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Andersen M, Krarup LH, Rolving N, Holsgaard-Larsen A, Pawlowski C, Rasmussen HM, Hubeishy MH. Healthcare Professionals' Perspectives on the Use of Standing Frames for Children Diagnosed With Cerebral Palsy: An Explanatory Mixed Methods Study. Child Care Health Dev 2024; 50:e13320. [PMID: 39143846 DOI: 10.1111/cch.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 07/11/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Standing frames are commonly used by healthcare professionals in their practice with children with cerebral palsy (CP) who do not have an independent standing function. A better understanding of healthcare professionals' attitudes and experiences with standing frames may impact practice and rehabilitation. Therefore, this study aimed to investigate the standing frame practice among healthcare professionals and expand their attitude and experience with the use of standing frames for children with CP. METHODS This is an explanatory sequential mixed methods study. A cross-sectional survey was conducted, providing quantitative data on 210 healthcare professionals' use of standing frames. The quantitative data were descriptively analysed. Subsequently, the results from the survey were followed up with five focus group interviews of healthcare professionals (n = 14). The qualitative data were analysed using thematic analysis, enabling integration between the quantitative and qualitative data. RESULTS When quantitative and qualitative data are integrated, expansion between the two datasets occurred. The quantitative dataset emphasised the use of GMFCS levels as a guideline for recommending standing frames, whereas the qualitative data showed that the healthcare professionals' recommendations were based on individual needs. Furthermore, the healthcare professionals expanded the quantitative data, showing that the healthcare professionals' considerations regarding age and dosage were based on clinical experience, and saw the standing frame as having many benefits. CONCLUSION The healthcare professionals had a child-centred approach, where the child's need for using a standing frame was assessed based on the functional level, stage of development, cognitive level and clinical assessment. All of these considerations showed that the use of standing frames for children with CP was individualised, thereby making it difficult to make unified descriptions.
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Affiliation(s)
| | - Lærke Hartvig Krarup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
- R82 A/S, Gedved, Denmark
| | - Nanna Rolving
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Anders Holsgaard-Larsen
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Pawlowski
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Helle Mätzke Rasmussen
- Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maja Husted Hubeishy
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Regional Hospital Central Jutland, Odense, Denmark
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Krarup LH, Holsgaard-Larsen A, Rasmussen HM, Kyed SØ, Pawlowski CS. How best to support parents in the management of standing frame usage in home settings: A mixed methods study. Child Care Health Dev 2024; 50:e13310. [PMID: 39056283 DOI: 10.1111/cch.13310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 06/20/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
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.
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Affiliation(s)
- Laerke Hartvig Krarup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- R82 A/S, Gedved, Denmark
| | - Anders Holsgaard-Larsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
| | - Helle Mätzke Rasmussen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Orthopaedic Research Unit, Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark
| | | | - Charlotte Skau Pawlowski
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Paleg GS, Williams SA, Livingstone RW. Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:669. [PMID: 38928915 PMCID: PMC11203597 DOI: 10.3390/ijerph21060669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024]
Abstract
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.
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Affiliation(s)
| | - Sian A. Williams
- School of Allied Health, Curtin University, Perth, WA 6009, Australia;
- Liggins Institute, University of Auckland, Auckland 1023, New Zealand
| | - Roslyn W. Livingstone
- Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2B5, Canada;
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Moen RD, Østensjø S. Understanding the use and benefits of assistive devices among young children with cerebral palsy and their families in Norway: a cross-sectional population-based registry study. Disabil Rehabil Assist Technol 2024; 19:1454-1462. [PMID: 37026592 DOI: 10.1080/17483107.2023.2198563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE Assistive technology intervention has become an important strategy in enhancing function in young children with cerebral palsy. This study aimed to provide an in-depth knowledge of the use of assistive devices by describing their purposes, the environments in which they are used, frequency of use and perceived benefits from the caregiver's perspective. MATERIAL AND METHODS This is a cross-sectional population-based study using data from national cerebral palsy registers in Norway. Of a total of 202 children, 130 participated (mean age 49.9 months, SD 14.0 months). RESULTS The 130 children and their families used a median of 2.5 assistive devices (range 0-12) to support positioning, mobility, self-care and training, stimulation and play. Devices most commonly had one or two main purposes and were used both at home and in kindergarten/school. The usage rate varied from less than twice a week to several times a day. The majority of parents reported significant benefits for caregiving and/or the child's functioning. Total use increased in accordance with the level of the child's gross motor limitations and was associated with restrictions imposed by housing concerns. CONCLUSIONS The frequent use of a wide range of devices, and the intended and perceived benefits, demonstrates that early provision of assistive devices can be an effective function-enhancing strategy in young children with cerebral palsy. However, the findings also indicate that factors others than the child's motor abilities must be considered when integrating the use of devices into the child's daily routines and activities.
