Non-ambulatory children with cerebral palsy: effects of four months of static and dynamic standing exercise on passive range of motion and spasticity in the hip

Purpose The aim of this study was to compare the effects of four months of two types of structured training regimes, static standing (StS) versus dynamic standing (DyS), on passive range of motion (PROM) and spasticity in the hip among non-ambulatory children with cerebral palsy. Method Twenty non-ambulatory children with cerebral palsy participated in an exercise intervention study with a crossover design. During StS, the Non-ambulatory children with cerebral palsy were encouraged to exercise according to standard care recommendations, including daily supported StS for 30–90 min. During DyS, daily exercise for at least 30 min at a speed between 30 and 50 rpm in an Innowalk (Made for movement, Norway) was recommended. We assessed adaptive effects from the exercise programs through PROM in the hip assessed with a handheld goniometer, and spasticity in the hip assessed with the Modified Ashworth Scale before and after 30 min of StS or DyS. A trained physiotherapist performed the assessments. The exercise test and exercise training were performed in the children’s habitual environment. Non-parametric statistics were used and each leg was used as its own control. Result PROM increased in all directions after 30 min (p < 0.001), and after four months of exercise training (p < 0.001) of DyS. Thirty minutes of DyS lowered the spasticity in the muscles around the hip (p < 0.001) more than 30 min of StS (p < 0.001). Conclusion Thirty minutes of DyS increased PROM and decreased spasticity among non-ambulatory children with CP. Four months of DyS increased PROM but did not decrease spasticity. These results can help inform individualised standing recommendations.

What does the study involve? Each child performs 4 months of static standing and 4 months of dynamic standing in a homesetting, including a wash-out period of 2 weeks between the exercise periods. Assessments and measurements are made at 4 occasions, at the beginning and end of each exercise period.
What are the possible benefits and risks of participating? Benefits include the knowledge gained about different types of standing. The study assessments and measurements were performed in a home setting to make the children/young people more comfortable and to minimise the possible inconveniences from the measurements. The parents could end their participation in the study at any time.
Where is the study run from? Lund University (Sweden)

Scientific title
Effects of 4 months static standing compared to 4 months dynamic supported standing among nonambulatory children and young people with cerebral palsy

Study hypothesis
The study hypotheses are that there are differences in the response to 4 months exercise of Static Standing and Dynamic Standing in metabolic response, respiration, physical activity, temperature at the feet, quality of life, pain, gastrointestinal function, spasticity and Passive Range Of Motion (PROM) in the hips, knee and ankle joints among non-ambulatory children and young people with cerebral palsy.

Patient information sheet
Not available in web format, please use contact details to request a participant information sheet

Condition
Cerebral palsy

Intervention
The standard care in Sweden for non-ambulatory children and young people with cerebral palsy (CP) includes daily static supported standing. The standing exercise training in standing frames is a static standing (StS) exercise where the child is fixated in the standing frame. No movements in the lower body can be achieved but making standing in an upright position possible. The motorised medical device Innowalk gives an opportunity to experience walking movements in an upright weight-bearing position, making dynamic standing (DyS) possible. The participants performed 4 months of standing for 30-60 minutes/day in StS and DyS at their home or preschool/school. Measurements were performed and questionnaires filled in at four occasions, at the beginning and end of each exercise period. Assessments of spasticity and passive range of motion (PROM) were performed and thereafter, capillary blood sample was taken and heart rate belt were put on. The child was positioned in either the standing frame or in the Innowalk. If the Innowalk was to be used it was individually adjusted to the child. When the child was in an upright position the airtight mask covering mouth and nose was put on. The indirect caloric assessment in a standing position was performed for 30 minutes. Temperature of the feet was measured every 10th minute during standing. After 30 minutes of standing the child was lifted down on a mat and a capillary blood sample was taken and assessments of spasticity and PROM were performed once more.

Results and Publications
Publication and dissemination plan The study protocol will be available on request. 3-6 scientific papers and presentations at conferences are planned.
IPD sharing statement Participant level data will be available on request from Dr Katarina Lauruschkus (katarina.lauruschkus@med.lu.se) from December 2018 to November 2028. Consent from the participants' parents as their legal guardians was obtained. All data presented are anonymised, and there is a code list locked in at Lund University.