Phys. Ther. Korea 2024; 31(2): 131-141
Published online August 20, 2024
https://doi.org/10.12674/ptk.2024.31.2.131
© Korean Research Society of Physical Therapy
Changho Kim1 , PT, PhD, Hyunsuk Park2
, PT, MPH
1Yonsei Child Development Center, Yongin, 2Rehabilitation Team, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea
Correspondence to: Changho Kim
E-mail: workffid@hanmail.net
https://orcid.org/0000-0001-5627-0243
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Standing frames are a common intervention for children with cerebral palsy (CP), yet there is a lack of standardized dosing recommendations, impeding the enhancement of treatment outcomes in this population.
Objects: This paper aims to optimize dosing strategies for standing frame programs in children with CP. It evaluates effective durations and frequencies for using standing frames to improve gait, hip joint integrity, functional activities, joint range of motion, and muscle tone. The goal is to provide evidence-based clinical recommendations to guide practitioners in treating pediatric CP patients.
Methods: A comprehensive research was conducted across seven databases, yielding 23 studies meeting inclusion criteria. Strength of evidence was assessed using established tools. Clinical recommendations were formulated based on the amalgamation of existing evidence.
Results: The paucity of evidence-based dosing recommendations for children with CP supported standing device is highlighted in this review. Key findings suggest that standing frames implemented 5 days per week demonstrate positive effects on gait (45 minutes/day, 3 times/ week), hip joint integrity (60 minutes/day), functional activities (60 minutes/day in 30° to 60° of bilateral hip abduction), joint range of motion (60 minutes/day), and muscle tone (30 minutes/day).
Conclusion: This systematic review of the treatment regimens for children with CP is providing useful insights to the dosing strategies of standing frames. The evidence supports a 30–60 minutes per day and 3–5 days a week intervention with specified durations for optimal outcomes. In enhancing the effectiveness of standing frames, as well as promoting evidencebased practices in the management of children with CP, these clinical recommendations offer guidance for practitioners.
Keywords: Cerebral palsy, Physical therapy modalities, Systematic review
Phys. Ther. Korea 2024; 31(2): 131-141
Published online August 20, 2024 https://doi.org/10.12674/ptk.2024.31.2.131
Copyright © Korean Research Society of Physical Therapy.
Changho Kim1 , PT, PhD, Hyunsuk Park2
, PT, MPH
1Yonsei Child Development Center, Yongin, 2Rehabilitation Team, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea
Correspondence to:Changho Kim
E-mail: workffid@hanmail.net
https://orcid.org/0000-0001-5627-0243
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Standing frames are a common intervention for children with cerebral palsy (CP), yet there is a lack of standardized dosing recommendations, impeding the enhancement of treatment outcomes in this population.
Objects: This paper aims to optimize dosing strategies for standing frame programs in children with CP. It evaluates effective durations and frequencies for using standing frames to improve gait, hip joint integrity, functional activities, joint range of motion, and muscle tone. The goal is to provide evidence-based clinical recommendations to guide practitioners in treating pediatric CP patients.
Methods: A comprehensive research was conducted across seven databases, yielding 23 studies meeting inclusion criteria. Strength of evidence was assessed using established tools. Clinical recommendations were formulated based on the amalgamation of existing evidence.
Results: The paucity of evidence-based dosing recommendations for children with CP supported standing device is highlighted in this review. Key findings suggest that standing frames implemented 5 days per week demonstrate positive effects on gait (45 minutes/day, 3 times/ week), hip joint integrity (60 minutes/day), functional activities (60 minutes/day in 30° to 60° of bilateral hip abduction), joint range of motion (60 minutes/day), and muscle tone (30 minutes/day).
Conclusion: This systematic review of the treatment regimens for children with CP is providing useful insights to the dosing strategies of standing frames. The evidence supports a 30–60 minutes per day and 3–5 days a week intervention with specified durations for optimal outcomes. In enhancing the effectiveness of standing frames, as well as promoting evidencebased practices in the management of children with CP, these clinical recommendations offer guidance for practitioners.
Keywords: Cerebral palsy, Physical therapy modalities, Systematic review
Table 1 . Summary of findings (included studies, best available evidence levels).