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Affiliation(s)
- Rikke Damkjær Moen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Medical Manager, Made for Movement, Skien, Norway
| | - Sigrid Østensjø
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Altunalan T, Dikmen Hoşbaş B, Vatansever M. Usability of the dynamic scaffolding system: an adaptive mobility device in children with special needs. Disabil Rehabil Assist Technol 2024; 19:1-8. [PMID: 37610156 DOI: 10.1080/17483107.2023.2248185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE Maintaining vertical position and moving are essential to healthy development. Children with motor difficulties may need assistive devices to stand upright or move. The Dynamic Scaffolding System (DSS) device was developed to support these skills. This study aims to explain the DSS's developmental stages, compare the device's usage times based on diagnoses and motor impairment, and investigate the degree of satisfaction among parents of children using the device. MATERIALS AND METHODS The study included children with difficulty standing or stepping and their parents. We compared usage times of DSS depending on diagnosis (cerebral palsy (CP) or other diagnoses) and motor impairment levels. We assessed parental satisfaction by using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) and recorded adverse events. RESULTS The ages of the participants (n:100) were between 9 and 108 months (44.94 ± 17.59), and 60% of the children had CP, and 40% had other diagnoses (genetic, metabolic, neuromuscular diseases). The duration of daily use of DSS ranged from 44.17 (±26.16) to 110 (±97.98) minutes, and the duration was similar among children at different levels of motor impairment (p = 0.262). The parents were most satisfied with the size, simplicity of use, and effectiveness, and they were least satisfied with the ease of adjustment, safety, and durability. They did not report any adverse events during the study. CONCLUSIONS DSS can be considered a useable assistive device option for children with CP and other diagnoses with difficulty standing or stepping and a satisfactory device for parents of such children.
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Affiliation(s)
- Turgay Altunalan
- Department of Physical Therapy and Rehabilitation, Karadeniz Technical University, Trabzon, Türkiye
| | - Beyzanur Dikmen Hoşbaş
- Department of Physical Therapy and Rehabilitation, Üsküdar University, İstanbul, Türkiye
| | - Melek Vatansever
- Department of Physical Therapy and Rehabilitation, Üsküdar University, İstanbul, Türkiye
- Meleğin Desteği Medical Devices Consulting Company, Bursa, Türkiye
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McLean LJ, Paleg GS, Livingstone RW. Supported-standing interventions for children and young adults with non-ambulant cerebral palsy: A scoping review. Dev Med Child Neurol 2022; 65:754-772. [PMID: 36463377 DOI: 10.1111/dmcn.15435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 12/07/2022]
Abstract
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.
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Affiliation(s)
- Lynore J McLean
- Neuromotor Program, Sunny Hill Health Centre, Vancouver, BC, Canada
| | - Ginny S Paleg
- Montgomery County Infants and Toddlers Program, Silver Spring, MD, USA
| | - Roslyn W Livingstone
- Occupational Science and Occupational Therapy University of British Columbia, Vancouver, BC, Canada
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Vinkel MN, Rackauskaite G, Finnerup NB. Classification of pain in children with cerebral palsy. Dev Med Child Neurol 2022; 64:447-452. [PMID: 34726259 DOI: 10.1111/dmcn.15102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Abstract
Pain in patients with cerebral palsy (CP) is a major health issue strongly associated with reduced quality of life. In this study, we provide an overview of pain conditions in children with CP using the International Classification of Diseases, 11th Revision (ICD-11), which has been updated with a classification of chronic pain. Common causes of pain in children with CP, including hip displacement, muscle spasms, and procedures, are discussed; less studied pain types including headaches, neuropathic pain, visceral pain, and acute versus chronic pain are also highlighted. The addition of chronic pain to the ICD-11 is an important step forward in optimizing both the registration and assessment of pain conditions. However, a tool designed specifically for the different types of pain in patients with CP is imperative. In this paper, we propose a Cerebral Palsy Pain Classification that is aligned with the underlying mechanisms of pain and the ICD-11 pain classification.
