Evidence Based Practice

Evidence Update: Long-Term Benefits of Abducted Standing in Children with Cerebral Palsy

April 12, 2021 by Elena Noble, MPT

A girl standing in a Rifton Supine Stander, playing a game with her caretakerNon-ambulatory children with cerebral palsy are at risk for hip displacement because of strong adduction, flexion and internal rotation muscle forces at the hip. Available research points to the benefits of standing in abduction to prevent hip migration and subsequent dislocation. A recent study in the Pediatric Physical Therapy Journal further adds to this current knowledge base.

This study draws data from the Swedish CPUP (Cerebral Palsy Uppfoljning) register, a hip surveillance program following children with CP in Sweden from birth to adulthood. Children chosen for the study were between three and seventeen years old, classified in GMFCS level IV or V, and using a standing frame ten hours per week at fifteen degrees to thirty degrees abduction for each leg. They were further divided into two groups: one in which participants had adductor-psoas tenotomy surgery and the other which participants did not. The control group performed abducted standing at zero degrees to ten degrees for each leg and were matched on age and surgery category.

Over the course of seven years, all the children who stood for a total of ten hours per week at fifteen degrees to thirty degrees hip abduction showed a reduction in hip migration percentage, regardless of the surgery category. The greatest reduction in hip migration percentage (eighteen percent) was in the group that performed abducted standing after having surgery. An additional finding of the study group was that range of motion at the hip and knee was maintained.

On the other hand, migration percentage in the control groups increased.

Hip surveillance and intervention for non-ambulatory children with CP is a work in progress, but certainly, abducted standing is effective – at least up to seven years as measured in the study. So providing children with optimal time in adaptive standers with abduction during the day contributes to these positive outcomes.

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Heiko | April 12, 2021

A great finding!

Kim | April 14, 2021

Thanks for great information to apply functionally in school setting; also provides parents information to apply in home setting as well.

Janet | May 05, 2021

Did the children WITH the tenotomys who stood in zero to 10 degrees of abduction also experience hip migration?

Elena | May 05, 2021

The children who had tenotomy surgery and stood in zero to 10 degrees abduction reduced migration percentage by a median of 3.5%, whereas the kids who had tenotomy surgery and stood in 15-30 degrees abduction had 18% reduction in hip migration percentage.

Ruth A Rosenkrans | September 27, 2022
I am wondering what information you have on the use and benefit of standers at the Junior High and High School levels? I work in a public school setting. This is the age where sitting is more of the norm in the classrooms. I am wondering how best to incorporate.
Elena Noble | October 03, 2022
Hi Ruth, Thank you for your inquiry. First of all, I’m referencing the Jackmann 2022 and Novak 2020 studies which provide evidence-based guidelines for interventions of children and young people with CP. Overall, they address the necessity and importance of goal-directed, contextual and activity-based interventions for this population. This can be taken any number of ways, but most importantly, that passive comfortable sitting (such as in a wheelchair) for an entire school-day does not contribute to any motor skill development which is equally important to a child’s well-being and health as are the academic they are participating in. As you say, utilizing a device such as a stander or gait trainer can change this. Rifton has long worked with an activity-based program called the MOVE Curriculum. It is a curriculum that meshes academics with motor skill building. Wheelchairs are parked when kids get off the bus and the students are assisted throughout the day with sitting, standing, walking and transitions in order to best engage in their day. It takes a lot of creativity and activity-planning and teamwork to incorporate these motor skills, but a highly effective program. Because kids have multiple practice opportunities to work on standing (or any other skill) as it is incorporated into their daily routine, they do show progress and goal achievement in all motor areas. There are other studies that speak to the use of adaptive standers and their benefits- bmd, rom, hip health for this population. Glickman 2010, Capati 2019, Paleg 2013, 2021, 2022. A particular study on evidence-based clinical recommendations for dosing of standing programs by Ginny Paleg is worth a look at. The research is certainly not strong in any of these areas, but at least gives an idea. Hope this helps, Elena