Positioning in Standing Frames

A study of severe spastic quadriplegic children with poor head / trunk control showed that best weight-bearing was achieved when standing at a prone angle of 20 degrees. Another sutdy looked specifically at the effects of small changes in prone angle on weight bearing using a Jenx prone stander (Junior size). The researcher concluded that an angle of 25 degrees from the vertical enabled four out of the five children studied to generate most force through their feet in standing. She also noted that relatively high pressures were exerted at the knees particularly in children with reduced ranges who were more active. Based on the findings of her small study the author suggests that encouraging more dynamic weight bearing activities whilst children are standing would be a good topic of study for future research as greater forces were exerted at sites where children were actively fixing in order to initiate movement (in this case the knees).

The Medicines and Healthcare Products Regulatory Agency (MHRA) document ‘An Evaluation of Standing Frames for 8 to 14 year olds’ (2004) includes the results of a small study conducted to determine the amount of weight bearing achieved by children when positioned in different frames and at different angles within the frames. Three children participated in weight-bearing tests. Child A and Child B had cerebral palsy (quadriplegia), Child C had no known disability. Each child was positioned in at least two different standing frames and the force transmitted through both feet was recorded through two footplates, each with four load cells.

Readings were taken with the frame set at five degree intervals from vertical (90°) through to 30° in a prone position, (120°) or 30° in supine (120°) depending on the style of the frame. Calculations were carried out to identify the percentage of a child’s total body mass transmitted through the feet at each five degree interval. Results are presented in the table below (reproduced from the MHRA paper).

N.B. Child A has CP (Quad) whereas Child C has no disabilities.

N.B. Child B has CP (Quadriplegia).

Interestingly Child A and Child B (who were both Quadriplegic) were both tested on the Whirl Prone but showed different amounts of weight bearing at the same angles. This tells us that what works best for one child may not work best for another, and furthermore, how do we know how much weight a child is putting through their feet. Therefore, the findings of these weight-bearing tests cannot be indicative of the performance of these particular frames as participant’s physical needs and requirements differed. The findings in the study are inconclusive but do suggest that further research is required to establish the effect factors such as positioning, angle and frame features can have on weight bearing..

 

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