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Research Studies on the Benefits of Standing

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Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy.

Author(s): Ahlborg L, Andersson C, Julin P.
Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden. lotta.ahlborg@ds.se
Publication: J Rehabil Med. 2006 Sep;38(5):302-8.

OBJECTIVE: The aim of this study was to evaluate the effect on spasticity, muscle strength and motor performance after 8 weeks of whole-body vibration training compared with resistance training in adults with cerebral palsy. METHODS: Fourteen persons with spastic diplegia (21-41 years) were randomized to intervention with either whole-body vibration training (n=7) or resistance training (n=7). Pre- and post-training measures of spasticity using the modified Ashworth scale, muscle strength using isokinetic dynamometry, walking ability using Six-Minute Walk Test, balance using Timed Up and Go test and gross motor performance using Gross Motor Function Measure were performed. RESULTS: Spasticity decreased in knee extensors in the whole-body vibration group. Muscle strength increased in the resistance training group at the velocity 30 degrees /s and in both groups at 90 degrees /s. Six-Minute Walk Test and Timed Up and Go test did not change significantly. Gross Motor Function Measure increased in the whole-body vibration group. CONCLUSION: These data suggest that an 8-week intervention of whole-body vibration training or resistance training can increase muscle strength, without negative effect on spasticity, in adults with cerebral palsy.

Categories: Cerebral Palsy , Reduce Spasticity, Tone, Spasms , Improve Strength , Develop or Improve Motor Ability

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 16931460 [PubMed - indexed for MEDLINE]

Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years.

Author(s): Alekna V, Tamulaitiene M, Sinevicius T, Juocevicius A.
Faculty of Medicine, Vilnius University, Vilnius, Lithuania. vidmantas.alekna@ekmi.vu.lt
Publication: Spinal Cord. 2008 Nov;46(11):727-32. Epub 2008 Apr 29.

STUDY DESIGN: Prospective study on patients with spinal cord injuries. OBJECTIVES: To evaluate the loss of bone mineral density (BMD) in various body regions of patients with spinal cord injury (SCI) and its dependence on weight bearing activities during 2 years post injury. METHODS: BMD of the whole body was measured in patients with SCI. Baseline measurement was performed in 6-16 weeks after SCI, the second and the third-respectively 12 and 24 months after injury. Fifty-four subjects were selected and divided into two groups: standing and non-standing. From these groups 27 pairs were made according to gender, age and height. RESULTS: There was found to be a well-marked decrease in BMD values for lower extremities, but there was no significant difference between paraplegic and tetraplegic patients 1 and 2 year after injury. Leg BMD reduced by 19.62% (95% CI, 17-22%) in the standing group and by 24% (95% CI, 21-27%) in non-standing group during the first year. Two years after SCI patients in standing group had significantly higher leg BMD-1.018 g/cm(2) (95% CI, 0.971-1.055 g/cm(2)) than in the non-standing group-0.91 g/cm(2) (95% CI, 0.872-0.958 g/cm(2)) (Por=1 h and not less than 5 days per week, had significantly higher BMD in the lower extremities after 2 years in comparison to those patients who did not perform standing.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 18443599 [PubMed - indexed for MEDLINE]

Considerations in Passive Standing Programs for Clients who are Medically Fragile

Author(s): Aukland, K.A, Lombar, I.L. & Paleg, G.
Publication: Pediatric Physical Therapy

BACKGROUND & PURPOSE: Standing is a recommended treatment method for persons unable to stand independently for a variety of medical or physical reasons, including increasing/maintaining bone density, improving bowel/bladder function, maintaining PROM, and improving postural control. Review of published data reveals that there is no established optimum daily schedule range to be used for training/maintaining endurance for standing in a person who is medically fragile.

CASE DESCRIPTION: Subject: 20 year old female with history of medical fragility following TBI, s/p (3.25 years) R frontotemporal craniotomy, s/p L frontal craniotomy, flaccid hypotonicity, tracheostomy, G-tube, diabetes insipidus, panhypopituitarism, hypothalamic storms during early rehabilitation, and autonomic dysregulation, including temperature control impairment.

METHODS AND MATERIALS: Digital blood pressure monitor (LifeSource UA 767), pulse oximeters (including Datex Ohmeda 3800), and stander (Easy Stand 5000 Series) with adaptations. Data was recorded by Physical and Occupational therapists. Parameters measured included Start/End BP, Start/High/Low Pulse Rate and Start/High/Low SpO2.

OUTCOMES: Analyses: Use of Microsoft Excel with Regression Analysis - scatter charts with trend lines.

RESULTS: Hypertension and decreased start/low SpO2 were directly related to amount of time between standing sessions. As exposure to interventions increased, incidence of negative outcomes decreased.

DISCUSSION: Results suggested that negative outcomes were most likely when there were 8 or more days between interventions, but increased hypertensive tendencies were noted by the 3rd day of non-participation. Previous studies made recommendations on frequency of intervention based on the desired benefits of the standing program. When considering a person with medical fragility, further attention to scheduling of the intervention may be required to prevent undesirable sequelae secondary to cardiovascular and pulmonary stress, yet still provide adequate stress to increase/maintain endurance.

Caretakers need to be involved in assessing their ability to be consistent with a standing schedule before accepting a standing program. They require adequate training on how to safely reinstitute standing when the schedule is disrupted. To support consistency, choice of equipment should fit caretakers needs as well as those of the person receiving the intervention.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Improve Bowel Function & Digestion , Improve Circulation/Respiratory/ Cardio Function , Improve Bladder Function

Standing and its importance in spinal cord injury management.

Author(s): Axelson P, Gurski D, Lasko-Harvill A.
IMEX Inc. San Jose, California, Beneficial Designs, Inc., Santa Cruz, California
Publication: RESNA 10th Annual Conference San Jose, California 1987

A broad spectrum of physiological problems are associated with lack of gravitational stress in the individual with spinal cord injury. Prolonged immobilization results in systemic de-adaptations which include cardiovascular changes, the alteration of calcium homeostasis which leads to bone de-mineralization and risk of urinary calculi.

Weight bearing in the standing posture has been shown to ameliorate many of these problems and offers physiological advantages for the individual with spinal card injury.

There are also significant psychological and social benefits to standing, including improved self-image, and eye-to-eye interpersonal contact. Increased vocational, recreational and daily living independence are additional benefits of standing.

Categories: Effects of Immobilization , Review of Literature , Spinal Cord Injury

A randomized trial evaluation of the Oswestry Standing Frame for patients after stroke.

Author(s): Bagley P, Hudson M, Forster A, Smith J, Young J.
School of Health Studies, University of Bradford, Bradford BD5 0BB, UK. P.J.Bagley@Bradford.ac.uk
Publication: Clin Rehabil. 2005 Jun;19(4):354-64.

BACKGROUND: Standing is believed to have benefits in addressing motor and sensory impairments after stroke. One device to facilitate standing for severely disabled patients is the Oswestry Standing Frame. OBJECTIVE: To evaluate the effectiveness of the Oswestry Standing Frame for severely disabled stroke patients. DESIGN: A single centre, randomized controlled trial. SETTING: An inpatient stroke rehabilitation unit. SUBJECTS: Patients were recruited if they had a clinical diagnosis of stroke, were medically stable and unable to achieve any score on the Trunk Control Test or unable to stand in mid-line without the assistance of two therapists. INTERVENTION: The intervention (n = 71) and control (n = 69) groups both received usual stroke unit care but the intervention group also received a minimum of 14 consecutive days' treatment using the standing frame. MAIN OUTCOME MEASURES: The primary outcome measure was the Rivermead Mobility Index (RMI). Secondary measures included the Barthel Index; the Rivermead Motor Assessment; the balanced sitting and sitting to standing components of the Motor Assessment Scale; the Trunk Control Test and the Hospital Anxiety and Depression Scale. Blind assessment was undertaken at baseline, six weeks, 12 weeks and six months post stroke. Information on resource use was also collected. RESULTS: There was no statistically significant difference between groups in any of the outcome measures or for resource use. Mann-Whitney U-tests for the RMI change from baseline scores to six weeks, 12 weeks and six months post stroke were p = 0.310; p = 0.970 and p = 0.282, respectively. CONCLUSION: Use of the Oswestry Standing Frame did not improve clinical outcome or provide resource savings for this severely disabled patient group.

Categories: Stroke , Develop or Improve Motor Ability

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Pubmed ID: 15929503 [PubMed - indexed for MEDLINE]

Active standing and passive tilting similarly reduce the slope of spontaneous baroreflex in healthy subjects.

Author(s): Bahjaoui-Bouhaddi M, Henriet MT, Cappelle S, Dumoulin G, Regnard J.
Explorations Fonctionnelles Rénales et Métaboliques, CHU de Besancon, France.
Publication: Physiol Res. 1998;47(4):227-35.

Non-invasive assessment of the sensitivity of cardiac baroreflex was performed by recording each RR-interval and each blood pressure cycle (Finapres). In sequences of at least three cardiac cycles in which systolic blood pressure and RR-interval had changed in the same direction, the slope of linear regression of RR duration as a function of the change in systolic arterial pressure was taken for estimating the sensitivity of the spontaneous cardiac baroreflex. This technique was used in healthy humans to examine how a postural change from supine to upright by either active standing up or 60 degrees head-up tilting modified the sensitivity of the spontaneous baroreflex. We observed that the slope of the spontaneous baroreflex averaged 14.6 +/- 2 ms.mm Hg-1 during rest in the supine position, and decreased to 7.8 +/- 1.2 ms.mm Hg-1 (p < 0.05) after active standing, while the number of sequences was significantly increased in the upright as compared to the supine position. Head-up tilting by 60 degrees led to values similar to those following active standing. The adjustment of baroreflex slope to either postural change occurred in a few seconds, so that posture-characteristic values were obtained from five-minute records. We conclude that non-invasive recording of spontaneous sequences of related changes in blood pressure and RR-interval during several minutes provides reproducible values of the slope of cardiac baroreflex in the supine and upright position. This easy and reliable determination of the sensitivity of the cardiac baroreflex might prove to be useful when assessment of baroreflex function is needed.

Categories: Active (Reciprocal Leg Movement) Standing

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 9803468 [PubMed - indexed for MEDLINE]

Therapeutic standing for people with multiple sclerosis:

Author(s): Baker, K., Cassidy, E., Rone-Adams, S.
Publication: International Journal of Therapy and Rehabilitation

The purpose of this pilot study was to assess the feasibility and efficacy of a daily standing programme in the community for subjects with multiple sclerosis (MS).A single blind randomized crossover design was used. There were two interventions; daily standing in a standing frame for 30minutes and a daily exercise programme. Interventions were sequential and crossed after 3weeks. The primary outcome measures were the Ashworth scale, spasm frequency scale and range of movement. Subjects consisted of six individuals with a diagnosis of secondary progressive MS. Statistically significant improvements were demonstrated in hip and ankle range of movement with standing when compared to the exercise phase for both groups. No significant differences in spasticity or spasm were found although a downward trend was seen. All subjects achieved 30minutes of therapeutic standing. Three subjects achieved 30minutes standing after building up tolerance over the 3-week intervention period. In conclusion therapeutic standing increased range of movement in wheelchair dependent subjects. Further examination of the immediate and long-term effects of standing on spasm and spasticity is warranted.

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Categories: Reduce Spasticity, Tone, Spasms , Improve Range of Motion, Prevent Contractures

Locomotor training after human spinal cord injury: a series of case studies.

Author(s): Behrman AL, Harkema SJ.
Department of Physical Therapy and University of Florida Brain Institute, University of Florida, Gainesville 32510-0154, USA. abehrman@hp.ufl.edu
Publication: Phys Ther. 2000 Jul;80(7):688-700.

Many individuals with spinal cord injury (SCI) do not regain their ability to walk, even though it is a primary goal of rehabilitation. Mammals with thoracic spinal cord transection can relearn to step with their hind limbs on a treadmill when trained with sensory input associated with stepping. If humans have similar neural mechanisms for locomotion, then providing comparable training may promote locomotor recovery after SCI. We used locomotor training designed to provide sensory information associated with locomotion to improve stepping and walking in adults after SCI. Four adults with SCIs, with a mean postinjury time of 6 months, received locomotor training. Based on the American Spinal Injury Association (ASIA) Impairment Scale and neurological classification standards, subject 1 had a T5 injury classified as ASIA A, subject 2 had a T5 injury classified as ASIA C, subject 3 had a C6 injury classified as ASIA D, and subject 4 had a T9 injury classified as ASIA D. All subjects improved their stepping on a treadmill. One subject achieved overground walking, and 2 subjects improved their overground walking. Locomotor training using the response of the human spinal cord to sensory information related to locomotion may improve the potential recovery of walking after SCI.

Categories: Active (Reciprocal Leg Movement) Standing , Spinal Cord Injury

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 10869131 [PubMed - indexed for MEDLINE]

Physical rehabilitation as an agent for recovery after spinal cord injury.

Author(s): Behrman AL, Harkema SJ.
Department of Physical Therapy, College of Public Health and Health Professions, P.O. Box 100154, University of Florida, Gainesville, FL 32610-0154, USA. abehrman@phhp.ufl.edu
Publication: Phys Med Rehabil Clin N Am. 2007 May;18(2):183-202, v.

The initial level of injury and severity of volitional motor and clinically detectable sensory impairment has been considered the most reliable for predicting neurologic recovery of function after spinal cord injury (SCI). This consensus implies a limited expectation for physical rehabilitation interventions as important in the facilitation of recovery of function. The development of pharmacologic and surgical interventions has always been pursued with the intent of altering the expected trajectory of recovery after SCI, but only recently physical rehabilitation strategies have been considered to improve recovery beyond the initial prognosis. This article reviews the recent literature reporting emerging activity-based therapies that target recovery of standing and walking based on activity-dependent neuroplasticity. A classification scheme for physical rehabilitation interventions is also discussed to aid clinical decision making.

Categories: Active (Reciprocal Leg Movement) Standing , Review of Literature , Spinal Cord Injury

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 17543768 [PubMed - indexed for MEDLINE]

Effects of functional electrical stimulation on the joints of adolescents with spinal cord injury.

Author(s): Betz R, Boden B, Triolo R, Mesgarzadeh M, Gardner E, Fife R.
Shriners Hospital, Philadelphia, PA 19152, USA.
Publication: Paraplegia. 1996 Mar;34(3):127-36.

Nineteen adolescent subjects with complete spinal cord injuries resulting in paraplegia or tetraplegia participated in a functional electrical stimulation (FES) program consisting of computerized, controlled exercise and/or weight bearing. The effects of stimulated exercise and standing/walking on the lower extremity joints were prospectively studied. Plain radiographs and MRIs were obtained prior to and following completion of the exercise and standing and walking stages. In addition, the joints of five subjects were studied with synovial biopsies, arthroscopy, and the analysis of serum and synovial fluid for a 550 000 dalton cartilage matrix glycoprotein (CMGP). Pre-exercise joint abnormalities secondary to the spinal cord injury improved following the stimulation program. None of the subjects developed Charcot joint changes. Upon standing with FES, one subject with poor hip coverage prior to participation developed hip subluxation which required surgical repair. No other detrimental clinical effects occurred in the lower extremity joints of subjects participating in an FES program over a 1-year period.

Categories: Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 8668353 [PubMed - indexed for MEDLINE]

Osteogenesis imperfecta: rehabilitation approach with infants and young children.

Author(s): Binder H, Hawks L, Graybill G, Gerber NL, Weintrob JC.
Publication: Arch Phys Med Rehabilitation. 1984 Sep;65(9):537-41.

A rehabilitation approach, consisting of initial handling and positioning followed by functional and formal strengthening exercises, was developed for the child with severe progressive osteogenesis imperfecta (OI). The program was developed because of the increased life expectancy for infants and children with severe progressive OI, combined with the lack of published reports dealing with their rehabilitation. The program can be followed easily by parents or therapists with regular monitoring by a psychiatrist. The goals are to improve the life span as well as the quality of life of these children by preventing the following: (1) positional contractures and deformities, (2) muscle weakness and osteoporosis, and (3) malalignment of the lower extremity joints prohibiting weight-bearing. Implementation of the program requires full cooperation of the parents. The initial results in four children between the ages of 3 and 11 years are encouraging. The benefits of increased strength and mobility leading to more age-appropriate activities and behaviors outweigh the only observed negative result, that is trauma-related lower extremity fractures in children with milder disease, and therefore greater mobility and higher activity levels.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Reduce Spasticity, Tone, Spasms

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 6477088 [PubMed - indexed for MEDLINE]

Bone measurements by peripheral quantitative computed tomography (pQCT) in children with cerebral palsy

Author(s): Binkley T, Johnson J, Vogel L, Kecskemethy H, Henderson R, Specker B.
Ethel Austin Martin Human Nutrition Program, South Dakota State University, Brookings, South Dakota 57007, USA.
Publication: J Pediatr. 2005 Dec;147(6):791-6.

OBJECTIVE: To use peripheral quantitative computed tomography (pQCT) to determine bone measurements in patients with cerebral palsy (CP) age 3 to 20 years and compare them with control subjects. STUDY DESIGN: A total of 13 (5 male) patients with CP, along with 2 sex- and age-matched controls for each, were included in a mixed-model analysis with matched pairs as random effects for pQCT bone measurements of the 20% distal tibia. RESULTS: Tibia length was similar in the CP and control groups (P = .57). Weight was marginally higher in the control group (P = .06). Cortical bone mineral content (BMC), area, thickness, polar strength-strain index (pSSI), and periosteal and endosteal circumferences were greater in the control group (P < .05 for all). Relationships between bone measurements and weight showed that cortical BMC, area, periosteal circumference, and pSSI were greater at higher weights in the control group (group-by-weight interaction, P < .05 for all). Cortical thickness was greater in the control group and was correlated with weight. Cortical volumetric bone mineral density (vBMD) was greater with higher weights in the CP group (group-by-weight interaction, P = .03). CONCLUSIONS: Bone strength, as indicated by pSSI, is compromised in children with CP due to smaller and thinner bones, not due to lower cortical bone density.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 16356433 [PubMed - indexed for MEDLINE]

Effect of Exercise, Standing, Negative Trunk and Positive Skeletal Pressure on Bed Rest Induced Orthostasis and Hypercalciuria

Author(s): Birkhead, N.C., Blizzard, J.J., Issekutz, B., Rodahl, K.
Wright-Patterson Air Force Base, Ohio
Publication: Aerospace Medical Research Laboratories

Tilt intolerance and hypercalciuria were induced in healthy subjects fed weighed diets by 18-32 days continuous bed rest in a Metabolic Ward. The effect of supplementing bed rest with daily supine bicycle exercise (2 or 4 hours), quiet standing (3 hours), or longitudinal supine skeletal pressure on orthostasis and urinary calcium was determined. Tilt tolerance was evaluated by blood pressure and heart rate response to 10 minutes of 70? head-up body tilt and urinary calcium excretion by analysis of 3- or 6-day urine collections. Supine bicycle exercise was ineffective in significantly reducing tilt intolerance or hypercalciuria. Standing decreased orthostasis in 3 of 5 subjects and decreased urinary calcium in 4 of 5 subjects. Longitudinal skeletal pressure decreased hypercalciuria in 1 of 2 subjects but did not improve tilt tolerance. Intermittent lower body negative pressure during bed rest in one subject impeded development of orthostasis but increased urine calcium. Three hours daily standing is the minimum effective duration for reversing bed rest-induced tilt intolerance and hypercalciuria while supine bicycle exercise is not a practical method for obtaining similar effects.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Improve Circulation/Respiratory/ Cardio Function

Effects of a dynamic versus a static prone stander on bone material density and behavior in four children with severe cerebral palsy.

Author(s): Bjorg Gudjonsdottir, MS, PT, Vicki Stemmons Mercer, PhD, PT
Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC
Publication: Pediatric Physical Therapy 2002;14:38-46.

PURPOSE: in this case series, we examined how two types of prone standers affected bone material density and behavioral variables in four children of preschool age with severe cerebral palsy. METHODS: In phase one, four children of preschool age participated in an eight-week standing program, standing for 30 minutes a day, five days a week. Two children stood in a conventional stander, and two stood in a new type of motorized (dynamic) stander that provides intermittent weight bearing. Measurements of bone material density before and after the program revealed increases in bone material density in both children who used a dynamic stander and one child who used a static stander. In phase two, all four subjects stood in both types of stander during three separate test sessions. RESULT: Measures of behavioral variables, including behavioral state, reactivity, goal directedness, and attention span, indicated little or no effect of type of stander on behavior. CONCLUSIONS: These results suggest there is potential value in additional research concerning the effects of static and dynamic standers on bone material density and behavior in children with cerebral palsy.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy , Mobile / Dynamic Standing , Promote Psychosocial Skills and Improve Sleep

Nonoperative treatment of osteogenesis imperfecta: orthotic and mobility management.

Author(s): Bleck EE.
Publication: Clin Orthop Relat Res. 1981 Sep;(159):111-22.

The problem of osteoporosis superimposed on the basic collagen defect of osteogenesis imperfecta has been approached by the use of plastic containment orthoses for the lower limbs, in addition to developmentally staged mobility devices that assist early standing and walking. The purpose of forcing early weight-bearing is to provide stress to the lower limb bones in order to minimize osteoporosis, prevent refracture and deformity, and curb subsequent immobilization osteoporosis, thus breaking a vicious cycle. Management goals are based upon adult needs for independence: efficiency in daily living activities and in mobility. These goals were reached in most of our patients via use of plastic orthoses, early weight-bearing, and electrically powered wheelchairs. Manual osteoclasis of the tibia followed by plastic orthoses utilizing principles of fluid compression to support fractured or structurally weak bones appeared successful at the time of follow-up. Intramedullary rodding of the femur was necessary in most of the 12 children with osteogenesis imperfecta congenita. Supplementary plastic orthoses have reduced the refracture rate in both the tibia and the femur. Social integration of the children was reflected by the fact that among the 12 OI congenita cases, ten were attending regular educational institutions. Twelve OI tarda children fared well, all attaining complete independence in daily living, mobility and ambulation. Seven of this group were treated with intramedullary rodding of the femur or tibia and with plastic orthoses. Five patients required no treatment.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Reduce Spasticity, Tone, Spasms

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 7285447 [PubMed - indexed for MEDLINE]

Tilt table standing for reducing spasticity after spinal cord injury.

Author(s): Bohannon RW
Department of Rehabilitation, Hartford Hospital, CT
Publication: Arch Physical Medicine Rehabilitation. 1993 Oct;74(10):1121-2.

A patient with a T12 spinal cord injury and intractable extensor spasms of the lower extremities participated in tilt table standing trial on 5 nonconsecutive days to determine if the intervention would affect his spasticity and spasms. Each day's standing trial was followed by an immediate reduction in lower extremity spasticity (measured using the modified Ashworth scale and pendulum testing). Standing was also accompanied by a reduction in spasms that lasted until the following morning. The reduction of spasms was particularly advantageous to the performance of car transfers. Tilt table standing merits further examination as a physical treatment of spasms that accompany central nervous system lesions.

Categories: Reduce Spasticity, Tone, Spasms , Spinal Cord Injury

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 8215868 [PubMed - indexed for MEDLINE]

Passive ankle dorsiflexion increases in patients after a regimen of tilt table-wedge board standing. A clinical report.

Author(s): Bohannon RW, Larkin PA.
Publication: Phys Ther. 1985 Nov;65(11):1676-8.

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.

Categories: Stroke , Improve Range of Motion, Prevent Contractures

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 4059330 [PubMed - indexed for MEDLINE]

Cerebrovascular and cardiovascular responses to graded tilt in patients with autonomic failure.

Author(s): Bondar RL, Dunphy PT, Moradshahi P, Kassam MS, Blaber AP, Stein F, Freeman R.
University of Western Ontario, Faculty of Kinesiology, London, Ontario, Canada.
Publication: Stroke. 1997 Sep;28(9):1677-85.

