Health Parameters in Standing and Nonstanding Nonambulatory Adults With Cerebral Palsy

OBJECTIVE: To assess effects of standing exercise on adults with cerebral palsy with a focus on bone density, transfer skills, quality of life, and related health parameters. DESIGN: Prospective case series; pilot study. SETTING: Outpatient multispecialty clinic. PARTICIPANTS: Nonambulatory adults with cerebral palsy, 13 standers and 7 nonstanders, comparable in age, sex, and other physical characteristics (N=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Bone mineral density per dual energy x-ray absorptiometry, stand pivot transfers, comprehensive blood serum assessments, fractures, spasms, perceived pain, and quality of life. RESULTS: No appreciable differences could be detected between the standing and nonstanding groups from baseline and over a 2-year subsequent study with respect to bone density, range of motion, comprehensive chemistry, hematologic blood serum levels, fractures, spasms, perceived pain, continence of bowel and bladder, seizures, orthotics, and orthopedic surgery. All individuals reported positive life effects of standing with only 1 negative effect reported: increased fatigue at the end of the day. Midline independent head control >30 seconds was identified only in the standing group. Functional stand pivot transfers were seen only in individuals with a history of standing. CONCLUSIONS: The pilot data indicate no appreciable difference in measured outcome variables of a static nature between nonambulatory adults with cerebral palsy who stand compared with those who do not. We identified occurrences of improved head control and functional stand pivot transfers only in those with a history of standing. The value of a functional pivot transfer over the lifetime is difficult to overestimate. Encouragement is given toward future studies with a focus more toward functional outcome variables.