Effects of a Dynamic Versus a Static Prone Stander on Bone Mineral Density and Behavior in Four Children with Severe Cerebral Palsy

Gudjonsdottir, Bjorg; Mercer, Vicki S.

doi:10.1097/00001577-200204000-00006

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…Cerebral palsy, gait, standing program Prolonged standing programs are used for children with cerebral palsy (CP) and have been shown to have wide-ranging positive effects in these children. Standing frames are recommended for children with limited mobility in the upright posture, including children with CP, to encourage proper alignment and weight bearing on the lower extremities (Gudjonsdottir & Mercer, 2002;Stuberg, 1992). Standing programs have been shown to increase range of motion (Baker, Cassidy, & Rone-Adams, 2007;Richardson, 1991;Tsai, Yeh, Chang, & Chen, 2001), improve muscle tone (Bohannon, 1993;Eng et al, 2001;Fefr, Fisher, & Langbein, 1994Odeen & Knutson, 1981;Pin, 2007;Shields & Dudley-Javoroski, 2005;Tremblay, Malouin, Richards, & Dumas, 1990;Tsai et al, 2001), improve bone growth, and increase bone mineral density (Caulton et al, 2004;Gudjonsdottir & Mercer, 2002;Gudjonsdottir & Stemmons, 1997;Stuberg, 1992;Wilmshurst, Ward, Adams, Langton, & Mughal, 1996), and are assumed to prevent or reduce secondary impairments by maintaining muscle extensibility, preventing muscle and soft tissue contracture, and promoting optimal musculoskeletal development (Stuberg, 1992).…”

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confidence: 99%

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

Salem¹,

Lovelace-Chandler²,

Zabel³

et al. 2010

Physical & Occupational Therapy In Pediatrics

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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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mentioning

confidence: 99%

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

Salem¹,

Lovelace-Chandler²,

Zabel³

et al. 2010

Physical & Occupational Therapy In Pediatrics

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“…The standing position was a way to straighten the body and to strengthen the skeleton and the hip joints. This experience was supported by Caulton et al (2004) and Gudjonsdottir and Mercer (2002), who found that children who used standing devices showed an increased BMD compared to control groups. Standing one hour per day with the maximal achievable hip abduction and extension also had a positive effect on the migration percentage for children with cerebral palsy (Martinsson and Himmelmann, 2011).…”

Section: Discussionmentioning

confidence: 82%

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

Nordström

Näslund

Ekenberg

et al. 2014

Physiotherapy Theory and Practice

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There is an inherent duality related to the use of a standing device. Standing in a standing device was seen as a treatment of body structures and functions, as well as a possible source of pain. Standing was considered to influence freedom in activities and participation both positively and negatively. The parents experienced that standing influenced other peoples' views of their child, while the children experienced standing as a way to extend the body and as something that gave them benefits in some activities. Physiotherapists working with children should take into account both the social and physical dimensions of using a standing device and consider both the child's and the parents' views.

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“…Previous work by Gudjonsdottir found that the use of a motorized 'dynamic' stander may increase bone mineral density of children and adolescents and warranted further investigation [6]. However, due to the additional complications of joint contractures and severe risk of hip dislocations among others in the population considered in this study, neither Gudjonsdottir's or other 'dynamic' standing devices available on the market are appropriate.…”

Section: Introductionmentioning

confidence: 84%

Increasing bone mineral density in immobilized children using a dynamic stander: Pilot study

Damcott

Blochlinger

Mantilla

et al. 2009

2009 IEEE 35th Annual Northeast Bioengineering Conference

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With passive standing increasingly being incorporated into the therapeutic programs of immobilized children, the impact of mechanical loading on bone mineral density (BMD) has become a focus in the field. However, concurrent research in the bone mechanostat suggests that the oscillating flow created during the reciprocal loading of bone in daily activities is a maj~r contributing factor for increasing BMD. Therefore a dynamic stander, which applies reciprocal loading mimicking those loads experienced during normal walking, was designed. This pilot study was aimed to test the feasibility of using the device in the clinical and educational settings. The preliminary results suggest minimal design modifications and while the data for BMD is inconclusive, results do suggest further investigation to determine the impact the new device has on BMD is warranted.

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Effects of a Dynamic Versus a Static Prone Stander on Bone Mineral Density and Behavior in Four Children with Severe Cerebral Palsy

Cited by 12 publications

References 21 publications

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy

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

Increasing bone mineral density in immobilized children using a dynamic stander: Pilot study

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