BACKGROUND AND PURPOSE: Patients with autonomic nervous system failure often experience symptoms of orthostatic intolerance while standing. It is not known whether these episodes are caused primarily by a reduced ability to regulate arterial blood pressure or whether changes in cerebral autoregulation may also be implicated. METHODS: Eleven patients and eight healthy age- and sex-matched control subjects were studied during a graded-tilt protocol. Changes in their steady state middle cerebral artery mean flow velocities (MFV), measured by transcranial Doppler, brain-level mean arterial blood pressures (MABPbrain), and the relationship between the two were assessed. RESULTS: Significant differences between patients and control subjects (P < .05) were found in both their MFV and MABPbrain responses to tilt. Patients' MFV dropped from 60 +/- 10.2 cm/s in the supine position to 44 +/- 14.0 cm/s at 60 degrees head-up tilt, whereas MABPbrain fell from 109 +/- 11.7 to 42 +/- 16.9 mm Hg. By comparison, controls' MFV dropped from 54 +/- 7.8 cm/s supine to 51 +/- 8.8 cm/s at 60 degrees, whereas MABPbrain went from 90 +/- 11.2 to 67 +/- 8.2 mm Hg. Linear regression showed no significant difference in the MFV-MABPbrain relationship between patients and control subjects, with slopes of 0.228 +/- 0.09 cm.s-1.mm Hg-1 for patients and 0.136 +/- 0.16 cm.s-1.mm Hg-1 for control subjects. CONCLUSIONS: The present study found significant differences between patients and control subjects in their MFV and MABPbrain responses to tilt but no difference in the autoregulatory MFV-MABPbrain relationship. These results suggest that patients' decreased orthostatic tolerance may primarily be the result of impaired blood pressure regulation rather than a deficiency in cerebral autoregulation.

Categories: Improve Circulation/Respiratory/ Cardio Function , Stroke

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 9303009 [PubMed - indexed for MEDLINE]

Pathological fractures in patients with cerebral palsy.

Author(s): Brunner R, Doderlein L.
Department of Paediatric Orthopaedics, University of Basel, Switzerland.
Publication: J Pediatr Orthop B. 1996 Fall;5(4):232-8. Comment in: J Pediatr Orthop B. 1996 Fall;5(4):223-4.

A retrospective study was made of 37 patients with 54 fractures that occurred without significant trauma. The morbidity and causes of these pathological fractures in patients with cerebral palsy were analyzed. The major causes for the fractures were long and fragile lever arms and stiffness in major joints, particularly the hips and knees. An additional factor was severe osteoporosis following a long period of postoperative immobilization. Seventy-four percent of the fractures occurred in the femoral shaft and supracondylar region. Stress fractures were rare (7%) and involved only the patella. Conservative treatment was sufficient in most cases but surgical fixation provided a good alternative for fractures of the femoral shaft. Intraarticular fractures with joint incongruity resulted in a decreased level of activity of the patient. Since osteoporosis is a major risk factor, patients with cerebral palsy should bear weight to prevent pathological fractures. Any stiffness of major joints and extended periods of immobilization should be avoided.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 8897254 [PubMed - indexed for MEDLINE]

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

Author(s): Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JE, Mughal MZ.
The Manchester School of Physiotherapy, Manchester Royal Infirmary, Manchester, UK.
Publication: Arch Dis Child. 2004 Feb;89(2):131-5.

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 semi-prone 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/cm3 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.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy , Effects of Immobilization

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 14736627 [PubMed - indexed for MEDLINE]

The effect of a weight-bearing physical activity program on bone mineral content and estimated volumetric density in children with spastic cerebral palsy.

Author(s): Chad KE, Bailey DA, McKay HA, Zello GA, Snyder RE.
College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Publication: J Pediatr 1999 Jul;135(1):115-7.

After an 8-month physical activity intervention in children with cerebral palsy, increases in femoral neck bone mineral content (BMC) (9.6%), volumetric bone mineral density (v BMD) (5.6%), and total proximal femur BMC (11.5%) were observed in the intervention group (n = 9) compared with control subjects (n = 9; femoral neck BMC, -5. 8%; v BMD, -6.3%; total proximal femur BMC, 3.5%).

Publication Types:
• Clinical Trial
• Randomized Controlled Trial

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 10393617 [PubMed - indexed for MEDLINE]

Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients.

Author(s): Chang AT, Boots RJ, Hodges PW, Thomas PJ, Paratz JD.
Department of Physiotherapy, University of Queensland, St Lucia, Australia. a.chang@shrs.uq.edu.au
Publication: Arch Phys Med Rehabil. 2004 Dec;85(12):1972-6.

OBJECTIVE: To investigate the effect of standing with assistance of the tilt table on ventilatory parameters and arterial blood gases in intensive care patients. DESIGN: Consecutive sample. SETTING: Tertiary referral hospital. PARTICIPANTS: Fifteen adult patients who had been intubated and mechanically ventilated for more than 5 days (3 subjects successfully weaned, 12 subjects being weaned). INTERVENTION: Passive tilting to 70 degrees from the horizontal for 5 minutes using a tilt table. MAIN OUTCOME MEASURES: Minute ventilation (VE), tidal volume (VT), respiratory rate, and arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2). RESULTS: Standing in the tilted position for 5 minutes produced significant increases in VE (P <.001) and produced both increases in respiratory rate (P <.001) and VT (P =.016) compared with baseline levels. These changes were maintained during the tilt intervention and immediately posttilt. Twenty minutes after the tilt, there were no significant changes in ventilatory measures of VE, VT, or arterial blood gases PaO2 and PaCO2 compared with initial values. CONCLUSIONS: Standing for 5 minutes with assistance of a tilt table significantly increased ventilation in critical care patients during and immediately after the intervention. There were no improvements in gas exchange posttilt. Using a tilt table provided an effective method to increase ventilation in the short term.

Categories: Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 15605335 [PubMed - indexed for MEDLINE]

Bone metabolism in quadriplegia: dissociation between calciuria and hydroxyprolinuria.

Author(s): Claus-Walker J, Spencer WA, Carter RE, Halstead LS, Meier RH 3rd, Campos RJ
Publication: Arch Phys Med Rehabil. 1975 Aug;56(8):327-32.

Relationships between duration of paralysis, recumbency, muscular activity, and urinary loss of calcium (Cau), phosphorus (Pu), and hydroxyproline (OHPu) were studied daily in 32 traumatic quadriplegic patients during comprehensive rehabilitation and randomly in those readmitted for treatment. Within days after onset, quadriplegic patients had increases in Pu, then OHPu, and finally, Cau. Patients actively engaged in rehabilitation exercises showed a steady fall in OHPu, whereas CAU remained high for up to 18 months. Patients paralyzed for over 18 months (late) had low Cau, Pu and OHPu; but if the patients were kept in bed, OHPu increased rapidly. Patients with early quadriplegia have an increased bone remodeling, suggesting that the excess OHPu and Cau are derived from resorbed bone. Patients with late quadriplegia have little bone remodeling, therefore the excess OHPu occurring during recumbency may be derived from the resorption of new collagen produced during the removal of weight bearing without further change in muscular activity. Resorbed new collagen is excreted in part as large, OHP-containing polypeptides; these were found in the urine of quadriplegic patients, and therefore were present in blood and may play a role in initiating ectopic bone and renal calculi. The presence of OHP in 11 bladder calculi from quadriplegic patients tends to support this hypothesis. These studies indicate that muscular activity and weight bearing influence the bone metabolism of quadriplegic patients and suggest that the presence in body fluids of increased catabolic products from bone may have a role in bone-related complications.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury , Improve Bladder Function

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Pubmed ID: 1156124 [PubMed - indexed for MEDLINE]

A long-term survey of the incidence of renal calculosis in paraplegia.

Author(s): Comarr AE.
Publication: J Urol. 1955 Oct;74(4):447-52.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury , Improve Bladder Function

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Pubmed ID: 13264308 [PubMed - indexed for MEDLINE]

Acute effects of whole-body vibration on muscle activity, strength, and power.

Author(s): Cormie P, Deane RS, Triplett NT, McBride JM.
Neuromuscular Laboratory, Department of Health, Leisure & Exercise Science, Appalachian State University, Boone, North Carolina 28608, USA.
Publication: J Strength Cond Res. 2006 May;20(2):257-61.

The purpose of this study was to investigate the effects of a single bout of whole-body vibration on isometric squat (IS) and countermovement jump (CMJ) performance. Nine moderately resistance-trained men were tested for peak force (PF) during the IS and jump height (JH) and peak power (PP) during the CMJ. Average integrated electromyography (IEMG) was measured from the vastus medialis, vastus lateralis, and biceps femoris muscles. Subjects performed the 2 treatment conditions, vibration or sham, in a randomized order. Subjects were tested for baseline performance variables in both the IS and CMJ, and were exposed to either a 30-second bout of whole-body vibration or sham intervention. Subjects were tested immediately following the vibration or sham treatment, as well as 5, 15, and 30 minutes posttreatment. Whole-body vibration resulted in a significantly higher (p < or = 0.05) JH during the CMJ immediately following vibration, as compared with the sham condition. No significant differences were observed in CMJ PP; PF during IS or IEMG of the vastus medialis, vastus lateralis, or biceps femoris during the CMJ; or IS between vibration and sham treatments. Whole-body vibration may be a potential warm-up procedure for increasing vertical JH. Future research is warranted addressing the influence of various protocols of whole-body vibration (i.e., duration, amplitude, frequency) on athletic performance.

Categories: Vibration While Standing , Improve Strength

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Pubmed ID: 16686550 [PubMed - indexed for MEDLINE]

Bone-loading response varies with strain magnitude and cycle number.

Author(s): Cullen DM, Smith RT, Akhter MP.
Osteoporosis Research Center, Creighton University, Omaha, Nebraska 68131, USA. dcullen@creighton.edu
Publication: J Appl Physiol. 2001 Nov;91(5):1971-6.

Mechanical loading stimulates bone formation and regulates bone size, shape, and strength. It is recognized that strain magnitude, strain rate, and frequency are variables that explain bone stimulation. Early loading studies have shown that a low number (36) of cycles/day (cyc) induced maximal bone formation when strains were high (2,000 microepsilon) (Rubin CT and Lanyon LE. J Bone Joint Surg Am 66: 397-402, 1984). This study examines whether cycle number directly affects the bone response to loading and whether cycle number for activation of formation varies with load magnitude at low frequency. The adult rat tibiae were loaded in four-point bending at 25 (-800 microepsilon) or 30 N (-1,000 microepsilon) for 0, 40, 120, or 400 cyc at 2 Hz for 3 wk. Differences in periosteal and endocortical formation were examined by histomorphometry. Loading did not stimulate bone formation at 40 cyc. Compared with control tibiae, tibiae loaded at -800 microepsilon showed 2.8-fold greater periosteal bone formation rate at 400 cyc but no differences in endocortical formation. Tibiae loaded at -1,000 microepsilon and 120 or 400 cyc had 8- to 10-fold greater periosteal formation rate, 2- to 3-fold greater formation surface, and 1-fold greater endocortical formation surface than control. As applied load or strain magnitude decreased, the number of cyc required for activation of formation increased. We conclude that, at constant frequency, the number of cyc required to activate formation is dependent on strain and that, as number of cyc increases, the bone response increases.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Vibration While Standing

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Pubmed ID: 11641332 [PubMed - indexed for MEDLINE]

Lower extremity functional neuromuscular stimulation in cases of spinal cord injury.

Author(s): Cybulski GR, Penn RD, Jaeger RJ.
Publication: Neurosurgery. 1984 Jul;15(1):132-46.

Functional neuromuscular stimulation (FNS) provides a mechanism for the activation of muscles paralyzed by injury to the spinal cord. Although this technique was first used to treat patients with spinal cord injury over 20 years ago, only recent advances in electronics and biomechanics have made it a promising aid for the rehabilitation of these patients. Thus far, restoration of palmar prehension and lateral prehension in quadriplegics and of standing and biped gait in paraplegics has been achieved under carefully controlled laboratory conditions. This article reviews the current status of FNS and its potential as a practical tool to aid spinal cord-injured patients. Neurosurgeons who care for these patients might be expected to be involved in the future use of FNS if implantable systems are developed and tested.

Categories: Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 6382044 [PubMed - indexed for MEDLINE]

Tilt table testing in childhood: improved sensitivity by non-invasive haemodynamic monitoring devices?

Author(s): Dalla Pozza R, Kleinmann A, Kozlik-Feldmann R, Netz H.
Department of Paediatric Cardiology, Ludwig-Maximilians-University, Munich, Germany. Robert.DallaPozza@med.unimuenchen.de
Publication: Acta Cardiol. 2006 Dec;61(6):615-21.

OBJECTIVE: Tilt table testing represents a valuable diagnostic method in suspected neurally mediated syncope. As sympathovagal imbalance and impaired baroreceptor sensitivity (BRS) have been observed in these patients, both methods were used in this study to investigate whether a combination of these parameters would improve sensitivity and whether specific patterns of neurally mediated syncopes would correspond to characteristic trends in heart rate variability (HRV) and BRS. METHODS AND RESULTS: Fifty-one pts. (29 female, mean age 14.5 +/- 3.9 y) with unexplained syncope and 15 control subjects (9 female, mean age 14.8 +/- 3.0 y) were tested following a standard tilt table test protocol. Power spectral analysis (PSA) of HRV and BRS calculation were used additionally to beat-to-beat blood pressure and ECG-monitoring. Twenty-three out of 51 pts. (45%) experienced a syncope after 18 +/- 10.2 min of tilting. In 2/23 patients (8.6%) a postural tachycardia syndrome (POTS), in 14/23 (60.8%) a neurally mediated syncope of mixed type, in 2/23 (8.6%) a vasodepressor syncope and in 5/23 (21.7%) a cardioinhibitory syncope with asystole were observed. PSA of HRV and BRS revealed a specificity, sensitivity, and positive and negative predictive values of the cut-off points in combination (LF/HF > or = 2.7 and BRS > or = 8) of 93.3%, 65.2%, 93% and 39%, respectively. CONCLUSION: In this study population, BRS and PSA of HRV were able to improve sensitivity of tilt testing after unexplained syncope. Specific BRS or HRV patterns in different mechanisms of neurally mediated syncope could not be identified possibly due to the small sample size.

Categories: Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 17205918 [PubMed - indexed for MEDLINE]

Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women.

Author(s): Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ.
Washington University School of Medicine, St. Louis, Missouri.
Publication: Ann Intern Med. 1988 Jun;108(6):824-8.

STUDY OBJECTIVE: To assess the effect of weight-bearing exercise training and subsequent detraining on lumbar bone mineral content in postmenopausal women. DESIGN: Non-randomized, controlled, short-term (9 months) trial and long-term (22 months) exercise training and detraining (13 months). SETTING: Section of applied physiology at a university school of medicine. PATIENTS: Thirty-five healthy, sedentary postmenopausal women, 55 to 70 years old. All women completed the study. There was 90% compliance with exercise training. INTERVENTIONS: All women were given calcium, 1500 mg daily. The exercise group did weight-bearing exercise (walking, jogging, stair climbing) at 70% to 90% of maximal oxygen uptake capacity for 50 to 60 min, 3 times weekly. MEASUREMENTS AND MAIN RESULTS: Bone mineral content increased 5.2% (95% confidence interval [CI], 2.0% to 8.4%; P = 0.0037) above baseline after short-term training whereas there was no change (-1.4%) in the control group. After 22 months of exercise, bone mineral content was 6.1% (95% CI, 3.9% to 8.3% above baseline; P = 0.0001) in the long-term training group. After 13 months of decreased activity, bone mass was 1.1% above baseline in the detraining group. CONCLUSIONS: Weight-bearing exercise led to significant increases above baseline in bone mineral content which were maintained with continued training in older, postmenopausal women. With reduced weight-bearing exercise, bone mass reverted to baseline levels. Further studies are needed to determine the threshold exercise prescription that will produce significant increases in bone mass.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 3259410 [PubMed - indexed for MEDLINE]

A review of standing frame features and their impact on user acceptability

Author(s): Daniels, N., Pinnington, L., Clift, M., Gopsill, C., Armstrong, A.
Publication: International Journal of Therapy and Rehabilitation

Over 70 standing frames are available in the UK. This equipment can be used by adults and children with a range of disabilities to help them achieve or maintain a standing posture. Variations exist between the styles of frames available and the features they offer. Factors such as positioning, comfort and personal acceptance can have a significant impact on duration and frequency of use. Practical issues, such as ease of use, adjustability, manoeuvrability and storage, can also affect the acceptance of such equipment.
To meet the diverse needs of different clinical groups and the changing needs of individuals, it is essential that appropriate features are selected. Awareness and knowledge of individual features and their appropriateness for user needs can help with successful frame selection and optimize the benefits of this intervention.
This article provides an overview of a selection of standing frame features and discusses their potential advantages and limitations in relation to the impact on user acceptability.

Find Article Here

Categories: Review of Literature

Cardiorespiratory fitness and muscular strength of wheelchair users.

Author(s): Davis GM, Kofsky PR, Kelsey JC, Shephard RJ.
Publication: Can Med Assoc J. 1981 Dec 15;125(12):1317-23.

The classification of lower-limb disabilities is commonly based on the site of the spinal cord lesion or the amount of functional muscle. Another important variable in assessing wheelchair users is their ability to carry out the activities of daily living. The cardiorespiratory fitness of those with lower-limb disabilities is usually assessed with arm-ergometry and wheelchair tests, each of which has some advantages. Muscle strength and endurance are also important aspects of the disabled person's ability to function. Fitness is often poor in the disabled, and normal wheelchair use does not seem to prove an adequate training stimulus. Exercise with an arm ergometer and with pulleys and participation in vigorous wheelchair sports can improve physical condition. Participation in exercise programs should be based on the results of a fitness assessment and on the level of the spinal cord lesion in those with paraplegia. Progression in such programs should be gradual to ensure that the exerciser does not become discouraged and drop out of classes before fitness is increased. Data on wheelchair athletes suggest that, with persistence, many individuals in wheelchairs can adjust relatively well to their disabilities.

Categories: Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 6459841 [PubMed - indexed for MEDLINE]

Changes of tibia bone properties after spinal cord injury: effects of early intervention.

Author(s): De Bruin ED, Frey-Rindova P, Herzog RE, Dietz V, Dambacher MA, Stussi E.
Department of Material Sciences, Laboratory for Biomechanics ETH, Zurich, Switzerland.
Publication: Arch Physical Medicine Rehabilitation. 1999 Feb;80(2):214-20.

OBJECTIVE: To evaluate the effectiveness of an early intervention program for attenuating bone mineral density loss after acute spinal cord injury (SCI) and to estimate the usefulness of a multimodality approach in diagnosing osteoporosis in SCI. DESIGN: A single-case, experimental, multiple-baseline design. SETTING: An SCI center in a university hospital. METHODS: Early loading intervention with weight-bearing by standing and treadmill walking. PATIENTS: Nineteen patients with acute SCI. OUTCOME MEASURES: (1) Bone density by peripheral computed tomography and (2) flexural wave propagation velocity with a biomechanical testing method. RESULTS: Analysis of the bone density data revealed a marked decrease of trabecular bone in the nonintervention subjects, whereas early mobilized subjects showed no or insignificant loss of trabecular bone. A significant change was observed in 3 of 10 subjects for maximal and minimal area moment of inertia. Measurements in 19 subjects 5 weeks postinjury revealed a significant correlation between the calculated bending stiffness of the tibia and the maximal and minimal area moment of inertia, respectively. CONCLUSION: A controlled, single-case, experimental design can contribute to an efficient tracing of the natural history of bone mineral density and can provide relevant information concerning the efficacy of early loading intervention in SCI. The combination of bone density and structural analysis could, in the long term, provide improved fracture risk prediction in patients with SCI and a refined understanding of the bone remodeling processes during initial immobilization after injury.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization , Spinal Cord Injury

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Pubmed ID: 10025500 [PubMed - indexed for MEDLINE]

Soleus motor neuron excitability before and after standing.

Author(s): Deshpande P, Shields RK.
Graduate Program in Physical Therapy & Rehabilitation Science, The University of Iowa, Iowa City, Iowa 52242-1190, USA.
Publication: Electromyogr Clin Neurophysiol. 2004 Jul-Aug;44(5):259-64.

H-reflexes have been used to assess the effect of various postures on the excitability of the soleus motor neuronal pool. The purpose of this study was to determine if the excitability of the motor neuron pool, measured via H-reflexes in a seated position, change after a standing protocol in able-bodied individuals. We hypothesized that the excitability of the motor neuronal pool is minimally affected by the standing protocol leading to a reproducible H-reflex. Ten healthy individuals (height = 69.05+/-2.27 inches, weight = 161.7+/-22.44 lbs, age = 27.7+/-7.0 years) participated in the study. Soleus H-reflex recruitment curves were established before and after a standing protocol in a seated position. The standing protocol involved 12 minutes of active upright standing interspersed with 10 minutes of relaxed passive standing in a standing frame, similar to a protocol currently used for spinal cord injured subjects. The maximum M-waves and H-reflex amplitudes were not systematically changed before and after standing. There was also a strong agreement between the H-reflexes and M-waves measured before and after standing (ICC = 0. 99 and .96, respectively). We conclude that the H-reflexes measured in this study were reproducible, indicating that standing had no long lasting effect on the motor neuronal pool excitability. The findings support that the method discussed in this report is appropriate to assess the effects of electrically induced standing on motor neuron pool excitability in individuals with spasticity from spinal cord injury.

Categories: Reduce Spasticity, Tone, Spasms , Spinal Cord Injury , Develop or Improve Motor Ability

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Pubmed ID: 15378863 [PubMed - indexed for MEDLINE]

Predicting renal calculus occurrence in spinal cord injury patients.

Author(s): DeVivo MJ, Fine PR.
Publication: Arch Phys Med Rehabil. 1986 Oct;67(10):722-5

This case-control study develops a model to predict the occurrence of renal calculi in patients with spinal cord injury (SCI). Risk factors were assessed at the time of diagnosis in 25 patients who developed calculi, and at a comparable postinjury time period in 100 patients with SCI who remained calculus-free several years after injury. Logistic regression analysis was used to develop a predictive model; accuracy was assessed by using the model to classify all 125 patients studied. Renal calculi occurred more frequently on the right side and 72% of the affected patients developed a second calculus within two years. Patients who developed renal calculi were more likely to be older, have neurologically complete quadriplegia, have Klebsiella or Serratia infections, a history of bladder calculi, and high serum calcium values. The predictive model was 84% sensitive and 81% specific. While other determinants of renal calculi undoubtedly exist, these findings demonstrate that high risk patients may be identified with a comparatively small set of predictor variables. Although these findings are encouraging, use of any predictive model is meant only to supplement and not replace clinical judgement.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury , Improve Bladder Function

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Pubmed ID: 3767621 [PubMed - indexed for MEDLINE]

Effect of prolonged bed rest on bone mineral.

Author(s): Donaldson CL, Hulley SB, Vogel JM, Hattner RS, Bayers JH, McMillan DE.
Publication: Metabolism. 1970 Dec; 19(12): 1071-84

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization

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Pubmed ID: 4321644 [PubMed - indexed for MEDLINE]

Standing and walking for the T6 paraplegic.

Author(s): Duffus A, Wood J.
Publication: Physiotherapy. 1983 Feb;69(2):45-6.

Categories: Improve Circulation/Respiratory/ Cardio Function , Spinal Cord Injury

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Pubmed ID: 6867159 [PubMed - indexed for MEDLINE]

Follow-up assessment of standing mobility device users.

Author(s): Dunn RB, Walter JS, Lucero Y, Weaver F, Langbein E, Fehr L, Johnson P, Riedy L.
Rehabilitation Research & Development Center, Edward Hines Jr. Veterans Affairs Hospital, Illinois 60141, USA.
Publication: Assistive Technology. 1998;10(2):84-93.

The use of standing devices by spinal cord-injured subjects was investigated through a national survey of a sample of individuals who returned their manufacturer's warranty card to two companies. We obtained a 32% response rate (99/310). The majority of respondents were male (87%) with a median age between 41 and 50 years. Seventy-seven percent were paraplegic and 21% were quadriplegic. Forty percent had between 1 and 5 years experience with their device, and 84% of those responding were currently using their standing device. Forty-one percent used their standing device one to six times a week; two-thirds stood between 30 minutes and 1 hour for each use. Less than 10% of subjects experienced any side effects, such as nausea or headaches, from standing. Twenty-one percent of subjects reported being able to empty their bladder more completely. There was also a favorable response by some individuals on the effects of the standing devices on bowel regularity, reduction of urinary tract infections, leg spasticity, and number of bedsores. Finally, 79% of subjects highly recommended use of standing devices to other people with spinal cord injury. The positive responses of individuals using standing devices is a strong recommendation for the assistive technology community to make these devices more available to individuals with spinal cord injury.

