Category: Standing Frame Comparison/Product Evaluation

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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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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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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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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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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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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.
pubmed_ID:PMID:21791851

 

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.

DESIGN:

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.

RESULTS:

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.

CONCLUSION:

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.