Stander Use for an Adolescent with Cerebral Palsy at GMFCS Level with Hip and Knee Contractures

RESNA and CTF position on the application of supported standing devices: Current state of the literature

Supported standing devices are often used to maintain a standing position by people with difficulty or inability to ambulate or stand for a period of time. Supported standing programs are first implemented by healthcare professionals with goals to impact health and function. This paper intends to update previous position on wheelchair standing devices by the Rehabilitation Engineering and Assistive Technology Association of North America, and was written in conjunction with the Clinician Task Force. The current paper expands the previous focus on wheelchair standing devices to all types of supported standing devices. A scoping review methodology found 42 studies examining outcomes of supported standing programs in the International Classification of Functioning, Disability, and Health framework in five areas of body functions, seven areas of activities and participation, and one body structure. Patterns in outcomes related to standing device type, as dynamic, or mobile, standing devices contributed to independent daily activity performance and static standing devices impacted neuromuscular capacity. Studies support engaging consistently in supported standing from nine months of age, or as soon after onset of ambulatory disability as possible, to maximize benefits. Clinical reasoning is required to apply the information in this document to unique individual cases.

How best to support parents in the management of standing frame usage in home settings: A mixed methods study

BACKGROUND

An improved understanding of the current practice of standing frame use may have implications for supporting parents in managing standing frames. We aimed to investigate how parents of children with cerebral palsy perceive and manage standing frame use in home settings.

METHODS

We conducted a mixed methods study with an explanatory sequential design, first collecting and analysing quantitative questionnaire data and then using these results to inform a qualitative follow-up phase to explain them. The questionnaire was answered by 103 parents of children with cerebral palsy across five countries, Denmark, Norway, Great Britain, Canada and the United States, and 12 Danish families participated in the subsequent interviews. A descriptive analysis was conducted using the questionnaire data. The qualitative data were analysed using a directed content analysis, enabling integration of the quantitative and qualitative data.

RESULTS

The quantitative analysis showed that 89% of the parents felt confident with their child's standing frame, and 82% felt they had sufficient knowledge about how their child's standing frame could/should be used. However, the qualitative analysis showed that even when feeling confident, the parents experienced insecurity regarding whether their child was positioned correctly, and being responsible for positioning was challenging.

CONCLUSION

Our study implies a need for providing educational materials to assist the parents in ensuring optimal positioning of their child in the standing frame to decrease insecurity. Additionally, our study suggests a need to provide more thorough information about the benefits of using a standing frame and ensure alignment of expectations in relation to the child's prognosis of functional independence.

Supported standing and stepping device use in young children with cerebral palsy, gross motor function classification system III, IV and V: A descriptive study

This study described and compared use of supported-standing and stepping devices by young children with cerebral palsy, Gross-Motor Function Classification System (GMFCS) levels III-V following power mobility introduction. Data was collected at two time-points, 5-6 months apart, for 42 participants, aged 18-80 months, using the Home Use of Technology for CHildren (HUTCH). Supported-standing and stepping device choice and time in each device remained stable over 6 months. Associations between device use and three functional classifications were examined. Children with more impaired motor, postural and manual abilities were more likely to use a supine stander rather than a prone/upright stander or no stander. Children at GMFCS V tended to use hands-free stepping devices, while support-arms stepping devices were more common for children at GMFCS IV. Only children at GMFCS III used convertible stepping devices. Using power mobility, standers and supported-stepping devices was feasible and 19/34 classified at GMFCS IV/V used all three devices over 6 months. A key finding was that introduction of power mobility did not reduce use of supported-stepping devices at any GMFCS level. Use of multiple upright positioning and mobility devices may assist children with limited mobility to be actively engaged and participate in daily life.

Looking beyond Body Structure and Function: ICF Foci and Who Is Being Assessed in Research about Adolescents and Young Adults with Cerebral Palsy-A Scoping Review

PURPOSE

The purpose of this study is to summarize the ICF foci, looking beyond body structures and function, and to analyze who has been assessed in research about adolescents and young adults (AYAs) with CP in the phase of transition to adulthood.

METHOD

Medline, EMBASE, PsycINFO, and CINAHL databases were searched using terms related to cerebral palsy, adolescents/young adults, health development, participation, and independence. Studies including youth with CP (13-30 years old) published in English from 2014 to 2021 were considered. The methods of assessment reported in the included studies were used to identify the ICF foci and who was assessed.

RESULTS

In this study, 86 studies were reviewed. The main ICF foci are activity and participation (51% of the studies), personal factors (23%), ICF not covered (14%), ICF not defined (9%), with environmental factors being the least focused ICF component (3%). Most studies assessed AYAs directly (49% of studies).

CONCLUSIONS

Activity- and participation-related constructs are the leading research focus of studies, and more attention is needed concerning environmental factors. AYAs are the main source of information, and the perspectives of other key figures are also being valued. To bridge the gap between child and adult health care, a broader view of health development and approaches to explore AYA developmental issues must be taken.

Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus

Children functioning at Gross Motor Function Classification System (GMFCS) levels IV-V cannot maintain an aligned standing position or take steps without support. Upright positioning and mobility devices have psycho-social significance for these children and their families, enhancing use of vision, communication, functioning and emotional well-being. Standers and supported stepping devices facilitate opportunities for biomechanical loading, potentially helping to build and maintain muscle and bone integrity, and they promote physical development. However, families are often required to choose between these two devices for their young child. This study aims to synthesize evidence for use and benefits of both supported standing and stepping devices through the lens of two contemporary theoretical frameworks to support clinical reasoning and implementation. The F-words for childhood development (functioning, family, fitness, fun, friends, future) and the interdependence-Human Activity Assistive Technology (iHAAT) models were combined to illustrate the complex interactions between the child, family, caregivers, peers and contextual factors when implementing standing and stepping devices with children at GMFCS levels IV and V. Supported standing and stepping devices provide complementary benefits, and both may be necessary starting at 9-15 months. We propose they both be included ON-Time, along with other age-appropriate positioning and mobility devices, to promote more equitable developmental opportunities for children with non-ambulant cerebral palsy.

Sting and evaluation of a prototype of a mobility trainer: Verticalizer for children (2 to 7 years) weighing up to 20 kg

BACKGROUND

The prototype of mobility trainer-verticalizer (hereinafter - PMTV) is designed to develop existing movements caused by individual physical conditions and disease damage, as close as possible to the natural biomechanics of a healthy person. The aim is to make the equipment comfortable, simple, suitable for everyday use in a variety of environments, from medical institutions to the patient's home, and customizable according to the anthropometric data of the growing child.

OBJECTIVE

To investigate and evaluate the technical characteristics and feasibility of a PMTV for children (2 to 7 years) weighing up to 20 kg.

METHODS

Empirical research method (anthropometric measurements); quantitative research method (survey); qualitative research method (interviews).

RESULTS

The PMTV is suitable for use with children aged 2 to 7 years, although children with various disabilities may have heights, weights and other anthropometric data that fall far below or exceed the healthy standard. The exercise with the use of a PMTV had a positive effect on muscle tone, with a decrease in muscle tone in both the upper and lower limbs. An increased range of motion (hereinafter - ROM) of shoulder flexion and abduction was observed. In the lower limb, there was an improvement in the ROM of hip internal and external rotation and the flexion and extension of knee.

CONCLUSION

Physiotherapy using PMTV had a positive effect on the subject's limb volume and muscle tone, a positive effect on the subject's passive ROM, and a positive effect on the subject's gross motor function.

Supported-standing interventions for children and young adults with non-ambulant cerebral palsy: A scoping review

AIM

To describe the evidence, outcomes, and lived experience of supported standing for children and young adults with cerebral palsy aged 25 years or younger, classified in Gross Motor Function Classification System levels IV and V.

METHOD

This scoping review included searches in eight electronic databases and manual searching from database inception to May 2020 and updated on 21st February 2022. Two of three reviewers independently screened titles and abstracts and extracted and appraised data. Methodological quality and risk of bias were appraised using tools appropriate to study type. Content analysis and frequency effect sizes were calculated for qualitative and descriptive evidence.

RESULTS

From 126 full-text references, 59 citations (one study was reported over two citations) were included: 16 systematic reviews, 17 intervention studies reporting over 18 citations, eight analytical cross-sectional studies, five descriptive cross-sectional/survey studies, five qualitative studies, and one mixed-methods study were identified, along with six clinical guidelines. Maintenance of bone mineral density and contracture prevention outcomes were supported by the most experimental studies and evidence syntheses, while evidence supporting other outcomes was primarily quasi-experimental or descriptive. Qualitative evidence suggests that programmes are influenced by attitudes, device, child, and environmental factors.

INTERPRETATION

Individualized assessment and prescription are essential to match personal and environmental needs. Although experimental evidence is limited due to many factors, lived-experience and cohort data suggest that successful integration of standing programmes into age-appropriate and meaningful activities may enhance function, participation, and overall health.

Evidence-informed clinical perspectives on postural management for hip health in children and adults with non-ambulant cerebral palsy

Postural management is a multi-disciplinary approach incorporating a comprehensive schedule of daily and night-time positions, equipment and physical activity to help maintain or improve body structures and function and increase activity and participation. Postural management may play a role in preventing contracture, deformity, pain, and asymmetry. This article provides an overview of the evidence supporting use of postural management to positively influence hip health in individuals with cerebral palsy, functioning as Gross Motor Classification System (GMFCS) levels IV or V. Sitting or lying without changing position for more than 8 hours, unsupported supine lying and asymmetrical or windswept postures are associated with pain and hip subluxation/dislocation. Although high-quality experimental research is still limited by many factors, there is limited evidence of harm, and most individuals at GMFCS IV or V require positioning supports to enable participation and function and ease caregiving. Clinical recommendations combining research and clinical opinion support the early use of comfortable positioning routines and/or equipment to reduce time spent in sustained asymmetrical or potentially harmful sitting and lying positions. Supported standing, active weightbearing and stepping are recommended to promote active movement and position change when possible, depending on individual, family and caregiver routines and preferences.