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Why You Should Stand
GLENN G. REYNOLDS, M.D. Certified: American Board of Physical Medicine and Rehabilitation
Your bones throw off calcium when you are sedentary for a prolonged time whether it's from bed rest, sitting or other forms of immobilization. An interesting example is when NASA scientists discovered abnormal loss of calcium and reduced bone densities in astronauts who spent extended time in weightless environments. The reversal of their bone loss occurred after these astronauts returned to substantial time of normal activity under full gravity. Link to Article

The Benefits of Passive Standing
Abstract: Passive standing with the aid of braces, tilt table or standing frame has traditionally been recommended as part of a comprehensive therapeutic exercise program to maintain the health and physical fitness of spinal cord injured (SCI) individuals (Axelson et: al., 1987; Nyquist, 1962). During acute rehabilitation, tilting in bed or on a tilt table is initiated as soon possible to establish orthostatic tolerance for future wheelchair mobilization and, if indicated, gait training (Lopes & Figoni, 1981). In the V.A. health care system, periodic standing in a standing frame or long leg brace is frequently prescribed later for a variety of potential physiological benefits. Generally, these therapeutic claims include reduction of spasticity (Odeen & Knuttson, 1981), prevention of hypercalciuria, renal calculcsis, osteoporosis, and pathological fractures (Abramson, 1948; Abramson & Delagi, 1961; Comarr, 1955; Hattner & McMillan, 1968; Kaplan et: al., 1981), increased flexibility and prevention of contractures of hip, knee and ankle joints (Abramson & Ebel, 1953) orthostatic and cardiovascular conditioning (Lopes, Figoni & Parkash, 1984; Odeen, 1979), improved urinary drainage and renal function (Gould et: al., 1955), and pressure relied and prevention of pressure sores on seated weight bearing areas (Abramson & Ebel, 1953). Furthermore, recent proliferation of mobile passive seating aids and stand-up wheelchairs has increased the opportunities for SCI wheelchair users to assume upright postures for more frequent and extended periods of time at work and at home. Link to Article

Treatment and Prevention Of Secondary disabilities of the mobility Impaired Through Assisted standing Technology
GLENN G. REYNOLDS, M.D. Certified: American Board of Physical Medicine and Rehabilitation
Abstract: Increasing evidence in the lifetime management of physical disability points to the horrendous impact of secondary complications of disability and its financial consequences. The study of the natural course history of mobility impairment in the disabled has established a consistent chain of predictable events that adds to the morbidity and mortality of these individuals. Link to Article

Standing and its importance in spinal cord injury management
Abstract: A broad spectrum of physiological problems is associated with lack of gravitational stress in the individual with spinal cord injury. Prolonged immobilization results in systemic de-adaptations, which include cardiovascular changes, the alteration of calcium homeostasis, which leads to bone de-mineralization and risk of injury calculi. Weight bearing in the standing posture has been shown to ameliorate many of these problems and offers physiological advantages for the individual with spinal cord injury. There are also significant psychological and social benefits to standing, including improved self-image and eye-to-eye interpersonal contact. Increased vocational, recreational and daily living independence are additional benefits to standing. Link to Article

Moving Forward
by Ginny Paleg, MS, PT
Abstract: New products can help improve kids' cognition through enhanced mobility. Mobility can make kids smarter. Children who move independently through space score higher on tests of cognition (mostly visual skills). In fact, recent studies by Kermoian, Campos, Bell, and Fox1,2 looked at infants who were at the same developmental level and chronological age—those who used augmentative mobility did better on tests of object permanence. Link to Article

Stand for Success: Therapists can get younger patients on their feet for optimal ability
Yvonne Smith, PT Posted on: June 1, 2010 Vol. 21 • Issue 12 • Page 28
Abstract: The physiological and medical benefits of standing have been well documented over the lifespan of people with physical disabilities. They include improved range of motion, decrease in tone, improved respiration, endurance, bladder and bowel function, upper-extremity function and bone health.1 Recent studies have found positive psychosocial benefits for children in schools using standers.2 But how does standing affect educational issues? Could there be an impact on learning by utilizing standing? Link to Article

Locomotion, Active Choice, and Spatial Memory in Children
Foreman N, Foreman D, Cummings A, Owens S.
Source: Department of Psychology, University of Leicester.
Erratum in: J Gen Psychol 1990 Jul;117(3):354-5.

Abstract: In two studies, children between 4 and 6 years old were tested on a radial search task requiring nonredundant sampling of eight identically labeled positions in a room. In the training phase (5 days), children made free choices by walking between positions, were passively transported in a pushchair, actively directed their own route from a pushchair, or were led on foot to positions selected by the experimenter. When tested (whether walking or directing while seated in a pushchair), children who had either walked independently or directed the experimenter while being pushed performed competently; those led on foot without spatial choice performed almost as well. Only the children who had neither independent locomotor experience nor autonomous choice performed very poorly. The results are related to neurobiological models of spatial cognition and may have implications for the transportation of children with mobility problems. Link to Article

