**4.13 Results of the implementation of the bipedestation in the subject of study**

Making the comparison between the physiotherapeutic evaluation before and after the standing protocol in the study subject, it was found that:

	- On the scale of perceived exertion (modified Borg), the study subject initially considered standing activity with a rating of hard; after finishing the sessions, the rating decreased to soft.
	- When performing the evaluation of ventilatory mechanics, it was found that there was an increase of 0.5 cm in the thoracic expansion of the study subject.
	- In the initial evaluation, the BMI was in the 65th percentile and in the final evaluation it was in the 30th percentile. Despite this decrease, the BMI was in the normal ranges.
	- Regarding the perimeters, an increase of 1.5 cm was found in shoulders and abdomen; at the hip 2 cm; 1.7 cm for the right upper thigh and 2.7 cm for the left and 0.5 cm for the leg. Likewise, there was a decrease in some perimeters, such as 1 cm in the right middle thigh and 0.8 cm in the lower thigh.
	- Regarding the pressure ulcer presented by the study subject, it was found that in the initial evaluation, it had dimensions of 2.4 cm wide x 1.5 cm high; in the final evaluation it was 2.1 cm wide x 1 cm high. This shows a decrease of 0.3 cm in width and 0.5 cm in height in the crater.
	- Superficial sensitivity: when evaluating touch and pain, it was obtained that the study subject initially reported perceiving the stimuli up to the level of T12 on the left side and T11 on the right side. In the final evaluation, a

**85**

*Design of a Standing Device for Children with Spinal Dysraphysm*

**Joint Range of motion**

**Right and left hip flexion** 22° **Right hip internal rotation** 26° **Left hip internal rotation** 16° **Left hip external rotation** 7° **Left knee flexion** 6° **Knee extension** 10° **Right foot neck inversion** 5° **Left foot neck inversion** 3° **Right foot neck eversion** 30° **Left foot neck eversion** 25°

**Hip adduction** 17° **Left foot neck dorsiflexion** 15° **Right metatarsophalangeal flexion** 18° **Left metatarsophalangeal flexion** 30° **Bilateral metatarsophalangeal extension** 10°

perception of the stimulation was obtained on the lateral aspect of L2 in the

○ ASIA: in the initial evaluation, the sensitive level was T11 and in the final evaluation it was L1. The motor level remained the same in the two evaluations, however in the final evaluation a slight contraction of the hip flexors

*Comparison of gain and decrease in the ranges of motion obtained in the pre and post physiotherapeutic* 

○ Postural alignment in sitting position: pelvic obliquity changed the score from slight elevation of 10° to the right side to normal; the lateral displacement of the trunk was maintained in a grade of mild, going from a displacement of 5° to the left to a 5° displacement to the right; lateral head tilt changed from Tilt 10° to the right (slight) to normal; hip rotation remained normal in both evaluations; posterior pelvic tilt, thoracic and lumbar curvature remained the same in the two evaluations; in the posterior inclination of the head there was a decrease of 13°, going from slight to normal; slight pelvic rotation remained the same in both evaluations; in the adduction and

○ Positive Galeazzi sign, finding a decrease in the difference of 0.9 cm, with

○ Spine: mobility was evaluated with the Schober test, finding an increase of 1 cm in the displacement of the vertebrae. The alignment of the spine was also

right hemibody and up to L1 in the left side.

• In the postural analysis the following results were found:

abduction of the hips a grade of normal was maintained.

the lower right limb is the lowered one.

was found.

*DOI: http://dx.doi.org/10.5772/intechopen.97758*

**Gain**

**Decrease**

**Table 1.**

*evaluations.*

*Design of a Standing Device for Children with Spinal Dysraphysm DOI: http://dx.doi.org/10.5772/intechopen.97758*


### **Table 1.**

*Therapy Approaches in Neurological Disorders*

a child of the same age and schooling as the study subject, finding that after a brief instruction, the child was able to maneuver the standing frame in all

**4.13 Results of the implementation of the bipedestation in the subject of study**

○ On the scale of perceived exertion (modified Borg), the study subject

• Regarding the anthropometric characteristics, the following changes

initially considered standing activity with a rating of hard; after finishing the

○ When performing the evaluation of ventilatory mechanics, it was found that there was an increase of 0.5 cm in the thoracic expansion of the study subject.

○ In the initial evaluation, the BMI was in the 65th percentile and in the final evaluation it was in the 30th percentile. Despite this decrease, the BMI was in

○ Regarding the perimeters, an increase of 1.5 cm was found in shoulders and abdomen; at the hip 2 cm; 1.7 cm for the right upper thigh and 2.7 cm for the left and 0.5 cm for the leg. Likewise, there was a decrease in some perimeters, such as 1 cm in the right middle thigh and 0.8 cm in the lower thigh.

