Category: Bowel Function & Digestion

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A systematic review of supported standing programs

date: 2010;3(3):197-213. doi: 10.3233/PRM-2010-0129.
author: Glickman LB1, Geigle PR, Paleg GS.
publication: J Pediatr Rehabil Med.
pubmed_ID:PMID:21791851

 

The routine clinical use of supported standing in hospitals, schools and homes currently exists. Questions arise as to the nature of the evidence used to justify this practice. This systematic review investigated the available evidence underlying supported standing use based on the Center for Evidence-Based Medicine (CEBM) Levels of Evidence framework.

DESIGN:

The database search included MEDLINE, CINAHL, GoogleScholar, HighWire Press, PEDro, Cochrane Library databases, and APTAs Hooked on Evidence from January 1980 to October 2009 for studies that included supported standing devices for individuals of all ages, with a neuromuscular diagnosis. We identified 112 unique studies from which 39 met the inclusion criteria, 29 with adult and 10 with pediatric participants. In each group of studies were user and therapist survey responses in addition to results of clinical interventions.

RESULTS:

The results are organized and reported by The International Classification of Function (ICF) framework in the following categories: b4: Functions of the cardiovascular, haematological, immunological, and respiratory systems; b5: Functions of the digestive, metabolic, and endocrine systems; b7: Neuromusculoskeletal and movement related functions; Combination of d4: Mobility, d8: Major life areas and Other activity and participation. The peer review journal studies mainly explored using supported standers for improving bone mineral density (BMD), cardiopulmonary function, muscle strength/function, and range of motion (ROM). The data were moderately strong for the use of supported standing for BMD increase, showed some support for decreasing hypertonicity (including spasticity) and improving ROM, and were inconclusive for other benefits of using supported standers for children and adults with neuromuscular disorders. The addition of whole body vibration (WBV) to supported standing activities appeared a promising trend but empirical data were inconclusive. The survey data from physical therapists (PTs) and participant users attributed numerous improved outcomes to supported standing: ROM, bowel/bladder, psychological, hypertonicity and pressure relief/bedsores. BMD was not a reported benefit according to the user group.

CONCLUSION:

There exists a need for empirical mechanistic evidence to guide clinical supported standing programs across practice settings and with various-aged participants, particularly when considering a life-span approach to practice.

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Bone-mineral density in children and adolescents who have spastic cerebral palsy.

date:
author: Henderson RC, Lin PP, Greene WB.
publication: J Bone Joint Surg Am. 1995 Nov;77(11):1671-81.
pubmed_ID: 7593076

Bone-mineral density was studied in a heterogeneous group of 139 children (mean age, nine years; range, three to fifteen years) who had spastic cerebral palsy. The evaluation included serum analyses and a nutritional assessment based on a dietary history and anthropometric measurements. The bone-mineral density of the proximal parts of the femora and the lumbar spine was measured with dual-energy x-ray absorptiometry and was normalized for age against a series of ninety-five normal children and adolescents who served as controls. Bone-mineral density varied greatly but averaged nearly one standard deviation below the age-matched normal means for both the proximal parts of the femora (-0.92 standard deviation) and the lumbar spine (-0.80 standard deviation). Ambulatory status was the factor that best correlated with bone-mineral density. Nutritional status, assessed on the basis of caloric intake, skinfolds, and body-mass index, was the second most significant variable. The pattern of involvement, durations of immobilization in a cast, and a calcium intake of less than 500 milligrams per day were additional factors of less significance. The age when the child first walked, previous fractures, use of anticonvulsants, and serum vitamin-D levels did not correlate with bone-mineral density after adjustment for covariance with the ambulatory status and the nutritional status. Serum levels of calcium, phosphate, alkaline phosphatase, and osteocalcin were not reliable indicators of low bone-mineral density.

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Long-term followup of renal function after spinal cord injury.

date: 09/01/1985
author: Kuhlemeier KV, Lloyd LK, Stover SL.
publication: J Urol. 1985 Sep;134(3):510-3.
pubmed_ID: 4032551

Effective renal plasma flow was measured in acute spinal cord injury patients for up to 10 years after injury to determine the extent of renal deterioration in these patients and to identify the factors associated with a loss of renal function. The over-all mean decrease in effective renal plasma flow for all patients as a whole was 4.5 ml. per year. Factors associated with a statistically significant reduction in effective renal plasma flow included age, gender, renal calculi, quadriplegia, and a history of chills and fever. Other factors examined but not found to be statistically significant included years since injury, presence of severe decubiti, bladder calculi, bacteriuria and extent of injury. This study suggests that renal function usually can be preserved in spinal cord injury patients if the treatable risk factors are managed properly.

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Case study to evaluate a standing table for managing constipation.

date: 06/01/2001
author: Hoenig H, Murphy T, Galbraith J, Zolkewitz M.
publication: SCI Nurse 2001 Summer;18(2):74-7.
pubmed_ID: 12035465

Standing devices have been advocated as a potentially beneficial treatment for constipation in persons with spinal cord injury (SCI); however, definitive data are lacking. A case of a patient who requested a standing table to treat chronic constipation is presented as an illustration of a method to address this problem on an individual patient level. The patient was a 62-year-old male with T12-L1 ASIA B paraplegia who was injured in 1965. The patient was on chronic narcotics for severe, nonoperable shoulder pain. His bowel program had been inadequate to prevent impactions. A systematic approach was used to measure the effects of a standing table on frequency of bowel movements (BMs) and on length of bowel care episodes. There was a significant (p < 0.05) increase in frequency of BMs and a decrease in bowel care time with the use of the standing table 5 times/week versus baseline. For this patient, the use of the standing table was a clinically useful addition to his bowel care program.

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Indications for a home standing program for individuals with spinal cord injury.

date: 09/01/1999
author: Walter JS, Sola PG, Sacks J, Lucero Y, Langbein E, Weaver F.
publication: J Spinal Cord Med. 1999 Fall;22(3):152-8.
pubmed_ID: 10685379

Additional analyses were conducted on a recently published survey of persons with spinal cord injury (SCI) who used standing mobility devices. Frequency and duration of standing were examined in relation to outcomes using chi square analyses. Respondents (n = 99) who stood 30 minutes or more per day had significantly improved quality of life, fewer bed sores, fewer bladder infections, improved bowel regularity, and improved ability to straighten their legs compared with those who stood less time. Compliance with regular home standing (at least once per week) was high (74%). The data also suggest that individuals with SCI could benefit from standing even if they were to begin several years after injury. The observation of patient benefits and high compliance rates suggest that mobile standing devices should be more strongly considered as a major intervention for relief from secondary medical complications and improvement in overall quality of life of individuals with SCI.