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Commentary on “Effect of Weight-Bearing in Abduction and Extension on Hip Stability in Children With Cerebral Palsy”

Senesac, Claudia PT, PhD, PCS; Lammers, Jenna PT; Algood, Cathy PT

Pediatric Physical Therapy: July 2011 - Volume 23 - Issue 2 - p 158
doi: 10.1097/PEP.0b013e31821933da
Clinical Bottom Line

University of Florida, Gainesville (Senesac)

Shands Hospital, Gainesville, Florida (Lammers)

Marion County School System, Ocala, Florida (Algood)

“How should I apply this information?”

This study was a case series in which 2 groups of children with cerebral palsy who were nonabmulatory were followed for 1 year to determine the effect of standing with maximal hip abduction and extension from ½ to 1½ hours per day. One group of 3 children who underwent bilateral adductor-iliopsoas-tenotomies was matched with 20 control subjects. Another group of 8 children, the prevention group, received the standing intervention and did not require surgery. This second group was matched with 63 control subjects. Pre- and postintervention radiographs were used to determine migration percentage (MP) and range of motion.

  • In the surgery group, those using the stander demonstrated the largest decrease of MP.
  • In the prevention group those receiving intervention for 1 hour per day demonstrated a significant improvement in MP.
  • In the prevention group, those who stood for shorter periods of time (½ hour per day) maintained the MP or had MP increases less than the control group.
  • Contractures were noted only in the involved hip and knee musculature in the control group that did have surgery.
  • Families and children reported that manual stretching was easier after standing and that while in the stander they were able to perform other skills, that is, play activities.
  • This intervention is relatively easy to carry out in home or school environments by parents/caregivers.

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

  • This is a case series with a very small number of subjects in both intervention groups and not a clinical trial.
  • Children received other therapeutic interventions during the year; thus, the influence those therapies had on MP and range of motion is difficult to determine.
  • This study only investigated the abduction angle of 30°. The authors state that it is yet to be determined if 30° is necessary to keep the acetabular rim free from pressure.
  • Clinicians should exercise caution if using the stander for children with hip flexor and knee flexor contractures.
  • Care should be taken to not apply the results to populations other than children with cerebral palsy of similar age who are nonambulatory.

Claudia Senesac, PT, PhD, PCS

University of Florida, Gainesville

Jenna Lammers, PT

Shands Hospital, Gainesville, Florida

Cathy Algood, PT

Marion County School System, Ocala, Florida

© 2011 Lippincott Williams & Wilkins, Inc.