Categories: Improve Bowel Function & Digestion , Mobile / Dynamic Standing , Prevent Pressure Ulcers/Maintain Skin Integrity , Reduce Spasticity, Tone, Spasms , Review of Literature , Spinal Cord Injury , Increase Self-Care , Improve Bladder Function , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 10339284 [PubMed - indexed for MEDLINE]

Effect of dynamic weight bearing on neuromuscular activation after spinal cord injury.

Author(s): Edwards LC, Layne CS.
Laboratory of Integrated Physiology, 3855 Holman Street, Houston, TX 77204, USA.
Publication: Am J Phys Med Rehabil. 2007 Jun;86(6):499-506.

OBJECTIVE: To determine whether individuals who have a spinal cord injury have neuromuscular and physiologic responses to a personalized exercise program during dynamic weight bearing (DWB). DESIGN: Four subjects with spinal cord injuries (T6, T5-6, C2-5, and C5) completed a 12-wk exercise program that included DWB. Surface electromyography (EMG) was recorded from the right gastrocnemius, biceps femoris, rectus femoris, rectus abdominus, and external oblique. Heart rate (HR) and blood pressure (BP) were recorded throughout training. Descriptive statistics were used to analyze the data. RESULTS: The results of this study indicate that the subjects actively responded to exercise during DWB, as measured by EMG, HR, and BP. CONCLUSIONS: The results suggest that exercise during DWB can induce physiologic and neuromuscular responses in individuals who have a spinal cord injury, and that exercise during DWB may serve as a preparatory program for more advanced rehabilitation.

Categories: Improve Circulation/Respiratory/ Cardio Function , Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation) , Improve Strength

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Pubmed ID: 17515690 [PubMed - indexed for MEDLINE]

Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke.

Author(s): Eng JJ, Chu KS.
School of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada. Janicee@interchange.ubc.ca
Publication: Arch Phys Med Rehabilitation. 2002 Aug;83(8):1138-44.

OBJECTIVES: To determine the test-retest reliability over 2 separate days for weight-bearing ability during standing tasks in individuals with chronic stroke and to compare the weight-bearing ability among 5 standing tasks for the paretic and nonparetic limbs. DESIGN: Prospective study using a convenient sample. SETTING: Free-standing tertiary rehabilitation center. PARTICIPANTS: Fifteen community-dwelling stroke individuals with moderate motor deficits; volunteer sample. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Weight-bearing ability as measured by the vertical ground reaction force during 5 standing tasks (rising from a chair, quiet standing, weight-shifting forward, backward, laterally). RESULTS: The weight-bearing ability was less for the paretic limb compared with the nonparetic limb, but the intraclass correlation coefficients were high (.95-.99) for both limbs between the 2 sessions for all 5 tasks. The forward weight-shifting ability was particularly low in magnitude on the paretic side compared with the other weight-shifting tasks. In addition, the forward weight-shift ability of the nonparetic limb was also impaired but to a lesser extent. Large asymmetry was evident when rising from a chair, with the paretic limb bearing a mean 296N and the nonparetic side bearing a mean 458N. The weight-bearing ability during all 5 tasks correlated with one another (r range,.56-.94). CONCLUSIONS: Weight-bearing ability can be reliably measured and may serve as a useful outcome measure in individuals with stroke. We suggest that impairments of the hemiparetic side during forward weight shifting and sit-to-stand tasks presents a challenge to the motor systems of individuals with stroke, which may account for the poor balance that is often observed in these individuals. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Categories: Reduce Spasticity, Tone, Spasms , Stroke

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Pubmed ID: 12161837 [PubMed - indexed for MEDLINE]

Use of prolonged standing for individuals with spinal cord injuries.

Author(s): Eng JJ, Levins SM, Townson AF, Mah-Jones D, Bremner J, Huston G.
School of Rehabilitation Sciences, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5.janicee@interchange.ubc.ca
Publication: Phys Ther. 2001 Aug;81(8):1392-9.

BACKGROUND AND PURPOSE: Prolonged standing in people with spinal cord injuries (SCIs) has the potential to affect a number of health-related areas such as reflex activity, joint range of motion, or well-being. The purpose of this study was to document the patterns of use of prolonged standing and their perceived effects in subjects with SCIs. SUBJECTS: The subjects were 152 adults with SCIs (103 male, 49 female; mean age=34 years, SD=8, range=18-55) who returned mailed survey questionnaires. METHODS: A 17-item self-report survey questionnaire was sent to the 463 members of a provincial spinal cord support organization. RESULTS: Survey responses for 26 of the 152 respondents were eliminated from the analysis because they had minimal effects from their injuries and did not need prolonged standing as an extra activity. Of the 126 remaining respondents, 38 respondents (30%) reported that they engaged in prolonged standing for an average of 40 minutes per session, 3 to 4 times a week, as a method to improve or maintain their health. The perceived benefits included improvements in several health-related areas such as well-being, circulation, skin integrity, reflex activity, bowel and bladder function, digestion, sleep, pain, and fatigue. The most common reason that prevented the respondents from standing was the cost of equipment to enable standing. DISCUSSION AND CONCLUSION: Considering the many reported benefits of standing, this activity may be useful for people with SCI. This study identified a number of body systems and functions that may need to be investigated if clinical trials of prolonged standing in people with SCI are undertaken.

Categories: Improve Bowel Function & Digestion , Improve Circulation/Respiratory/ Cardio Function , Prevent Pressure Ulcers/Maintain Skin Integrity , Promote Psychosocial Skills and Improve Sleep , Reduce Spasticity, Tone, Spasms , Review of Literature , Spinal Cord Injury , Improve Pain Management , Increase Self-Care , Improve Bladder Function

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Pubmed ID: 11509069 [PubMed - indexed for MEDLINE]

Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury.

Author(s): Faghri PD, Yount JP, Pesce WJ, Seetharama S, Votto JJ.
School of Allied Health, University of Connecticut, Storrs, CT 06269-2101, USA. Pouran.Faghri@uconn.edu
Publication: Arch Phys Med Rehabil. 2001 Nov;82(11):1587-95

OBJECTIVE: To evaluate the effects of functional electric stimulation (FES) of lower limb muscles during 30 minutes of upright standing on the central and peripheral hemodynamic response in persons with spinal cord injury (SCI). DESIGN: A repeated-measure design. Subjects were used as their own control and underwent 2 testing protocols of FES-augmented standing (active standing) and non-FES standing (passive standing). SETTING: Rehabilitation hospital. PARTICIPANTS: Fourteen individuals with SCI (7 with tetraplegia, 7 with paraplegia). INTERVENTIONS: During active standing, FES was administered to 4 muscle groups of each leg in an overlapping fashion to produce a pumping mechanism during standing. During passive standing, subjects stood for 30 minutes using a standing frame with no FES intervention. MAIN OUTCOME MEASURES: Central hemodynamic responses of stroke volume, cardiac output, heart rate, arterial blood pressure, total peripheral resistance (TPR), and rate pressure product (RPP) were evaluated by impedance cardiography. All measurements were performed during supine and sitting positions before and after standing, and during 30 minutes of upright standing. RESULTS: Comparisons between the groups with paraplegia and tetraplegia showed a significant increase in heart rate in the paraplegics after 30 minutes of active standing. During active standing, paraplegics' heart rate increased by 18.2% (p = .015); during passive standing, it increased by 6% (p = .041). TPR in the tetraplegics significantly (p = .003) increased by 54% when compared with the paraplegics during passive standing. Overall, the tetraplegic group had a significantly lower systolic blood pressure (p = .013) and mean arterial pressure (p = .048) than the paraplegics during passive standing. These differences were not detected during active standing. When data were pooled from both groups and the overall groups response to active and passive standing were compared, the results showed that cardiac output, stroke volume, and blood pressure significantly decreased (p < .05) during 30 minutes of passive standing, whereas TPR significantly increased (p < .05). All of the hemodynamic variables were maintained during 30 minutes of active standing, and there were increases in RPP and heart rate after 30 minutes of active standing. CONCLUSION: FES of the lower extremity could be used by persons with SCI as an adjunct during standing to prevent orthostatic hypotension and circulatory hypokinesis. This effect may be more beneficial to those with tetraplegia who have a compromised autonomic nervous system and may not be able to adjust their hemodynamics to the change in position. Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Categories: Improve Circulation/Respiratory/ Cardio Function , Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 11689980 [PubMed - indexed for MEDLINE]

Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury.

Categories: Improve Circulation/Respiratory/ Cardio Function , Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 11689980 [PubMed - indexed for MEDLINE]

Pressure sore prevention for the wheelchair-bound spinal injury patient.

Author(s): Ferguson-Pell MW, Wilkie IC, Reswick JB, Barbenel JC.
Publication: Paraplegia. 1980 Feb;18(1):42-51.

The concept of a wheelchair cushion fitting clinic for the prevention of pressure sores is reviewed in the light of recent estimates of the cost of pressure sores in the U.K. A method for measuring the pressure beneath the ischial tuberosities is discussed and techniques for measuring a patient's habitual exercise frequency and seated posture are described. Results from the records of 600 spinal injury patients including Rancho Los Amigos Hospital are reported and used to demonstrate the importance of low pressure beneath the ischial tuberosities as an indicator of wheelchair cushion suitability.

Categories: Prevent Pressure Ulcers/Maintain Skin Integrity , Spinal Cord Injury

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Pubmed ID: 7375126 [PubMed - indexed for MEDLINE]

Moving the arms to activate the legs.

Author(s): Ferris DP, Huang HJ, Kao PC.
Department of Movement Science, University of Michigan, Ann Arbor, MI 48109-2214, USA. ferrisdp@umich.edu
Publication: Exerc Sport Sci Rev. 2006 Jul;34(3):113-20.

Recent studies on neurologically intact individuals and individuals with spinal cord injury indicate that rhythmic upper limb muscle activation has an excitatory effect on lower limb muscle activation during locomotor-like tasks. This finding suggests that gait rehabilitation therapy after neurological injury should incorporate simultaneous upper limb and lower limb rhythmic exercise to take advantage of neural coupling.

Categories: Active (Reciprocal Leg Movement) Standing , Spinal Cord Injury

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Pubmed ID: 16829738 [PubMed - indexed for MEDLINE]

Femoral loads during passive, active, and active-resistive stance after spinal cord injury: a mathematical model.

Author(s): Frey Law LA, Shields RK.
Graduate Program in Physical Therapy and Rehabilitation Science, The University of Iowa, 1-252 Medical Education Building, Iowa City, IA 52242, USA.
Publication: Clin Biomech (Bristol, Avon). 2004 Mar;19(3):313-21.

OBJECTIVE: The purpose of this study was to estimate the loading environment for the distal femur during a novel standing exercise paradigm for people with spinal cord injury. DESIGN: A mathematical model based on experimentally derived parameters. BACKGROUND: Musculoskeletal deterioration is common after spinal cord injury, often resulting in osteoporotic bone and increased risk of lower extremity fracture. Potential mechanical treatments have yet to be shown to be efficacious; however, no previous attempts have been made to quantify the lower extremity loading during passive, active, and active-resistive stance. METHODS: A static, 2-D model was developed to estimate the external forces; the activated quadriceps forces; and the overall bone compression and shear forces in the distal femur during passive (total support of frame), active (quadriceps activated minimally), and active-resistive (quadriceps activated against a resistance) stance. RESULTS: Passive, active, and active-resistive stance resulted in maximal distal femur compression estimates of approximately 45%, approximately 75%, and approximately 240% of body weight, respectively. Quadriceps force estimates peaked at 190% of body weight with active-resistive stance. The distal femur shear force estimates never exceeded 24% of body weight with any form of stance. CONCLUSIONS: These results support our hypothesis that active-resistive stance induces the highest lower extremity loads of the three stance paradigms, while keeping shear to a minimum. RELEVANCE: This model allows clinicians to better understand the lower extremity forces resulting from passive, active, and active-resistive stance in individuals with spinal cord injury.

Categories: Active (Reciprocal Leg Movement) Standing , Spinal Cord Injury

For the complete document, please visit www.pubmed.com or your local medical library.
Pubmed ID: 15003348 [PubMed - indexed for MEDLINE]

Pressure ulcers in veterans with spinal cord injury: a retrospective study.

Author(s): Garber SL, Rintala DH.
Houston Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX 77030, USA. sgarber@bcm.tmc.edu
Publication: J Rehabil Res Dev. 2003 Sep-Oct;40(5):433-41.

Pressure ulcers are a major complication of spinal cord injury (SCI) and have a significant effect on general health and quality of life. The objectives of this retrospective chart review were to determine prevalence, duration, and severity of pressure ulcers in veterans with SCI and to identify predictors of (1) outcome in terms of healing without surgery, not healing, or referral for surgery; (2) number of visits veterans made to the SCI outpatient clinic or received from home care services for pressure ulcer treatment; and (3) number of hospital admissions and days hospitalized for pressure ulcer treatment. From a sampling frame of 553 veterans on the Houston Veterans Affairs Medical Center SCI roster, 215 (39%) were reported to have visited the clinic or received home care for pressure ulcers (ICD-9 code 707.0 = decubitus, any site) during the 3 years studied (1997, 1998, and 1999). From this sample, 102 veterans met the inclusion criteria for further analyses, 56% of whom had paraplegia. The duration of ulcers varied greatly from 1 week to the entire 3-year time-frame. Overall, Stage IV pressure ulcers were the most prevalent as the worst ulcer documented. Number and severity of ulcers predicted outcome and healthcare utilization. This study illustrates the magnitude of the pressure ulcer problem among veterans with SCI living in the community. Reducing the prevalence of pressure ulcers among veterans with SCI will have a significant impact on the Department of Veterans Affairs' financial and social resources. Innovative approaches are needed to reduce pressure ulcer risk in veterans with SCI.

Categories: Prevent Pressure Ulcers/Maintain Skin Integrity , Spinal Cord Injury

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Pubmed ID: 15080228 [PubMed - indexed for MEDLINE]

Osteoporosis after spinal cord injury.

Author(s): Garland DE, Stewart CA, Adkins RH, Hu SS, Rosen C, Liotta FJ, Weinstein DA.
Department of Neurotrauma, Rancho Los Amigos Medical Center, Downey, California 90242.
Publication: J Orthop Res. 1992 May;10(3):371-8.

Dual-photon absorptiometry characterized bone loss in males aged less than 40 years after complete traumatic paraplegic and quadriplegic spinal cord injury. Total bone mass of various regions and bone mineral density (BMD) of the knee were measured in 55 subjects. Three different populations were partitioned into four groups: 10 controls (healthy, age matched); 25 acutely injured (114 days after injury), with 12 reexamined 16 months after injury; and 20 chronic (greater than 5 years after injury). Significant differences (p less than 0.0001) in bone mass mineral between groups at the arms, pelvis, legs, distal femur, and proximal tibia were found, with no differences for the head or trunk. Post hoc analyses indicated no differences between the acutely injured at 16 months and the chronically injured. Paraplegic and quadriplegic subjects were significantly different only at the arms and trunk, but were highly similar at the pelvis and below. In the acutely injured, a slight but statistically insignificant rebound was noted above the pelvis. Regression techniques demonstrated early, rapid, linear (p less than 0.0001) decline of bone below the pelvis. Bone mineral loss occurs throughout the entire skeleton, except the skull. Most bone loss occurs rapidly and below the pelvis. Homeostasis is reached by 16 months at two thirds of original bone mass, near fracture threshold.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury

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Pubmed ID: 1569500 [PubMed - indexed for MEDLINE]

New assistive technology for passive standing.

Author(s): Gear AJ, Suber F, Neal JG, Nguyen WD, Edlich RF.
Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA.
Publication: J Burn Care Rehabil. 1999 Mar-Apr;20(2):164-9.

The anesthetic skin of patients with spinal cord injuries makes these patients a high-risk population for burn injuries. Innovations in rehabilitation engineering can now provide the disabled with mechanical devices that allow for passive standing. Passive standing has been shown to counteract many of the effects of chronic immobilization and spinal cord injury, including bone demineralization, urinary calculi, cardiovascular instability, and reduced joint range of motion and muscular tone. This article will describe several unique assistive devices that allow for passive standing and an improvement in daily living for people with disabilities.

Categories: Effects of Immobilization , Prevent Pressure Ulcers/Maintain Skin Integrity , Spinal Cord Injury

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Pubmed ID: 10188115 [PubMed - indexed for MEDLINE]

Skeletal adaptations to alterations in weight-bearing activity: a comparison of models of disuse osteoporosis.

Author(s): Giangregorio L, Blimkie CJ.
Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada.
Publication: Sports Med. 2002;32(7):459-76.

The removal of regular weight-bearing activity generates a skeletal adaptive response in both humans and animals, resulting in a loss of bone mineral. Human models of disuse osteoporosis, namely bed rest, spinal cord injury and exposure to micro-gravity demonstrate the negative calcium balance, alterations in biochemical markers of bone turnover and resultant loss of bone mineral in the lower limbs that occurs with reduced weight-bearing loading. The site-specific nature of the bone response is consistent in all models of disuse; however, the magnitude of the skeletal adaptive response may differ across models. It is important to understand the various manifestations of disuse osteoporosis, particularly when extrapolating knowledge gained from research using one model and applying it to another. In rats, hindlimb unloading and exposure to micro-gravity also result in a significant bone response. Bone mineral is lost, and changes in calcium metabolism and biochemical markers of bone turnover similar to humans are noted. Restoration of bone mineral that has been lost because of a period of reduced weight bearing may be restored upon return to normal activity; however, the recovery may not be complete and/or may take longer than the time course of the original bone loss. Fluid shear stress and altered cytokine activity may be mechanistic features of disuse osteoporosis. Current literature for the most common human and animal models of disuse osteoporosis has been reviewed, and the bone responses across models compared.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization , Spinal Cord Injury

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Pubmed ID: 12015807 [PubMed - indexed for MEDLINE]

Bone loss and muscle atrophy in spinal cord injury: epidemiology, fracture prediction, and rehabilitation strategies.

Author(s): Giangregorio L, McCartney N.
Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada. lmgiangr@uwaterloo.ca
Publication: J Spinal Cord Med. 2006;29(5):489-500.

Individuals with spinal cord injury (SCI) often experience bone loss and muscle atrophy. Muscle atrophy can result in reduced metabolic rate and increase the risk of metabolic disorders. Sublesional osteoporosis predisposes individuals with SCI to an increased risk of low-trauma fracture. Fractures in people with SCI have been reported during transfers from bed to chair, and while being turned in bed. The bone loss and muscle atrophy that occur after SCI are substantial and may be influenced by factors such as completeness of injury or time post injury. A number of interventions, including standing, electrically stimulated cycling or resistance training, and walking exercises have been explored with the aim of reducing bone loss and/or increasing bone mass and muscle mass in individuals with SCI. Exercise with electrical stimulation appears to increase muscle mass and/or prevent atrophy, but studies investigating its effect on bone are conflicting. Several methodological limitations in exercise studies with individuals with SCI to date limit our ability to confirm the utility of exercise for improving skeletal status. The impact of standing or walking exercises on muscle and bone has not been well established. Future research should carefully consider the study design, skeletal measurement sites, and the measurement techniques used in order to facilitate sound conclusions.

Categories: Active (Reciprocal Leg Movement) Standing , Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 17274487 [PubMed - indexed for MEDLINE]

The use of standing frames for contracture management for nonmobile children with cerebral palsy.

Author(s): Gibson SK, Sprod JA, Maher CA.
Physical Rehabilitation, Novita Children's Services, South Australia, Australia. carol.maher@unisa.edu.au
Publication: Int J Rehabil Res. 2009 Dec;32(4):316-23.

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.

Categories: Cerebral Palsy , Effects of Immobilization , Weight Bearing & FES (Functional Electrical Stimulation) , Improve Range of Motion, Prevent Contractures , School-Based Therapy

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Pubmed ID: PMID: 19901618 [PubMed - indexed for MEDLINE]

Bone mineral status in paraplegic patients who do or do not perform standing.

Author(s): Goemaere S, Van Laere M, De Neve P, Kaufman JM.
Department of Rheumatology, University Hospital of Ghent, Belgium.
Publication: Osteoporos Int. 1994 May;4(3):138-43.

Bone mineral density (BMD) was assessed by dual-photon X-ray absorptiometry at the lumbar spine (L3, L4), the proximal femur and the femoral shaft, and by single-photon absorptiometry at the forearm in 53 patients with complete traumatic paraplegia of at least 1 year's duration and in age- and sex-matched healthy controls. The patients did (n = 38) or did not (n = 15) regularly perform passive weightbearing standing with the aid of a standing device. Compared with the controls, the BMD of paraplegic patients was preserved in the lumbar spine and was markedly decreased in the proximal femur (33%) and the femoral shaft (25%). When considering all patients performing standing, they had a better-preserved BMD at the femoral shaft (p = 0.009), but not at the proximal femur, than patients not performing standing. BMD at the lumbar spine (L3, L4) was marginally higher in the standing group (significant only for L3; p = 0.040). A subgroup of patients performing standing with use of long leg braces had a significantly higher BMD at the proximal femur than patients using a standing frame or a standing wheelchair (p = 0.030). The present results suggest that passive mechanical loading can have a beneficial effect on the preservation of bone mass in osteoporosis found in paraplegics.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury

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Pubmed ID: 8069052 [PubMed - indexed for MEDLINE]

The effect of posture on bladder pressure

Author(s): Gould, D.W., Hsieh, A.C., Tinckler, L.F.
Publication: Journal of Physiology

SUMMARY
1. Intravesical and intragastric pressures, together with respirations, have been recorded in five human subjects in various postures.
2. Moving from the horizontal to the upright position produces a two- to threefold rise or more in bladder pressure.
3. This rise in bladder pressure is probably due to the weight of the abdominal contents bearing upon the organ.
4. The fact is noted that in certain persons in the upright position, deep inspiration causes a sharp fall in intra-abdominal pressure.

Categories:

The effect of posture on bladder pressure

Author(s): Gould, D.W., Hsieh, A.C., Tinckler, L.F.
Publication: Journal of Physiology

Categories: Improve Bladder Function

A motorized dynamic stander.

Author(s): Gudjonsdottir B, Mercer VS.
Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Publication: Pediatr Phys Ther. 2002 Spring;14(1):49-51.

PURPOSE: The purpose of this clinical suggestion is to describe a new type of a stander, a dynamic stander. KEY POINTS: The dynamic stander may give children with severe cerebral palsy an opportunity for movement in lower extremities and trunk while they are standing. It may increase their tolerance for standing in a stander for a considerable period of time. In addition, the potential for increased bone mineral density might be greater with a dynamic stander than a conventional stander. The design, development, and initial clinical use of the new type of stander is described. SUMMARY: Some minor problems related to the design of the dynamic stander were noted. Design changes to correct these problems could be easily implemented before the introduction of the stander for more widespread clinical use.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy , Mobile / Dynamic Standing , Promote Psychosocial Skills and Improve Sleep

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Pubmed ID: 17053681 [PubMed - indexed for MEDLINE]

Hip and Spine in Children with Cerebral Palsy: Musculoskeletal Development and Clinical Implications.

Author(s): Gudjonsdottir, B., Mercer, V.S.
Publication: Pediatric Physical Therapy

Development of the musculoskeletal system in children with cerebral palsy can be very different from development in children without disabilities. Hip and spine problems are common in children who are more severely involved. The purpose of this article is to review the literature related to the development of the hip and spine in children with cerebral palsy and to discuss the clinical implications of this information. According to the literature, primary causes of abnormal development of the hip and spine include muscle imbalances, abnormal positioning, and delayed or insufficient weight-bearing. Secondary complications include contractures, malformation of joints, decreased bone mineral density, and increased incidence of fractures. Development of musculoskeletal deformities is often accompanied by pain, difficulty in maintaining sitting and standing postures, and limited functional abilities. Physical therapy should focus on slowing the progression of deformity, avoiding positioning that contributes to its development, and improving bone modeling by weight-bearing with good alignment.

