Dynamic Standing Exercise in a Novel Assistive Device Compared with Standard Care for Children with Cerebral Palsy Who Are Non-Ambulant, with Regard to Quality of Life and Cost-Effectiveness

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 who were non-ambulant with cerebral palsy 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.

“It is something that gives us hope”: Lived experience among parents to children with cerebral palsy who are non-ambulant of the phenomenon physical activity, with or without the use of a novel dynamic standing device

“…The parents described the Innowalk as an investment for a healthy future as possible. However, they were also aware of the higher costs of the Innowalk compared to static standers, which is in agreement with our findings in an earlier study ( 20 ). Another way of being physically active for people with moderate-to-severe walking impairment is Frame Running, allowing them to propel themselves using a three-wheeled frame with a saddle and handlebars.…”

“…However, dynamic standing in the Innowalk has shown to be a physical activity and is not passive. We found that dynamic standing had positive effects regarding the passive range of motion and spasticity in the hip, on bowel function, on pain, and on health-related quality of life ( 19 , 20 ). Another study, of 46 patients, found that dynamic standing exercise in the Innowalk was secure to perform and improved passive assisted motion, intestinal function, body stability, and joint mobility ( 21 ).…”

Supported‐standing interventions for children and young adults with non‐ambulant cerebral palsy: A scoping review

“…In total, 59 citations met the inclusion criteria: 16 systematic reviews; 13‐20,36‐43 17 intervention studies reporting over 18 citations; 44–61 eight analytical cross‐sectional studies; 62–69 five descriptive cross‐sectional/survey studies; 70–74 five qualitative studies; 75–79 and one mixed‐methods study 80 were identified, along with six clinical guidelines 12,81–85 . The systematic reviews examined 10 individual studies and nine systematic reviews that were included in this scoping review.…”

“…Of 17 intervention studies (18 citations), four reported external sources of funding 44,[52][53][54][55] (non-industry-related grants) and five declared no COI. 45,49,[52][53][54]61 For those studies investigating outcomes from a specific commercial product, three research groups did not disclose COI, 56,59,50 one declared that the study was unfunded but COI (reportedly disclosed) was not noted in the publication (although one author had worked as an educational consultant for the manufacturer), 48 one group declared no COI, 61 another declared no COI and stated that the commercial company was only involved in setting up the device for participants, 52,54 one researcher disclosed that they were a consultant for the manufacturer, 57 and the final group disclosed that the lead author held patents but had not participated in outcome measurements. 55…”

“…100 A positive influence of upright positioning on bowel function has been described in case studies 48,49 but only noted after Hart walker and Innowalk interventions where supported standing was the comparison. 52,56 However, it should be noted that parents in the mixed-methods study identified improvement in bowel function as high priority to measure in future supported-standing clinical trials; 80 improved bowel care routines have also been reported in adult studies. 107,108,111…”