• In the positive internal contextual factors and participation, it was found that the patient improved her mood after the start of standing, has greater initiative to conduct different activities that she did not do before, such as helping to

○ Regarding the pressure ulcer presented by the study subject, it was found that in the initial evaluation, it had dimensions of 2.4 cm wide x 1.5 cm high; in the final evaluation it was 2.1 cm wide x 1 cm high. This shows a decrease

• Regarding joint integrity and mobility, the results obtained can be seen in

• In the muscle evaluation, a slight contraction was found in the hip flexor

○ Superficial sensitivity: when evaluating touch and pain, it was obtained that the study subject initially reported perceiving the stimuli up to the level of T12 on the left side and T11 on the right side. In the final evaluation, a

• In the evaluation of sensory and neuromotor integrity it was found:

wash the dishes after eating, help serve in the store of their parents.

• Regarding integumentary and vascular integrity, it was found:

of 0.3 cm in width and 0.5 cm in height in the crater.

muscles on both sides in the final evaluation.

Making the comparison between the physiotherapeutic evaluation before and

directions, so no this modification is considered necessary.

after the standing protocol in the study subject, it was found that:

sessions, the rating decreased to soft.

were found:

the normal ranges.

• In the cardiovascular and respiratory dimension it was found:

**84**

**Table 1**:

*Comparison of gain and decrease in the ranges of motion obtained in the pre and post physiotherapeutic evaluations.*

perception of the stimulation was obtained on the lateral aspect of L2 in the right hemibody and up to L1 in the left side.

	- Postural alignment in sitting position: pelvic obliquity changed the score from slight elevation of 10° to the right side to normal; the lateral displacement of the trunk was maintained in a grade of mild, going from a displacement of 5° to the left to a 5° displacement to the right; lateral head tilt changed from Tilt 10° to the right (slight) to normal; hip rotation remained normal in both evaluations; posterior pelvic tilt, thoracic and lumbar curvature remained the same in the two evaluations; in the posterior inclination of the head there was a decrease of 13°, going from slight to normal; slight pelvic rotation remained the same in both evaluations; in the adduction and abduction of the hips a grade of normal was maintained.
	- Positive Galeazzi sign, finding a decrease in the difference of 0.9 cm, with the lower right limb is the lowered one.
	- Spine: mobility was evaluated with the Schober test, finding an increase of 1 cm in the displacement of the vertebrae. The alignment of the spine was also

evaluated with the Adams test, which shows an increase in curvature toward the left side in the dorsal area, maintaining the same result in both evaluations.

The researchers also consider it pertinent mentioning other changes that occurred in the study subject during assisted standing; These data were obtained from the parents' narratives during the course of the investigation and will be presented below:


According to these results, it is observed that it is necessary to design these devices based on the individual characteristics of each patient/user, so as to guarantee an adequate man–machine correlation and therefore obtain better results derived from the use of the device. This is why this research bets on a personalized design and not in series, economic, light and esthetic, unlike most of the stanchions.

The researchers recognize the importance of having received training in various areas that contributed to the development of the research, however, a limitation of the study corresponds to a gap in training in terms of basic elements of design and production of orthotic devices or attachments and the review of other systems, such as bladder and gastrointestinal function, which are also a fundamental part of the human body movement, but which still do not have a concrete argument from the point of view of the physiotherapist. Therefore researchers would hope that a project will be proposed, hopefully in the short term, where this area is deepened and subjects are offered, where these issues and views are explored and reflected by physiotherapists in training.

**87**

**Author details**

Aydeé Robayo-Torres1

\* and Katherine Quiñones-Argote2

© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Departamento del Movimiento Corporal Humano, Facultad de Medicina,

Universidad Nacional de Colombia, Bogotá, Colombia

2 Universidad Nacional de Colombia, Bogotá, Colombia

\*Address all correspondence to: alrobayot@unal.edu.co

provided the original work is properly cited.

*Design of a Standing Device for Children with Spinal Dysraphysm*

After completing this investigative process, the researchers have reached the

• The intervention of the physiotherapists in terms of design and generation of structures and technologies that facilitate the habilitation and rehabilitation of the patient, from the paradigm of design applied to the user, are one of the intervention modalities that is most respectful of individual characteristics and context in which the orthosis is going to be implemented, so in the mediation between the human and the technological, a judicious monitoring of the

• The experiences reported by the experts show us that with the prototype produced in this research it is necessary and useful, while without neglecting its esthetic appearance, greater functionality was always sought in the patient.

• Assisted standing should be a right for the population with spina bifida, since kidney, gastrointestinal and respiratory diseases are the main reasons why these patients have a high level of morbidity and mortality. Therefore, devices such as the one proposed in this work, made with national materials and with Colombian design, 10 times cheaper than those on the market, could respond to these needs.

*DOI: http://dx.doi.org/10.5772/intechopen.97758*

**5. Conclusions**

following conclusions:

process is necessary.
