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A new early intervention programme in standing

Clinical evidence shows that regular standing in abduction can halt and even reverse hip migration in children with cerebral palsy. Original research from Sweden is now backed by a new UK study.

The use of postural management equipment before 18 months of age can help decrease the incidence of hip pathology in children with GMFCS III, IV or V with bilateral CP and the need for treatment at 5 years of age. (Pountney TE et al, 2009) It is recommended that a standing programme should be introduced at 12 months.

Standing programmes for young children should include positioning in hip abduction. Recent level 4 evidence by Pountney also suggests that weight bearing in abduction and extension (straddle weight bearing) for 30 to 90 minutes a day for a year can reduce Migration Percentage (MP) after abductor-iliopsoas tenotomies in non ambulatory children with CP as well as prevent an increase in MP in children with CP who did not require surgery.

A Swedish study by Caroline Martinsson and Kate Himmelmann (2011) found that standing in abduction daily for at least 1 hour daily reduced MP by 8.6%. After surgery and standing in abduction for at least 1 hour every day MP was reduced by 20.8%.

Frances George, physiotherapist at Humberston Park Special School, Grimsby has 13 years experience working with children with complex needs. She has been working with Lily Mae (4 years) who has had a dislocated left hip since birth and other health problems. After reading Caroline Martinsson’s work and following discussions with Lily Mae’s consultant Mr Flowers, an R82 Gazelle was purchased to support a programme of abducted standing.

This programme has been used in conjunction with hydrotherapy work and managed posture in seating to build a comprehensive case study that signposts the effectiveness of this therapy approach.

Find out more about Gazelle PS here

 

 

 

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