The use of standing frames for contracture management for nonmobile children with cerebral palsy

The objective of this study was to determine whether static weight-bearing in a standing frame affected hamstring length and ease of activities of daily living (ADLs) in nonambulant children with cerebral palsy (CP). A convenient sample of nonambulant children with CP was recruited for this one-group quasi-experimental study. Participants stood in a standing frame for 1 h, 5 days per week, for 6 weeks, followed by 6 weeks of not using a standing frame; each phase was repeated. Popliteal angle measurements were made at baseline and weekly throughout the study period. Carers provided written feedback regarding ease of ADLs at the end of each standing and nonstanding phase. Five children were recruited (age range 6-9 years, mean age 7 years 2 months, SD 1 year 4 months). High compliance with the standing regime was achieved (85% of intended sessions completed). Repeated-measures analysis of variance and Mests showed hamstrings significantly lengthened during standing phases (mean improvement 18.1 degrees, SD 5.5, P <0.01 for first standing phase; mean improvement 12.1 degrees, SD 7.7, P=0.03 for second standing phase). A trend for hamstrings to shorten during nonstanding phases was observed (mean change - 14.0 degrees, SD 4.2, P=0.02 for first nonstanding phase; mean change - 7.3 degrees, SD 6.5, P=0.20 for second nonstanding phase). Feedback from carers suggested that transfers and ADLs became slightly easier after phases of standing frame use. Preliminary evidence that 6 weeks of standing frame use leads to significant improvements in hamstring length in nonambulant children with CP, and may increase ease of performance of ADLs was found.