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Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy , Promote Psychosocial Skills and Improve Sleep

Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity.

Author(s): Hägglund G, Andersson S, Düppe H, Lauge-Pedersen H, Nordmark E, Westbom L
Department of Orthopedics, University Hospital, Lund, Sweden. Gunnar.Hagglund@ort.lu.se
Publication: J Pediatr Orthop B. 2005 Jul;14(4):269-73.

During the 1990s three new techniques to reduce spasticity and dystonia in children with cerebral palsy (CP) were introduced in southern Sweden: selective dorsal rhizotomy, continuous intrathecal baclofen infusion and botulinum toxin treatment. In 1994 a CP register and a health care programme, aimed to prevent hip dislocation and severe contractures, were initiated in the area. The total population of children with CP born 1990-1991, 1992-1993 and 1994-1995 was evaluated and compared at 8 years of age. In non-ambulant children the passive range of motion in hip, knee and ankle improved significantly from the first to the later age groups. Ambulant children had similar range of motion in the three age groups, with almost no severe contractures. The proportion of children treated with orthopaedic surgery for contracture or skeletal torsion deformity decreased from 40 to 15% (P = 0.0019). One-fifth of the children with spastic diplegia had been treated with selective dorsal rhizotomy. One-third of the children born 1994-1995 had been treated with botulinum toxin before 8 years of age. With early treatment of spasticity, early non-operative treatment of contracture and prevention of hip dislocation, the need for orthopaedic surgery for contracture or torsion deformity is reduced, and the need for multilevel procedures seems to be eliminated.

Categories: Cerebral Palsy , Reduce Spasticity, Tone, Spasms , Improve Hip Integrity

Swedish National Health Care Quality Programme for prevention of hip dislocation and severe contractures in cerebral palsy.

Author(s): Hagglund, G.
Lund University Hospital, Department of Orthopedics, Sweden
Publication: Proceedings from the 6th World Congress on Conductive Education.

INTRODUCTION:
Children with cerebral palsy (CP) often have an increased muscle tone, muscle weakness and muscle imbalance. For this reason, they are at an increased risk of developing muscle contracture, hip dislocation and scoliosis. Hip dislocation in CP results in significant morbidity in terms of pain, contractures, sitting/standing/walking problems, fractures, skin ulceration and problems with perineal care, pelvic obliquity and scoliosis.
The first report indicating that hip dislocation in CP is preventable was published fifty years ago.

On the basis of this knowledge, CPUP, a cerebral palsy register and a health care programme for children with CP, was established in southern Sweden in 1994. All children with CP, who were born in the area since 1992 were included. The main goal of the programme is to prevent hip dislocation and severe contractures. Other aims of the programme are to describe the course of functioning and development in CP, to evaluate treatment methods and increase cooperation between health care professionals.

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Categories: Cerebral Palsy , Improve Hip Integrity , Improve Range of Motion, Prevent Contractures

Randomised trial of the effects of four weeks of daily stretch on extensibility of hamstring muscles in people with spinal cord injuries.

Author(s): Harvey LA, Byak AJ, Ostrovskaya M, Glinsky J, Katte L, Herbert RD.
Moorong Spinal Injury Unit, Royal Rehabilitation Centre Sydney, Ryde, NSW 2112, Australia. harveyl@doh.health.nsw.gov.au
Publication: Aust J Physiother. 2003;49(3):176-81.

The aim of this assessor-blind randomised controlled trial was to determine the effect of four weeks of 30 minute stretches each weekday on extensibility of the hamstring muscles in people with recent spinal cord injuries. A consecutive sample of 16 spinal cord-injured patients with no or minimal voluntary motor power in the lower limbs and insufficient hamstring muscle extensibility to enable optimal long sitting were recruited. Subjects' legs were randomly allocated to experimental and control conditions. The hamstring muscles of the experimental leg of each subject were stretched with a 30 Nm torque at the hip for 30 minutes each weekday for four weeks. The hamstring muscles of the contralateral leg were not stretched during this period. Extensibility of the hamstring muscles (hip flexion range of motion with knee extended, measured with a 48 Nm torque at the hip) of both legs was measured by a blinded assessor at the commencement of the study and one day after the completion of the four-week stretch period. Changes in hamstring muscle extensibility from initial to final measurements were calculated. The effect of stretching was expressed as the mean difference in these changes between stretched and non-stretched legs. The mean effect of stretching was 1 degree (95% CI -2 to 5 degrees). Four weeks of 30 minute stretches each weekday does not affect the extensibility of the hamstring muscle in people with spinal cord injuries.

Categories: Spinal Cord Injury , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 12952517 [PubMed - indexed for MEDLINE]

Bone mineral content in preterm infants at age 4 to 16.

Author(s): Helin I, Landin LA, Nilsson BE.
Publication: Acta Paediatr Scand. 1985 Mar;74(2):264-7.

Using photon absorptiometry the forearm bone mineral content (BMC) was determined in 75 children aged 4 to 16, who all had a low birth weight. Forty-five of them were born preterm AGA (27 boys, 18 girls, mean weight 1 580 g; range 920-2 060 g) and 30 preterm SGA (17 boys, 13 girls, mean weight 1510; range 940-2130 g). The results were compared with a control group of children of the same age, and analyses of covariance with age, height and weight as the covariant factors were performed. The BMC, weight and height did not differ between the children born AGA or SGA. Irrespective of AGA or SGA, the BMC was significantly decreased in boys but the difference was less pronounced and less significant when height and weight were used as covariant factors. Boys who had been born preterm had a less BMC than the control boys for their age but they were also somewhat shorter and lighter than expected with regard to their age.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 3993373 [PubMed - indexed for MEDLINE]

Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy.

Author(s): Henderson RC, Kairalla JA, Barrington JW, Abbas A, Stevenson RD.
Department of Orthopaedics and Biostatistics, University of North Carolina, NC 27599, USA. rchh@med.unc.edu
Publication: J Pediatr. 2005 Jun;146(6):769-75

OBJECTIVE: To assess the natural history of "growth" in bone mineral density (BMD) in children and adolescents with moderate to severe cerebral palsy (CP). STUDY DESIGN: A prospective, longitudinal, observational study of BMD in 69 subjects with moderate to severe spastic CP ages 2.0 to 17.7 years. Fifty-five subjects were observed for more than 2 years and 40 subjects for more than 3 years. Each evaluation also included assessments of growth, nutritional status, Tanner stage, general health, and various clinical features of CP. RESULTS: Lower BMD z-scores at the initial evaluation were associated with greater severity of CP as judged by gross motor function and feeding difficulty, and with poorer growth and nutrition as judged by weight z-scores. BMD increased an average of 2% to 5%/y in the distal femur and lumbar spine, but ranged widely from +42%/y to -31%. In spite of increases in BMD, distal femur BMD z-scores decrease with age in this population. CONCLUSIONS: Children with severe CP develop over the course of their lives clinically significant osteopenia. Unlike elderly adults, this is not primarily from true losses in bone mineral, but from a rate of growth in bone mineral that is diminished relative to healthy children. The efficacy of interventions to increase BMD can truly be assessed only with a clear understanding of the expected changes in BMD without intervention.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 15973316 [PubMed - indexed for MEDLINE]

Bone density and metabolism in children and adolescents with moderate to severe cerebral palsy.

Author(s): Henderson RC, Lark RK, Gurka MJ, Worley G, Fung EB, Conaway M, Stallings VA, Stevenson RD.
Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina 27599, USA. rchh@med.unc.edu
Publication: Pediatrics. 2002 Jul;110(1 Pt 1):e5.

OBJECTIVES: Diminished bone density and a propensity to fracture with minimal trauma are common in children and adolescents with moderate to severe cerebral palsy (CP). The purpose of this study was to provide a detailed evaluation of bone mineral density (BMD) and metabolism in this population and to assess the relationship of these measures to multiple other clinical, growth, and nutrition variables. METHODS: The study group consisted of 117 subjects ages 2 to 19 years (mean: 9.7 years) with moderate to severe CP as defined by the Gross Motor Functional Classification scale. Population-based sampling was used to recruit 62 of the participants, which allows for estimations of prevalence. The remaining 55 subjects were a convenience sampling from both hospital- and school-based sources. The evaluation included measures of BMD, a detailed anthropometric assessment of growth and nutritional status, medical and surgical history, the Child Health Status Questionnaire, and multiple serum analyses. BMD was measured in the distal femur, a site specifically developed for use in this contracted population, and the lumbar spine. BMD measures were converted to age and gender normalized z scores based on our own previously published control series (n > 250). RESULTS: Osteopenia (BMD z score <-2.0) was found in the femur of 77% of the population-based cohort and in 97% of all study participants who were unable to stand and were older than 9 years. BMD was not as low in the lumbar spine (population-based cohort mean +/- standard error z score: -1.8 +/- 0.1) as in the distal femur (mean z score: -3.1 +/- 0.2). Fractures had occurred in 26% of the children who were older than 10 years. Multiple clinical and nutritional variables correlated with BMD z scores, but interpretation of these findings is complicated by covariance among variables. In stepwise regression analyses, it was found that severity of neurologic impairment as graded by Gross Motor Functional Classification level, increasing difficulty feeding the child, use of anticonvulsants, and lower triceps skinfold z scores (in decreasing order of importance) all independently contribute to lower BMD z scores in the femur. CONCLUSIONS: Low BMD is prevalent in children with moderate to severe CP and is associated with significant fracture risk. The underlying pathophysiology is complex, with multiple factors contributing to the problem and significant variation between different regions of the skeleton.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 12093986 [PubMed - indexed for MEDLINE]

Bisphosphonates to treat osteopenia in children with quadriplegic cerebral palsy: a randomized, placebo-controlled clinical trial.

Author(s): Henderson RC, Lark RK, Kecskemethy HH, Miller F, Harcke HT, Bachrach SJ.
Department of Orthopaedics, University of North Carolina, Chapel Hill 27599, USA.
Publication: J Pediatr. 2002 Nov;141(5):644-51.

OBJECTIVE: To evaluate in a double-blind, placebo-controlled clinical trial the safety and efficacy of intravenous pamidronate to treat osteopenia in nonambulatory children with cerebral palsy. STUDY DESIGN: Six pairs of subjects generally matched within each pair for age, sex, and race completed the protocol. One member of each pair randomly received plain saline placebo, the other pamidronate. Drug/placebo was administered intravenously daily for 3 consecutive days, and this 3-day dosing session was repeated at 3-month intervals for one year. Evaluations were continued for 6 months after the year of treatment. Bone mineral density (BMD) was measured in the distal femur, a site specifically developed for use in this contracted population, and the lumbar spine. RESULTS: In the metaphyseal region of the distal femur, BMD increased 89% +/- 21% (mean +/- SEM) over the 18-month study period in the pamidronate group compared with 9% +/- 6% in the control group. Age-normalized z scores increased from -4.0 +/- 0.6 to -1.8 +/- 1.0 in the pamidronate group and did not significantly change in the control group (-4.2 +/- 0.3 to -4.0 +/- 0.3). The first dosing with pamidronate caused a transient drop in serum calcium that was asymptomatic and not treated. No other potentially adverse effects were noted. CONCLUSIONS: In this small controlled clinical trial, pamidronate was found to be a safe and very effective agent to increase BMD in nonambulatory children with cerebral palsy.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 12410192 [PubMed - indexed for MEDLINE]

Bone-mineral density in children and adolescents who have spastic cerebral palsy.

Author(s): Henderson RC, Lin PP, Greene WB.
University of North Carolina at Chapel Hill 27599-7055, USA.
Publication: J Bone Joint Surg Am. 1995 Nov;77(11):1671-81.

Bone-mineral density was studied in a heterogeneous group of 139 children (mean age, nine years; range, three to fifteen years) who had spastic cerebral palsy. The evaluation included serum analyses and a nutritional assessment based on a dietary history and anthropometric measurements. The bone-mineral density of the proximal parts of the femora and the lumbar spine was measured with dual-energy x-ray absorptiometry and was normalized for age against a series of ninety-five normal children and adolescents who served as controls. Bone-mineral density varied greatly but averaged nearly one standard deviation below the age-matched normal means for both the proximal parts of the femora (-0.92 standard deviation) and the lumbar spine (-0.80 standard deviation). Ambulatory status was the factor that best correlated with bone-mineral density. Nutritional status, assessed on the basis of caloric intake, skinfolds, and body-mass index, was the second most significant variable. The pattern of involvement, durations of immobilization in a cast, and a calcium intake of less than 500 milligrams per day were additional factors of less significance. The age when the child first walked, previous fractures, use of anticonvulsants, and serum vitamin-D levels did not correlate with bone-mineral density after adjustment for covariance with the ambulatory status and the nutritional status. Serum levels of calcium, phosphate, alkaline phosphatase, and osteocalcin were not reliable indicators of low bone-mineral density.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Improve Bowel Function & Digestion , Improve Circulation/Respiratory/ Cardio Function , Cerebral Palsy

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Pubmed ID: 7593076 [PubMed - indexed for MEDLINE]

Bone density and other possible predictors of fracture risk in children and adolescents with spastic quadriplegia.

Author(s): Henderson RC.
University of North Carolina, Chapel Hill 27599-7055, USA.
Publication: Dev Med Child Neurol. 1997 Apr;39(4):224-7.

Forty-three patients with spastic quadriplegia (mean age 7.9 years, range 3.3 to 17.2 years) underwent bone mineral density (BMD) measurement of the lumbar spine and were evaluated between 2.6 and 5.5 years (mean 3.8) later to determine whether this measurement had predicted risk of fracture over the subsequent period of observation. Other potential risk factors that were evaluated include body weight z score, serum vitamin D levels, previous fracture, and hip spica casting. The baseline measurements showed that BMD falls further below normal with increasing age and was more than one standard deviation below age-matched normal mean in 38 of the 43 patients. Fracture rate did not differ between those with low and those with very low spinal BMD. Similarly, serum vitamin D levels and body weight z scores were not predictive of fracture. However, fracture rate was over fourfold greater following spica casting and more than threefold greater following an initial fracture. Fracture rates in the study group were similar to those reported for age- and sex-matched normal children, though generally the location of the fractures and mechanisms of injury differed.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 9183259 [PubMed - indexed for MEDLINE]

Quantifying weight-bearing by children with cerebral palsy while in passive standers.

Author(s): Herman D, May R, Vogel L, Johnson J, Henderson RC.
Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina, USA.
Publication: Pediatr Phys Ther. 2007 Winter;19(4):283-7.

PURPOSE: Children who are nonambulatory are placed into standers with the goal of providing benefits from weight-bearing. The purpose of this study was to quantify weight-bearing loads by children with cerebral palsy while in standers. METHODS: Electronic load-measuring footplates were fabricated specifically for this study. Weight-bearing loads were continuously measured in 19 children who were nonambulatory during routine 30-minute standing sessions (3-6 sessions/child, total 110 sessions). RESULTS: Weight-bearing ranged widely (23%-102%) with a mean of 68% of body weight. There was some variation over the course of a session and between different sessions, but more variance was noted between subjects. CONCLUSIONS: Actual weight borne in a stander is quite variable, and in some instances only a fraction of actual body weight. Further studies are required to delineate relevant factors and identify ways to maximize weight-bearing loads while in a stander.

Categories: Cerebral Palsy , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 18004195 [PubMed - indexed for MEDLINE]

Orthostasis and transcapillary fluid shifts.

Author(s): Hinghofer-Szalkay HG.
Institute for Adaptive and Spaceflight Physiology, Austrian Society for Aerospace Medicine (ASM), Graz, Austria.
Publication: J Gravit Physiol. 1995;2(1):P131-3.

Postural blood volume changes aggravate the regulation of arterial blood pressure and perfusion vis-a-vis the hydrostatic effects of orthostasis, ie, blood pooling below the hydrostatic indifferent points and reduced cardiac preload. Corresponding problems surface with extended passive standing, particularly in highly trained, dehydrated, or otherwise compromised subjects, or after long-lasting immobilization, as with space flight.

Categories: Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 11538896 [PubMed - indexed for MEDLINE]

Spontaneous fractures in cerebral palsy.

Author(s): Hobbs, C.J, Wynne, J.M.
Publication: British Medical Journal

Editor,-Last year a patient of ours presented to hospital with a chest infection. She was 19 years old, had cerebral palsy, and at the time was chronically malnourished because of feeding difficulties. On the day after the girl's admission her mother noticed a change in her behavior and that she was sitting on a bean bag in a position that her mother thought was uncomfortable. Later it was realized that her thighs were swollen. Subsequent x ray films showed an oblique fracture of the left femur and a greenstick fracture of the right femur. The fractures were recent and the bones demineralised and thinned.

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Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

Case study to evaluate a standing table for managing constipation.

Author(s): Hoenig H, Murphy T, Galbraith J, Zolkewitz M.
Duke University Medical Center, Durham, North Carolina, USA.
Publication: SCI Nurse 2001 Summer;18(2):74-7.

Standing devices have been advocated as a potentially beneficial treatment for constipation in persons with spinal cord injury (SCI); however, definitive data are lacking. A case of a patient who requested a standing table to treat chronic constipation is presented as an illustration of a method to address this problem on an individual patient level. The patient was a 62-year-old male with T12-L1 ASIA B paraplegia who was injured in 1965. The patient was on chronic narcotics for severe, nonoperable shoulder pain. His bowel program had been inadequate to prevent impactions. A systematic approach was used to measure the effects of a standing table on frequency of bowel movements (BMs) and on length of bowel care episodes. There was a significant (p < 0.05) increase in frequency of BMs and a decrease in bowel care time with the use of the standing table 5 times/week versus baseline. For this patient, the use of the standing table was a clinically useful addition to his bowel care program.

Categories: Improve Bowel Function & Digestion , Spinal Cord Injury

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Pubmed ID: 12035465 [PubMed - indexed for MEDLINE]

Cardiopulmonary response in spinal cord injury patients: effect of pneumatic compressive devices.

Author(s): Huang CT, Kuhlemeier KV, Ratanaubol U, McEachran AB, DeVivo MJ, Fine PR.
Publication: Arch Phys Med Rehabil. 1983 Mar;64(3):101-6.

The purpose of this study was to determine the effects of an inflatable abdominal corset and bilateral pneumatic leg splints on certain physiologic parameters during and after postural change in 27 quadriplegic patients. Data reflecting respiratory rate, tidal volume, heart rate, systolic and diastolic blood pressure were collected and analyzed. Measurements were acquired with patients in supine, 20 degrees head-up, 45 degrees head-up, and 20 degrees head-down positions. The study population was divided into 2 groups of cervical spinal cord injured patients: group I included 13 patients with C6 or C7 lesions; group II included 14 patients with C4 or C5 lesions. The mean time between injury and data collection was 47 days. Several trends were identified: (1) the neurologic level of lesion in quadriplegics appears relatively unimportant in determining cardiopulmonary response to postural change; (2) the use of assistive compressive devices does not improve pulmonary ventilatory parameters during postural change, although such devices do help maintain cardiovascular parameters; and (3) the abdominal corset appears more effective than pneumatic leg splints in maintaining blood pressure at pretilt levels. A tidal volume of 350ml to 400ml is most easily maintained by placing patients in a supine position and eschewing assistive compressive devices. Because the pneumatic devices proved successful in helping quadriplegic patients maintain cardiovascular stability during postural changes, therapeutic modalities, such as tilt table treatments, may be initiated at an earlier stage in the rehabilitation process.

Categories: Improve Circulation/Respiratory/ Cardio Function , Spinal Cord Injury

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Pubmed ID: 6830418 [PubMed - indexed for MEDLINE]

Neural coupling between upper and lower limbs during recumbent stepping.

Author(s): Huang HJ, Ferris DP.
Department of Biomedical Engineering, Human Neuromechanics Laboratory, 1206A CCRB, 401 Washtenaw Ave., Univ. of Michigan, Ann Arbor, MI 48109-2214, USA. hjhuang@umich.edu
Publication: J Appl Physiol. 2004 Oct;97(4):1299-308. Epub 2004 Jun 4.

During gait rehabilitation, therapists or robotic devices often supply physical assistance to a patient's lower limbs to aid stepping. The expensive equipment and intensive manual labor required for these therapies limit their availability to patients. One alternative solution is to design devices where patients could use their upper limbs to provide physical assistance to their lower limbs (i.e., self-assistance). To explore potential neural effects of coupling upper and lower limbs, we investigated neuromuscular recruitment during self-driven and externally driven lower limb motion. Healthy subjects exercised on a recumbent stepper using different combinations of upper and lower limb exertions. The recumbent stepper mechanically coupled the upper and lower limbs, allowing users to drive the stepping motion with upper and/or lower limbs. We instructed subjects to step with 1) active upper and lower limbs at an easy resistance level (active arms and legs); 2) active upper limbs and relaxed lower limbs at easy, medium, and hard resistance levels (self-driven); and 3) relaxed upper and lower limbs while another person drove the stepping motion (externally driven). We recorded surface electromyography (EMG) from six lower limb muscles. Self-driven EMG amplitudes were always higher than externally driven EMG amplitudes (P < 0.05). As resistance and upper limb exertion increased, self-driven EMG amplitudes also increased. EMG bursts during self-driven and active arms and legs stepping occurred at similar times. These results indicate that active upper limb movement increases neuromuscular activation of the lower limbs during cyclic stepping motions. Neurologically impaired humans that actively engage their upper limbs during gait rehabilitation may increase neuromuscular activation and enhance activity-dependent plasticity.

Categories: Active (Reciprocal Leg Movement) Standing , Spinal Cord Injury , Stroke

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Pubmed ID: 15180979 [PubMed - indexed for MEDLINE]

Effect of prolonged bedrest on the propensity for renal stone formation.

Author(s): Hwang TI, Hill K, Schneider V, Pak CY.
Department of Internal Medicine, Southwestern Medical School, University of Texas Health Science Center, Dallas 75235.
Publication: J Clin Endocrinol Metab. 1988 Jan;66(1):109-12.

The effect of prolonged bedrest immobilization on urinary risk factors for stone formation and on the propensity for the crystallization of calcium salts was examined in eight normal subjects. During 5 weeks of bedrest, the mean urinary calcium excretion rose during the first week and remained elevated (from 5.68 to approximately 7.50 mmol/day). Mean urinary phosphorus excretion increased by the second week of bedrest and remained elevated (from 2.70 to approximately 30.6 mmol/day). Urinary sodium and uric acid excretion rose slightly, as did urinary magnesium. Urinary pH, oxalate, and citrate changed slightly or not at all. Owing to these biochemical alterations, urinary saturation of calcium phosphate, calcium oxalate, and monosodium urate increased significantly during bedrest, but that of uric acid did not change. The inhibitor activity against the spontaneous nucleation of brushite (CaHPO4.2H2O) and calcium oxalate was not altered significantly by bedrest. Thus, the propensity for the crystallization of stone-forming calcium salts was enhanced by bedrest, suggesting that immobilization may confer increased risk for the formation of calcium-containing renal stones.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization , Improve Bladder Function

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Pubmed ID: 3335600 [PubMed - indexed for MEDLINE]

Effect of prolonged bed rest on urinary calcium output.

Author(s): Issekutz B Jr, Blizzard JJ, Birkhead NC, Rodahl K.
Publication: J Appl Physiol. 1966 May;21(3):1013-20.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Improve Bowel Function & Digestion , Effects of Immobilization

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Pubmed ID: 5912717 [PubMed - indexed for MEDLINE]

Supine Stander for Severely Handicapped Child

Author(s): Ivey, A., McDaniel, C., Perkins, S., Roblyer, D.D., Ruiz, J.
Publication: Physical Therapy

Positioning handicapped children to normalize tone and enhance educational programming is a major responsibility of therapists in educational settings. The standing position is valuable for proprioceptive and visual stimulation, as well as for skeletal development. Yet, although prone standers and standing boxes are useful for clients with fair head control, we have found no standers designed for cerebral palsied children with poor head control. We developed a supine stander for a severely involved cerebral palsied child who is a noisy breather, is dominated by extensor reflexes, and has very poor head control. He is positioned in the stander at school for classroom activities. His teacher and his therapists have been pleased to observe more normal breathing, muscle tone, and arm control when he is standing.

