Standing
| Author Year; Country Score Research Design Total Sample Size |
Methods | Outcome |
|---|---|---|
| Standing (n=5 studies) | Standing (n=5 studies) | Standing (n=5 studies) |
| Dudley-Javoroski et al. 2012; USA Longitudinal Level 2 N=28 |
Population: 28 participants (24 men, 4 women) with SCI; AIS A & B; age: 16-64 years. 14 non-disabled control participants (11 men, 3 women; age: 22-50 years). Treatment: 3 doses of bone compressive loads: no standing, passive standing, quadriceps activation during stance.7 participants performed unilateral quadriceps stimulation in supported stance (150% body weight compressive load = “High Dose”) while the opposite leg received 40% body weight = “Low Dose”. 5 participants stood passively without applying quadriceps NMES to either leg (40% body weight load). 16 participants performed no standing (0% body weight load – “untrained”). Outcome Measures: BMD assessment between 1-6 times over a 3-year training protocol. |
|
| Goktepe et al. 2008; Turkey Observational Level 5 N=92 |
Population: 71 participants (60 men, 11 women; 64 traumatic, 7 nontraumatic); age: 30.9 years (range: 18-46), TPI: 4.5 years and AIS A (n=64) – B (n=7). Treatment: Participants were divided into 3 groups: Group A had standing ≥1hr daily, Group B stood <1hour/day, and Group C did not stand at all. Outcome Measures: BMD by DXA of bilateral hips (Ward’s triangle and femoral neck) and spine (L2 to L4) |
|
| Needham-Shropshire et al. 1997; USA Pre-post Level 4 N=16 |
Population: 13 men and 3 women; age: 28.4 ± 6.6 years; TPI: 4.0 + 3.5 years; complete injuries; T4-T11; no controls. Treatment: Standing and ambulation. 32 sessions then participants continued ambulation for 8 more weeks. Outcome measures: Hip BMD by DPA |
|
| Kunkel et al. 1993; USA Pre-post Level 4 N=6 |
Population: 6 men; age: 49 years (range: 36-65); complete and incomplete; C5-T12; 4 traumatic and 2 nontraumatic (multiple sclerosis); no controls. Treatment: Passive standing frame. Increased gradually until able to “stand” 30 mins 3x/day. Progressed to 45 mins 2x/day then participants completed 45 mins of standing 2x/day for 5 months. Outcome measures: Lumbar spine and femoral neck BMD and fracture risk by DPA |
|
| Kaplan et al. 1981; USA Pre-post Level 4 N=10 |
Population: 8 men and 2 women; age: 19-56 years; incomplete tetraplegia; no controls. Treatment: Tilt-table weight-bearing and strengthening exercises. Each tilt table session lasted at least 20mins 1x/day, and the tilt table angle attained was ≥450. Two groups: 1) early (within 6 months of SCI) and 2) late group (12-18 months post SCI). Outcome Measures: urinary calcium excretion |
|
| Walking (n=4 studies) | Walking (n=4 studies) | Walking (n=4 studies) |
| Carvalho et al. 2006; Brazil Prospective controlled trial Level 2 N=21 |
|
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| Giangregorio et al. 2006; Canada Pre-post Level 4 N=14 |
Population: 11 men and 2 women; age: 22-53 years; TPI: 7.4 years (range 1.2-24); with incomplete traumatic injuries; C4-T12; AIS B-C; matched control group. Treatment: Body-weight-supported treadmill training, 12 months.Completed protocol 3x/week for 144 sessions; intensity increased as tolerated Outcome Measures: BMD by DXA, bone markers |
|
| Thoumie et al. 1995; France Pre-post Level 4 N=7 |
Population: For bone assessment, there were 6 men and 1 woman; age: 31 years (range: 26-33); TPI: 29 months (range: 15-60); T2-T10. Treatment: reciprocating gait orthosis – II hybrid orthosis. Completed the protocol within 3-14 months (2-hour sessions 2x/week). Outcome measures: BMD by DPA |
|
| Ogilvie et al. 1993; England Pre-post Level 4 N=4 |
Population: Bone assessment with 2 men (25 and 28 years) and 2 women (16 and 42 years), with traumatic paraplegia. Treatment: Reciprocal gait orthosis. No protocol provided. Quantitative computed tomography repeated every 6 months from the 1st referral, orthotic fitting and training, to independent and regulator ambulation (mean=5 months). The reciprocating gait orthosis was used daily on average for 3 hours. Outcome measures: Lumbar spine and hip BMD by QCT |
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* All data expressed as mean±SD, unless expressed otherwise.
Discussion
There is inconclusive evidence for Reciprocating Gait Orthosis, long leg braces or passive standing as a treatment for low bone mass after SCI. One mixed cross-sectional and a longitudinal study found that participants who underwent quadriceps activation during stance with 150% body weight compressive load, had significantly higher BMD than participants who underwent quadriceps activation during stance with 40% body weight compressive load and passive standing. One cross-sectional study (Goemaere et al. 1994) used a self-report physical activity measure to highlight the potential for standing to reduce BMD decline at the femoral shaft; patients with long leg braces had a significantly higher trochanter and total BMD compared with standing frame or standing wheelchair. In contrast, another cross-sectional investigation of bone outcomes and self-report physical activity measures found no effect of activity on lower extremity bone parameters (Jones et al. 2002).
Conclusions
There is inconclusive evidence for Reciprocating Gait Orthosis, long leg braces, passive standing, or self-reported physical activity as a treatment for low bone mass.
There is level 4 evidence (Dudley-Javoroski et al. 2012) for quadriceps activation during stance with 150% body weight compressive load to increase BMD.
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