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A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy
Background: Severely disabled children with cerebral palsy (CP) are prone to low trauma fractures, which are associated with reduced bone mineral density. Aims: To determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an inc...
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Published in: | Archives of disease in childhood 2004-02, Vol.89 (2), p.131-135 |
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description | Background: Severely disabled children with cerebral palsy (CP) are prone to low trauma fractures, which are associated with reduced bone mineral density. Aims: To determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular bone mineral density (vTBMD) of non-ambulant children with CP. Methods: A heterogeneous group of 26 pre-pubertal children with CP (14 boys, 12 girls; age 4.3–10.8 years) participated in this randomised controlled trial. Subjects were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to either intervention (50% increase in the regular standing duration) or control (no increase in the regular standing duration) groups. Pre- and post-trial vertebral and proximal tibial vTBMD was measured by quantitative computed tomography (QCT). Results: The median standing duration was 80.5% (9.5–102%) and 140.6% (108.7–152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group showed an increase of 8.16 mg/cm3 representing a 6% mean increase in vertebral vTBMD. No change was observed in the mean proximal tibial vTBMD. Conclusion: A longer period of standing in non-ambulant children with CP improves vertebral but not proximal tibial vTBMD. Such an intervention might reduce the risk of vertebral fractures but is unlikely to reduce the risk of lower limb fractures in children with CP. |
doi_str_mv | 10.1136/adc.2002.009316 |
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Aims: To determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular bone mineral density (vTBMD) of non-ambulant children with CP. Methods: A heterogeneous group of 26 pre-pubertal children with CP (14 boys, 12 girls; age 4.3–10.8 years) participated in this randomised controlled trial. Subjects were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to either intervention (50% increase in the regular standing duration) or control (no increase in the regular standing duration) groups. Pre- and post-trial vertebral and proximal tibial vTBMD was measured by quantitative computed tomography (QCT). Results: The median standing duration was 80.5% (9.5–102%) and 140.6% (108.7–152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group showed an increase of 8.16 mg/cm3 representing a 6% mean increase in vertebral vTBMD. No change was observed in the mean proximal tibial vTBMD. Conclusion: A longer period of standing in non-ambulant children with CP improves vertebral but not proximal tibial vTBMD. Such an intervention might reduce the risk of vertebral fractures but is unlikely to reduce the risk of lower limb fractures in children with CP.</description><identifier>ISSN: 0003-9888</identifier><identifier>EISSN: 1468-2044</identifier><identifier>DOI: 10.1136/adc.2002.009316</identifier><identifier>PMID: 14736627</identifier><identifier>CODEN: ADCHAK</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</publisher><subject>Anticonvulsants ; Biological and medical sciences ; BMD ; Bone Density ; Bone mineral density ; Brain ; Cerebral palsy ; Cerebral Palsy - physiopathology ; Child ; Child, Preschool ; Children ; Children & youth ; Class Activities ; Committees ; Computed tomography ; Control Groups ; dual energy x ray absorptiometry ; DXA ; Educational Needs ; Ethics ; Female ; Fractures ; Fractures, Bone - prevention & control ; Grading ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Humans ; Learning Activities ; Male ; Medical sciences ; Nervous system (semeiology, syndromes) ; Neurology ; Original ; Osteoporosis - prevention & control ; Parent Responsibility ; Posture ; Puberty ; QCT ; quantitative computed tomography ; randomised controlled trial ; RCT ; Recruitment ; reference nutrient intake ; Risk reduction ; RNI ; Sample Size ; Scientific Concepts ; SDS ; Special Education ; Special Needs Students ; Spine - physiopathology ; standard deviation score ; standing programme ; Tibia - physiopathology ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonic imaging ; volumetric trabecular bone mineral density ; vTBMD</subject><ispartof>Archives of disease in childhood, 2004-02, Vol.89 (2), p.131-135</ispartof><rights>Copyright 2004 Archives of Disease in Childhood</rights><rights>2004 INIST-CNRS</rights><rights>COPYRIGHT 2004 BMJ Publishing Group Ltd.</rights><rights>COPYRIGHT 2004 BMJ Publishing Group Ltd.</rights><rights>Copyright: 2004 Copyright 2004 Archives of Disease in Childhood</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b669t-8c1530380bb270ce917c08a38bcc84c7a449c5838747a1c36e92f69ab1f2ca633</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/1828213443/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/1828213443?