Effects Of Standing Frames On Bone Mineral Density

Bone mineral density (BMD) has been reported to be abnormal in children with CP (Shaw et al. 1994). The causes are thought to be multiple and include nutritional and non-nutritional factors. Poor nutrition and abnormal vitamin D metabolism, genetic and hormonal factors, along with the inability to provide adequate and consistent loading through normal movement (weight-bearing and muscle tension) establish a cycle that leads to generalised lowered BMD, and increased risk of fracture. Bone loss during disuse occurs fastest in trabecular bone because of its rapid metabolic turnover compared to cortical bone (Stuberg 1992). Hence most fractures occur in sites of trabecular bone e.g. tibial plateau in children with CP.

Chad et al. (2000) conducted a study examining the BMD of nutritionally adequate ambulatory and non-ambulatory children with CP and compared them to a healthy reference group. Findings indicated that children with CP who were ambulatory had significantly higher BMD than those with CP who were confined to a wheelchair or experienced minimal weight-bearing activities. The importance of this study was that it controlled for the exclusion of nutritional factors amongst this group, thereby providing evidence that weight-bearing has a direct role in the maintenance of BMD in nutritionally adequate children with CP. It was however a small study with only 17 subjects matched against a database control group       of 894.



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