Annika Näslund

Reach performance and postural adjustments during standing in children with severe spastic diplegia using dynamic ankle-foot orthoses.

OBJECTIVE To investigate the co-ordination between reaching, ground reaction forces and muscle activity in standing children with severe spastic diplegia wearing dynamic ankle-foot orthoses compared with typically developing children. DESIGN Clinical experimental study. SUBJECTS Six children with spastic diplegia (Gross Motor Function Classification System level III-IV) and 6 controls. METHODS Ground reaction forces (AMTI force plates), ankle muscle activity (electromyography and displacement of the hand (ELITE systems) were investigated while reaching for an object. RESULTS For the children with severe spastic diplegia who were wearing dynamic ankle-foot orthoses, co-ordination between upward and forward reach velocity differed regarding the temporal sequencing and amplitude of velocity peaks. During reaching, these children lacked interplay of pushing force beneath the reach leg and braking force beneath the non-reach leg and co-ordinated ankle muscle activity, compared with controls. CONCLUSION The results suggest differences in reach performance and postural adjustments for balance control during a reaching movement in standing between children with spastic diplegia Gross Motor Function Classification System level III-IV, wearing dynamic ankle-foot orthoses compared with typically developing children.

Incidence and seasonality of falls amongst old people receiving home help services in a municipality in northern Sweden

Objectives. Falls among old people is a well-documented phenomenon; however, falls among people living in the community and receiving home help services have been under-researched. The aim of this study was to investigate the incidence, including possible seasonal variation, circumstances and injuries related to falls among community living home help receivers, and to investigate whether fall incidence is associated with the type and amount of home help services received. Study design. Prospective cohort study. Methods. All 614 persons aged 65 and over who were living in a particular northern Swedish community and receiving municipality home help were included. Data on age, sex and home help service use were collected from home help service records, and falls were reported by staff on report forms specifically designed for the study. Results. A total number of 264 falls were recorded among 122 participants. The overall fall incidence was 626 per 1,000 PY, and incidence rate ratios were significantly correlated to the total amount of services used (p&0.001), as well as to the degree of help for I-ADL needs (p&0.001), P-ADL needs (p&0.001) and escort service (p=0.007). The proportion of falls reported as resulting in injury was 33%. The monthly fall incidence was significantly associated to daylight photoperiod, however it was not associated to temperature. Conclusions. Fall incidence among home help receivers aged 65 and over seems correlated to the amount of services they receive. This is probably explained by the fact that impairments connected to ADL limitations and home help needs also are connected to an increased risk of falls. This implies that fall prevention should be considered when planning home help care for old people with ADL limitations. Further research on the connection between daylight photoperiod and fall incidence in populations at different latitudes is needed.

The Impact of Supported Standing on Well-Being and Quality of Life

PURPOSE To identify the characteristics of people who use standing devices and to explore their degree of device use, experiences with and reasons for standing, and perceived impact of the use of standing devices on well-being and quality of life (QOL). METHOD Anyone with a current prescription at the time for the study in any of five counties in Sweden (n=545), according to a national register of prescribed devices, was invited to participate in a descriptive survey; the questionnaire was mailed to respondents for self-rating. RESULTS People between 2 and 86 years old were represented among respondents. Standing time decreased with increased age. Respondents who were totally dependent for mobilization or who had received their standing device more than 5 years earlier used their device most frequently. The most common reasons given for standing were to improve circulation and well-being and to reduce stiffness. CONCLUSION It is important to pay attention to the experiences of standing for this vulnerable group of people, as the use of a standing device has a positive impact on well-being and QOL.

