Research

1. Does research support the efficacy of weight-bearing treatment plans for non-ambulatory children with developmental delays? Kaitlyn Reid and Kaitlyn Stahl Bellarmine University Background Research ClinicalRelevance Summary • Article 1 • Increasing WB in a passive stander is an effective tool to improve bone quality • It is necessary to choose a stander that makes transfers and positioning easier • Article 2 • Evidence supporting the numerous benefits of static weight-bearing exercises in children with cerebral palsy remains limited • Evidence does, however, support findings of increased bone density and temporary reduction in spasticity from WB exercise treatments • Article 3 • First RCT of its kind • Longer duration of standing can significantly increase vertebral BMD • Not likely, however, to reduce LE long bone fractures in children with CP There is a multitude of research that looks at healthy adults and the impact of standing on the effects of bed rest. As the body develops, it adapts to the stresses placed on it. What about children who have never been able to walk? Their body does not know these stresses unless artificially applied. This leads to the question of whether or not weight-bearing programs are an effective treatment approach for non-ambulatory children with developmental delays. Standing is commonly used by physical therapists for the treatment and management of children with developmental disabilities. Is there justification for implementing weight-bearing as an integral part of the treatment plan for children in this population? Should parents and insurances be spending thousands of dollars on equipment that these children will eventually grow out of? The purpose of our poster is to investigate the evidence supporting the efficacy of implementing weight-bearing in non-ambulatory children with developmental delays. • Article 1 1 • Purpose: • To quantify WB in a stander and to directly compare different standers • Outcomes: • WB average 76% body weight • WB difference in standers = 29% • Fatigue was minimal • Side-to-side variance 10% • Article 2 2 • Purpose: • To examine the research on effectiveness of static weight-bearing exercises in children with cerebral palsy • Outcomes: • Good evidence favoring WB exercises through the LEs for increasing bone mineral density in the spine or femur in children with CP • Evidence for SWB exercises in reducing spasticity and improving hand function in the UE in children with CP is limited • Article 3 3 • Purpose: • To determine whether participation in 50% greater standing time would increase bone mineral density in non-ambulatory children with CP • Outcomes: • 6% mean increase in vertebral BMD in intervention group When considering the implementation of a weight-bearing treatment plan for children in this patient population, it is important for clinicians to identify each patient’s targeted impairments, as well as the child’s individual needs. Although there is limited evidence to support many of the claimed physiological benefits of weight-bearing exercises for non-ambulatory patients, prolonged weight-bearing treatments have been proven to increase bone density and temporarily reduce spasticity in non-ambulatory children with developmental delays. This is important clinically because many of these children have compromised bone density due to their inability to bear weight independently. Physical therapists should consider weight-bearing exercises for patients in this population when addressing impairments associated with decreased bone mineral density and/or increased spasticity. It is important to implement an appropriate weight-bearing protocol that fits the individual needs of each patient and allows for optimal outcomes. Conclusion Research does support the efficacy of weight-bearing treatment plans for non-ambulatory children, with proven benefits of increased bone mineral density and temporary reduction in spasticity in children with cerebral palsy. http://www.slocounty.ca.gov/Assets/PH/MTP/PT+Gait+Trainer.jpg References 1. Kecskemethy HH, Herman D, May R, Paul K, Bachrach SJ, Henderson RC. Quantifying weight bearing while in passive standers and a comparison of standers. Dev. Med. Child Neurol. 2008;50(7):520–3. Available at: http://www.ncbi.nlm.nih.gov/pubmed/18611202. Accessed November 11, 2013. 2. Tamis WP. Effectiveness of Static Weight-Bearing Exercises in Children with Cerebral Palsy. Pediatr. Phys. Ther. 2007;(19):62–73. 3. Caulton JM. A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy. Arch. Dis. Child. 2004;89(2):131–135. Available at: http://adc.bmj.com/cgi/doi/10.1136/adc.2002.009316. Accessed November 11, 2013. http://physical-therapy.advanceweb.com/SharedResources/Images http://www.rifton.com/~/media/images/rifton/products/overview-tab/pacer-gait-trainers/rifton-pacer-gait-trainer-preschool.jpg?mh=2000&mw=2000