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Categories: Improve Circulation/Respiratory/ Cardio Function , Cerebral Palsy , Reduce Spasticity, Tone, Spasms

Rollermobile for Children with Cerebral Palsy

Author(s): Ivey, A., Roblyer, D.D.
Publication: Physical Therapy

Children with severe neurological deficits may work for years in therapy to gain basic head control and pelvic and shoulder girdle stability. Functional play activities that allow them to use these slowly gained abilities are limited. We adapted, from Nancy Finnie's book, a wheeled roller seat for use by severely involved, elementary-school-aged children with cerebral palsy (Fig. 1).1 On the roller seat, the children may use whatever control they have gained in therapy to move themselves around. They can be stabilized in a fairly therapeutic position. They adore their "car," which is an excellent motivator for progress during therapy sessions.

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Categories: Cerebral Palsy , Mobile / Dynamic Standing , Develop or Improve Motor Ability

Physiologic responses to electrically assisted and frame-supported standing in persons with paraplegia.

Author(s): Jacobs PL, Johnson B, Mahoney ET.
Department of Neurologic Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA. pjacobs@miamiproject.med.miami.edu
Publication: J Spinal Cord Med. 2003 Winter;26(4):384-9.

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.

Categories: Improve Circulation/Respiratory/ Cardio Function , Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 14992341 [PubMed - indexed for MEDLINE]

Estimating the user population of a simple electrical stimulation system for standing.

Author(s): Jaeger RJ, Yarkony GM, Roth EJ, Lovell L.
Pritzker Institute of Medical Engineering, Illinois Institute of Technology, Chicago.
Publication: Paraplegia. 1990 Oct;28(8):505-11

Many laboratory demonstrations have been reported on standing or walking with the aid of electrical stimulation. These demonstrations have typically been in small numbers of selected spinal cord injured individuals. The extent to which this technology might ultimately be applicable to the spinal cord injured population at large is not presently known. This study reports estimates of the size of the potential user population of a specific surface electrical stimulation device and protocol. The medical records were reviewed of 192 patients with traumatic thoracic, lumbar, or sacral spinal cord injury resulting in paraplegia. Based on the inclusionary criteria, between 20 and 48 patients (10.4% and 25%) of this sample population could be considered eligible for this surface stimulation protocol. As approximately 45% of the USA population of spinal cord injured individuals have paraplegia, the results suggest that between 4.7% and 11.25% of all spinal cord injured persons in the USA might be potential users of this particular electrical stimulation technology.

Categories: Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 2263407 [PubMed - indexed for MEDLINE]

Rehabilitation technology for standing and walking after spinal cord injury.

Author(s): Jaeger RJ, Yarkony GM, Roth EJ.
Pritzker Institute of Medical Engineering, Illinois Institute of Technology, Chicago, IL 60616.
Publication: Am J Phys Med Rehabil. 1989 Jun;68(3):128-33.

The purpose of this paper is to review the rehabilitation technology available for standing and walking by the spinal-cord injured. Existing aids for standing and walking and those aids under development in research laboratories are discussed. One conclusion is that therapeutic and perhaps functional standing could be achieved in a greater number of individuals using existing technology; however it must also be realized that some barriers still exist which prevent various technologies from being more widely used. Studies which measure the benefits of standing, and more fully establish minimum standing times to achieve these benefits, are needed. Standing is a necessary component of many tasks, and it is unlikely single type of standing aid is likely to perform adequately in every situation that requires standing. Therefore it may be prudent to have a variety of standing aids available to patients.

Categories: Review of Literature , Spinal Cord Injury

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Pubmed ID: 2659042 [PubMed - indexed for MEDLINE]

Changes in physical strain and physical capacity in men with spinal cord injuries.

Author(s): Janssen TW, van Oers CA, Rozendaal EP, Willemsen EM, Hollander AP, van der Woude LH.
Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
Publication: Med Sci Sports Exerc. 1996 May;28(5):551-9.

To determine longitudinal changes in physical capacity and physical strain during activities of daily living (ADL), 37 men with spinal cord injuries (C4/5-L5) performed an exercise test and various ADL on two occasions (T1 and T2; interval 34.5 +/- 1.5 months). Parameters of physical capacity were aerobic power (VO(2peak)) and maximal power output (PO(max)). Physical strain was estimated by the heart rate response relative to the heart rate reserve. VO(2peak) at T2 (1.75 +/- 0.55 1*min(1)) did not significantly differ from that at T1 (1.67 + 0.47 1*min(-1)). Absolute PO max improved (P < 0.05) from 64.9 +/- 25.9 (T1) to 71.7 +/- 27.2 W (T2), whereas relative PO(max) did not change. Activity level, time since injury, change in body mass, and occurrence of rehospitalization were the most important predictors of changes in physical capacity. Changes in relative VO(2peak) were related (P < 0.05) to changes in strain during transfers to the shower wheelchair (r = -0.39) and shower seat (r = -0.46), and during the curb ascent (r = -0.47). In conclusion, the hypothesized decline in physical capacity did not occur over the 3-yr period. Maintenance of physical capacity, which may in part be achieved through sport participation and improved medical care, together with avoidance of excessive body mass, may be useful to prevent high levels of strain during ADL.

Categories: Improve Circulation/Respiratory/ Cardio Function , Spinal Cord Injury

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Pubmed ID: 9148083 [PubMed - indexed for MEDLINE]

Calcium balance in paraplegic patients: influence of injury duration and ambulation.

Author(s): Kaplan PE, Gandhavadi B, Richards L, Goldschmidt J.
Publication: Arch Phys Med Rehabil. 1978 Oct;59(10):447-50.

Calcium metabolic balance determinations, which have been done in various clinical and experimental conditions, were applied to the study of 8 spinal cord injured patients receiving a diet with 1600 mg calcium and 85 to 120 gm protein daily. All of the patients had hypercalciuria prior to ambulation. Those with spinal cord injuries of less than 3 months duration (early group) had a calcium balance of -27 mg before ambulation and 235 mg after ambulation. Patients with spinal cord injuries of 6 months or more duration (late group) had calcium balances of 55 mg before ambulation and 175 mg after ambulation. Ambulation significantly decreased the hypercalciuria and modified the calcium balance in a positive direction. Smaller changes were noted in the responses of the late group than in those of the early group. Early ambulation will probably prevent bone loss, calcium stones in the genitourinary tract, and other sequellae of negative calcium balance.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury

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Pubmed ID: 718407 [PubMed - indexed for MEDLINE]

Can Using Standers Increase Bone Density In Non-Ambulatory Children?

Author(s): Katz, Danielle,MD, Snyder, Bryan MD, PhD, Dodek, Anton MD, Holm, Ingrid MD Miller, Claire BS
Children’s Hospital, Harvard Medical School, Boston, Massachusetts
Publication: Abstract as published in the American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) 2006 Conference Proceedings

Purpose: Pathologic fractures are a significant source of morbidity for non-ambulatory children with neuromuscular dysfunction. We hypothesize that increasing weight-bearing in non-ambulatory children will increase bone material density (BMD) and decrease fracture risk. The aim of this pilot study was to demonstrate that non-ambulatory children participating in a standing program for at least two hours a day will experience an increase in BMD in the weight bearing bones. We also evaluate the reliability of measuring BMD at the calcaneous (weight bearing bones) and distal forearm (non-weight bearing bone) using peripheral DXA in delayed, non-ambulatory children.

Methods: After receiving IRB approval, 12 non-ambulatory, quadriplegic children (ages 12-21) consented to participate in a 2 hour/day, 5 day/week standing program. A history, orthopaedic exam, determination of bone age, laboratory tests for metabolic bone disease and BMD at the calcaneal tuberosity and distal forearm metaphyses were obtained. Compliance with the prescribed standing program was monitored for 6 months. BMD was measured using peripheral DXA at baseline and every 3 months. Using Jan. 2003 BMD data as a baseline, the ratio of change in BMD at the calcaneous and distal forearm was evaluated as a function of percent compliance with standing program.

Results: Intrarater reliability for BMD measured by peripheral DXA was good: Pearson correlation for the calcaneous = 0.90 (p=0.01) and for the forearm = 0.96 (p=0.01). Paired t test between two sets of data measured at each site on the same day were not different for calcaneous (t=0.92, df=15, p=0.37) or forearm (t=0.05, df=15, p=0.96). Compliance with the standing program was inconsistent. No patients were 100% compliant. Patients tended to stand longer at the initiation of the study Jan.-April (Jan vs Apr, p = 0.018; Jan vs Jul, p = 0.89; Apr vs Jul, p = 0.063). Compliance (%) was positively correlated (r = -0.62) with increased calcaneous BMD measured in April. This is in contrast to forearm BMD measured at the same time; which was negatively correlated (r = -0.44) with standing compliance. This support the notion that standing preferentially increases bone mass in the weight-bearing bones. However the BMD at the calcaneous measured in July was decreased, perhaps reflecting the decreased compliance the with standing program over the succeeding interval April-July.

Conclusion: It is feasible to have non-ambulatory children participate in a rigorous standing program. The weight bearing “dose” affects BMD at the calcaneous but the benefit appears to be transient if the intensive standing program is not sustained.

Significance: The intensive use of standers (10 hours/wk) may have a beneficial effect on BMD of weight bearing bones in non-ambulatory children.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

Alternate leg movement amplifies locomotor-like muscle activity in spinal cord injured persons.

Author(s): Kawashima N, Nozaki D, Abe MO, Akai M, Nakazawa K.
Department of Rehabilitation for Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama 359-8555, Japan. nori@rehab.go.jp
Publication: J Neurophysiol. 2005 Feb;93(2):777-85. Epub 2004 Sep 22.

It is now well recognized that muscle activity can be induced even in the paralyzed lower limb muscles of persons with spinal cord injury (SCI) by imposing locomotion-like movements on both of their legs. Although the significant role of the afferent input related to hip joint movement and body load has been emphasized considerably in previous studies, the contribution of the "alternate" leg movement pattern has not been fully investigated. This study was designed to investigate to what extent the alternate leg movement influenced this "locomotor-like" muscle activity. The knee-locked leg swing movement was imposed on 10 complete SCI subjects using a gait training apparatus. The following three different experimental conditions were adopted: 1) bilateral alternate leg movement, 2) unilateral leg movement, and 3) bilateral synchronous (in-phase) leg movement. In all experimental conditions, the passive leg movement induced EMG activity in the soleus and medial head of the gastrocnemius muscles in all SCI subjects and in the biceps femoris muscle in 8 of 10 SCI subjects. On the other hand, the EMG activity was not observed in the tibialis anterior and rectus femoris muscles. The EMG level of these activated muscles, as quantified by integrating the rectified EMG activity recorded from the right leg, was significantly larger for bilateral alternate leg movement than for unilateral and bilateral synchronous movements, although the right hip and ankle joint movements were identical in all experimental conditions. In addition, the difference in the pattern of the load applied to the leg among conditions was unable to explain the enhancement of EMG activity in the bilateral alternate leg movement condition. These results suggest that the sensory information generated by alternate leg movements plays a substantial role in amplifying the induced locomotor-like muscle activity in the lower limbs.

Categories: Active (Reciprocal Leg Movement) Standing , Spinal Cord Injury

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Pubmed ID: 15385590 [PubMed - indexed for MEDLINE]

Shaping appropriate locomotive motor output through interlimb neural pathway within spinal cord in humans.

Author(s): Kawashima N, Nozaki D, Abe MO, Nakazawa K.
Department of Rehabilitation for the Movement Functions, Research Institute of the National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama 359-8555, Japan. nori.kawashima@utoronto.ca.
Publication: J Neurophysiol. 2008 Jun;99(6):2946-55. Epub 2008 Apr 30.

Direct evidence supporting the contribution of upper limb motion on the generation of locomotive motor output in humans is still limited. Here, we aimed to examine the effect of upper limb motion on locomotor-like muscle activities in the lower limb in persons with spinal cord injury (SCI). By imposing passive locomotion-like leg movements, all cervical incomplete (n = 7) and thoracic complete SCI subjects (n = 5) exhibited locomotor-like muscle activity in their paralyzed soleus muscles. Upper limb movements in thoracic complete SCI subjects did not affect the electromyographic (EMG) pattern of the muscle activities. This is quite natural since neural connections in the spinal cord between regions controlling upper and lower limbs were completely lost in these subjects. On the other hand, in cervical incomplete SCI subjects, in whom such neural connections were at least partially preserved, the locomotor-like muscle activity was significantly affected by passively imposed upper limb movements. Specifically, the upper limb movements generally increased the soleus EMG activity during the backward swing phase, which corresponds to the stance phase in normal gait. Although some subjects showed a reduction of the EMG magnitude when arm motion was imposed, this was still consistent with locomotor-like motor output because the reduction of the EMG occurred during the forward swing phase corresponding to the swing phase. The present results indicate that the neural signal induced by the upper limb movements contributes not merely to enhance but also to shape the lower limb locomotive motor output, possibly through interlimb neural pathways. Such neural interaction between upper and lower limb motions could be an underlying neural mechanism of human bipedal locomotion.

Categories: Active (Reciprocal Leg Movement) Standing , Spinal Cord Injury

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Pubmed ID: 18450579 [PubMed - indexed for MEDLINE]

Orthostatic vasomotor response in spinal man.

Author(s): Krebs M, Ragnarrson KT, Tuckman J.
Publication: Paraplegia. 1983 Apr;21(2):72-80.

The cardiovascular adaptation of tetraplegics to the upright position has been previously demonstrated to be deficient. Presumably this is due to the interruption of the spinal pathways linking supraspinal control centres with the peripheral sympathetic motor neurons. Review of previous studies of this phenomenon reveals that vasomotor responses have been determined primarily from blood flow measurements in the extremities. Contradictory conclusions have been drawn. Study of the visceral circulation, in particular renal blood flow, could shed more light on this poorly understood area. Renal clearance tests were carried out on seven healthy controls and eight chronic, clinically complete tetraplegic patients. Renal blood flow, mean arterial pressure, and total renal vascular resistance in both supine and passive head-up tilt positions were calculated from collected data. Renal blood flow and total renal vascular resistance showed significant decrease and increase respectively during tilting in controls and tetraplegic subjects. Although the renal circulation is autoregulated, postural change causes profound alteration of the renal blood flow mediated through the haemodynamic effects of the renal nerves. Sympathetic renal vasoconstriction is mediated by the carotid sinus reflex through the vasomotor centre in the brainstem. In the absence of supraspinal influence the renal vasculature is shown to respond to an orthostatic stimulus with a vigorous vasoconstriction. The adaptation of spinal man to the upright position may involve the recovery of a spinal vasomotor reflex involving the splanchnic circulation.

Categories: Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 6866558 [PubMed - indexed for MEDLINE]

Standing Frames and Standing Wheelchairs: Implications for Standing

Author(s): Kreutz, D.
Publication: Orthotics in Spinal Cord Injury

Standing frames and standing wheelchairs serve a specific function, allowing the person with a spinal cord injury to stand and perform functional activities. These orthotic devices support the paralyzed lower extremities and trunk to allow hand-free standing. This article will review the literature relevant to effects of passive standing on the person with a spinal cord injury.

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Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Reduce Spasticity, Tone, Spasms , Spinal Cord Injury

Year-to-year changes in effective renal plasma flow in asymptomatic spinal cord injury patients.

Author(s): Kuhlemeier KV, Huang CT, DeVivo MJ, Lloyd LK
Publication: Urology. 1986 Oct;28(4):270-4.

Year-to-year variations in effective renal plasma flow (ERPF) measurements were determined in 78 patients with spinal cord injury who had no urologic complications or surgery or bouts of chills and fever between consecutive annual follow-up examinations. The effects of age, gender, level and degree of lesion, and time since injury on the degree of variability were also determined. None of the factors considered had a statistically significant effect (P greater than 0.05) on year-to-year variations in ERPF. About 90 per cent of the individual kidney ERPF measurements were within 100 ml/min of the measurement made in the previous year, and 90 per cent of the total ERPF measurements were within 175 ml/min of the previous year's measurement. Follow-up of patients whose year-to-year variability exceeded these limits showed that most subsequently regressed toward the mean spontaneously. These data suggest that kidney blood flow varies considerably from year to year in otherwise healthy patients with spinal cord injury and that changes of 100 ml/min or more for an individual kidney or 175 ml/min or more for both kidneys together are common, but probably of little clinical significance, provided the absolute levels of ERPF remain within normal limits.

Categories: Spinal Cord Injury , Improve Bladder Function

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Pubmed ID: 3765233 [PubMed - indexed for MEDLINE]

Long-term followup of renal function after spinal cord injury.

Author(s): Kuhlemeier KV, Lloyd LK, Stover SL.
Publication: J Urol. 1985 Sep;134(3):510-3.

Effective renal plasma flow was measured in acute spinal cord injury patients for up to 10 years after injury to determine the extent of renal deterioration in these patients and to identify the factors associated with a loss of renal function. The over-all mean decrease in effective renal plasma flow for all patients as a whole was 4.5 ml. per year. Factors associated with a statistically significant reduction in effective renal plasma flow included age, gender, renal calculi, quadriplegia, and a history of chills and fever. Other factors examined but not found to be statistically significant included years since injury, presence of severe decubiti, bladder calculi, bacteriuria and extent of injury. This study suggests that renal function usually can be preserved in spinal cord injury patients if the treatable risk factors are managed properly.

Categories: Improve Bowel Function & Digestion , Spinal Cord Injury

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Pubmed ID: 4032551 [PubMed - indexed for MEDLINE]

Effect of "standing" on spasticity, contracture, and osteoporosis in paralyzed males.

Author(s): Kunkel CF, Scremin AM, Eisenberg B, Garcia JF, Roberts S, Martinez S.
Veterans Affairs Medical Center, Rehabilitation Medicine Service, Albuquerque, NM 87108.
Publication: Arch Phys Med Rehabil. 1993 Jan;74(1):73-8.

The effect of "standing" in a frame on spasticity (clinical assessment and H-reflex), contracture (lower extremity joint range of motion), and osteoporosis (dual photon absorptiometry) was studied in six paralyzed males (mean age 49 yr) who had been confined to wheelchairs for an average of 19 years. Standing time averaged 144 hours over a mean of 135 days. Clinical Assessment measured reflexes, tone, and clonus in the legs. Results revealed no important differences between initial and final scores for clinical assessment and joint range of motion. In three subjects for whom H-reflexes were found, latency and amplitude were not altered by "standing." Bone density was normal in the lumbar spine but significantly reduced in the femoral neck. "Standing" did not modify the bone density in any site. A follow-up interview revealed that 67% of subjects continued to "stand" and felt healthier because of it. In summary, "standing" had no ill effects, did not alter measured variables, and had a positive psychological impact.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Reduce Spasticity, Tone, Spasms , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 8420525 [PubMed - indexed for MEDLINE]

Modulation of bone loss during calcium insufficiency by controlled dynamic loading.

Author(s): Lanyon LE, Rubin CT, Baust G.
Publication: Calcif Tissue Int. 1986 Apr;38(4):209-16.

Changes in the midshaft cross-sectional area of the ulna were measured in egg-laying turkeys on a diet insufficient in calcium. Left:right comparisons were used to assess the bone loss over a six-week period due to 1) calcium insufficiency, 2) calcium insufficiency plus disuse, and 3) calcium insufficiency and disuse interrupted by a short daily period of intermittent loading applied from an external device. Calcium insufficiency alone in the intact ulna resulted in a 15% reduction in cross-sectional area. In the functionally deprived bones this loss was increased to 32%. In bones where the disuse was interrupted by a single short daily period of loading, the degree of bone loss was significantly modified (P less than 0.006) to 25%. No significant difference in the modulating effect of loading was achieved by varying the peak strain from 0.0015 to 0.003, the strain rate from 0.01 to 0.05, or the duration of the single loading period from 100 sec per day to 25 minutes. All the loading regimes employed had been demonstrated to be osteogenic in mature male birds on a diet sufficient in calcium.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Vibration While Standing

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Pubmed ID: 3085898 [PubMed - indexed for MEDLINE]

Static vs dynamic loads as an influence on bone remodelling.

Author(s): Lanyon LE, Rubin CT.
Publication: J Biomech. 1984;17(12):897-905.

Remodelling activity in the avian ulna was assessed under conditions of disuse alone, disuse with a superimposed continuous compressive load, and disuse interrupted by a short daily period of intermittent loading. The ulnar preparation consisted of the 110mm section of the bone shaft between two submetaphyseal osteotomies. Each end of the preparation was transfixed by a stainless steel pin and the shaft either protected from normal functional loading with the pins joined by external fixators, loaded continuously in compression by joining the pins with springs, or loaded intermittently in compression for a single 100s period per day by engaging the pins in an Instron machine. Similar loads (525 N) were used in both static and dynamic cases. The strains engendered were determined by strain gauges, and at their maximum around the bone's midshaft were -0.002. The intermittent load was applied at a frequency of 1 Hz as a ramped square wave, with a rate of change of strain during the ramp of 0.01 s-1. Peak strain at the midshaft of the ulna during wing flapping in the intact bone was recorded from bone bonded strain gauges in vivo as -0.0033 with a maximum rate of change of strain of 0.056 s-1. Examination of bone sections from the midpoint of the preparation after an 8 week period indicated that in both non-loaded and statically loaded bones there was an increase in both endosteal diameter and intra cortical porosity. These changes produced a decrease in cross sectional area which was similar in the two groups (-13%).(ABSTRACT TRUNCATED AT 250 WORDS)

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Spinal Cord Injury , Vibration While Standing

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Pubmed ID: 6520138 [PubMed - indexed for MEDLINE]

Bone mineral density and fractures in boys with Duchenne muscular dystrophy.

Author(s): Larson CM, Henderson RC.
Department of Orthopaedics, University of North Carolina, Chapel Hill, USA.
Publication: J Pediatr Orthop. 2000 Jan-Feb;20(1):71-4.

The relationships between bone density, mobility, and fractures were assessed in 41 boys with Duchenne muscular dystrophy. Bone density in the lumbar spine was only slightly decreased while the boys were ambulatory (mean z-score, -0.8), but significantly decreased with loss of ambulation (mean z-score, -1.7). In contrast, bone density in the proximal femur was profoundly diminished even when gait was minimally affected (mean z-score, -1.6), and then progressively decreased to nearly 4 standard deviations below age-matched normals (mean z-score, -3.9). These are consistent with the findings that 18 (44%) of the boys sustained a fracture, 66% of these fractures involved the lower extremities, and there were no spinal compression fractures. Furthermore, four (44%) of nine boys who were walking with aids or support at the time of fracture never resumed walking after the fracture. Osteoporosis is most profound in the lower extremities of boys with Duchenne muscular dystrophy, and begins to develop early while still ambulating. Frequent fractures that may result in loss of ambulation are the clinical consequences.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 10641693 [PubMed - indexed for MEDLINE]

Pathologic fractures in severely handicapped children and young adults.

Author(s): Lee JJ, Lyne ED.
Division of Pediatric Orthopaedics, Henry Ford Hospital, Detroit, Michigan 48202.
Publication: J Pediatr Orthop. 1990 Jul-Aug;10(4):497-500.

The incidence (42%) of vitamin D abnormalities is high in severely handicapped children and young adults who sustain fractures, especially those who sustain multiple fractures. Fractures occur primarily in the lower extremity and heal with simple immobilization. In patients with normal vitamin D levels, a history of a significant traumatic event should be identified and child abuse ruled out. Vitamin D-deficient patients respond to nutritional and vitamin D supplementation, with decreased fracture incidence.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization

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Pubmed ID: 2358490 [PubMed - indexed for MEDLINE]

"The pieces fall into place": the views of three Swedish habilitation teams on conductive education and support of disabled children.

Author(s): Lind L.
Disability and Handicap Research Group, Department of Human Development, Learning and Special Education, Stockholm Institute of Education, PO Box 47 308, SE-100 74 Stockholm, Sweden.
Publication: Int J Rehabil Res. 2003 Mar;26(1):11-20.

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.

Categories: Review of Literature

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Pubmed ID: 12601263 [PubMed - indexed for MEDLINE]

Spontaneous fractures in children and adolescents with cerebral palsy.