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,21378,21394,27924,27925,33611,33612,33877,33878,43733,43880,53791,53793,74221,74397</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15456620$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14736627$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Caulton, J M</creatorcontrib><creatorcontrib>Ward, K A</creatorcontrib><creatorcontrib>Alsop, C W</creatorcontrib><creatorcontrib>Dunn, G</creatorcontrib><creatorcontrib>Adams, J E</creatorcontrib><creatorcontrib>Mughal, M Z</creatorcontrib><title>A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy</title><title>Archives of disease in childhood</title><addtitle>Arch Dis Child</addtitle><description>Background: Severely disabled children with cerebral palsy (CP) are prone to low trauma fractures, which are associated with reduced bone mineral density. Aims: To determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular bone mineral density (vTBMD) of non-ambulant children with CP. Methods: A heterogeneous group of 26 pre-pubertal children with CP (14 boys, 12 girls; age 4.3–10.8 years) participated in this randomised controlled trial. Subjects were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to either intervention (50% increase in the regular standing duration) or control (no increase in the regular standing duration) groups. Pre- and post-trial vertebral and proximal tibial vTBMD was measured by quantitative computed tomography (QCT). Results: The median standing duration was 80.5% (9.5–102%) and 140.6% (108.7–152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group showed an increase of 8.16 mg/cm3 representing a 6% mean increase in vertebral vTBMD. No change was observed in the mean proximal tibial vTBMD. Conclusion: A longer period of standing in non-ambulant children with CP improves vertebral but not proximal tibial vTBMD. Such an intervention might reduce the risk of vertebral fractures but is unlikely to reduce the risk of lower limb fractures in children with CP.</description><subject>Anticonvulsants</subject><subject>Biological and medical sciences</subject><subject>BMD</subject><subject>Bone Density</subject><subject>Bone mineral density</subject><subject>Brain</subject><subject>Cerebral palsy</subject><subject>Cerebral Palsy - physiopathology</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Children & youth</subject><subject>Class Activities</subject><subject>Committees</subject><subject>Computed tomography</subject><subject>Control Groups</subject><subject>dual energy x ray absorptiometry</subject><subject>DXA</subject><subject>Educational Needs</subject><subject>Ethics</subject><subject>Female</subject><subject>Fractures</subject><subject>Fractures, Bone - prevention & control</subject><subject>Grading</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Humans</subject><subject>Learning Activities</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Original</subject><subject>Osteoporosis - prevention & control</subject><subject>Parent Responsibility</subject><subject>Posture</subject><subject>Puberty</subject><subject>QCT</subject><subject>quantitative computed tomography</subject><subject>randomised controlled trial</subject><subject>RCT</subject><subject>Recruitment</subject><subject>reference nutrient intake</subject><subject>Risk reduction</subject><subject>RNI</subject><subject>Sample Size</subject><subject>Scientific Concepts</subject><subject>SDS</subject><subject>Special Education</subject><subject>Special Needs Students</subject><subject>Spine - physiopathology</subject><subject>standard deviation score</subject><subject>standing programme</subject><subject>Tibia - physiopathology</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Ultrasonic imaging</subject><subject>volumetric trabecular bone mineral density</subject><subject>vTBMD</subject><issn>0003-9888</issn><issn>1468-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>ALSLI</sourceid><sourceid>CJNVE</sourceid><sourceid>M0P</sourceid><recordid>eNqFkk2P0zAQhiMEYsvCmRuyhEACKV1_NXEuK5UCBbRiOcBeLcdxUpfELnYC23_PhFZbiiohH2xlnpnMvPMmyVOCp4Sw7EJVekoxplOMC0aye8mE8EykFHN-P5lgjFlaCCHOkkcxrjEmVAj2MDkjPGdZRvNJcjtHQbnKdzaaCmnv-uDbFp59sKpFvkaxh7h1DdoE3wTVdQZ5h0rvDOqsMwGoyrho-y2yDjnvUtWVQ6tcj_TKtlUwDv2y_QppE0w54hvVxu3j5EENt3myv8-Tb-_ffV18SK-ulx8X86u0zLKiT4UmM4aZwGVJc6xNQXKNhWKi1FpwnSvOCz0TTOQ8V0SzzBS0zgpVkppqlTF2nlzu6m6GsjOVNjChauUm2E6FrfTKyuOIsyvZ-J-S5KTIBYUCL_cFgv8xmNhL0EqbFiY0fohSYEIoJhjA5_-Aaz8EB8NJIqighHE-9pPuqEa1RlpXe_irbswfJUHU2sLnOSyXkwLWCPz0BA-nMp3VJxNeHSWMOzW3faOGCM0ur47Z9BSrRws0RsIiFtfH_MWO18HHGEx9pyPBcjSkBEPK0ZByZ0jIePa3_Ad-70AAXuwBFbVqa3CjtvHAzfgMOHxo1UZo8S6uwneZ5Syfyc83C_lFzPDbN5-W8gb41zu-7Nb_7fI34gEDcA</recordid><startdate>20040201</startdate><enddate>20040201</enddate><creator>Caulton, J M</creator><creator>Ward, K A</creator><creator>Alsop, C W</creator><creator>Dunn, G</creator><creator>Adams, J E</creator><creator>Mughal, M Z</creator><general>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</general><general>BMJ</general><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8GL</scope><scope>0-V</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88B</scope><scope>88E</scope><scope>88I</scope><scope>8A4</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ALSLI</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>CJNVE</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0P</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEDU</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20040201</creationdate><title>A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy</title><author>Caulton, J M ; Ward, K A ; Alsop, C W ; Dunn, G ; Adams, J E ; Mughal, M Z</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b669t-8c1530380bb270ce917c08a38bcc84c7a449c5838747a1c36e92f69ab1f2ca633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Anticonvulsants</topic><topic>Biological and medical sciences</topic><topic>BMD</topic><topic>Bone Density</topic><topic>Bone mineral density</topic><topic>Brain</topic><topic>Cerebral palsy</topic><topic>Cerebral Palsy - physiopathology</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children</topic><topic>Children & youth</topic><topic>Class Activities</topic><topic>Committees</topic><topic>Computed