Abstract
Children with cerebral palsy who are non-ambulant cannot stand or walk independently. In Sweden, daily static standing is part of standard care for these children even though it is time-consuming and costly, and while it may benefit the well-being of many children, it is inconvenient for others. A novel stander enables dynamic standing through walking movements. The aim of this study was to compare dynamic and static standing regarding quality of life and cost-effectiveness. Twenty children with cerebral palsy who were non-ambulant were included in this randomized controlled study with a cross-over design. Mean age of the participants was 11.6 ± 3.6 years, nine were female. They participated in four months of static and four months of dynamic standing. Quality of life was assessed with the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD), which has been shown to be valid and reliable, and is tailored to children with severe cerebral palsy. Information about other aspects of quality of life and about cost-effectiveness was collected by study-specific questionnaires. Dynamic standing was the preferred alternative from the family perspective, as it cost less (€64, p < 0.01) and had greater benefits than standard (static standing) care. From societal and healthcare provider perspectives, dynamic standing had benefits but higher costs than static standing (€290 and €354 respectively, p < 0.01). These findings may contribute to the development of individualized standing recommendations.
Highlights
Cerebral palsy (CP) is the most prevalent motor disability amongst children, and is caused by a non-progressive interference, lesion, or other abnormality of the immature brain
The functional limitations in children with CP vary from being able to walk without limitations to being non-ambulant and in need of support in all postures, and many children with CP experience a challenge in participating in physical activities
The number of children included in the study was based on a power calculation from preliminary data collected in a previous pilot and feasibility study
Summary
Cerebral palsy (CP) is the most prevalent motor disability amongst children, and is caused by a non-progressive interference, lesion, or other abnormality of the immature brain. It is often accompanied by comorbidities such as pain, epilepsy, and intellectual disability [1]. In Sweden, 30–90 min of daily static standing (StS) is included in the standard care for children with CP who are non-ambulant (CP-NA) [3]. They do this either in individually built and adjusted standing shells placed in a prefabricated stander, or in prefabricated standers without a standing shell (Figure 1A–C). A variety of structural and functional effects of StS have been described, including improved bone mineral density, improved hip stability, a larger passive range of motion in
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