study was to show that the amount of force reduction at the seat would differ across these 3 methods within their respective clinical ranges.

PARTICIPANTS:

Six able-bodied (AB) subjects (2 men, 4 women) with a median age of 25 years, and 10 subjects (8 men, 2 women) with spinal cord injury (SCI) with a median age of 35.5 years.

METHODS:

Subjects sat on a power wheelchair with Tekscan pressure mats placed underneath a foam backrest and cushion. Data were collected at 5 positions for each method. Order of position and method tested were randomized. Linear regressions were used to calculate the relationships of normalized seat and backrest forces to seat and backrest angles for each chair configuration.

RESULTS:

Normalized seat loads had strong linear relationships with the angles of change in tilt, recline, and standing for both groups. Maximum decreases in seat load occurred at full standing and full recline in the SCI subjects and in full standing in the AB subjects. Loads linearly increased on the back during tilt and recline and linearly decreased during standing for both groups.

CONCLUSIONS:

Standing and recline offered similar seat load reductions at their respective terminal positions. Standing also reduced loading on the backrest. Recognizing that each method had clinical benefits and drawbacks, the results of this study indicate that tilt, recline, and standing systems should be considered as a means of weight shifting for wheelchair users.

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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.