Author(s): Lingam, S., Joester, J.
Publication: British Medical Journal

Children and adolescents with cerebral palsy, in addition to the motor disability, have other, associated disabilities: hearing and visual impairment, learning disabilities, failure to thrive in infancy and poor growth in childhood, and scoliosis. They are prone to dislocations, particularly dislocation of the hips. They also develop other contractures and deformities, which may need surgery. We report on five children and adolescents who developed spontaneous fractures of long bones, an association which, as far as we are aware, is not recognized.

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Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

Health status of children with moderate to severe cerebral palsy.

Author(s): Liptak GS, O'Donnell M, Conaway M, Chumlea WC, Wolrey G, Henderson RC, Fung E, Stallings VA, Samson-Fang L, Calvert R, Rosenbaum P, Stevenson RD.
University of Rochester Medical Center, NY 14642, USA. gregory_liptak@urmc.rochester.edu
Publication: Dev Med Child Neurol. 2001 Jun;43(6):364-70. Comment in: Dev Med Child Neurol. 2001 Jun;43(6):363.

The aim of the study was to evaluate the health of children with cerebral palsy (CP) using a global assessment of quality of life, condition-specific measures, and assessments of health care use. A multicenter population-based cross-sectional survey of 235 children, aged 2 to 18 years, with moderate to severe impairment, was carried out using Gross Motor Function Classification System (GMFCS) levels III (n = 56), IV (n = 55), and V (n = 122). This study group scored significantly below the mean on the Child Health Questionnaire (CHQ) for Pain, General Health, Physical Functioning, and Impact on Parents. These children used more medications than children without CP from a national sample. Fifty-nine children used feeding tubes. Children in GMFCS level V who used a feeding tube had the lowest estimate of mental age, required the most health care resources, used the most medications, had the most respiratory problems, and had the lowest Global Health scores. Children with the most severe motor disability who have feeding tubes are an especially frail group who require numerous health-related resources and treatments. Also, there is a relationship among measures of health status such as the CHQ, functional abilities, use of resources, and mental age, but each appears to measure different aspects of health and well-being and should be used in combination to reflect children's overall health status.

Categories: Cerebral Palsy

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Pubmed ID: 11409824 [PubMed - indexed for MEDLINE]

Hypokinesia-induced negative net calcium balance reversed by weight-bearing exercise.

Author(s): Lutz J, Chen F, Kasper CE.
Publication: Aviat Space Environ Med. 1987 Apr;58(4):308-14.

Negative calcium balance and bone loss occurring with immobilization and hypokinesia have been attributed to a lack of weight bearing on bones. The effects of weight-bearing exercise for promotion of calcium balance after hypokinesia were examined. Rats were randomly assigned to either hypokinetic suspension for 28 d or to a control sedentary group, free to move about their cages at will. After 28 d, the rats in each group were randomly subdivided to either post-hypokinetic forced running (HR), post-hypokinetic sedentary (HS), control forced running (CR), or control sedentary (CS) groups. Net calcium balance was then determined for 25 consecutive days. Net calcium balance of HR was negative for the first 5-d period of recovery and then became positive; that of HS was negative for 25 d; that of CR and CS remained essentially positive. Net calcium absorption paralleled net calcium balance. Forced running was effective in reestablishment of positive net calcium balance after 28 d of decreased weight bearing.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 3579816 [PubMed - indexed for MEDLINE]

The effects of the standing programs with abduction for children with spastic diplegia

Author(s): Macias, LM
Publication: Pediatric Physical Therapy

PURPOSE/HYPOTHESIS: Hyperactivity of the adductor muscles is typical in the majority of children with spastic diplegia. The delay of weight-bearing in standing and muscle imbalance can lead to hip dysplasia. The purpose of this research was to show the long term benefits of the use of a standing device in abduction on hip development, muscle alignment and functional gait. NUMBER OF SUBJECTS: Fourteen children with diagnosis of cerebral palsy, spastic diplegic involvement participated in the project. Seven children between 14-17 months old from a local early intervention program participated in the standing program until age five years and another group of seven children were assessed at five years of age for comparison who did not participate in any standing programs. MATERIALS/METHODS: The children, who all demonstrated a scissor stepping pattern and required assistance for standing balance began the standing program using a standing device in abduction (made individually with plaster). The degree of abduction varied in each case (55-70 degrees of abduction). The children used the standing device 45 minutes a day at home until the age of five. Hip development was measured by X ray (hip migration percentage (HM) and acetabular index (AI)) at 14-17 months and five years of age for the children who stood with abduction and at five years for the comparison group of children. Muscle alignment was assessed by goniometric measurement of hip adductor range of motion. RESULTS: The adductor muscles did not lose the range of motion in the group who stood in abduction. There was a widening of the base of support with improved functional step generally seen. The HM percentage remained within normal limits in all children who stood with abduction (13-21%) at the age of five, in comparison to children who did not stand in abduction (12-43%). There was a significant difference in hip migration index on the left side only (t = -3.68, P = 0.001) in comparing the children who stood to controls at five years of age. Comparison of AI from age 14-17 months on the standing group demonstrated a significant decrease in AI in comparison to age 5 years (decrease from 17 degrees to 14 degrees on average, t = 5.47, P < 0.005 on the right and t = 4.47, P < 0.009 on the left). AI for the control children at age five ranged from 12-25 degrees. AI was significantly different for the left leg (t = -2.75, P < 0.008), but not on the right leg at age five (t = 0.08, P = 0.93). CONCLUSIONS: The effects of weight-bearing with abduction can contribute to the development of the acetabulum, as measured by the hip migration percentage, acetabular index and maintenance of hip adductor muscle legth for functional gait. CLINICAL RELEVANCE: Children with spastic diplegia are at risk for hip dislocation, asymmetrical acetabular growth, and muscular imbalance. The results of this small population using a standing program in abduction provide evidence that it is important to include abduction in the standing program. Further investigation is required to determine the amount of years to stand in abduction to improve the quality of walking.

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Categories: Cerebral Palsy , Weight Bearing & FES (Functional Electrical Stimulation) , Improve Hip Integrity , Improve Range of Motion, Prevent Contractures

The vertical wheeler: a device for ambulation in cerebral palsy.

Author(s): Manley MT, Gurtowski J.
Publication: Arch Phys Med Rehabilitation. 1985 Oct;66(10):717-20.

The vertical wheeler is a new mobility aid that was specifically designed to help improve the quality of life for the handicapped child by providing mobility while standing. Results of a clinical trial in a population of patients with cerebral palsy are presented. Criteria were selected to allow evaluation of the rehabilitative effect of the device on the population. Results showed that the children in this cerebral palsy group all benefited from ambulation with the wheeler. Patients with spastic quadriparesis seemed to gain the most immediate benefit. The device contributed to improved mobility, posture, and self-image. The wheeler was safe and fun for the children. It has the potential for improving the psychologic and medical status of the child with severe locomotion impairment.

Categories: Cerebral Palsy , Mobile / Dynamic Standing

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Pubmed ID: 4051716 [PubMed - indexed for MEDLINE]

Osteoporosis, calcium and physical activity.

Author(s): Martin AD, Houston CS.
Publication: CMAJ. 1987 Mar 15;136(6):587-93.

Sales of calcium supplements have increased dramatically since 1983, as middle-aged women seek to prevent or treat bone loss due to osteoporosis. However, epidemiologic studies have failed to support the hypothesis that larger amounts of calcium are associated with increased bone density or a decreased incidence of fractures. The authors examine the evidence from controlled trials on the effects of calcium supplementation and physical activity on bone loss and find that weight-bearing activity, if undertaken early in life and on a regular basis, can increase the peak bone mass of early adulthood, delay the onset of bone loss and reduce the rate of loss. All of these factors will delay the onset of fractures. Carefully planned and supervised physical activity programs can also provide a safe, effective therapy for people who have osteoporosis.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 3545420 [PubMed - indexed for MEDLINE]

Bone dynamics: stress, strain and fracture.

Author(s): Martin AD, McCulloch RG.
Sport and Exercise Sciences Research Institute, University of Manitoba, Winnipeg, Canada.
Publication: J Sports Sci. 1987 Summer;5(2):155-63.

Bone is a dynamic tissue whose functional mass is controlled by the balance between the endocrine drive towards bone resorption and the mechanically-engendered drive towards bone formation. Strain is the key intermediate variable between loading forces and bone remodelling. Animal studies have shown that static loading of bone has no osteogenic effect; bone loss occurs as if there were no loading at all. However, dynamic loading, that is, cyclic change in internal strain, is strongly osteogenic, with relatively few cycles required for maximum effect. However, if a sufficient number of cycles is applied, repetitive loading can cause stress fractures. This number decreases as internal strains increase. Thus strain redistribution within bone, as caused by muscle fatigue or improper sports equipment, is a significant cause of fracture.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 3326949 [PubMed - indexed for MEDLINE]

Fractures in Patients with Cerebral Palsy

Author(s): McIvor, W.C. and Samilson, R.L.
Sonoma State Hospital, Eldridge, and the University of California School of Medicine, San Francisco
Publication: Journal of Bone and Joint Surgery Am.

1. Ninety-two patients with cerebral palsy and 134 fractures were studied during the past ten years at Sonoma State Hospital, Eldridge, California.
2. One hundred thirty-one of the 134 fractures united.
3. Pre-existent contracture of contiguous joints was the factor most consistently associated with fracture, a finding which provides yet another reason for prevention and early correction of contractures.
4. Closed treatment, modified according to the individual patient's needs, is most efficacious.

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Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy , Improve Range of Motion, Prevent Contractures

Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis.

Author(s): McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ.
Department of Physical Medicine & Rehabilitation, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298, USA.
Publication: Arch Phys Med Rehabilitation. 1999 Nov;80(11):1402-10.

OBJECTIVE: To analyze the incidence, risk factors, and trends of long-term secondary medical complications in individuals with traumatic spinal cord injury. DESIGN: Data were reviewed from the National SCI Statistical Center on annual evaluations performed at 1, 2, 5, 10, 15, and 20 years after injury on patients injured between 1973 and 1998. SETTING: Multicenter Regional SCI Model Systems. MAIN OUTCOME MEASURES: Secondary medical complications at annual follow-up years, including pneumonia/atelectasis, autonomic dysreflexia, deep venous thrombosis, pulmonary embolism, pressure ulcers, fractures, and renal calculi. RESULTS: Pressure ulcers were the most frequent secondary medical complications in all years, and individuals at significant (p < .05) risk included those with complete injuries (years 1, 2, 5, 10), younger age (year 2), concomitant pneumonia/atelectasis (year 1, 2, 5), and violent injury (years 1, 2, 5, 10). The incidence of pneumonia/atelectasis was 3.4% between rehabilitation discharge and year-1 follow-up with those most significantly at risk being older than 60 years (years 1, 2, 5, 10) and tetraplegia-complete (years 1, 2). One-year incidence of deep venous thrombosis was 2.1% with a significant decline seen at year 2 (1.2%), and individuals most significantly (p < .001) at risk were those with complete injuries (year 1). The incidence of calculi (kidney and/or ureter) was 1.5% at 1-year follow-up and 1.9% at 5 years and was more frequent in patients with complete tetraplegia. Intermittent catheterization was the most common method of bladder management among patients with paraplegia but became less common at later postinjury visits. CONCLUSIONS: Pressure ulcers, autonomic dysreflexia, and pneumonia/atelectasis were the most common long-term secondary medical complications found at annual follow-ups. Risk factors included complete injury, tetraplegia, older age, concomitant illness, and violent injury.

Categories: Effects of Immobilization , Prevent Pressure Ulcers/Maintain Skin Integrity , Spinal Cord Injury

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Pubmed ID: 10569434 [PubMed - indexed for MEDLINE]

Skeletal cell stresses and bone adaptation.

Author(s): McLeod KJ, Rubin CT, Otter MW, Qin YX.
Musculoskeletal Research Laboratory, Health Sciences Center, State University of New York, Stony Brook 11794-8181, USA kmcleod@ccmail.sunysb.edu
Publication: Am J Med Sci. 1998 Sep;316(3):176-83.

There is no tissue in which mechanical stresses have been studied in more detail than the skeletal system, this focus arising primarily because bone plays a clear structural role in the body. However, the hypothesis that the skeleton represents an optimally designed structure has contributed remarkably little to our understanding of the development and adaptive capabilities of bone tissue. Recent investigations on the consequences of mechanical, hydrostatic, and electrical stresses on the cells of bone tissue have served to redirect the discussion of bone modeling and remodeling processes. These studies have refocused attention on the importance of chronic low-level dynamic stresses in mediating the physiologic response of bone tissue. Important recent observations suggest that an approach premised on the self-organizational properties of bone tissue may lead to significant improvements in our understanding and control of bone morphologic development, adaptation, and healing.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density

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Pubmed ID: 9749559 [PubMed - indexed for MEDLINE]

Effects of Adaptive Positioning on Psychological Test Scores for Preschool Children With Cerebral Palsy.

Author(s): Miedaner, J., Finuf, L.
Publication: Pediatric Physical Therapy

Studies suggest that adaptive positioning improves the performance of children with neuromotor impairment in areas such as speech intelligibility, upper extremity function, head control, and pulmonary function. The purpose of this study was to evaluate whether positioning in therapist-recommended adaptive equipment could improve a child's performance on psychological test scores when compared with testing done without equipment. Twelve children, 17 to 58 months of age, with a diagnosis of spastic quadriplegia or diplegia, comprised the subjects for this study. After selection of the best supporting adaptive equipment, the Bayley Scales of Infant Development were administered with and without adaptive equipment by a certified psychologist. A two-period crossover design showed statistically significantly higher test scores during positioned trials. During 67% of the testing situations, the child's ability to perform fine motor tasks improved so the child was able to complete one or more of the tasks they were unable to do without positioning. Adaptive positioning seems to have a positive impact on test performance. The extent, significance, and limitations of adaptive positioning will be discussed.

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Categories: Cerebral Palsy , Promote Psychosocial Skills and Improve Sleep , School-Based Therapy

Effects of four weeks of absolute bed rest on circulatory functions in man.

Author(s): Miller PB, Johnson RL, Lamb Le.
Publication: Aerosp Med. 1964 Dec;35:1194-200.

Categories: Improve Circulation/Respiratory/ Cardio Function , Effects of Immobilization

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Pubmed ID: 14230666 [PubMed - indexed for MEDLINE]

Spontaneous fractures in the brain-crippled, bedridden patient.

Author(s): Miller PR, Glazer DA.
Publication: Clin Orthop Relat Res. 1976 Oct;(120):134-7.

This report deals with the treatment of 31 spontaneous fractures which occurred in 50 institutionalized patients who were bedridden primarily because of severe cerebral palsy associated with brain injury. More than one-half of the group sustained a spontaneous fracture. Satisfactory healing of all fractures with a minimum of complications occurred without any immobilization or realignment. In 4 patients with delayed compound wounds, the treatment consisted of resection of the protruding portion of the bone after allowing the bony protrusion to wall itself off.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization

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Pubmed ID: 975648 [PubMed - indexed for MEDLINE]

Technical note--a patient propelled variable-inclination prone stander.

Author(s): Motloch WM, Brearley MN.
Publication: Prosthet Orthot Int. 1983 Dec;7(3):176-7.

A self-propelled mobile standing device is described with the facility of patient-operated inclination of the support platform, enabling objects on the floor to be reached. The device is provided with a removable tray at the level of the occupant's chest.

Categories: Mobile / Dynamic Standing

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Pubmed ID: 6647014 [PubMed - indexed for MEDLINE]

The effect of positioning on the hand function of boys with cerebral palsy.

Author(s): Noronha J, Bundy A, Groll J.
Handicapped Children's Services, Washington, DC.
Publication: Am J Occup Ther. 1989 Aug;43(8):507-12.

The effect of positioning (sitting and prone standing) on the hand function of 10 boys (mean age = 12.5 years, SD = 1.2 years) with spastic diplegic cerebral palsy was studied. Two groups of subjects were tested twice (Tests 1 and 2) with the Jebsen-Taylor Hand Function Test (Jebsen, Taylor, Treischmann, Trotter, & Howard, 1969; Taylor, Sand, & Jebsen, 1973) to measure rate of manipulation. In addition, a scale modified from Hohlstein (1982) was used to measure quality of grasp on each subtest of the Jebsen-Taylor test. No significant differences between the mean scores of the two groups were found on the total scores of the Jebsen-Taylor test, either between Tests 1 and 2 or between sitting and prone standing. When the data from Tests 1 and 2 were combined, it was found that on one subtest--simulated feeding--the subjects performed significantly faster while in a prone standing position. On another subtest--picking up small objects--the subjects performed significantly faster while in a sitting position. Except during the simulated feeding subtest, the quality of the subjects' grasp was observed to be mature and tailored to the objects manipulated. This paper presents considerations for analyzing positioning in relation to upper extremity tasks.

Categories: Cerebral Palsy , Develop or Improve Motor Ability

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Pubmed ID: 2774051 [PubMed - indexed for MEDLINE]

Preliminary results on the mobility after whole body vibration in immobilized children and adolescents

Author(s): O. Semler, O. Fricke, K. Vezyroglou, C. Stark, E. Schoenau
Children’s Hospital, University of Cologne, Cologne, Germany
Publication: J Musculoskelet Neuronal Interact 2007; 7(1):77-81

The present article is a preliminary report on the effect of Whole Body Vibration (WBV) on the mobility in long-term immobilized children and adolescents. WBV was applied to 6 children and adolescents (diagnoses: osteogenesis imperfecta, N=4; cerebral palsy, N=1; dysraphic defect of the lumbar spine, N=1) over a time period of 6 months. WBV was applied by a vibrating platform constructed on a tilt-table. The treatment effect was measured by alternations of the tilt-angle of the table and with the "Brief assessment of motor function" (BAMF). All 6 individuals were characterized by an improved mobility, which was documented by an increased tilt-angle or an improved BAMF-score. The authors concluded WBV might be a promising approach to improve mobility in severely motor-impaired children and adolescents. Therefore, the Cologne Standing-and-Walking-Trainer powered by Galileo is a suitable therapeutic device to apply WBV in immobilized children and adolescents.

Categories: Effects of Immobilization , Vibration While Standing , Develop or Improve Motor Ability

Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia.

Author(s): Odeen I, Knutsson E.
Publication: Scand J Rehabilitation Medicine. 1981;13(4):117-21.

Clinical observations on patients with spastic paraplegia have indicated that a training regime including weight load on the lower limbs may reduce the muscular hypertonus. Due to the spontaneous fluctuations and great variability in muscle tone it is difficult to judge from clinical findings how the effects may be related to muscle stretch and weight load. Therefore, quantitative determination of the effects on muscle tone by stretch and loading was made in 9 paraplegic patients. Muscle tone was measured before and after 30 min of stretch or weight load in 8 sessions on 4 consecutive days. Stretch was obtained by bracing the foot in maximal dorsal flexion with patient in supine position. For weight load on the lower limbs, the patient stood on a tilt-table at an angle of 85 degrees with feet in 15 degrees dorsal or plantar flexion. Resistance to passive movements was determined during a series of sinusoidal ankle joint movements at three different speeds. After weight load in standing with the feet in dorsal or plantar flexion, the average reduction was 32 and 26%, respectively. After stretch in supine, the average reduction was 17%. Thus, the three procedures tested all resulted in reduction of muscle tone. The largest reductions were obtained by weight load with stretch imposed upon the calf muscles.

Categories: Spinal Cord Injury , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 7347432 [PubMed - indexed for MEDLINE]

Reduction of muscular hypertonus by long-term muscle stretch.

Author(s): Odeen I.
Publication: Scand J Rehabilitation Medicine. 1981;13(2-3):93-9.

In 10 patients with spastic paraparesis, the effect of long-term stretch on hip adductor muscle tone was studied. Stretch was accomplished by using a mechanical leg-abductor device giving individually adjusted adductor muscle stretch in single or repeated 30 min periods. The effect on muscle tone was estimated from surface EMG activity and by range of voluntary and passive hip abduction. The passive movements were obtained by an individually adjusted constant pulling force. After a single session of stretch, range of voluntary hip abduction increased 3 to 16 degrees (average 85%). Range of passive movement increased 1 to 9 degrees (average 23%). After repeated stretch periods in a home program (4 patients), range of voluntary hip abduction increased 5 to 22 degrees (average 255%). Range of passive movements increased 6 to 12 degrees (average 48%). In all patients studied the co-activation of the antagonists in voluntary hip abduction was reduced after a stretch session.

Categories: Reduce Spasticity, Tone, Spasms , Spinal Cord Injury

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Pubmed ID: 7345572 [PubMed - indexed for MEDLINE]

Measurement of muscle thickness as quantitative muscle evaluation for adults with severe cerebral palsy.

Author(s): Ohata K, Tsuboyama T, Ichihashi N, Minami S.
Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kyoto University, Kyoto, Japan. oohta@hs.med.kyoto-u.ac.jp
Publication: Phys Ther. 2006 Sep;86(9):1231-9.

BACKGROUND AND PURPOSE: The muscle strength of people with severe cerebral palsy (CP) is difficult to quantify because of cognitive and selective motor control problems. However, if muscle strength is related to muscle atrophy caused by activity limitation, quantitative morphological analysis such as analysis of muscle thickness (MTH), measured by ultrasound imaging, may be used to examine the muscle condition in daily use. The primary purpose of this investigation was to clarify the difference in MTH of several muscles by the motor functions used in daily activity in adults with CP with different levels of severity of involvement. The secondary purpose was to examine whether MTH is associated with age, body characteristics, and muscle spasticity. SUBJECTS: Data were collected from a convenience sample of 25 adults with severe CP. METHODS: The MTH of the biceps brachii (BB), quadriceps femoris (QF), triceps surae (TS), and longissimus (LO) muscles was measured with an ultrasound imaging device. The severity of the condition was classified with the Gross Motor Function Classification System (GMFCS), and functional status in sitting and standing was evaluated with a questionnaire administered to the staff assisting in the care of the subjects. Muscle spasticity was assessed with the Modified Ashworth Scale (MAS). RESULTS: The MTH of the QF, LO, and TS showed significant differences according to the GMFCS level, and the MTH of the QF and LO differed significantly depending on functional status during activities of daily living. Age and body mass index showed no significant correlation with the MTH of any muscle. Body weight was correlated with the MTH of the BB and LO. The girth of the extremity was correlated only with the MTH of the BB. There was no relationship between MTH and MAS scores. DISCUSSION AND CONCLUSION: These results suggest that the MTH of the QF and LO differed significantly depending on the subjects' motor function during daily activity. The measurement of MTH may be an alternative method of quantitative muscle evaluation for people with severe CP for whom direct measurement of muscle strength is difficult.

Categories: Cerebral Palsy , Effects of Immobilization , Mobile / Dynamic Standing , Prevent Pressure Ulcers/Maintain Skin Integrity , Promote Psychosocial Skills and Improve Sleep , Reduce Spasticity, Tone, Spasms , Review of Literature , Improve Hip Integrity , Improve Pain Management , Increase Self-Care , Develop or Improve Motor Ability , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 16959671 [PubMed - indexed for MEDLINE]

Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta

Author(s): Oliver Semler, Oliver Fricke, Katharina Vezyroglou, Christina Stark, Angelika Stabrey, Eckhard Schoenau
Children's Hospital, University of Cologne, Cologne, Germany
Publication: Clinical Rehabilitation, Vol. 22, No. 5, 387-394 (2008)

Objective: To evaluate the effect of whole body vibration on the mobility of long-term immobilized children and adolescents with a severe form of osteogenesis imperfecta. Osteogenesis imperfecta is a hereditary primary bone disorder with a prevalence from 1 in 10000 to 1 in 20000 births. Most of these children are suffering from long-term immobilization after recurrent fractures. Due to the immobilization they are affected by loss of muscle (sarcopenia) and secondary loss of bone mass.

Subjects: Whole body vibration was applied to eight children and adolescents (osteogenesis imperfecta type 3, N=5; osteogenesis imperfecta type 4, N=3) over a period of six months.

Interventions and results: Whole body vibration was applied by a vibrating platform (Galileo Systems) constructed on a tilting-table. Success of treatment was assessed by measuring alterations of the tilting-angle and evaluating the mobility (Brief Assessment of Motor Function). All individuals were characterized by improved muscle force documented by an increased tilting-angle (median = 35 degrees) or by an increase in ground reaction force (median at start=30.0 [N/kg] (14.48—134.21); median after six months = 146.0 [N/kg] (42.46—245.25).

