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Commentary on “Effects of Passive Versus Dynamic Loading Interventions on Bone Health in Children Who Are Nonambulatory”

Nirider, Juanita L. Hansen PT, MS; Hickman, Robbin PT, DSc, PCS

Pediatric Physical Therapy: Fall 2013 - Volume 25 - Issue 3 - p 256
doi: 10.1097/PEP.0b013e318297329c
Clinical Bottom Line

Multicare, Good Samaritan Children's Therapy Unit Puyallup, Washington

University of Nevada Las Vegas, Nevada

The authors have no conflicts of interest to report.

“How should I apply this information?”

Children using a stander that incorporated a rhythmic-reciprocal load improved bone mineral content in comparison to a more traditional form of passive standing after 6 to 9 months of use. Establishing a means of alternate weight loading during a standing program may improve bone health in addition to other physiologic changes previously associated with standing programs such as changes in bowel, bladder, and respiratory function. The apparatus used in this study was custom designed and implemented. We agree with the authors that, after modifications are completed to improve practicality, use of the apparatus should be further explored. Clinicians wishing to apply this study in practice may consider attaining rhythmic loading of body-weight percentages similar to those achieved in this study through use of an adapted tilt board under a traditional stander, partial weight-bearing during treadmill ambulation, use of a suspension walker, gait trainer, or a commercially available dynamic stander.

“What should I be mindful about in applying this information?”

Some changes seen in this study may have been due to use of either standing program, maturation, or other confounding factors. However, the presence of a comparison group receiving more traditional standing support that did not experience similar bone mineral changes supports the potential usefulness of the dynamic loading apparatus. The bony architecture measures used in this study may not be widely available to clinicians and carry a small risk of radiation exposure to the children when used repeatedly to measure progress over time. Determining rates of expected bone growth and linking bone health measures to clinically relevant activity and participation measures are important next steps.

Juanita L. Hansen Nirider, PT, MS

Multicare, Good Samaritan Children's Therapy Unit

Puyallup, Washington

Robbin Hickman, PT, DSc, PCS

University of Nevada

Las Vegas, Nevada

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