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Affiliation(s)
- Michael N Vinkel
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gija Rackauskaite
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Rapson R, King T, Morris C, Jeffery R, Mellhuish J, Stephens C, Marsden J. Effect of different durations of using a standing frame on the rate of hip migration in children with moderate to severe cerebral palsy: a feasibility study for a randomised controlled trial. Physiotherapy 2022; 116:42-49. [DOI: 10.1016/j.physio.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 07/23/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Murphy KP, Gueron L, McMillin C, Marben KB. Health Parameters in Standing and Nonstanding Nonambulatory Adults With Cerebral Palsy. Arch Rehabil Res Clin Transl 2021; 3:100110. [PMID: 34179748 PMCID: PMC8212004 DOI: 10.1016/j.arrct.2021.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To assess effects of standing exercise on adults with cerebral palsy with a focus on bone density, transfer skills, quality of life, and related health parameters. DESIGN Prospective case series; pilot study. SETTING Outpatient multispecialty clinic. PARTICIPANTS Nonambulatory adults with cerebral palsy, 13 standers and 7 nonstanders, comparable in age, sex, and other physical characteristics (N=20). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Bone mineral density per dual energy x-ray absorptiometry, stand pivot transfers, comprehensive blood serum assessments, fractures, spasms, perceived pain, and quality of life. RESULTS No appreciable differences could be detected between the standing and nonstanding groups from baseline and over a 2-year subsequent study with respect to bone density, range of motion, comprehensive chemistry, hematologic blood serum levels, fractures, spasms, perceived pain, continence of bowel and bladder, seizures, orthotics, and orthopedic surgery. All individuals reported positive life effects of standing with only 1 negative effect reported: increased fatigue at the end of the day. Midline independent head control >30 seconds was identified only in the standing group. Functional stand pivot transfers were seen only in individuals with a history of standing. CONCLUSIONS The pilot data indicate no appreciable difference in measured outcome variables of a static nature between nonambulatory adults with cerebral palsy who stand compared with those who do not. We identified occurrences of improved head control and functional stand pivot transfers only in those with a history of standing. The value of a functional pivot transfer over the lifetime is difficult to overestimate. Encouragement is given toward future studies with a focus more toward functional outcome variables.
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Affiliation(s)
- Kevin P. Murphy
- Pediatric Rehabilitation Medicine, Sanford Health Systems, Bismarck, ND
| | - Laura Gueron
- Adult Phalen Clinic, Gillette Specialty Healthcare, St Paul, MN
| | | | - Kim B. Marben
- Adult Phalen Clinic, Gillette Specialty Healthcare, St Paul, MN
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Capati V, Covert SY, Paleg G. Stander Use for an Adolescent with Cerebral Palsy at GMFCS Level with Hip and Knee Contractures. Assist Technol 2020; 32:335-341. [PMID: 30945990 DOI: 10.1080/10400435.2019.1579268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Aims: Adolescents with cerebral palsy (CP) report high rates of pain and contractures. Standing may positively affect these outcomes, yet there are no published studies on how to accommodate contractures or when a stander is no longer beneficial. This is the first study that answers the question: Can an adolescent with CP and 40-degree knee and/or hip flexion contractures benefit from a standing program, after being non-weight bearing for many years? Methods: A 16-year-old male with spastic tetraplegic CP, Gross Motor Function Classification System (GMFCS) level V, used a stander with a "knee and hip contracture system." Knee and hip extension, as well as upright inclination, were increased weekly. Knee and hip passive range of motion (PROM) measurements, pain scale, and a parent survey were completed at baseline, 7 and 15 months. Results: After 15 months of stander use, both hips and left knee PROM improved. The subject's activity and participation increased, while pain, suppository use, and time spent on bowel care decreased. Conclusion: An adolescent with 40-degree knee and hip flexion contractures may be positioned well in a stander with a specialized contracture system. PROM, bowel function, pain, activity, and participation may improve for some adolescents at GMFCS level V, through use of a stander.
