A Montgomery County Public Schools, Early Intervention Program (??), Rockville Maryland
B University of Maryland, School of Medicine, Department of Physical Therapy and Rehabilitation Science, Baltimore Maryland
KEYWORDS:
Stander, supported standing, letter of medical necessity
Objective:
To demonstrate the evidence that exists in the peer-reviewed literature underlying the use of supported standing programs for persons with neuromuscular diagnoses, particularly those with cerebral palsy and spinal cord injury. This information can be used to support funding for the equipment.
Hypothesis:
There is evidence underlying the use of supported standing programs based on the Center for Evidence-Based Medicine (CEBM) Levels of Evidence framework. Third party payors must be educated and assisted in determining funding based on perceived lack of evidence.
Design:
A systematic review of peer-reviewed literature based on the CEBM and the International Classification of Function (ICF) framework.
Methods:
The database search using MEDLINE, CINAHL, GoogleScholar, HighWire Press, PEDro, Cochrane Library databases, and APTAs Hooked on Evidence (January 1980 to October 2009) targeted studies with supported standing programs for persons of all ages, with a neuromuscular diagnosis. We identified 122 unique studies from which 39 met the inclusion criteria, 29 with adult and 10 with pediatric participants.
Results:
The results are organized and reported by four ICF categories. The studies mainly explored using supported standing programs for improving bone mineral density (BMD), cardiopulmonary function, muscle strength/function, and range of motion (ROM). The data were moderately strong to increase BMD, showed some support for decreasing hypertonicity (including spasticity), improving bowel function and improving ROM, and were inconclusive for other benefits. The addition of whole body vibration (WBV) to supported standing programs appeared a promising trend but empirical data were inconclusive. The survey data from physical therapists (PTs) and participant users attributed numerous improved outcomes to supported standing programs: ROM, bowel/bladder, psychological, hypertonicity and pressure relief/bedsores. BMD was not a reported benefit according to the user group.
Conclusions:
Data exists underlying the use of supported standing programs for specific benefits from the peer-reviewed literature. However, there is still a need for more empirical mechanistic evidence to guide the application of these programs across practice settings and with various-aged persons, particularly when considering a life-span approach.
REFERENCES:
- Dunn RB, Walter JS, Lucero Y. (1998). Follow-up assessment of standing mobility device users. Assistive Technology. 1998;10:84-93.
- Ward K, Alsop C, Caulton J, Rubin C, Adams J, Mughal Z. Low magnitude mechanical loading is osteogenic in children with disabling conditions. J Bone Mineral Res. 2004;19:360-9.
- Taylor K. factors affecting prescription and implementation of standing-frame programs by school-based physical therapists for children with impaired mobility. Pediatr Phys Ther. 2009;21:282-88.
- Caulton JM, Ward, KA, Alsop CW, Dunn G, Adams JE, Mughal MZ. A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy. Archiv Disease in Childhood. 2004;89:131-5.
- Hoenig H, Murphy T, Galbraith J, Zolkewitz, M. Case study to evaluate a standing table for managing constipation. Spinal Cord Injury Nursing. 2001;18:74-7.
- Netz Y, Argov E, Burstin A, Brown R, Heyman SN, Dunsky A, Alexander NB. Use of a device to support standing during a physical activity program to improve function of individuals with disabilities who reside in a nursing home. Disability and Rehabi: Assistive Technology. 2007;2:43-9.
- Ben M, Harvey L, Denis S. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries? Aus J Physiother. 2005;51:251-56.
- Odeen, I. Knutsson, E. Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia. Scandanavian J Rehabil Med. 1981;13, 117-21.
Presenter’s Contact:
Ginny Paleg 420 Hillmoor Dr, Silver Spring, MD 20901 301-452-4656 ginny@paleg.com