A recently published article consolidates evidence regarding the use and benefits of supported standing and stepping devices for children with Cerebral Palsy classifies as non-ambulatory (GMFCS IV and V) in relation to the F-words: Functioning, family, fitness, fun, friends and future.
A recently published article consolidates evidence regarding the use and benefits of supported standing and stepping devices for children with Cerebral Palsy classified as non-ambulatory (GMFCS IV and V) in relation to the F-Words: Functioning, family, fitness, fun, friends and future.
You find the full article in the International Journal of Environmental Research and Public Health:Supported Standing and Supported Stepping Devices for Children with Non-Ambulant Cerebral Palsy: An Interdependence and F-Words Focus
However, to give you a brief overview of the study, here is an article summary:
Introduction
The researchers stress the importance of therapeutic interventions for children with cerebral palsy (CP), especially those who are non-ambulant (Gross Motor Function Classification System [GMFCS] levels IV and V). While much research centres on ambulant children, there is a critical need for evidence-based interventions for non-ambulant children, who constitute approximately 24–32.5% of the CP population. These children frequently rely on wheeled mobility devices and face increased risks of musculoskeletal impairments, pain, and functional limitations.
The authors underscore the value of early interventions to foster development and avert issues such as muscle degeneration and decreased bone density. Identifying at-risk children early enables timely implementation of supported standing and stepping devices, which can enhance their function, fitness, and participation in everyday activities.
Despite their benefits, current practices often compel families and therapists to select between standing and stepping devices due to funding limitations, thus restricting children's ability to access both types of assistive technology.
Aim of the study
The study aims to consolidate evidence supporting the use of both devices for children with non-ambulant CP. It employs two theoretical frameworks—the F-words for childhood development and the interdependence-Human Activity Assistive Technology (iHAAT) model—to guide clinical decision-making and advocate for equitable access to these essential interventions.
Material and methods
The study is based on two scoping reviews (1,2) covering the use of supported standing and stepping devices for children classified as GMFCS levels IV and V. It compares findings using the F-words for childhood development and the interdependence-Human Activity Assistive Technology (iHAAT) model.
The authors analysed data to see how these devices impact participation, functioning, and development according to the F-words and iHAAT framework. They explored how assistive devices interact with the child's environments to support participation and engagement.
The study aims to guide clinical decision-making for the equitable use of both devices, highlighting their contributions to the child's quality of life, participation, and autonomy.
Results
The researchers have compared the evidence from two scoping reviews on the use of supported standing and stepping devices for children classified as GMFCS levels IV and V. This analysis was conducted through the lenses of the F-words for childhood development and the interdependence-Human Activity Assistive Technology (iHAAT) framework.
F-Words Framework:
- Functioning: Supported stepping devices greatly enhance mobility, including stepping and walking, and encourage indoor exploration. Both devices also help improve daily activities like standing transfers, play, self-feeding, communication, and motor function.
- Family: Both devices lowered caregiving burdens, and parents were generally satisfied with their use. However, transferring older children posed some challenges.
- Fitness: Supported standing helped maintain bone mineral density (BMD) and prevent contractures, while stepping devices improved physical fitness and energy expenditure. Both devices supported muscle and bone health through weight-bearing activities.
- Fun: Stepping devices provided children with joy and autonomy through movement, whereas standing devices needed to be integrated into meaningful activities for optimal enjoyment.
- Friends: Both devices enabled social interaction by allowing children to be at eye level with peers, which improved inclusion and self-esteem.
- Future: Standing devices offer better control over body alignment, effective for maintaining bone mineral density (BMD), preventing contractures, and improving hip stability. Stepping devices enhance mobility and are more effective for muscle development and cardio-respiratory fitness. Additionally, both devices positively impact psycho-social health by boosting self-esteem, confidence, communication, and social interactions, which can have long-lasting effects on children's future opportunities and achievements.
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Key Findings by iHAAT Framework:
- Human: The child’s abilities, family goals, and caregiver capacity influence device use. Both devices increase engagement and peer interactions, improving the child's and family’s quality of life.
- Activity: Devices enable participation in meaningful activities, with stepping devices often better suited for mobility and interaction. Goals and preferences drive the choice of device.
- Assistive Technology: Satisfaction and usage depend on ease of use, transfer capabilities, and design features. Standing devices are preferred for control and alignment, while stepping devices foster mobility.
- Context: The physical and social environment, caregiver support, and space for transfers all influence device use. Both devices need to fit into a child’s routines and environments.
- Well-being: All domains interact to improve the child’s quality of life, enhancing physical health, social participation, and emotional well-being.
Both frameworks show that supported standing and stepping devices offer unique benefits for children with non-ambulant CP, and their integration into daily life depends on child, family, and environmental factors.
Read also: All for Ella – and an independent life despite of her CP
Conclusion
The authors recommend introducing supported standing and stepping devices within the first year for children with non-ambulant CP (GMFCS levels IV and V) to aid their development in areas like function, family, fitness, fun, friends, and future under the ON-Time mobility framework. Therapists should provide these devices along with power mobility to support weightbearing and mobility for medical and developmental benefits, fostering equal opportunities. The interdependence framework stresses involving family, caregivers, and peers to boost autonomy and participation in meaningful activities.