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Affiliation(s)
- Vicente Capati
- Los Angeles County Department of Public Health, California Children's Services, Children's Medical Services , El Monte, California, USA
| | - Stephanie Yu Covert
- Los Angeles County Department of Public Health, California Children's Services, Children's Medical Services , El Monte, California, USA
| | - Ginny Paleg
- Montgomery County Infants and Toddlers Program , Rockville, Maryland, USA
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Barton C, Buckley J, Samia P, Williams F, Taylor SR, Lindoewood R. The efficacy of appropriate paper-based technology for Kenyan children with cerebral palsy. Disabil Rehabil Assist Technol 2020; 17:927-937. [DOI: 10.1080/17483107.2020.1830442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Catherine Barton
- Physiotherapy Department, Powys Teaching Health Board, Brecon, Wales, UK
- Centre for Active Living, University Centre Shrewsbury (University of Chester), Chester, UK
| | - John Buckley
- Centre for Active Living, University Centre Shrewsbury (University of Chester), Chester, UK
| | - Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - Fiona Williams
- Department of Geography and International Development, University of Chester, Chester, UK
| | - Suzan R. Taylor
- Centre for Active Living, University Centre Shrewsbury (University of Chester), Chester, UK
| | - Rachel Lindoewood
- Brecon Children’s Centre, Powys Teaching Health Board, Brecon, Wales, UK
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Stinson M, Crawford S, Madden E. Current clinical practice in 24-hour postural management and the impact on carers and service users with severe neurodisability. Br J Occup Ther 2020. [DOI: 10.1177/0308022620944739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions. The aim of this research was to investigate the use of 24-hour postural management by occupational therapists and to explore its impact on service users with neurodisability and their carers. Methods Quantitative and qualitative methods were employed in two phases: (a) online survey with 96 occupational therapists across one UK region, with data analysed by descriptive statistics and correlations; (b) focus groups with service users and/or carers ( n = 9), with data analysed by thematic analysis. Results Findings showed moderate positive correlation between frequency of use and (a) all key intervention skills and (b) knowledge of night-time positioning ( p < 0.001). Moderate positive correlations were found between level of training and (a) assessment skills and (b) knowledge of night-time positioning ( p < 0.001). The overarching theme from focus groups was ‘reliance on individualised equipment’, with overwhelming frustration from lack of support, loss of identity, equipment cost, insufficient focus on preventative strategies and accessibility issues. Conclusion A clinical practice guideline, including training, is crucial to direct practice. Providers must engage with service users and carers to address their frustrations.
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Affiliation(s)
- May Stinson
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Shelley Crawford
- Occupational Therapy Department, Wheelchair Resource Team, Western Health and Social Services Trust, Londonderry, UK
| | - Emma Madden
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, UK
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Smirnova LM, Dzhomardly EI, Koltsov AA. Objective Signs of Foot Deformities in Children with Spastic Form of Cerebral Paralysis: Justification of Individual Approach to Footwear Support. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2019. [DOI: 10.21823/2311-2905-2019-25-3-90-99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Relevance. Foot deformities are the most common locomotor pathology in children with infantile cerebral paralysis. At the same time many children suffering from this pathology wear standard shoes that do not take into account the individual foot anatomy. Purpose of the study — to justify the expedience of individual approach to orthopaedic support for children with infantile cerebral paralysis. Materials and methods. The authors examined 220 feet in 110 patients aging from 3 to 18 years: 62 patients with spastic form of infantile cerebral paralysis and 48 children who were examined during periodic screening at general education institutions (control group). Clinical examination methods, computerized plantography and podometry by flatbed foot scanning (ventrally, posteriorly, medially) in standing position were used in the present study. Results. Statistically significant variances (p*0.005) were obtained for 8 indicators of foot deformity in three planes in children with infantile cerebral paralysis as compared to the norm, as well as differences between the groups of patients with varying degree of disorders in gross motor functions. The authors established pathological foot deformities in children with infantile cerebral paralysis; statistically significant variances in types and degrees of these disorders for patient groups with different levels of gross motor functions disorders; distinctiveness of foot deformities within each of the groups. Conclusion. Objectively instrumental method was used to identify the main components of foot deformities in patients with infantile cerebral paralysis with preservation and realization of walking capability: loss of height of longitudinal arches, midfoot pronation and hindfoot valgus, hallux valgus. Increased elevation of longitudinal arches (cavus foot), midfoot supination and hindfoot varus are rarer components of deformities occurring more often in patients with severer forms of the pathology. Strong variation in the spread of foot anatomy parameters observed within different groups of motor dysfunctions indicates the expediency of individual approach to footwear recommendations: standard, less or more complex orthopaedic shoes. Implementation of obtained data into the clinical practice requires additional series of biomechanical trials aimed at elaboration of criteria for recommendations and efficiency evaluation of various footwear types that take into account not only specifics of foot anatomy but also its statodynamic function as well as the level of gross motor functions of a particular patient.
