Effect of Weight-Bearing in Abduction and Extension on Hip Stability in Children With Cerebral Palsy

Abstract

: 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.

Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy

“…The results of this research support the findings of Gibson et al, 28 Martinsson and Himmelmann, 31 Salem et al, 18 and Paleg et al, 32 which show that muscle flexibility can be maintained through the use of a sustained stretching program. According to a recent systematic review by Paleg et al 32 on recommendations for pediatric standing programs, the use of standing devices seems to have positive effects on lower-extremity ROM, hip biomechanics, and spasticity.…”

“…30,31 Other authors have provided support for the use of prolonged stretch through the use of a night-time hip abduction positioning system. 36 According to the study by Martinsson and Himmelmann,31 weight-bearing with 60 • of total hip abduction and 0 • of hip extension for at least 1 hour per day reduced hip migration percentage and preserved ROM. However, we think that the use of the standing program twice a day for at least 45 minutes is better than once a day.…”

“…33 A standing frame that could be adapted to the individual characteristics of each child and allowing more abduction for each leg is desired to promote flexibility of the hip adductor musculature and acetabular development. 31 In 1995, our Public Early Intervention Department initiated a program to manage hip ROM in children with spastic CP. This involved children who had not attained independent walking by 12 to 14 months of age, who demonstrated decreased weight-bearing because of their delayed walking skill development, and who showed muscle imbalance at the hip with a tendency toward increased hip adduction in standing or supported walking.…”

“…28 Researchers concluded that standing at least 45 to 60 minutes daily is necessary and 60 minutes is optimal to increase hip, knee, and ankle ROM. 18,[28][29][30][31][32] Most models of standing devices on the market do not allow more than 40 • of combined hip abduction when the child is standing. For children with adductor spasticity, this degree of abduction is felt to be insufficient to maintain the extensibility of the hip adductor muscles.…”

The ambiguity of standing in standing devices: a qualitative interview study concerning children and parents experiences of the use of standing devices

“…Martinsson and Himmelmann (2011) also found that weight bearing with maximal achievable abduction and zero degrees of hip extension for at least one hour per day decreased the risk of subluxation of the hip for children with cerebral palsy. However, they pointed out that larger studies are needed to validate the evidence.…”