Author | OCEBM Levels of Evidence | Dosage used | Participant |
---|---|---|---|
Gibson et al. [13] | 2 | 1 hour/day, 5 days/week, 6 weeks | 5 nonambulatory children with CP |
Martinsson and Himmelmann [14] | 2 | 30–90 minutes (60 minutes worked best), 5 times/week for 1 year | 97 children with CP, 2–6 years old, GMFCS levels 3-5 |
Salem et al. [15] | 2 | 45 minutes/day, 3 times/week in prone stander, 9 sessions | 6 children with CP, GMFCS levels 2 and 3 |
Tremblay et al. [16] | 2 | One session, 30 minutes, tilt table with ankle dorsiflexioned | 22 children with CP |
Rapson et al. [17] | 2 | 60 minutes, 5 times a week | 25 children with CP, 1–12 years old, GMFCS levels 3–5 |
Lauruschkus et al. [18] | 2 | 30–90 minutes, daily | 20 children with CP, 5–17 years old, GMFCS levels 4 or 5 |
Hägglund et al. [19] | 3 | No dosing information provided in this study | 212 children followed until 9–16 years of age |
Noronha et al. [20] | 3 | One session | 10 children with spastic diplegic CP |
Rauf et al. [21] | 3 | 24 hours positioning in specific seats, night positioning and standing frames for 6 months | 74 children with quadriplegic CP aged 3 to 8 years |
Martinsson and Himmelmann [22] | 3 | 10 hours/week, every week, for 8 months to 7 years | 269 children with CP were studied for more than 7 years in 2 case-control groups, GMFCS levels 4 or 5 |
Gudjonsdottir and Stemmons Mercer [23] | 4 | 30 minutes a day, 5 days a week for 8 weeks | 4 children of preschool age with severe CP |
Stark et al. [24] | 4 | Total program included 6 months | 78 children with bilateral CP |
Pountney et al. [25] | 4 | 30 minutes/day, Prone standers used daily for an average | 59 children with bilateral CP |
Pountney et al. [26] | 4 | 3 years of daily use of prone stander | 39 children with bilateral CP |
Dalén et al. [27] | 4 | 40 minutes/day (range 4–164 minutes/day) | 11 boys and 7 girls, median age 10.5 years, with severe CP |
Wilmshurst et al. [28] | 4 | Regularly weight bearing in a frame | 9 girls and 18 boys with CP aged 5 to 14 years |
Miedaner and Finuf [29] | 4 | 1 session | 12children, 17 to 58 months of age, with a diagnosis of spastic quadriplegia or diplegia |
Rivi E et al. [30] | 4 | 30–60 minutes of verticalization per day for 5 days a week | 1 child with quadriplegia, GMFCS level 5 |
Goodwin et al. [31] | 4 | 30–60 minutes, 3 times a week on average | 12 young people with CP |
Barbier et al. [32] | 4 | Standing frame for an average of 30 minutes/day | 24 children with severe CP, GMFCS levels 4 and 5 |
Macias [33] | 5 | 55°–70° of abduction, 45 minutes a day at home until the age of 5 | 14 children with diagnosis of CP, spastic diplegia |
Rauch [34] | 5 | Standing frame with whole-body vibration,twice per week over a 6-month period | 4 children with CP |
Ruys [35] | 5 | Long leg abduction brace when standing on a prone board, 20 minutes/day | 1 boy 12 years of age with hypotonic athetosis and severe acetabular dysplasia |
OCEBM, Oxford Centre for Evidence-Based Medicine; CP, cerebral palsy; GMFCS, gross motor function classification system..
Table 2 . Assessment of methodological quality using the PEDro scale.
Tremblay et al. [16] | Gibson et al. [13] | Salem et al. [15] | Martinsson and Himmelmann [14] | Rapson et al. [17] | Lauruschkus et al. [18] | |
---|---|---|---|---|---|---|
Randomization of participants | Y | N | N | N | Y | Y |
Concealed allocation | Y | N | Y | N | Y | Y |
Groups similar at baseline | Y | Y | Y | Y | Y | Y |
Blinding of participants | N | N | N | N | N | N |
Blinding of therapists | N | N | N | N | N | N |
Blinding of assessors | N | N | N | N | Y | NA |
More than 85% follow-up of participants in at least one of key outcomes | Y | Y | Y | Y | Y | Y |
Intention to treat analysis | N | Y | Y | Y | Y | N |
Statistical comparisons between group | Y | Y | Y | Y | Y | Y |
Point estimate of at least one of the key outcomes | Y | Y | Y | Y | Y | Y |
Total score | 6/10 | 5/10 | 6/10 | 5/10 | 8/10 | 6/10 |
PEDro, Physiotherapy Evidence Database; Y, yes; N, no; NA, not applicable..