18-24 months: Is standing important for children with Cerebral Palsy?
There are many benefits to standing, amongst them is improved bone health, less constipation, and enhanced endurance.
Many therapists and doctors believe that standing also helps the development of balance, head control, and spatial conceptualisation. Children who may later be able to use a power chair gain a better sense of the three-dimensional space in which they will eventually move around. These beliefs of doctors are difficult to prove, but we do know that children without disabilities develop these concepts in this way. It seems logical that children with cerebral palsy need the same stimulation to develop their abilities to the greatest extent possible.
Between 18 and 24 months of age is usually a practical time to start considering a stander. By this time, the child’s acute medical issues are mostly resolved, and parents and doctors have a good sense of the rate of gain in development. Also, by this time, many children with quadriplegia are able to move by crawling or rolling on the floor. Some are able to scoot in the sitting position, and some are able to pull to a standing position. If a child is able to pull up to a standing position by 24 months, can bear her weight will most likely to progress with time to a walker. If a child has not reached this milestone at 24 months, a standing programme with a stander should be started.
There are four types of standers: prone, supine, sit-to-stand, and parapodium. The parapodium, or freedom stander is most useful for children with spina bifida who have a normal upper body. It has almost no usefulness for children with cerebral palsy because most children with CP have poor upper body control and will end up falling forward in this type of stander. Those children with CP who have very little upper body involvement usually are able to pull themselves to a standing or are able to use a walker.
Children with poor or no head control should be started in a supine stander. The disadvantage of this type of stander is that the child leans backward and therefore his field of vision is limited to the ceiling. This can be compensated for by hanging interesting objects above the child’s head to provide stimulation or by positioning a mirror to reflect the activity that’s going on in the room.
For children with some head control, the prone stander is better because it stimulates them to hold up their heads. In addition, a lap tray placed in front of them can allow them to play while they are standing. The tilt of both the supine and prone stander can be adjusted so that the child is as upright as possible yet comfortable.
How much time should a child spend in a stander?
It is usually best to start off by having the child spend just a short period of time, typically 10 to 15 minutes, in the stander. As the child becomes accustomed to the stander, a parent should try to work the child up to a one-hour, stretch twice a day if the child tolerates it. Standing should not be a period of great difficulty for the child, however. By working with different positions and involving the child in activities, the parent can make time spent in the stander more enjoyable for the child. Physical therapists can help parents design a successful programme for their child.
If the child develops a severe aversion to the stander, it may be better to stop working with it for several months and come back to it with a new approach. For the child who is not walking, the goal should be to stay with a standing programme into and through adolescence. There are many adults who still find the stander useful.
Are motorised wheelchairs appropriate for this age group?
No, they are not. Motorised wheelchairs are often very appealing because they are ‘state of the art’. For many parents, they may represent the best they can provide for their child with a disability. However, a motorised chair for a child with cerebral palsy should not be considered until the child is approximately 6 years old.
A child with CP who is capable of using a motorised chair at age 3 is most likely capable of cruising (walking around by holding on to furniture) and will be a very functional walker within a year or two, depending on other impairments. Using a motorised chair at this age could hinder any further physical mobility development.
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