tomography</topic><topic>Control Groups</topic><topic>dual energy x ray absorptiometry</topic><topic>DXA</topic><topic>Educational Needs</topic><topic>Ethics</topic><topic>Female</topic><topic>Fractures</topic><topic>Fractures, Bone - prevention & control</topic><topic>Grading</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Humans</topic><topic>Learning Activities</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Original</topic><topic>Osteoporosis - prevention & control</topic><topic>Parent Responsibility</topic><topic>Posture</topic><topic>Puberty</topic><topic>QCT</topic><topic>quantitative computed tomography</topic><topic>randomised controlled trial</topic><topic>RCT</topic><topic>Recruitment</topic><topic>reference nutrient intake</topic><topic>Risk reduction</topic><topic>RNI</topic><topic>Sample Size</topic><topic>Scientific Concepts</topic><topic>SDS</topic><topic>Special Education</topic><topic>Special Needs Students</topic><topic>Spine - physiopathology</topic><topic>standard deviation score</topic><topic>standing programme</topic><topic>Tibia - physiopathology</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Ultrasonic imaging</topic><topic>volumetric trabecular bone mineral density</topic><topic>vTBMD</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Caulton, J M</creatorcontrib><creatorcontrib>Ward, K A</creatorcontrib><creatorcontrib>Alsop, C W</creatorcontrib><creatorcontrib>Dunn, G</creatorcontrib><creatorcontrib>Adams, J E</creatorcontrib><creatorcontrib>Mughal, M Z</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: High School</collection><collection>ProQuest Social Sciences Premium Collection【Remote access available】</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection (ProQuest Medical & Health Databases)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Education Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>Education Periodicals</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Social Science Premium Collection</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Education Collection</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>ProQuest Education Journals</collection><collection>Family Health Database (Proquest)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Science Database (ProQuest)</collection><collection>Biological Science Database</collection><collection>ProQuest One Education</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Archives of disease in childhood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Caulton, J M</au><au>Ward, K A</au><au>Alsop, C W</au><au>Dunn, G</au><au>Adams, J E</au><au>Mughal, M Z</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy</atitle><jtitle>Archives of disease in childhood</jtitle><addtitle>Arch Dis Child</addtitle><date>2004-02-01</date><risdate>2004</risdate><volume>89</volume><issue>2</issue><spage>131</spage><epage>135</epage><pages>131-135</pages><issn>0003-9888</issn><eissn>1468-2044</eissn><coden>ADCHAK</coden><abstract>Background: Severely disabled children with cerebral palsy (CP) are prone to low trauma fractures, which are associated with reduced bone mineral density. Aims: To determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular bone mineral density (vTBMD) of non-ambulant children with CP. Methods: A heterogeneous group of 26 pre-pubertal children with CP (14 boys, 12 girls; age 4.3–10.8 years) participated in this randomised controlled trial. Subjects were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to either intervention (50% increase in the regular standing duration) or control (no increase in the regular standing duration) groups. Pre- and post-trial vertebral and proximal tibial vTBMD was measured by quantitative computed tomography (QCT). Results: The median standing duration was 80.5% (9.5–102%) and 140.6% (108.7–152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group showed an increase of 8.16 mg/cm3 representing a 6% mean increase in vertebral vTBMD. No change was observed in the mean proximal tibial vTBMD. Conclusion: A longer period of standing in non-ambulant children with CP improves vertebral but not proximal tibial vTBMD. Such an intervention might reduce the risk of vertebral fractures but is unlikely to reduce the risk of lower limb fractures in children with CP.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health</pub><pmid>14736627</pmid><doi>10.1136/adc.2002.009316</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Anticonvulsants Biological and medical sciences BMD Bone Density Bone mineral density Brain Cerebral palsy Cerebral Palsy - physiopathology Child Child, Preschool Children Children & youth Class Activities Committees Computed tomography Control Groups dual energy x ray absorptiometry DXA Educational Needs Ethics Female Fractures Fractures, Bone - prevention & control Grading Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Humans Learning Activities Male Medical sciences Nervous system (semeiology, syndromes) Neurology Original Osteoporosis - prevention & control Parent Responsibility Posture Puberty QCT quantitative computed tomography randomised controlled trial RCT Recruitment reference nutrient intake Risk reduction RNI Sample Size Scientific Concepts SDS Special Education Special Needs Students Spine - physiopathology standard deviation score standing programme Tibia - physiopathology Time Factors Tomography, X-Ray Computed Treatment Outcome Ultrasonic imaging volumetric trabecular bone mineral density vTBMD |
title | A randomised controlled trial of standing programme on bone mineral density in non-ambulant children with cerebral palsy |
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