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:10.1097/00001577-200214010-00006

Cited by 36 publications

(23 citation statements)

References 21 publications

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“…A two phase study focused on the effects of a static versus a dynamic (motorized) prone stander on bone mineral density (phase I) and behaviour related to tasks and specific goals (phase II) in four preschool children with severe cerebral palsy (Gudjonsdottir & Stemmons Mercer, ). In phase I, there were increases in bone mineral density in both children who used a dynamic stander and one of two children who used a static stander.…”

Section: Resultsmentioning

confidence: 99%

Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review

Robertson

Baines

Emerson

et al. 2016

Research Intellect Disabil

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Background: Poor postural care can have severe and life-threatening complications.This scoping review aims to map and summarize existing evidence regarding postural care for people with intellectual disabilities and severely impaired motor function.Method: Studies were identified via electronic database searches (MEDLINE, CINAHL, PsycINFO and Web of Science) covering January 1990 to March 2016, and email requests to researcher networks. Results were collated via descriptive numerical summary of studies and thematic analysis. Results:Twenty-three studies were identified and summarized narratively in relation to three themes: characteristics and prevalence, interventions and service related issues. The evidence base is small with significant gaps. Lack of evidence for nighttime positioning equipment and 24-hr postural care needs to be addressed urgently. Conclusion:Future research should be clearly directed towards ascertaining how best postural care interventions can be employed to help improve the health and quality of life of people with intellectual disabilities. K E Y W O R D Sintellectual disabilities, postural care, scoping review |Published for the British Institute of Learning Disabilities ROBERTSON ET al. posture also underpin the ability to function and access the environment (Crawford & Stinson, 2015).Over the past 15 years, there has been increased awareness of the need to provide postural care over the entire 24-hr period. This usually involves adaptive seating and/or moulded wheelchairs; night-time positioning equipment (NTPE); moving and handling techniques; and advice and training across all settings that the person accesses (Crawford & Stinson, 2015). NTPE can be used during the substantial proportion of the day when the person is in bed and has been reported to be beneficial even for those with established body shape distortion (Goldsmith, 2000).It has been proposed that most people who lack the ability to change their position would benefit from 24-hr body positioning (Crawford & Stinson, 2015) and that 24-hr postural care strategies should be considered in physical therapy programmes to prevent or delay the development of contractures or skeletal deformities in children and young people at risk of developing these (National Institute for Health & Care Excellence, 2012). However, disabled children generally are not being provided with the specialist equipment they require (such as seating and postural support systems), with provision of equipment being patchy at best (Centre for Economics and Business Research, 2014). It is widely accepted that the current systems that provide equipment and related services to children fail (CSED Consultant's Report, 2010).The importance of the issue of postural care in relation to people with intellectual disabilities has been highlighted in a number of reports noting gaps in services and the need to provide postural care interventions to prevent postural deformities from developing (Heslop et al., 2013;Mansell, 2010;Michael, 2008, RCGP, 2012. No systematic...

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Section: Resultsmentioning

confidence: 99%

Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review

Robertson

Baines

Emerson

et al. 2016

Research Intellect Disabil

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“…We chose to implement the A 1 B 1 A 2 B 2 design, because we judged it appropriate to the context. This research design provides an alternation of phases of control (A 1 and A 2 ), without the use of the standing frame, and phases of intervention (B 1 and B 2 ), with the daily use of the standing frame in the living environment of the child, in accordance with the usual clinical practice (Herman et al, ; Kecskemethy et al, ; Eisenberg et al, ; Gudjonsdottir and Stemmons, ).…”

Section: Methodsmentioning

confidence: 99%

“…Health care professionals share the opinion that the upright position contributes to relieving constipation, so clinicians frequently indicate the standing frame with this clinical purpose. In searching the literature, we found one systematic review (Pin, ) and eight clinical trials dealing with the use of the standing frame in children with CP (Ivey et al, ; Motloch and Brearley, ; Herman et al, ; Kecskemethy et al, ; Eisenberg et al, ; Gibson et al, ; Gudjonsdottir and Stemmons, ; Salem et al, ) (Figure ). However, none of these studies investigated the effectiveness of the standing frame on constipation.…”

mentioning

confidence: 99%

Effectiveness of Standing Frame on Constipation in Children with Cerebral Palsy: A Single-Subject Study

et al. 2014

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Children with cerebral palsy (CP) and quadriplegia or severe diplegia suffer from highly reduced mobility and consequent constipation. Clinicians recommend standing frames to exercise the support reaction in this population, sharing the opinion that the upright position may facilitate intestinal transit, although no evidence supports this assumption. We conducted this study to determine the effects of the standing frame on spontaneous evacuation in children with CP. Moreover, we studied its effects on the frequency of induction of evacuation, the characteristics of the stool and the pain suffered by the child due to constipation and/or evacuation. We implemented a single-subject research design in one chronically constipated child with CP and quadriplegia, Gross Motor Function Classification System Level V. To monitor the effects of the standing frame, we measured the outcome of interest throughout the study using a daily diary and the Bristol Stool Scale. This study was approved by the local Ethics Committee. This study has several limitation; primarily, the use of a single-subject research design only makes possible the visual analysis of data obtained from a unique patient. So, by themselves, data obtained do not allow us any generalization for the target population. Future research should verify our results collecting more data and also investigating the effect of the standing-frame on respiratory functions. Although the standing frame did not affect the frequency of evacuations or the characteristics of the stool, its employment reduced the inductions of evacuation and the related pain suffered by the child. However, this study has several limitations, such as the lack of generalization due to the fact that we studied a unique patient and the overall brevity of the study due to external circumstances. Therefore, we suggest future research to verify our results, also investigating the effect of the standing frame on respiratory functions. Relevance to clinical practice. The standing frame may positively influence the management of constipation of these children, possibly improving their quality of life.

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“…112 Apart from the expected positive effects of standing on bone mineral density and circulation, positioning in a standing table provides an elongated position of the hip and knee flexors. [113][114][115] Benefits are achieved provided that the child is positioned correctly with sufficient attention to the position of the feet, sufficient knee-and hip extension, slight abduction, and external rotation in the hips and adequate pelvic tilt.…”

Section: Positioning In Orthoses and Mobility Aidsmentioning

confidence: 99%

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy

et al. 2019

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The aim of this paper is to provide a clinically applicable overview of different tone reducing modalities and how these can interact with or augment concurrent physical therapy (PT). Botulinum toxin (BoNT), oral tone-regulating medication, intrathecal baclofen (ITB), and selective dorsal rhizotomy are discussed within a physiotherapeutic context and in view of current scientific evidence. We propose clinical reasoning strategies to identify treatment goals as well as the appropriate and corresponding treatment interventions. Instrumented measurement of spasticity, standardized clinical assessment, and 3D clinical motion analysis are scientifically sound tools to help select the appropriate treatment and, when needed, to selectively target or spare individual muscles. In addition, particular attention is given to strength training as a necessary tool to tackle muscle weakness associated with specific modalities of tone reduction. More research is needed to methodologically assess the long-term effectiveness of such individualized tone treatment, optimize parameters such as medication dosage, and gain more insight into the kind of PT techniques that are essential in conjunction with tone reduction.

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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 36 publications

References 21 publications

Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review

Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review

Effectiveness of Standing Frame on Constipation in Children with Cerebral Palsy: A Single-Subject Study

Tone Reduction and Physical Therapy: Strengthening Partners in Treatment of Children with Spastic Cerebral Palsy

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