All material Copyright © May 2009 EasyStand
Reprinted with their express permission as originally published on their website.
By: Ginny Paleg, PT
Ginny is a pediatric Physical Therapist from Silver Spring, MD. She works in a 0-3 (Early Intervention) program for Montgomery County Public Schools. She recently completed her dissertation on Supported Standing and offers it as a free webinar on the EasyStand website.
When I began my systematic review of all the standing studies, I did not believe that standing would help develop or improve other motor skills in adults and/or children with neuromotor dysfunction (cerebral palsy, spinal cord injury, multiple sclerosis, stroke, etc). The evidence changed my mind. Turns out there are a handful of studies that show that a passive standing program can improve reach, eating, and even walking! Let’s take a closer look.
The most convincing study is from Ahlborg (2006). This study looked at 12 adults with cerebral palsy. Half of the subjects participated in a resistance training program and the other half stood on a vibration platform for 6 minutes a day. The standing group outperformed the exercise group on the GMFM for standing and walking! The idea here is that the whole body vibration platform causes almost every muscle cell to contract via the monosyaptic loop triggered by the stretch reflex. Adults with cerebral palsy who have never really experienced mass muscle contractions were now essentially “exercising” by bypassing their faulty neuromuscular system. Since they were standing on the platform with their knees bent, the primary benefits were seen in the muscles below the “bend” which essentially stops the vibration from traveling up past the “bend”. Now let’s take a quick look at nine more studies that show how standing can improve motor skills.
The second very strong and well constructed and conducted study is from Jesinkey (2003). Fifteen children with spastic diplegic cerebral palsy were tested in a standing shell, foot braces and neither. Their hand trajectories and reaching improved most when the child was in standing shell.
The Chailey School in the United Kingdom is a school for kids with severe disabilities. This group has published many studies looking at the positive effects of seating, positioning and equipment. In one of the Chailey studies, Green (1993) looked at the effects of using a stander for 30 minutes a day in 11 children with cerebral palsy. The results showed that 36% of the children improved their sitting and lying skills just by using a stander.
Netz (2007) took a group of adults with spinal stenosis, Parkinson’s, cerebral ataxia, and stroke in a nursing home and had them participate in an exercise program while in standers. The group participated in a12 week physical activity program in a stander for up to 5 times a week for 30 minutes each session. At the end of the intervention, the researchers found that the group had improved in the motor function as measured by the FIM. Specifically, the subjects improved in locomotion, mobility and motor score. 60% of subjects who required assistance to stand before intervention were able to stand independently for 1 minute on average and walk 14 meters with a walker. All this from just standing!
Noronha (1989) conducted simulated feeding in adaptive seating and a prone stander for ten children with spastic diplegic cerebral palsy. The subjects performed significantly faster while in a prone standing position.
When Riek (2008) placed 5 adults with spinal cord injury (ASIA A) whom had no sensation or motor below their level of lesion, in a knee ankle orthosis in a standing position, the subjects demonstrated improved shoulder and arm positioning.
Here are the research studies that document how a standing program helps motor skills.
One of the promising additions to passive standing equipment is whole body vibration. These platforms either rock and vibrate or just vibrate at 20-60 HZ. Some researchers believe that the vibration produces a stretch reflex of the muscle which causes fiber of the muscle to contract, even in paralyzed or spastic muscle. This increased muscle force may improve bone density and/or strength. Some studies have also shown improved balance and functional abilities. Garrett (2008) placed two children with spastic cerebral palsy (one had hemiplegia and one had diplegia) on the vibrating stander twice a week (10-40 hz) for 4 weeks. One subject improved balance and reported subjective improvements in other functional activities.
In Cologne, Germany, the researchers stood 6 children (with osteogenesis imperfecta, spinal cord defect or cerebral palsy) on a tilt table with a vibrating platform across the foot plate twice a day for six months. They reported 100% improved mobility, which was defined as an increased tilt-angle or an improved BAMF-score.
Zabel (2005) had six children with spastic cerebral palsy stand in an upright stander three times a week. The researchers reported improvements in walking including increased stride length, speed, and stance time.
Nelson (1997) looked a subject with spastic paraplegia and was able to show improved work productivity in standing vs. sitting (4% improvement) and improved posture in the stander when compared to unsupported sitting.
When looked at individually, most of these studies are not very powerful. They are very small subjects and some did a poor job of reporting the intervention, had no controls or poor outcome measures. But yet, when we look at them as a group we see a trend that warrants a closer look. Future studies on passive standing and those that include whole body vibration should include a standardized measure or function. I had never expected to systematically review the literature and find thesestudies linking standing and improved function. And yet here they are. I hope researchers continue to study standing and include outcome measures that include function.
For more information on the evidence backing up standing, read Ginny’s blog post on standing and hip integrity, watch the free webinar on Supported Standing, or read Ginny’s Synthesized Literature Review on Standing (PDF).
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