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[Effectiveness of the use of standing devices in the prevention of hip dislocation in children and adolescents with spastic cerebral palsy, GMFCS III, IV and V. A systematic review]. Rehabilitacion (Madr) 2019; 53:169-180. [PMID: 31370944 DOI: 10.1016/j.rh.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/08/2019] [Indexed: 01/15/2023]
Abstract
The standing devices are used as a preventive therapy for hip dislocation in patients with cerebral palsy. This review seeks to assess the effectiveness of standing devices in the prevention of hip dislocation of patients under 18 years old with a diagnosis of spastic cerebral palsy, GMFCS III-V. A systematic search was conducted in 10 biomedical databases, selecting randomized, quasi-experimental clinical trials and cohort studies. The use of standing devices with physical therapy, orthosis and/or soft tissue surgeries was compared. The percentage of migration of the femoral head was considered as the main result. The risk of bias was assessed using the Rob 2.0 and Robins I guidelines. As a result of the analysis of 6 primary studies, it is obtained that the use of standing devices maintained the percentage of migration of the femoral head within normal limits (MP:13-23%, p<.01), increased vertebral trabecular volumetric bone mineral density (8.16mg/cm3, p=.01), bone mineral content (p=.010) and hamstring muscle length (phase B1 p<.01 and B2 p=.03). However, the risk of bias in these studies was categorized as of some concern to moderate. In conclusion, it is stated that there is limited evidence of the effectiveness of the use of standing devices in the prevention of hip dislocation in the study population, due to the methodological heterogeneity and risk of bias of the included studies. A greater number of studies with a high level of evidence are required in order to generate a recommendation for its use. Registration in PROSPERO: CRD42018087641.
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Schmidt-Lucke C, Käferle J, Rydh Berner BM, Ahlborg L, Hansen HM, Skjellvik Tollefsen U, Thon T, Damkjær Moen R, Pekanovic A, Tornberg ÅB, Lauruschkus K. Effect of assisted walking-movement in patients with genetic and acquired neuromuscular disorders with the motorised Innowalk device: an international case study meta-analysis. PeerJ 2019; 7:e7098. [PMID: 31249736 PMCID: PMC6587941 DOI: 10.7717/peerj.7098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/08/2019] [Indexed: 12/31/2022] Open
Abstract
People with physical disabilities (PD) suffer from consequences due to lack of physical activity and consequently, are at increased risk of chronic diseases. We aimed to evaluate the ability of a motorised assistive device for dynamic standing with weight-bearing in addition to standard state-of-the-art therapy to improve clinical outcome in a meta-analysis of available studies. A total of 11 studies were identified from different European countries analysing the effect of the dynamic device Innowalk. Raw data of nine studies were pooled including a total of 31 patients observed between 2009 and 2017. Standardised questionnaires and physical outcomes were examined in this exploratory meta-analysis. We recorded patients' characteristics, duration, intensity, and location of usage as well as general clinical outcomes and improvement of passive range of motion (PROM). The analysed population consisted in 90% cases of patients younger than 18 years of age. Patients were severely disabled individuals (aged 8 (6-10) years; 58% male; 67% non-ambulatory, 86% cerebral palsy). A total of 94% used the Innowalk in a home-based or day-care setting. For nearly all individuals (94%), improvements were recorded for: walking or weight-bearing transfer (n = 13), control/strength of the trunk or head (n = 6), joint mobility (n = 14), sleep (n = 4 out of 6/67%), or muscle strength (n = 17), vital functions (n = 16), bowel function (n = 10), attention/orientation (n = 2). PROM of the hip (flexion, abduction, and adduction) significantly (p < 0.001 for multiple comparisons) increased after 1 month (p < 0.05 flexion, adduction) and further after 5 months (p < 0.05 each) in contrast (p < 0.05 each) to a control group with state-of-the-art therapy. Similarly, PROM showed a trend towards improvement in dorsal extension of the ankle (p = 0.07). In summary, this is the first report of a novel device with additional benefit to standard therapy for severe PD. These intriguing results warrant the planned prospective randomised controlled trial to prove the concept and mechanism of action of this device.