Adults with cerebral palsy: walking ability after progressive strength training.
Andersson C, Grooten W, Hellsten M, Kaping K, Mattsson E. Karolinska Institutet, Neurotec Department, Division of Physiotherapy, Huddinge, Sweden.
Abstract: The purpose of this study was to evaluate effects of a progressive strength training program on walking ability in adults with cerebral palsy. Ten individuals with spastic diplegia (seven males, three females; mean age 31, range 23-44 years) participated twice a week over 10 weeks. Seven individuals with spastic diplegia (four males, three females; mean age 33, range 25-47 years) who did not receive strength training served as controls. All individuals were ambulatory but motor ability ranged from functional walkers to individuals who always required walking aids and used a wheelchair regularly. Significant improvements were seen in isometric strength (hip extensors p=0.006, hip abductors p=0.01), and in isokinetic concentric work at 30 degrees/s (knee extensors p=0.02) but not in eccentric work. Results also showed significant improvements in Gross Motor Function Measure (GMFM) dimensions D and E (p=0.005), walking velocity (p=0.005), and Timed Up and Go (p=0.01). There was no increase in spasticity for those who underwent strength training. Individuals in the control group did not show any significant improvement in any measured variable. The groups were small, however, and there was no significant difference between the groups in any measured variable. These findings suggest that a 10-week progressive strength training program improves muscle strength and walking ability without increasing spasticity. Link to Article

New Perspectives on the Effects of Action on Perceptual and Cognitive Development
David H. Rakison, Carnegie Mellon University
Amanda L. Woodward, University of Maryland

Abstract: This special section was motivated by a resurgence in the view that it is impossible to investigate perceptual and cognitive development without considering how it is affected by, and intertwined with, infants’ and children’s action in the world. This view has long been foundational to the field, yet contemporary investigations of the effects of acting on cognition and perception have been limited. The research showcased in this section indicates that this trend is changing as researchers consider anew the ways in which cognition derives structure from action. The work presented here illustrates the breadth of these potential effects across ages and domains of development, and it highlights the breadth of methods that can be recruited to investigate them. This new research focus provides insight for the mechanisms by which action affects perception and cognition and at the same time reveals that much remains to be learned. Link to Article

Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years.
Blundell SW, Shepherd RB, Dean CM, Adams RD, Cahill BM.
Source: Faculty of Health Sciences, University of Sydney, New South Wales, Australia.

OBJECTIVE: To determine the effects of intensive task-specific strength training on lower limb strength and functional performance in children with cerebral palsy. Link to Article

High tech tots: Technology for mobility, manipulation, communication, and learning in early childhood
Abstract: Increasingly, the population from birth to 3 years is benefiting from advanced technology. At 3 months, infants have interacted with computers; at 18 months, they have used powered mobility and myoelectric hands; and at 2 years, children have talked via speech synthesizers. This article describes research and clinical experience in this field and raises issues and suggests future applications of advanced technology for this population. Link to Article

LOCOMOTOR EXPERIENCE: AFACILITOR of  SPATIAL COGNITIVE DEVELOMPENT
by Kermoian R, Campos JJ.
Source: University of Illinois, Urbana-Champaign.
Abstract: 2 studies were designed to test the prediction that spatial search strategies (i.e., "object permanence") may be influenced by locomotor experience. Infants were assigned to 3 groups based on locomotor history: prelocomotor, prelocomotor with walker-assisted experience, and hands-and-knees creeping. Infants in all groups were 8.5 months of age. Results showed that hands-and-knees and walker-assisted locomotor experience facilitated spatial search performance. The longer that infants had been moving, the higher their scores. Furthermore, there were no differences between the hands-and-knees and prelocomotor/walker-assisted groups, suggesting that the relation between locomotor experience and spatial search performance was not merely a function of the maturation of prone progression. A third study found that the quality of locomotion affected object permanence performance: Belly crawlers performed differently than infants with hands-and-knees or walker experience, insofar as they performed at prelocomotor levels regardless of weeks of locomotor experience. Taken together, the pattern of findings suggests that infants with more efficient modes of locomotion are more likely to profit from the experiences generated by locomotion. Link to Article

Standing Tall: The Benefits of Standing Devices
Author: Mark P. Warner
Abstract: In the author's opinion as a pediatric physical therapist, with the exception of a wheelchair, there is no other piece of assistive technology that is more beneficial to children and adults with special needs than a standing device. Postural symmetry during standing and walking activities is extremely important for everyone. Very few children with special needs are able to sustain their body in a symmetrical standing posture for more than two or three minutes without support. A standing device allows children and adults with differing abilities to maintain a symmetrical standing posture for an extended period of time. This extended period of time allows the muscles to elongate and stretch, stimulating the new tissue growth needed to catch up to their bone growth. The other benefits are many and include: (1) increased bone density; (2) a more alert state; (3) increased cardio-pulmonary output; and (4) improved peer interaction. Children involved in standing programs have experienced other benefits such as regular bowel program, better head control, and more upper extremity function. It is especially important for adolescents to be involved in a standing program since their ambulation skills can begin to decrease as they get larger. At this age they are still growing and are at high risk for joint contractures. It does not matter what level of ability a child has; there are a wide variety of standers available that will meet or exceed a child's needs, no matter what age the child is. This article details the four basic types of standing devices available, and the abilities needed by the child for the best fit possible. Advice on funding is also offered. The author concludes by encouraging parents to seek the assistance of those who see the abilities of their special needs child rather than the disabilities. Link to Article

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