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Published on: August 30, 2016
Effects of prolonged standing on gait in children with spastic cerebral palsy
Yasser Salem1, Venita Lovelace-Chandler, Reta J Zabel
1Division of Physical Therapy, Long Island University, Brooklyn, New York 11201, USA. Yasser.salem@liu.edu
Insights
Prolonged standing improved gait in children with spastic cerebral palsy, but the effects were temporary. Further research is needed to establish optimal standing program durations for lasting benefits.
Area of Science:
- Pediatrics
- Neurology
- Physical Therapy
Background:
- Spastic cerebral palsy (CP) significantly impacts children's gait and motor function.
- Gait impairments in CP can lead to secondary complications and reduced quality of life.
- Interventions aimed at improving gait characteristics are crucial for managing CP.
Purpose of the Study:
- To investigate the effects of a prolonged standing program on gait characteristics in children with spastic cerebral palsy.
- To assess changes in spasticity and muscle tone following the intervention.
- To determine the durability of any observed gait improvements.
Main Methods:
- A reverse baseline (A-B-A) design was employed over 9 weeks with 6 children (mean age 6.5 years) diagnosed with spastic CP (GMFCS levels II-III).
- The intervention phase included a prolonged standing program three times weekly, alongside usual physical therapy.
- Gait analysis and Modified Ashworth Scale assessments for muscle tone were conducted before and after each phase.
Main Results:
- Significant improvements were observed in stride length, gait speed, stride time, stance phase duration, and double support time (p <.001).
- Muscle tone (p <.02) and peak dorsiflexion angle during midstance (p <.004) also showed significant improvements.
- These positive effects on gait characteristics were not sustained 3 weeks post-intervention.
Conclusions:
- A prolonged standing program can temporarily enhance gait patterns in children with spastic cerebral palsy (GMFCS levels II-III).
- The observed improvements in gait and muscle tone are not maintained long-term without continued intervention.
- Further research with larger cohorts is recommended to optimize standing program "dosing" for sustained functional gains.
Abstract:
The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Gait analysis and clinical assessment of spasticity were performed before and after each phase. Analysis of variance (ANOVA) for repeated measurements was used to test for changes in gait measures across the four measurement sessions. Friedman's was used to test for changes in muscle tone (Modified Ashworth Scale) across the four measurement sessions. Stride length (p <.001), gait speed (p <.001), stride time (p <.001), stance phase time (p <.001), double support time (p <.003), muscle tone (p <.02), and peak dorsiflexion angle during midstance (p <.004) improved significantly following the intervention phase. The results of this study demonstrate that the gait pattern of children with cerebral palsy classified as level II or III on the Gross Motor Functional Classification System (GMFCS) improved by a prolonged standing program. However, these improvements were not maintained at 3 weeks. Further research is necessary with larger sample sizes to replicate these findings and determine specific "dosing" for standing programs to create long-lasting functional effects on gait.