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Affiliation(s)
- Caroline Schmidt-Lucke
- Charité University Berlin, Berlin, Germany.,Medico-academic Consultings, Berlin, Germany
| | | | - Britt-Marie Rydh Berner
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
| | - Lotta Ahlborg
- Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden
| | | | | | - Tonje Thon
- Municipality of Porsgrunn, Posgrunn, Norway
| | | | | | - Åsa B Tornberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Katarina Lauruschkus
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Goodwin J, Lecouturier J, Smith J, Crombie S, Basu A, Parr JR, Howel D, McColl E, Roberts A, Miller K, Cadwgan J. Understanding frames: A qualitative exploration of standing frame use for young people with cerebral palsy in educational settings. Child Care Health Dev 2019; 45:433-439. [PMID: 30883842 DOI: 10.1111/cch.12659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 03/09/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Consensus opinion supports standing frame use as part of postural management for nonambulant young people with cerebral palsy. Most young people with cerebral palsy in the United Kingdom, who use standing frames, use them at nursery or school, rather than at home. In this paper we report professionals' and parents' experiences and views of standing frame use specifically in educational settings. This research was conducted as part of a large mixed methods study to determine the acceptability and inform the design of a future trial of standing frames. METHODS Qualitative methods were used: focus groups with educational professionals, parents and clinicians (paediatricians, physiotherapists and occupational therapists) were convened. Data were analysed thematically using framework analysis. RESULTS Five focus groups were conducted. The overarching theme "flexibility" encompassed four subordinate themes: (i) "balancing education and therapy," which described the way education professionals had to juggle different priorities from health professionals within a multi-disciplinary team; (ii) "young people's autonomy," which highlighted participants' belief that standing frame use should be centred on the individual young person and their needs; (iii) "working within logistical boundaries," which demonstrated that "ideal" standing frame use was not always possible due to logistical issues (e.g., staffing and standing frame availability); and (iv) "competence and confidence," which highlighted that educational professionals felt that they lacked the training to confidently position young people in their standing frame. CONCLUSIONS This paper highlights the complexity of standing frame use in the educational setting. If a standing frame programme is prescribed to be delivered in an educational setting, strong multidisciplinary and interagency communication is essential to balance therapy versus education. Training is required to ensure staff are competent in using the standing frame with the young person understanding their individual requirements. A flexible approach-inclusive of the young person's needs, logistical demands and resource-is necessary.
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Affiliation(s)
- Jane Goodwin
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Johanna Smith
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Crombie
- Chailey Clinical Services, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Anna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK.,Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Andrew Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - Keith Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - Jill Cadwgan
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust (Kings Health Partners), London, UK
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17
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Goodwin J, Colver A, Basu A, Crombie S, Howel D, Parr JR, McColl E, Kolehmainen N, Roberts A, Lecouturier J, Smith J, Miller K, Cadwgan J. Understanding frames: A UK survey of parents and professionals regarding the use of standing frames for children with cerebral palsy. Child Care Health Dev 2018; 44:195-202. [PMID: 28809057 PMCID: PMC5811781 DOI: 10.1111/cch.12505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/13/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Standing frames are used for children with cerebral palsy (CP). They may improve body structure and function (e.g., reducing risk of hip subluxation, and improving bladder and bowel function), improving activity (e.g., motor abilities) and participation (e.g., interaction with peers), but there is little evidence that they do. We aimed to identify current UK standing frame practice for children with CP and to understand stakeholder views regarding their clinical benefits and challenges to use. METHOD Three populations were sampled: clinicians prescribing standing frames for children with CP (n = 305), professionals (health and education) working with children with CP who use standing frames (n = 155), and parents of children with CP who have used standing frames (n = 91). Questionnaires were developed by the co-applicant group and piloted with other professionals and parents of children with CP. They were distributed online via clinical and parent networks across the UK. RESULTS Prescribing practice was consistent, but achieving the prescribed use was not always possible. Respondents in all groups reported the perceived benefits of frames, which include many domains of the International Classification of Functioning Disability and Health for Children and Youth. Challenges of use are related to physical space and child-reported pain. CONCLUSIONS These survey findings provide information from key stakeholders regarding current UK standing frame practice.
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Affiliation(s)
- J. Goodwin
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Colver
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Basu
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - S. Crombie
- Sussex Community NHS Foundation TrustChailey Clinical ServicesBrightonUK
| | - D. Howel
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - J. R. Parr
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - E. McColl
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - N. Kolehmainen
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - A. Roberts
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS TrustOswestryUK
| | - J. Lecouturier
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - J. Smith
- Institute of Health and SocietyNewcastle UniversityNewcastle Upon TyneUK
| | - K. Miller
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS TrustOswestryUK
| | - J. Cadwgan
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK,Evelina London Children's HospitalGuys and St Thomas' NHS Foundation Trust (Kings Health Partners) UKLondonUK
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