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

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 semiprone 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/cm 3 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.

Whole-Body Vibration Exercise Is Well Tolerated in Patients With Duchenne Muscular Dystrophy: A Systematic Review

“…There is even some evidence to suggest that regular standing programs may have a positive effect on bone (Caulton, 2004). A Consensus Guideline document by Bushby et al (2010) recommends that all boys with DMD who are ambulatory or in the early non-ambulatory stage participate in regular sub maximum exercise to avoid disuse muscle atrophy and other complications of inactivity.…”

“…Exercise is a well-evidenced non-pharmacological treatment approach to improve bone mineral density (BMD) (Caulton, 2004). There is even some evidence to suggest that regular standing programs may have a positive effect on bone (Caulton, 2004).…”

Management of osteoporosis in children

“…If there is evidence of vitamin D deficiency and/or poor dietary calcium intake it would be appropriate to replace such deficits, but routine calcium and vitamin D supplementation is not recommended. In children with conditions with reduced mobility, who are able to stand, there is evidence that an increased duration of standing or physical activity will improve bone density in the spine and femur (21,22). An additional potential intervention in such a group is the use of a vibrating platform to stimulate muscle activity and consequently bone strength.…”

Endocrine Problems in Children and Adolescents Who Have Disabilities

“…This should be combined with as much time as possible spent in the weight-bearing position. Many children with major biomechanical disabilities are able, with encouragement and support, to stand for 20-30 min per day in a support frame, also shown to improve bone accrual [22,23,24]. …”