Commentary on: "Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy".

Abstract

“How could I apply this information?” Although children with cerebral palsy Gross Motor Function Classification System level III typically walk, they often have spasticity and hip problems that affect walking. The results of this study support prolonged daily standing with the hips abducted as effective in maintaining hip abduction range of motion (ROM). Manual stretching programs have not demonstrated this effect. Fabrication of a small, customized stander like the one used in this study is a good alternative to manufactured standers. Parent response: I feel like I'm not alone! My 5-year-old son participates in a home standing program to avoid hip surgery and maintain his ability to stand and walk. It is a lot of work, but other children with cerebral palsy could find success following this type of program. The nice thing about this study is that it divided the daily standing into 2 shorter time bouts, instead of 1 long session, which makes it more manageable for parents. “What should I be mindful about when applying this information?” The results may not generalize to other Gross Motor Function Classification System levels or ages. The plaster standers used were set at 10° less than maximum hip abduction range; thus, the results of maintained ROM instead of increased ROM would be expected. Appropriate frequency, intensity, and duration of standing are necessary for positive outcomes, and, consequently, adherence with the home protocol is important. Additional physical therapy was provided once weekly. Although details of that intervention were not included, the dosage was low and unlikely to have had an effect on ROM. Applying the plaster cast while maintaining leg symmetry is challenging and may result in less than optimal positioning. Therefore, keeping the child entertained and using 2 therapists during fabrication may help this process. Parent response: A home standing program sounds like an easy thing to do, but it is not! The reality is that children are not always cooperative. It is difficult to get them to stretch for an extended period of time. I need to keep my son extremely distracted and constantly engaged in a fun activity when standing or he makes it known that he “wants out.” Kids need to be kids during exercise and incorporating play is important. It may have been helpful for the researchers to take a parent survey of how the children reacted or complied during the home programs. Nicole Bishop, PT, DPT California Children's Services, County of Los Angeles Santa Clarita, California Beth A. Smith, PT, DPT, PhD University of Southern California Los Angeles, California Norma Prieto Mother of a boy with cerebral palsy Newhall, California