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Systematic Review and Evidence-Based Clinical Recommendations for Dosing of Pediatric Supported Standing Programs

Paleg, Ginny S. PT, MPT, DScPT; Smith, Beth A. PT, DPT, PhD; Glickman, Leslie B. PT, PhD

doi: 10.1097/PEP.0b013e318299d5e7
Review Article

Purpose: There is a lack of evidence-based recommendations for effective dosing of pediatric supported standing programs, despite widespread clinical use.

Methods: Using the International Classification of Functioning, Disability, and Health (Child and Youth Version) framework, we searched 7 databases, using specific search terms.

Results: Thirty of 687 studies located met our inclusion criteria. Strength of the evidence was evaluated by well-known tools, and to assist with clinical decision-making, clinical recommendations based on the existing evidence and the authors’ opinions were provided.

Conclusions and recommendations for clinical practice: Standing programs 5 days per week positively affect bone mineral density (60 to 90 min/d); hip stability (60 min/d in 30° to 60° of total bilateral hip abduction); range of motion of hip, knee, and ankle (45 to 60 min/d); and spasticity (30 to 45 min/d).

This systematic review of the literature establishes evidence based parameters for dosing of supported standing programs that affect body structure, body function, activities, and participation.

Montgomery County Infants and Toddlers Program (Dr Paleg), Rockville, Maryland; Balance Disorders Laboratory (Dr Smith), Departments of Neurology and Behavioral Neuroscience, Oregon Health and Science University, Portland, Oregon; Department of Physical Therapy and Rehabilitation Science (Dr Glickman), School of Medicine, University of Maryland, Baltimore, Maryland.

Correspondence: Ginny S. Paleg, PT, MPT, DScPT, 420 Hillmoor Drive, Silver Spring, MD 20901 (

Grant Support: Beth A. Smith was supported by a grant from the Foundation for Physical Therapy (New Investigator Fellowship Training Initiative) during completion of this work.

Ginny S. Paleg has worked as an educational consultant for various manufacturers and suppliers of standing devices. Funding from these sources did not influence the contents of this work. Beth A. Smith and Leslie B. Glickman declare no conflicts of interest.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association.