| 제목 |
The Effect of Weight Bearing on Bone Mineral Density and on Bone Growth in Children with CP |
| 소속 |
Bundang CHA, Department of Rehabilitation Medicine1, MyongJi Hospital, Department of Rehabilitation Medicine2, Jeju National University Hospital, Department of Rehabilitation Medicine3 |
| 저자 |
Sang Hee Im1†, Jung Hwa Choi2, Eun Young Han3, Min Young Kim1, Kyunghoon Min1, Junghoon Yu1* |
Objectives
Weight bearing standing exercise may enhance functional abilities, increase bone mineral density (BMD), and prevent or minimize musculoskeletal problems. But there is no guideline for children with developmental disabilities. This study was conducted to reveal the effect of weight bearing on BMD, bone growth in length in children with developmental disabilities.
Subjects & Methods
12 children with cerebral palsy(CP) and 7 normal children as a control group were recruited. Patients, who could not stand without support, having functional level V on gross motor functional classification scale (GMFCS). Exclusion criteria were: previous fracture, severe deformity of spine, hip dislocation, precious surgery history on spine or lower extremity.
Patients were randomly assigned to either programmed standing or standing as usual group: group 1 with programmed assisted standing for more than 2 hours a day, more 5 days a week; group 2 with assisted standing for 20 minutes a day, 2 or 3 days a week. Normal control group, group 1 and group 2 were homogeneous for age and sex.
All participants underwent a dual-energy X-ray absorptiometry (DEXA) scan to get BMD of femur and lumbar spine, and full length anteroposterior radiography to measure the bone length of femur and tibia at baseline and after 6 months. We used T-score to analyze the tendency of BMD change in all 3 groups because of lack of DEXA data of normal children. Bone length was measured as the summation of the lengths of Rt. femur (from distal medial condyle to femoral head) and Rt. tibia (from tibial tubercle to medial malleolus).
Statistical analyses were made using SPSS ver 13.0. Differences between groups were analyzed by the Mann-Whitney U test. The Wilcoxon signed-rank test was used to analyze the change of BMD and boney length before and after weight-bearing exercise. A level of p＜0.05 was considered statistically significant.
Results
At baseline study, BMD of patient groups were significantly decreased on femur neck, trochanter and 4th lumbar spine compared to normal control group. But no difference on BMD between group 1 and 2, and no difference on boney length between 3 groups.
6 month follow-up study showed significant increased BMD on femur neck (Fig. 1) and on some lumbar segment in control group (Fig. 2) and group 1 (Fig. 3), however significant decreased BMD on femur neck in group 2 (Fig. 1). Bone length was significantly increased in all 3 groups (Fig. 4) after 6 months. The change of bone length was large in control group, and of group 2 was the smallest.
Conclusions
Weight bearing exercise may play an import role for increasing or maintaining BMD, and the programmed standing exercise are more effective to increase BMD in children with developmental disabilities.
Weight bearing exercise may promote the bone growth in children with developmental disabilities.
Further researches with more participants and with longer experimental periods are needed. |
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Fig 1. The BMD change on femur neck (*p<0.05)
Fig 2. The BMD change on 3rd lumbar (*p<0.05)
Fig 3. The BMD change on the 4th lumbar (*p<0.05)
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