Research: Standing Programs, Hip Flexibility and Cerebral Palsy

Pediatric Physical Therapy published research on the results of a daily standing program and physical therapy on 13 children with spastic diplegia.  The participants were Gross Motor Functional Classification Level III.

Each child used a custom fabricated stander from 12-14 months of age to 5 years of age.  Hip abduction range of motion was evaluated with goniometry at the start of the program and at 5 years of age.

The results indicated that hip abduction was 42° at baseline and 43° at 5 years.

The researchers concluded that although the small difference in range of motion was not clinically significant, it indicated that it is possible to maintain hip abduction ROM in the spastic adductor muscles of children with cerebral palsy with a daily standing program during the children's first 5 years of development.

Reference:  Macias-Merlo et al.  Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy.  Pediatric Physical Therapy: Fall 2015 - Volume 27 - Issue 3 - p 243–249. doi: 10.1097/PEP.0000000000000150

Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders - A Guide for Parents and Professionals -  Find out more at http://yourtherapysource.com/CPmotorskills.html

Dosing for Standing Programs

Pediatric Physical Therapy published a systemic review and evidence based clinical recommendations for dosing of pediatric supported standing programs.  After reviewing the literature the following was recommended:

• standing programs 5 days per week, 60-90 minutes per day, positively affect bone mineral density
• standing programs 5 days per week, 60 minutes per day in  30° to 60° of total bilateral hip abduction positively affect hip stability
• standing programs 5 days per week, 45-60 minutes per day, positively effect range of motion of hip, knee, and ankle and spasticity (30 to 45 minutes per day).

Reference: Paleg, Ginny S. PT, MPT, DScPT; Smith, Beth A. PT, DPT, PhD; Glickman, Leslie B. PT, PhD. Systematic Review and Evidence-Based Clinical Recommendations for Dosing of Pediatric Supported Standing Programs. Pediatric Physical Therapy: Fall 2013 - Volume 25 - Issue 3 - p 232-247 doi: 10.1097/PEP.0b013e318299d5e7  

Standing Program and Cerebral Palsy

Pediatric Physical Therapy published research on the effect of weight-bearing in abduction and extension on hip stability in children with cerebral palsy. Three non ambulatory children with cerebral palsy post surgery participated in a standing program with hips in maximum abduction and hip and knee extension. Following one year of the standing program the three children exhibited the largest decrease in hip migration percentage compared to 20 children in the control group. Eight non ambulatory children who did not undergo surgery also participated in a preventative standing program for one year. The eight subjects also exhibited a decrease in hip migration percentage compared to the 63 controls. Only the control group had hip and knee contractures.

The authors concluded that:

• standing for one hour per day in maximum hip abduction and hip and knee extension may reduce hip migration percentage post adductor-iliopsoas-tenotomies
• standing for one hour per day in maximum hip abduction and hip and knee extension may prevent an increase in hip migration percentage and prevent muscle contractures in children who have not had surgery
• larger studies need to be performed to confirm the findings.

Reference: Martinsson, Caroline PT, MSc; Himmelmann, Kate MD, PhD Effect of Weight-Bearing in Abduction and Extension on Hip Stability in Children With Cerebral Palsy Pediatric Physical Therapy: Summer 2011 - Volume 23 - Issue 2 - p 150–157
doi: 10.1097/PEP.0b013e318218efc3

Effects of Standing Programs on Walking in Children with CP

Physical and Occupational Therapy in Pediatrics published research on the effects of prolonged standing on the walking patterns of children with cerebral palsy. Six children with spastic cerebral palsy (Gross Motor Function Classification Levels II and III) participated in this study over a period of 9 weeks. The first three weeks the children received physical therapy. The second three weeks the children received physical therapy and prolonged periods of standing, 3x per week. The last three weeks the children received only physical therapy again. Before and after each 3 week phase, gait analysis and spasticity assessment was performed. The results indicated that after the middle three week period with prolonged standing, testing showed a significant difference in improvements noted in the following areas: stride length, gait speed, stride time, stance phase time, double support time, muscle tone, and peak dorsiflexion angle during midstance. These results were not sustained when tested again 3 weeks later. The researchers recommend additional research with larger sample size and to establish specific duration and frequency of the standing program.

Reference: Yasser Salem‌ Venita Lovelace-Chandler‌ Reta J. Zabel‌ Amy Gross McMillan‌ Effects of Prolonged Standing on Gait in Children with Spastic Cerebral Palsy Physical & Occupational Therapy in Pediatrics February 2010, Vol. 30, No. 1, Pages 54-65