Conclusions: Whole body vibration may be a promising approach to improve mobility in children and adolescents severely affected with osteogenesis imperfecta.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization , Vibration While Standing , Develop or Improve Motor Ability

Development and reliability of a system to classify gross motor function in children with cerebral palsy.

Author(s): Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B.
Department of Physical Therapy, Allegheny University of the Health Sciences, Philadelphia, PA, USA.
Publication: Dev Med Child Neurol. 1997 Apr;39(4):214-23.

To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.

Categories: Cerebral Palsy , Develop or Improve Motor Ability

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Pubmed ID: 9183258 [PubMed - indexed for MEDLINE]

Prevention of Acquired Dislocation of the Hip in Cerebral Palsy

Author(s): Phelps, W.M.
Publication: Journal of Bone and Joint Surgery

Acquired dislocation of the hip in cerebral palsy appears to result from: (1) coxa valga, due to late weight-bearing; (2) spasticity or contracture of the adductor muscles; or (3) spasticity or contracture of the gracilis muscle. These three types are distinguishable from congenital dislocation of the hip and from each other on the basis of roentgenographic and clinical findings. Prevention of each type of dislocation is often possible by the specific measures described.

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Categories: Cerebral Palsy , Reduce Spasticity, Tone, Spasms , Improve Hip Integrity , Improve Range of Motion, Prevent Contractures

Effectiveness of static weight-bearing exercises in children with cerebral palsy.

Author(s): Pin TW.
School of Physiotherapy, University of Melbourne, Victoria, Australia.
Publication: Pediatr Phys Ther. 2007 Spring;19(1):62-73. Erratum in: Pediatr Phys Ther. 2007 Summer;19(2):172-8.

PURPOSE: Physiotherapists commonly use static weight-bearing exercises in children with cerebral palsy, which are believed to stimulate antigravity muscle strength, prevent hip dislocation, improve bone mineral density, improve self-esteem, improve feeding, assist bowel and urinary functions, reduce spasticity, and improve hand function. The effectiveness of these exercises has not been thoroughly investigated. This systematic review aimed to examine the research evidence of the effectiveness of static weight-bearing exercises in children with cerebral palsy. METHODS: Ten studies met the inclusion criteria for this review. RESULTS: The evidence supporting the effectiveness of static weight-bearing exercises in children with cerebral palsy, except the findings of increased bone density and temporary reduction in spasticity, remains limited because of an inadequate number of studies undertaken, inadequate rigor of the research designs and the small number of subjects involved. CONCLUSION: Clinicians should carefully consider all available evidence before making a decision regarding the potential effectiveness of static weight-bearing for the targeted outcomes.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy , Reduce Spasticity, Tone, Spasms , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 17304099 [PubMed - indexed for MEDLINE]

Management of hip dislocation with postural management.

Author(s): Pountney T, Mandy A, Green E, Gard P.
Chailey Heritage Clinical Services, North Chailey, East Sussex, UK. Teresa.Pountney@southdowns.nhs.uk
Publication: Child Care Health Dev. 2002 Mar;28(2):179-85.

BACKGROUND: Hip dislocation in children with cerebral palsy has a well-documented history and morbidity. OBJECTIVE: This paper presents a retrospective study of children with bilateral cerebral palsy who had various postural management and its effect on hip deformity. The most widely accepted theoretical model of hip subluxation/dislocation is that an imbalance in muscle length and strength around the hip leads to acetabular dysplasia and consequent hip subluxation. Maintenance of muscle length and strength and loadbearing is therefore a logical prevention. Research on normal infants' postures has provided biomechanical data to form the theoretical basis of 24 h postural management equipment. METHODS: The notes and X-rays of 59 children with bilateral cerebral palsy from East and West Sussex and Oxfordshire were examined and measured to determine whether a relationship existed between postural management and the level of hip subluxation/dislocation. X-rays were measured using Reimers' hip migration percentage. Postural management support was divided into three groups for analysis. Category 1: use of a 24-h postural management approach using Chailey Adjustable Postural Support (CAPS) systems in lying, sitting and standing; category 2: two items of CAPS (either lying/sitting or sitting/standing supports); category 3: use of the CAPS seat only and/or any other postural supports. Hip status was recorded for analysis as both hips safe (under 33% migrated), or one/both hips subluxed. RESULTS: Children using 'All CAPS' before hip subluxation maintained significantly more hip integrity than other groups (chi2 P < 0.05). CONCLUSIONS: Postural management interventions have an important role in the prevention of hip dysplasia.

Categories: Cerebral Palsy , Improve Hip Integrity

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Pubmed ID: 11952654 [PubMed - indexed for MEDLINE]

Fractures in patients with cerebral palsy.

Author(s): Presedo A, Dabney KW, Miller F.
Department of Orthopaedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE 19803, USA.
Publication: J Pediatr Orthop. 2007 Mar;27(2):147-53.

Fractures in children with cerebral palsy (CP) constitute a common clinical problem. The purpose of this retrospective study is to analyze the demographics, identify risk factors, and delineate guidelines for treatment in 156 children with CP who were treated for fractures. To identify changes in demographics, children treated before 1992 (56 patients) were compared with those treated from 1992 to 2000. The latter group of children was compared with an age- and gender-matched group of CP children without fractures. Ambulatory status, the presence of contractures, nutritional status, seizure medication, the type of treatment received, final outcomes, and complications were recorded and statistically analyzed. The mean age at the time of the first fracture was 10 years. Sixty-six percent of patients had spastic quadriplegia, of whom 83% were nonambulatory. Eighty-two percent of fractures occurred in the lower limbs. Forty-eight percent were delayed in diagnosis with no cause determined. Children treated after 1992 had higher incidence of multiple fractures, lower incidence contractures, and a younger age at first fracture. This group showed a statistically significant difference for anticonvulsant therapy (P=0.001), CP pattern (P=0.005), ambulatory status (P=0.001), and osteopenia (P=0.001) when compared with the group of CP patients without fractures. Eighty percent of fractures were treated with a soft bulky dressing. Complications occurred in 17% of patients. The greatest risk factor for fracture is the nonambulatory CP child on anticonvulsant therapy. These risk factors seem to have increased, resulting in a higher prevalence of low energy fractures. Future research must focus on the underlying mechanisms and prevention of this condition.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 17314638 [PubMed - indexed for MEDLINE]

Role of the renin-angiotensin system in mediating the effects of posture on renal function.

Author(s): Reinhart GA, Lohmeier TE.
Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson 39216-4505, USA.
Publication: Am J Physiol. 1996 Jul;271(1 Pt 2):R282-8

This study was designed to quantitate the influence of the neurohumoral activation associated with orthostatic stress on renal hemodynamics and sodium excretion and, furthermore, to determine the importance of the renin-angiotensin system in mediating these changes in renal function. Seven conscious dogs were studied while lying in the recumbent position and, subsequently, after standing in a supporting sling. Experiments were conducted under control conditions and after plasma angiotensin II (ANG II) concentration was fixed at control levels by chronic infusion of captopril (14 micrograms.kg-1.min-1) and ANG II (0.5 +/- 0.02 ng.kg-1.min-1). During control experiments, 45 min of standing increased plasma renin activity twofold, whereas mean arterial pressure, heart rate, and plasma norepinephrine concentration remained unchanged. During standing, glomerular filtration rate (GFR) and renal plasma flow (RPF) fell to 88 +/- 2 and 77 +/- 3% of recumbent values, respectively, whereas filtration fraction (FF) increased 16 +/- 1%. Additionally, urinary (UNaV) and fractional sodium excretion (FENa) decreased to 27 +/- 6 and 30 +/- 7% of recumbent values, respectively. When plasma ANG II concentration was fixed at control levels during standing, there were no significant changes in GFR, whereas increments in FF and reductions in RPF, UNaV, and FENa were attenuated by 63, 40, 30, and 33%, respectively. These data suggest that, in conscious dogs, standing in a supporting sling causes reflex activation of the sympathetic nervous and renin-angiotensin systems, eliciting reductions in GFR, RPF, and UNaV. Furthermore, ANG II contributes significantly to the effects of passive standing on renal hemodynamics and UNaV.

Categories: Improve Bladder Function

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Pubmed ID: 8760231 [PubMed - indexed for MEDLINE]

Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke

Author(s): Rhoda, Allison and Dennett, Rachel
Stroke Unit and Physiotherapy Department, Newton Abbot Hospital, Devon, UK
Publication: Clinical Rehabilitation 2007; 21: 614–619

Objective: To investigate whether provision of additional standing practice increases motor recovery and mobility post stroke.

Design: A pilot randomized controlled trial.

Setting: A stroke rehabilitation unit in the UK.
Participants: Seventeen participants, seven women and ten men, age range 51–92 admitted to the unit 6–58 days post stroke.

Intervention: Each participant was randomly allocated into a control (conventional
physiotherapy) or treatment (conventional therapy plus an additional session of standing practice) group. The period of intervention ranged from 14 to 28 days dependent upon length of stay on the unit.

Outcome measures: The Gross Functional Tool Section of the Rivermead Motor Assessment, the Trunk Control Test and the Berg Balance Scale were used on admission to the study, at weekly intervals during the intervention, and at
12 weeks (after discharge).

Results: Of the 17 participants recruited, three withdrew from the additional intervention
group citing fatigue as a barrier and 15 completed the study.Participants completing additional standing practice demonstrated higher scores in all motor measures at week 12, but this difference was not statistically significant.
There was a statistically significant difference (P0.05) in the changes in Berg Balance score when comparing week 1 with week 12, in support of the group receiving extra standing practice.

Conclusions: A larger study is required to establish the value of additional standing
practice after stroke. This pilot demonstrates that the Gross Functional Tool Section
of the Rivermead Motor Assessment and the Berg Balance Scale would be useful in such a study. Fatigue may be a significant barrier to ability to participate in more intensive programmes so screening participants for severe fatigue may be useful.

Categories: Stroke , Develop or Improve Motor Ability

Regulation of bone mass by mechanical strain magnitude.

Author(s): Rubin CT, Lanyon LE.
Publication: Calcif Tissue Int. 1985 Jul;37(4):411-7.

The in vivo remodeling behavior within a bone protected from natural loading was modified over an 8-week period by daily application of 100 consecutive 1 Hz load cycles engendering strains within the bone tissue of physiological rate and magnitude. This load regime resulted in a graded dose:response relationship between the peak strain magnitude and change in the mass of bone tissue present. Peak longitudinal strains below 0.001 were associated with bone loss which was achieved by increased remodeling activity, endosteal resorption, and increased intra-cortical porosis. Peak strains above 0.001 were associated with little change in intra-cortical remodeling activity but substantial periosteal and endosteal new bone formation.

Categories: Vibration While Standing

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Pubmed ID: 3930039 [PubMed - indexed for MEDLINE]

Effects of prolonged standing on gait in children with spastic cerebral palsy.

Author(s): Salem Y, Lovelace-Chandler V, Zabel RJ, McMillan AG.
Division of Physical Therapy, Long Island University, Brooklyn, New York 11201, USA. Yasser.salem@liu.edu
Publication: Phys Occup Ther Pediatr. 2010 Feb;30(1):54-65.

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.

Categories: Cerebral Palsy , Reduce Spasticity, Tone, Spasms , Develop or Improve Motor Ability

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Pubmed ID: 20170432 [PubMed - indexed for MEDLINE]

Preliminary results on the mobility after whole body vibration in immobilized children and adolescents.

Author(s): Semler O, Fricke O, Vezyroglou K, Stark C, Schoenau E.
Children's Hospital, University of Cologne, Cologne, Germany.
Publication: J Musculoskelet Neuronal Interact. 2007 Jan-Mar;7(1):77-81.

The present article is a preliminary report on the effect of Whole Body Vibration (WBV) on the mobility in long-term immobilized children and adolescents. WBV was applied to 6 children and adolescents (diagnoses: osteogenesis imperfecta, N=4; cerebral palsy, N=1; dysraphic defect of the lumbar spine, N=1) over a time period of 6 months. WBV was applied by a vibrating platform constructed on a tilt-table. The treatment effect was measured by alternations of the tilt-angle of the table and with the "Brief assessment of motor function" (BAMF). All 6 individuals were characterized by an improved mobility, which was documented by an increased tilt-angle or an improved BAMF-score. The authors concluded WBV might be a promising approach to improve mobility in severely motor-impaired children and adolescents. Therefore, the Cologne Standing-and-Walking- Trainer powered by Galileo is a suitable therapeutic device to apply WBV in immobilized children and adolescents.

Categories: Vibration While Standing , Develop or Improve Motor Ability

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Pubmed ID: 17396011 [PubMed - indexed for MEDLINE]

Monitoring standing wheelchair use after spinal cord injury: a case report.

Author(s): Shields RK, Dudley-Javoroski S.
Graduate Program in Physical Therapy and Physical Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA. richard-shields@uiowa.edu
Publication: Disabil Rehabil. 2005 Feb 4;27(3):142-6.

PURPOSE: An important issue in spinal cord injury (SCI) research is whether standing can yield positive health benefits. However, quantifying dose of standing and establishing subject compliance with a standing protocol is difficult. This case report describes a method to monitor dose of standing outside the laboratory, describes the standing patterns of one subject, and describes this subject's satisfaction with the standing protocol. METHOD: A man with T-10 complete paraplegia agreed to have his commercially available standing wheelchair instrumented with a custom-designed logging device for a 2-year period. The micro-controller-based logger, under custom software control, was mounted to the standing wheelchair. The logger recorded date, duration, angle of standing, and start/stop times. RESULTS: The client exceeded a suggested minimum dosage of standing per month (130.4% of goal), choosing to stand for short bouts (mean = 11.57 min) at an average angle of 61 degrees, on an average 3.86 days per calendar week. He was generally very satisfied with the standing device and provided subjective reports of improved spasticity and bowel motility. CONCLUSION: This case report describes a standing and surveillance system that allow quantification of standing dose. Future controlled studies are needed to evaluate whether standing can be beneficially affect secondary complications after SCI.

Categories: Reduce Spasticity, Tone, Spasms , Spinal Cord Injury , Improve Bladder Function

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Pubmed ID: 15823996 [PubMed - indexed for MEDLINE]

Complications of osteotomies in severe cerebral palsy.

Author(s): Stasikelis PJ, Lee DD, Sullivan CM.
University of Chicago Hospitals, Illinois, USA.
Publication: J Pediatr Orthop. 1999 Mar-Apr;19(2):207-10.

Seventy-nine consecutive children with cerebral palsy who underwent osteotomies about the hip for subluxation or dislocation were studied retrospectively to determine risk factors that would correlate with postoperative complications of death, fracture, or decubitus ulcer. Except for the three patients who died, all of the children had > or = 1 year of follow-up. Twenty (25%) patients had at least one complication. Three children died; one at 1 week, one at 2 weeks, and one at 5 months after surgery. Sixteen patients sustained 25 fractures. All were managed with cast or splint immobilization in the clinic. Five patients developed decubitus ulcers requiring > or = 2 weeks of local care, but none required skin grafts or flaps. Complications occurred in 13 (68%) of 19 children with gastrostomies or tracheostomies but in only seven (12%) of the remaining 60 children. Only one (8%) of 13 ambulatory patients had a complication compared with 19 (29%) of 66 nonambulatory patients. In conclusion, ambulatory function correlates well with the risk of complications after osteotomies. A nonambulatory patient with a gastrostomy or tracheostomy is at even greater risk. Fortunately the fractures and ulcers observed in this series healed uneventfully with no operative intervention.

Categories: Cerebral Palsy , Prevent Pressure Ulcers/Maintain Skin Integrity

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Pubmed ID: 10088690 [PubMed - indexed for MEDLINE]

Measurement of growth in children with developmental disabilities.

Author(s): Stevenson RD.
University of Virginia School of Medicine, Kluge Children's Rehabilitation Center and Research Institute, Charlottesville, 22903, USA.
Publication: Dev Med Child Neurol. 1996 Sep;38(9):855-60.

The clinical assessment of growth is a challenging, but essential, aspect of managing the health care of children with developmental disabilities. However, with standard equipment, modest training and some patience, almost all children can be measured reliably. Once reliable measurements are obtained, the interpretation or 'clinical meaning' of the measurements depends on their comparison with reference data from normal populations or, when available, with condition-specific reference data. More research is needed to improve our understanding of the clinical meaning of obtained measurements. The range of normal growth for some children with disabilities, particularly CP, remains to be defined. Research in the next ten years will, hopefully, lead to the development of growth charts for children with CP, and perhaps children with other conditions, which will facilitate the clinical interpretation of growth data and lead to improved management of health care for children with developmental disabilities.

Categories: Cerebral Palsy , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 8810718 [PubMed - indexed for MEDLINE]

Latrogenic dilatation of the upper urinary tract during radiographic evaluation of patients with spinal cord injury.

Author(s): Stover SL, Witten DM, Kuhlemeier KV, Lloyd LK, Fine PR.
Publication: J Urol. 1986 Jan;135(1):78-82

Patients with upper and lower motor neuron spinal cord injuries were observed to determine whether cystography immediately before excretory urography induced iatrogenic dilatation of the upper urinary tract that was indistinguishable from true pathological dilatation. Evidence is given that such dilatation occurs. This iatrogenic dilatation is not seen in patients with normally innervated urinary tracts and appears to be caused by exaggerated bladder reflexes in patients with upper motor neuron lesions. Bladder spasms precipitated by cystographic contrast material also may create vesicoureteral obstruction and lead to dilatation of the upper urinary tract. Consequently, it is suggested that cystography should not immediately precede excretory urography. When such a sequence is necessary, room or body temperature contrast medium should be used for the cystogram, the bladder should be emptied before the excretory urogram is started and a 1-hour interval should be allowed between the 2 procedures. The findings also suggest that any factors that induce repeated or continuing bladder spasms may contribute to progressive dilatation of the upper urinary tract.

Categories: Spinal Cord Injury , Improve Bladder Function

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Pubmed ID: 3941472 [PubMed - indexed for MEDLINE]

Considerations related to weight-bearing programs in children with developmental disabilities.

Author(s): Stuberg WA.
Meyer Rehabilitation Institute, University of Nebraska Medical Center, Omaha 68198-5450.
Publication: Phys Ther. 1992 Jan;72(1):35-40.

Standing is a common modality used in the management of children with developmental disabilities. The purpose of this article is to examine the scientific basis for standing programs, with specific emphasis on the known effects of weight bearing on bone development. Guidelines for the use of standing programs are presented, and the supporting rationale is discussed.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy , Review of Literature , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 1728047 [PubMed - indexed for MEDLINE]

Cardiovascular responses to upright and supine exercise in humans after 6 weeks of head-down tilt (-6 degrees)

Author(s): Sundblad P, Spaak J, Linnarsson D.
Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden. Patrik.Sundblad@fyfa.ki.se
Publication: Eur J Appl Physiol. 2000 Nov;83(4 -5):303-9.

Seven healthy men performed steady-state dynamic leg exercise at 50 W in supine and upright postures, before (control) and repeatedly after 42 days of strict head-down tilt (HDT) (-6 degrees) bedrest. Steady-state heart rate (fc), mean arterial blood pressure, cardiac output (Qc), and stroke volume (SV) were recorded. The following data changed significantly from control values. The fc was elevated in both postures at least until 12 days, but not at 32 days after bedrest. Immediately after HDT, SV and Qc were decreased by 25 (SEM 3)% and 19 (SEM 3)% in supine, and by 33 (SEM 5)% and 20 (SEM 3)% in upright postures, respectively. Within 2 days there was a partial recovery of SV in the upright but not in the supine posture. The SV and Qc during supine exercise remained significantly decreased for at least a month. Submaximal oxygen uptake did not change after HDT. We concluded that the cardiovascular response to exercise after prolonged bedrest was impaired for so long that it suggested that structural cardiac changes had developed during the HDT period.

Categories: Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 11138568 [PubMed - indexed for MEDLINE]

Cardiac output and blood pressure during active and passive standing.

Author(s): Tanaka H, Sjöberg BJ, Thulesius O
Department of Pediatrics, Osaka Medical College, Japan
Publication: Clin Physiol. 1996 Mar;16(2):157-70.

The present study compared the haemodynamic pattern of active and passive standing. We used non-invasive techniques with beat-to-beat evaluation of blood pressure, heart rate and stroke volume. Seven healthy subjects, aged 24-41 (mean 30) years were examined. Finger blood pressure was continuously recorded by volume clamp technique (Finapres), and simultaneous beat-to-beat beat stroke volume was obtained, using an ultrasound Doppler technique, from the product of the valvular area and the aortic flow velocity time integral in the ascending aorta from the suprasternal notch. Measurements were performed at rest, during active standing and following passive tilt (60 degrees). Active standing caused a transient but greater reduction of blood pressure and a higher increase of heart rate than passive tilt during the first 30s (delta mean blood pressure: -39 +/- 10 vs. -16 +/- 7 mmHg, delta heart rate: 35 +/- 8 vs. 12 +/- 7 beats m-1 (active standing vs. passive tilt; P < 0.01). There was a significantly larger increase in cardiac output during active standing (37 +/- 24 vs. 0 +/- 15%, P < 0.01) and a more marked decrease in total peripheral resistance (-58 +/- 11 vs. -16 +/- 17%, P < 0.01). A precipitous rise in intra-abdominal pressure (43 +/- 22 mmHg) could be observed upon rising only in active standing. This was interpreted as an indication of translocation of blood to the thorax. There was no significant difference in haemodynamic changes during the later stage of standing (1-7 min) between both manoeuvres. These results suggest that active standing causes a marked blood pressure reduction in the initial phase which seems to reflect systemic vasodilatation caused by activation of cardiopulmonary baroreflexes, probably due to a rapid shift of blood from the splanchnic vessels in addition to the shift from muscular vessels associated with abdominal and calf muscle contraction. Moreover, the ultrasound Doppler technique was found to be a more adequate method for rapid beat-to-beat evaluation of cardiac output during orthostatic manoeuvres.

Categories: Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 8964133 [PubMed - indexed for MEDLINE]

Cardiac output and blood pressure during active and passive standing.

Author(s): Tanaka H, Sjöberg BJ, Thulesius O.
Department of Pediatrics, Osaka Medical College, Japan.
Publication: Clin Physiol. 1996 Mar;16(2):157-70.

Categories: Active (Reciprocal Leg Movement) Standing , Improve Circulation/Respiratory/ Cardio Function

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Pubmed ID: 8964133 [PubMed - indexed for MEDLINE]

Bone mineral density in children with cerebral palsy.

Author(s): Tasdemir HA, Buyukavci M, Akcay F, Polat P, Yildiran A, Karakelleoglu C.
Department of Pediatric Neurology, Atatürk University Faculty of Medicine, Erzurum, Turkey.
Publication: Pediatr Int. 2001 Apr;43(2):157-60.

BACKGROUND: The purpose of the present study was to evaluate the severity of and factors related to osteopenia in children with cerebral palsy (CP). METHODS: Bone mineral density (BMD), calcium (Ca), phosphate (P), alkaline phosphatase (ALP), creatinine, parathyroid hormone (PTH) and 25-hydroxy vitamin D3 (25OHD3) concentrations were determined in 24 children with CP (15 ambulant, nine non-ambulant), aged between 10 months and 12 years (mean (+/-SD) 4.1+/-2.9 years). These vaules were compared with data obtained from a control group. RESULTS: Adjusted mean BMD values were lower in the patient group than in controls (P<0.05). However, there was no difference between BMD values of ambulant and non-ambulant patients. The Ca and P levels of the patient group were significantly higher than those of controls (P<0.05). CONCLUSIONS: The present study showed that BMD was decreased in all children with CP, but to a greater extent in non-ambulant children with CP, and immobilization is the major effective factor on bone mineralization.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 11285068 [PubMed - indexed for MEDLINE]

Factors Affecting Prescription and Implementation of Standing-Frame Programs by School-Based Physical Therapists for Children with Impaired Mobility

Author(s): Taylor, Kristin PT
Publication: Pediatric Physical Therapy: Fall 2009 - Volume 21 - Issue 3 - pp 282-288

Survey results on standing frame prescription and implementation by school based physical therapists was published in the latest issue of Pediatric Physical Therapy. The survey results indicated that most school based PT's prescribe standing programs based on ambulatory status and specific needs. The benefits of standing programs were rated very important for social and educational reasons. Most standing programs were prescribed for 30-45 minutes daily.