The psychosocial impact on standing devices

Abstract Purpose: The aim of this study was to explore the psychosocial impact of standing devices as experienced by users. Method: This is the second part of a comprehensive survey in five counties in Sweden where all the subjects with standing devices were invited to participate. The impact of standing devices on functional independence, quality of life and wellbeing was assessed using a questionnaire, Psychosocial Impact of Assistive Devices Scale (PIADS). Results: The psychosocial impact of the standing devices was perceived as positive. The highest PIADS scores in relation to age were found in the oldest group, aged 65 years and older. The ability to walk and independence in ambulation resulted in higher scores than the use of a wheelchair and/or dependence on others. Those who stood often awarded higher scores in the PIADS questionnaire compared to those who used the device less frequently. When standing was integrated in various activities, its psychosocial impact received high scores. Conclusion: The psychosocial impact of standing devices was generally experienced positively. The main results indicated that standing in a standing device had a value and we as professionals should ask the users about the intended purpose of their standing in order to prescribe the optimal device. Implications for Rehabilitation Standing in standing devices has positive psychosocial impact for the user. As professionals we should broaden our view of the use of standing devices, i.e. to see the standing device as an aid that not only treats the body’s structures or improves the user’s abilities in activities, but also provides a psychosocial impact on the user’s daily life, and to find meaningful goals for the user from a psychosocial perspective.

On an equal footing: adults’ accounts of the experience of using assistive devices for standing

Purpose: The aim of the study was to illuminate the meaning that standing holds for persons who require standing devices. Method: The phenomenological/hermeneutical analysis of the interviews was carried out using a life world-approach. Fifteen users of standing devices lacking the ability to stand independently participated in the interviews.Result: Each person’s lived experiences of standing in their devices indicated that the upright body position opens up an opportunity for connection to the outside world. An upright body position (i) alters the person’s sense of self, (ii) augments the person’s availability to the outside world, (iii) strengthens social interplay, and (iv) changes a person’s motivation and their expectations over time. Conclusion: Standing may be something that unites the body and self. Understanding the meaning of the altered body position that the use of standing devices opens up is vital for physiotherapists and occupational therapists prescribing these devices. Furthermore, it is important to take account of the subjective body, as well as the biological one, to enhance the adoption of different body positions and the person’s experiences. Implications for Rehabilitation Prolonged standing in standing devices Use of assistive devices for standing has benefits beyond physical/physiological ones. Standing in assistive devices for standing positively affects subjective well-being. Use of assistive devices for standing enhanced participation and social functioning of persons with severe disabilities such as spinal cord injury and multiple sclerosis.

Initiation of reaching when standing with and without DAFOs in children with spastic diplegia

We investigated whether the use of dynamic ankle foot orthoses (DAFOs) can improve the coordination between standing posture and a reaching movement. We investigated the temporal sequence between onset of center of pressure (CoP) displacement and onset of hand displacement by means of two AMTI force plates and a two-camera optoelectronic system (ELITE). The task was to reach for a cup. Reflective markers were placed on hand, trunk and the cup. Four children with spastic diplegia and eight control children (aged 5–12) participated. They were tested wearing DAFOs (diplegia) and the results were compared with wearing shoes (diplegia and control). The children with spastic diplegia were able to make use of anticipatory changes in CoP displacement. The results indicated that more trials in children with spastic diplegia had CoP onset preceding hand onset while wearing DAFOs (18/20) than when wearing only shoes. More trials (27/40) during the 20% reaching condition in the control group had CoP onset preceding hand onset than during the 10% reaching condition (18/40). In spite of different amounts of assistance, anticipatory postural adjustments were found in the diplegia group. Use of anticipatory postural adjustments was not consistent in the control group. Practice of reaching during standing can be carried out with DAFOs and/or hand support, and can promote motor learning of anticipatory postural adjustments.

The ambiguity of standing in standing devices: a qualitative interview study concerning children and parents experiences of the use of standing devices.

Abstract Aim: The aim of this study was to describe children’s and parents’ experiences of the significance of standing in a standing device. Methods: Individual interviews were performed with six children/teenagers (aged 7–19 years) and 14 parents. The interviews were transcribed and analyzed using a qualitative content analysis. Findings: The analysis resulted in the major theme, the duality of uprightness and the related themes: (1) the instrumental dimension of standing; (2) the social dimension of standing; and (3) the ambivalent dimension of standing. Each of the themes comprised several subthemes. Conclusions: There is an inherent duality related to the use of a standing device. Standing in a standing device was seen as a treatment of body structures and functions, as well as a possible source of pain. Standing was considered to influence freedom in activities and participation both positively and negatively. The parents experienced that standing influenced other peoples’ views of their child, while the children experienced standing as a way to extend the body and as something that gave them benefits in some activities. Physiotherapists working with children should take into account both the social and physical dimensions of using a standing device and consider both the child’s and the parents’ views.