Categories: Review of Literature , School-Based Therapy

The influence of upright posture on the metabolic rate

Author(s): Tepper, R.H., Hellebrandt, F.A.
Department of Physiology, University of Wisconsin
Publication: American Journal of Physiology

The maintenance of the upright stance without support is associated with an incessant shifting of the center weight (Hellebrandt, 1938). A plumb passing through its mean position closely approximates in location the geometric center of the base (Hellebrandt et al., 1937) and thus brings about what Morton (1935) calls “a forward unbalanced position of the leg.” The line of gravity, falling successively at various points in front of the ankle joint, represents a force which acts as a constantly changing stimulus for the geotonic contraction of the anti-gravity muscles. We have called standing movement upon a stationary base. This implies the liberation of energy for the performance of work. Although it is believed that the postural contraction of muscle occasion little augmentation of the calorific output (Roaf, 1912; Dusser de Barenne and Burger, 1924; Evans, 1930; Fulton, 1926; Weatherhead, 1932; Gaylor and Wishart, 1933), a concept of human standing as a dynamic phenomenon affected by mechanical factors in build warrants further study of the energy cots of standing in man. The object of these experiments was to determine the range of metabolic increase attributed to the brief maintenance of passively assumed upright stance.

Categories: Review of Literature

One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke.

Author(s): Tihanyi TK, Horváth M, Fazekas G, Hortobágyi T, Tihanyi J.
Semmelweis University, and Department of Rehabilitation Medicine, Saint John Hospital Budapest, Hungary.
Publication: Clin Rehabil. 2007 Sep;21(9):782-93.

OBJECTIVE: To determine the effect of whole body vibration on isometric and eccentric torque and electromyography (EMG) variables of knee extensors on the affected side of stroke patients. DESIGN: A randomized controlled study. SETTING: A rehabilitation centre. SUBJECTS: Sixteen patients (age 58.2+/-9.4 years) were enrolled in an inpatient rehabilitation programme 27.2+/-10.4 days after a stroke. INTERVENTIONS: Eight patients were randomly assigned to the vibration group and received 20 Hz vibration (5 mm amplitude) while standing on a vibration platform for 1 minute six times in one session. Patients in the control group also stood on the platform but did not receive vibration. MAIN MEASURES: Maximum isometric and eccentric torque, rate of torque development, root-mean-squared EMG, median frequency of vastus lateralis, and co-activation of knee flexors. RESULTS: Isometric and eccentric knee extension torque increased 36.6% and 22.2%, respectively, after vibration (P<0.05) and 8.4% and 5.3% in the control group. Vibration increased EMG amplitude 44.9% and the median frequency in the vastus lateralis by 13.1% (all P<0.05) without changes in the control group (10.6% and 3.9%). Vibration improved the ability to generate mechanical work during eccentric contraction (17.5%). Vibration reduced biceps femoris co-activation during isometric (8.4%, ns) and eccentric (22.5%, P<0.05) contraction. CONCLUSION: These results suggest that one bout of whole body vibration can transiently increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke.

Categories: Stroke , Vibration While Standing , Improve Strength

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Pubmed ID: 17875558 [PubMed - indexed for MEDLINE]

Osteomalacia associated with anticonvulsant drug therapy in mentally retarded children.

Author(s): Tolman KG, Jubiz W, Sannella JJ, Madsen JA, Belsey RE, Goldsmith RS, Freston JW.
Publication: Pediatrics. 1975 Jul;56(1):45-50.

A survey of 289 severely retarded inpatients at a school for retarded children in American Fork; Utah revealed 67 patients with osteomalacia as defined by hypocalcemia, hypophosphatemia, elevated serum alkaline phosphatase levels, and appropriate bone changes. Investigation of the variables which might influence bone mineralization revealed no differences in age, sex, physical activity, sunshine exposure, or dietary intake of vitamin D between the osteomalacia and nonosteomalacia groups. However, all of the patients with osteomalacia were receiving anticonvulsant medications, either phenobarbital, diphenylhydantoin, or both. Duration of anticonvulsant therapy was the most important contributing factor to the development of osteomalacia. Seventy-five percent of patients who had received anticonvulsants for more than ten years had osteomalacia. The single most costly medical problem at the school is the treatment of pathologic bone fractures due to demineralized bone.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Review of Literature

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Pubmed ID: 1161362 [PubMed - indexed for MEDLINE]

Effects of prolonged muscle stretch on reflex and voluntary muscle activations in children with spastic cerebral palsy.

Author(s): Tremblay F, Malouin F, Richards CL, Dumas F.
Neurobiology Laboratory, Faculty of Medicine, Laval University, Quebec, Canada.
Publication: Scand J Rehabilitation Medicine. 1990;22(4):171-80.

We studied the short term effects of a single session of prolonged muscle stretch (PMS) on reflex and voluntary muscle activations in 22 children with spastic cerebral palsy (CP) assigned to an experimental (n = 12) and a control group (n = 10). Children of the experimental group underwent PMS of the triceps surae (TS) by standing with the feet dorsiflexed on a tilt-table for 30 min, whereas children of the control group were kept at rest. The effects were determined by measuring the associated changes in torque and in electromyographic (EMG) activity of the TS and tibialis anterior (TA) muscles during both passive ankle movements and maximal static voluntary contractions. The results indicate that PMS led to reduced spasticity in ankle muscles as demonstrated by the significant reductions (p less than 0.05) of the neuromuscular responses (torque and EMG) to passive movement. These inhibitory effects lasted up to 35 min after cessation of PMS. In addition, the capacity to voluntarily activate the plantar flexors was significantly (p less than 0.05) increased post-PMS, but the capacity to activate the dorsiflexors was apparently not affected. These findings suggest that repeated sessions of PMS may have beneficial effects in the management of spasticity in children with CP.

Categories: Cerebral Palsy , Reduce Spasticity, Tone, Spasms , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 2263918 [PubMed - indexed for MEDLINE]

Effects of stimulated hip extension moment and position on upper-limb support forces during FNS-induced standing--a technical note.

Author(s): Triolo R, Wibowo M, Uhlir J, Kobetic R, Kirsch R.
Motion Study Laboratory, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, OH 44106, USA. rxt24@po.cwru.edu
Publication: J Rehabil Res Dev. 2001 Sep-Oct;38(5):545-55.

This study explores the effects of active hip extension moment produced by electrical stimulation on the support forces the arms must exert through an assistive device during quiet erect standing with functional neuromuscular stimulation (FNS) in individuals with spinal cord injuries (SCI). A static sagittal plane biomechanical model of human standing was developed to predict the effects of stimulated hip extension moment and sagittal plane hip angle on the arm support necessary to maintain an upright posture. Two individuals with complete thoracic SCI were then tested while they stood with continuous stimulation to the knee and trunk extensors. The steady-state active extension moment exerted at the hip was varied by activating different combinations of hip extensor muscles with continuous stimulation while steady-state support forces applied to the arms and feet during standing were measured. The steady-state support forces imposed on the arms during quiet standing decrease with increased stimulated hip extension moment and are highly dependent upon hip flexion angle, as predicted by the biomechanical simulations. Experimentally, the combination of gluteus maximus and semimembranosus stimulation produced three times more steady-state hip extension moment than did stimulation of the gluteus maximus and adductor magnus. This resulted in a ten-fold decrease in body weight supported on the arms. More vertical postures (smaller hip flexion angles) improve the effectiveness of the hip extensor muscles in reducing the support forces placed on the arms. A single Newton-meter of stimulated hip extension moment with the hips fixed at 5 degrees of flexion results in almost five times the reduction in arm support forces as with the hips at 20 degrees. To minimize the forces applied by the arms on an assistive device for support while standing with FNS, these preliminary results suggest that (1) efforts should be made to assume the most erect postures possible and (2) muscles and stimulation paradigms that maximize active hip extension moment should be chosen.

Categories: Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 11732832 [PubMed - indexed for MEDLINE]

Extent and direction of joint motion limitation after prolonged immobility: an experimental study in the rat.

Author(s): Trudel G, Uhthoff HK, Brown M.
Department of Medicine, University of Ottawa, and the Institute for Rehabilitation Research and Development, Ontario, Canada.
Publication: Arch Phys Med Rehabilitation. 1999 Dec;80(12):1542-7.

OBJECTIVES: To test the hypotheses that contractures progress at different rates in relation to the time after immobilization, that immobilization in flexion leads to loss of extension range of motion, and that joints of sham-operated animals are better controls than the contralateral joint of experimental animals. STUDY DESIGN: Experimental, controlled study in which 40 adult rats had one knee joint immobilized at 135 degrees of flexion for up to 32 weeks and 20 animals underwent a sham procedure. At intervals of 2, 4, 8, 16, and 32 weeks, 8 experimental and 4 sham-operated animals were killed and their knee motion measured in flexion and extension. RESULTS: In the experimental group, the range of motion decreased in the first 16 weeks of immobility at an average rate of 3.8 degrees per week (p<.0001) to reach 61.1 degrees of restriction. A plateau was then observed from which the contracture did not progress further. The loss in range of motion occurred in extension, not in flexion. CONCLUSION: This study defined an acute stage of contractures starting at the onset of immobility and lasting 16 weeks, during which the range of motion was progressively restricted, and a chronic stage during which no additional limitation was detected. The loss in motion was attributed to posterior knee structures not under tension during immobilization in flexion. Contrary to the hypothesis, the contralateral joint was validated as a control choice for range-of-motion experiments.

Categories: Effects of Immobilization , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 10597804 [PubMed - indexed for MEDLINE]

Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee.

Author(s): Trudel G, Uhthoff HK.
Department of Medicine, University of Ottawa, Canada.
Publication: Arch Phys Med Rehabilitation. 2000 Jan;81(1):6-13.

OBJECTIVES: To measure articular structures' contribution to the limitation of range of motion after joint immobility. STUDY DESIGN: Experimental, controlled study involving 40 adult rats that had one knee joint immobilized in flexion for durations of 2, 4, 8, 16, and 32 weeks; 20 rats underwent a sham procedure. The angular displacement was measured both in flexion and extension at three different torques. Myotomy of transarticular muscles allowed isolation of the arthrogenic component of the contracture. RESULTS: A contracture developed in all immobilized knees. The articular structures were incrementally responsible for the limitation in range of motion (from 12.6 degrees +/-6.7 degrees at 2 weeks to 51.4 degrees +/-5.4 degrees at 32 weeks). The myogenic restriction proportionately decreased over time (from 20.1 degrees +/-8.4 degrees at 2 weeks to only 0.8 degrees +/-7.2 degrees at 32 weeks). The increase in the arthrogenic component of contracture was predominant in extension. CONCLUSION: This study quantified the increasing role of arthrogenic changes in limiting the range of motion of joints after immobility, especially as the period of immobility extended past 2 weeks. These data provide a better understanding of joint contracture development and can be used to guide therapeutic approaches.

Categories: Effects of Immobilization , Reduce Spasticity, Tone, Spasms

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Pubmed ID: 10638868 [PubMed - indexed for MEDLINE]

Effects of a single session of prolonged muscle stretch on spastic muscle of stroke patients.

Author(s): Tsai KH, Yeh CY, Chang HY, Chen JJ.
Department of Industrial Management, Southern Taiwan University of Technology, Tainan, ROC.
Publication: Proc Natl Sci Counc Repub China B. 2001 Apr;25(2):76-81.

The control of spasticity is often a significant problem in the management of patients with spasticity. The aim of this study was to evaluate the effect of a single session of prolonged muscle stretch (PMS) on the spastic muscle. Seventeen patients with spastic hemiplegia were selected to receive treatment. Subjects underwent PMS of the triceps surae (TS) by standing with the feet dorsiflexed on a tilt-table for 30 minutes. Our test battery consisted of four measurements including the modified Ashworth scale of the TS, the passive range of motion (ROM) of ankle dorsiflexion, the H/M ratio of the TS, and the F/M ratio of the tibialis anterior (TA). The results indicated that the passive ROM of ankle dorsiflexion increased significantly (p < 0.05) compared to that before PMS treatment. Additionally, PMS reduced motor neuron excitability of the TS and significantly increased that of the TA (p < 0.05). These results suggest that 30 minutes of PMS is effective in reducing motor neuron excitability of the TS in spastic hemiplegia, thus providing a safe and economical method for treating stroke patients.

Categories: Reduce Spasticity, Tone, Spasms , Stroke , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 11370763 [PubMed - indexed for MEDLINE]

Will whole-body vibration training help increase the range of motion of the hamstrings?

Author(s): van den Tillaar R.
Section for Human Movement Science, Faculty of Social and Technology Management, Norwegian University of Science and Technology, Trondheim. roland.tillaar@svt.ntnu.no
Publication: J Strength Cond Res. 2006 Feb;20(1):192-6.

Muscle strain is one of the most common injuries, resulting in a decreased range of motion (ROM) in this group of muscles. Systematic stretching over a period of time is needed to increase the ROM. The purpose of this study was to determine if whole-body vibration (WBV) training would have a positive effect on flexibility training (contract-release method) and thereby on the ROM of the hamstring musculature. In this study, 19 undergraduate students in physical education (12 women and 7 men, age 21.5 +/- 2.0 years) served as subjects and were randomly assigned to either a WBV group or a control group. Both groups stretched systematically 3 times per week for 4 weeks according to the contract-release method, which consists of a 5-second isometric contraction with each leg 3 times followed by 30 seconds of static stretching. Before each stretching exercise, the WBV group completed a WBV program consisting of standing in a squat position on the vibration platform with the knees bent 90 degrees on the Nemes Bosco system vibration platform (30 seconds at 28 Hz, 10-mm amplitude, 6 times per training session). The results show that both groups had a significant increase in hamstring flexibility. However, the WBV group showed a significantly larger increase (30%) in ROM than did the control group (14%). These results indicate that WBV training may have an extra positive effect on flexibility of the hamstrings when combined with the contract-release stretching method.

Categories: Vibration While Standing , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 16503680 [PubMed - indexed for MEDLINE]

Indications for a home standing program for individuals with spinal cord injury.

Author(s): Walter JS, Sola PG, Sacks J, Lucero Y, Langbein E, Weaver F.
Edward Hines Jr. Veterans Affairs Hospital Research Service (151L), Hines, IL 60141, USA.
Publication: J Spinal Cord Med. 1999 Fall;22(3):152-8.

Additional analyses were conducted on a recently published survey of persons with spinal cord injury (SCI) who used standing mobility devices. Frequency and duration of standing were examined in relation to outcomes using chi square analyses. Respondents (n = 99) who stood 30 minutes or more per day had significantly improved quality of life, fewer bed sores, fewer bladder infections, improved bowel regularity, and improved ability to straighten their legs compared with those who stood less time. Compliance with regular home standing (at least once per week) was high (74%). The data also suggest that individuals with SCI could benefit from standing even if they were to begin several years after injury. The observation of patient benefits and high compliance rates suggest that mobile standing devices should be more strongly considered as a major intervention for relief from secondary medical complications and improvement in overall quality of life of individuals with SCI.

Categories: Improve Bowel Function & Digestion , Prevent Pressure Ulcers/Maintain Skin Integrity , Promote Psychosocial Skills and Improve Sleep , Reduce Spasticity, Tone, Spasms , Review of Literature , Spinal Cord Injury , Improve Pain Management , Improve Bladder Function , Improve Range of Motion, Prevent Contractures

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Pubmed ID: 10685379 [PubMed - indexed for MEDLINE]

Low magnitude mechanical loading is osteogenic in children with disabling conditions.

Author(s): Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z.
Clinical Radiology, Imaging Science & Biomedical Engineering, University of Manchester, Manchester, United Kingdom.
Publication: J Bone Miner Res. 2004 Mar;19(3):360-9. Epub 2004 Jan 27.

The osteogenic potential of short durations of low-level mechanical stimuli was examined in children with disabling conditions. The mean change in tibia vTBMD was +6.3% in the intervention group compared with -11.9% in the control group. This pilot randomized controlled trial provides preliminary evidence that low-level mechanical stimuli represent a noninvasive, non-pharmacological treatment of low BMD in children with disabling conditions. INTRODUCTION: Recent animal studies have demonstrated the anabolic potential of low-magnitude, high-frequency mechanical stimuli to the trabecular bone of weight-bearing regions of the skeleton. The main aim of this prospective, double-blind, randomized placebo-controlled pilot trial (RCT) was to examine whether these signals could effectively increase tibial and spinal volumetric trabecular BMD (vTBMD; mg/ml) in children with disabling conditions. MATERIALS AND METHODS: Twenty pre-or postpubertal disabled, ambulant, children (14 males, 6 females; mean age, 9.1 +/- 4.3 years; range, 4-19 years) were randomized to standing on active (n = 10; 0.3g, 90 Hz) or placebo (n = 10) devices for 10 minutes/day, 5 days/week for 6 months. The primary outcomes of the trial were proximal tibial and spinal (L2) vTBMD (mg/ml), measured using 3-D QCT. Posthoc analyses were performed to determine whether the treatment had an effect on diaphyseal cortical bone and muscle parameters. RESULTS AND CONCLUSIONS: Compliance was 44% (4.4 minutes per day), as determined by mean time on treatment (567.9 minutes) compared with expected time on treatment over the 6 months (1300 minutes). After 6 months, the mean change in proximal tibial vTBMD in children who stood on active devices was 6.27 mg/ml (+6.3%); in children who stood on placebo devices, vTBMD decreased by -9.45 mg/ml (-11.9%). Thus, the net benefit of treatment was +15.72 mg/ml (17.7%; p = 0.0033). In the spine, the net benefit of treatment, compared with placebo, was +6.72 mg/ml, (p = 0.14). Diaphyseal bone and muscle parameters did not show a response to treatment. The results of this pilot RCT have shown for the first time that low-magnitude, high-frequency mechanical stimuli are anabolic to trabecular bone in children, possibly by providing a surrogate for suppressed muscular activity in the disabled. Over the course of a longer treatment period, harnessing bone's sensitivity to these stimuli may provide a non-pharmacological treatment for bone fragility in children.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 15040823 [PubMed - indexed for MEDLINE]

The influence of activity on calcium metabolism.

Author(s): Whedon GD.
Publication: J Nutr Sci Vitaminol (Tokyo). 1985 Dec;31 Suppl:S41-4.

Many studies and observations have shown the bone-losing effects of physical inactivity of various forms. Contrariwise, less precise studies and observations have supported the reasonable premise that mechanical loading of the skeleton via physical activity shifts the balance of bone remodeling in favor of bone formation, and appears to do so at all ages. Some interesting starts have been made in research to discover the mechanisms of the action on bone of mechanical loading, but many pathways remain to be explored. Besides the mechanical forces, we need to know more about the interrelations of muscle function, probably mediated through muscle-tendon pull on periosteum, and more about other likely influences, notably changes in circulation to bones. The practical significance relative to calcium metabolism and aging of what has been learned thus far on the effects of activity, is that prolonged inactivity, either in a chair or in bed, is to be avoided, because of its deleterious effects, and that reasonably energetic gravitational exercise, such as walking or possibly jogging, promotes maintenance of bone health.

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Effects of Immobilization

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Pubmed ID: 3915756 [PubMed - indexed for MEDLINE]

Mobility status and bone density in cerebral palsy.

Author(s): Wilmshurst S, Ward K, Adams JE, Langton CM, Mughal MZ.
Department of Pediatrics, St Mary's Hospital, Manchester.
Publication: Arch Dis Child. 1996 Aug;75(2):164-5.

The spinal bone mineral density (SBMD) and calcaneal broadband ultrasound attenuation (BUA) was measured in 27 children with cerebral palsy. They were categorised into four mobility groups: mobile with an abnormal gait, mobile with assistance, non-mobile but weight bearing, non-mobile or weight bearing. Mean SD scores for BUA and SBMD differed among mobility groups (analysis of variance, p < 0.001 and p = 0.078, respectively).

Categories: Prevent Calciuria and Maintain or Re-gain Bone Density , Cerebral Palsy

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Pubmed ID: 8869203 [PubMed - indexed for MEDLINE]

Functional neuromuscular stimulation for standing after spinal cord injury.

Author(s): Yarkony GM, Jaeger RJ, Roth E, Kralj AR, Quintern J.
Pritzker Institute of Medical Engineering, Illinois Institute of Technology, Chicago.
Publication: Arch Phys Med Rehabil. 1990 Mar;71(3):201-6.

A study was undertaken to determine if functional neuromuscular stimulation could be used to obtain standing in patients with traumatic spinal cord injury. Twenty-five subjects were selected during the study, and standing was accomplished in 21 using bilateral quadriceps stimulation with the hips in hyperextension. Four subjects elected not to continue participation to the point of standing. Stimulation parameters were 0 to 120V pulse amplitude, frequency 13Hz or 20Hz, and pulse width of 0.4msec. Confirmation of standing with support of 95% of the body weight by the legs was verified by quantitative measurements with a dual-scale force platform or a biomechanics force platform. Subjects initially selected had injury levels between C7 and T11 and ranged in age from 22 to 47 years, with duration of injury from one to 13 years. The subjects had complete lesions, with no active motor function below the last normal level, and absent sensation or partial sparing of sensation with vague perception of pinprick, but no position sense. Six subjects stood at home and 15 stood only in the laboratory. This five-year experience indicates that paraplegic individuals may obtain standing with functional neuromuscular stimulation.

Categories: Spinal Cord Injury , Weight Bearing & FES (Functional Electrical Stimulation)

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Pubmed ID: 2317138 [PubMed - indexed for MEDLINE]

Effects of prolonged muscle stretch on spasticity by an assessment/treatment system

Author(s): Yeh, C.Y., Tsai, K.H., Chen, J.J.
Inst. of Biomed. Eng., Nat. Cheng Kung Univ., Tainan
Publication: Engineering in Medicine and Biology Society, 2001. Proceedings of the 23rd Annual International Conference of the IEEE

Spasticity frequently obstructs the functional movements in the stroke patients. The prolonged muscle stretch (PMS) has been proven to be an effective approach to reduce excessive muscle tone. However, PMS technique has failed to provide proper treatment criteria due to the incapacity to detect the severity of spasticity and to quantify the stretch force used during PMS. This situation has caused very high variation in the treatment result. The purpose of this study is to quantify the degree of spasticity and to identify the treatment mechanisms of PMS by the designed PMS treatment and assessment system in which the force applied to the subject can be easily assigned. In addition, the same system can be also used for quantifying the time-course changes of spastic hypertonia. Then, the clinical therapist can quantify the treatment intensity and evaluate treatment effects by way of the quantitative measurement system.

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Categories: Reduce Spasticity, Tone, Spasms , Stroke

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

Author(s): Zabel, R J.; McMillan, A G.; Salem, Y
Physical Therapy, University of Central Arkansas, Conway, AR, USA
Publication: Pediatric Physical Therapy:Volume 17(1)Spring 2005p 93

PURPOSE/HYPOTHESIS: The purpose of this study was to determine the effects of prolonged standing on several gait variables in ambulatory children with spastic cerebral palsy.
NUMBER OF SUBJECTS: Six children with spastic derebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4 - 9.8).
MATERIALS/METHODS: A reverse baseline design (A-B-A) was used. 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. Three dimensional gait analysis was performed before and after each phase. The Modified Ashworth Scale was used to measure muscle tone. Anaylsis of variance (ANOVA) for repeated measures was used to test for changes in gait measures across four measurement sessions.
RESULTS: Stride length (P < 0.001), speed (P < 0.001), stride time (P < 0.001), stance phase time (P < 0.005), and muscle tone (P < 0.02) improved significantly following the intervention period. No significant differences were found in swing phase time, double support time, foot angle, knee flexion angle, knee moment or ankle power.
CONCLUSIONS: The results of this study suggest that children with spastic cerebral palsy could benefit from a prolonged standing program to improve their gait.
CLINICAL RELEVANCE: Prolonged standing may improve gait in children with cerebral palsy.

Categories: Cerebral Palsy , Develop or Improve Motor Ability


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