This can be good news because there is hope for recovery and improved outcomes, but for some, this diagnosis can result in added hardship.Some of the problems those individuals encounter are unmanageable spasticity, low to intense pain along with the many other SCI related challenges.

I knew a physician that was fortunate to recover from an injury where he could walk with a cane, but he still has many complications resulting from the injury that he is dealing with. Those with incomplete injuries often struggle with waste elimination problems, autonomic dysreflexia, and fatigue. But the greatest problem reported by people with incomplete SCI is neuropathic spinal cord pain. Sometimes the pain is annoying and sometimes it can be debilitating. This pain can result from the increased intensity of spasticity, which is associated with incomplete injuries.

We have a collection of testimonials on our website, some from people stating that standing helped them relieve their pain symptoms. Others mentioned that they received the stander through their insurance company with the justification that it was to be used to manage their spasticity, but also found standing frequently relieved their pain. Pain medications can have serious side effects, besides adding up in monetary cost. A standing program can often help with managing pain, as well as decreasing spasticity and providing other benefits to help maintain a better quality of life.

Jadian is an active T5 paraplegic who stands several times a day for pain management. Watch Jadian’s SCI Standing Story.

Do you have an incomplete spinal cord injury? What are some of the complications that you face?

Photo courtesy of: cjc4454

Although I have a hard job to explain, I am especially fortunate to be working for EasyStand. I get to see firsthand how standing can improve lives, physically and emotionally, as I work with a large variety of people all over the country, from healthcare professionals, to suppliers, to the people that represent EasyStand and especially by working with consumers.

I am there to see a four year old boy in preschool stand for the first time and watch all his classmates, teachers, and even the people from the kitchen, come running up to him in excitement. I witness a husband and wife in Alabama crying, embracing each other, as the husband stands for the first time in four years. I get to laugh and enjoy the happiness two teachers are having explaining that a student of theirs has a bowel movement only when he stands at school, and how happy his parents are about this.

Recently, I heard from a young man telling me that he can now sleep because he has less pain and spasticity, when he stands in the evening. At the Abilities Expo I hear story, after story from many people about how their lives improved, when they stared to stand.

Another area of satisfaction is when I present educational programs and I see the change in thinking from healthcare providers. Instead of thinking a wheelchair and a bath bench is all a person needs when they are discharged, they are thinking about what is going to keep this person healthy as well. Many have realized that a consistent standing program can help keep a person healthy and strong to assist with ADLs, so they can stay independent and in their home.

I might have a difficult job to explain, but in today’s economy I am lucky to have one, and fortunate to have a job that is as rewarding as this.

Now’s your chance to share. What do you do?

I have met some people that stand consistently every morning for breakfast and they find that their bowel programs are easier and more successful. Some people who are coping with pain stand consistently because they find relief. Others simply enjoy the change and freedom from sitting all day!

There is a long list of benefits to standing but everyone is so very different and especially so in the disabled community. So, please tell us why you stand. Please do not tell us that you stand because your therapist told you to.

Many have already shared their standing stories with us, take a few minutes to read them…you will be glad that you did!

Why do you stand? Post a comment telling us what you like about standing or what you gain from it and we will send you a free gift!

While eating lunch with Cayden and his family, we noticed that he sat at the dinner table in his wheelchair, at a lower height than everyone else and looked a little bit uncomfortable. So we put him into the Bantam, removed the Shadow Tray, had his mom push him up to the dinner table and lifted him into a slight anterior tilt position.  Now Cayden was sitting at the same height, making it easier to interact with his family at the table, and was in a better position to eat independently!

The other really neat thing that the Bantam did for Cayden, was allow him to rest in the supine position.  Cayden’s mom is great about getting Cayden into his stander every day, but his diagnosis of  SMA makes him tire easily.  Cayden also has flexible knee contractures, so he cannot stand totally upright. The Bantam’s sit to stand function allows Cayden to stand at a nearly upright standing position that he can tolerate.  When he needed a rest, we took Cayden back down to the anterior tilt sitting position, then tilted the stander into a supine position.  This was a great resting position for Cayden, because he could relax his muscles and lay back while being supported.  We could tell how he really felt by the “Aaaaahhh” he let out and the smile on his face!

How has changing positions benefited your child? Do they feel more comfortable like Cayden?

The body is not meant to sit. Unfortunately, wheelchair users can be in their wheelchair as much as 14 to 18 hours per day. Sitting for these periods of time creates numerous problems including:
•Lower extremity contractures
•Bone density loss
•Urinary tract infections
•Decrease in bowel function
•Decreased range of motion
•Spasticity
•Decreased respiratory function
•Increased risk of pressure ulcers
•Decreased circulation

Therapists, ATP’s, and physicians sometimes overlook the importance and need for the user to stand in order to maintain and even improve the user’s overall health and well-being.

Individuals who rely on a wheelchair for mobility should also look to a standing device or standing frame as a way prevent the secondary complications that often result from prolonged use of a wheelchair. For years physicians and therapists have recommended assisted standing for a variety of medical and health benefits that occur when maintaining a natural standing posture. However, in addition to the physiological health benefits, many people also experience significant psychological benefits from being in the upright standing position, such as improved self-esteem and social development. Many of these health and physiological benefits of standing are listed below.

Medical Benefits of Standing
Passive standing has been demonstrated to prevent, reverse, or improve many of the adverse effects of prolonged immobilization. The most widely accepted medical benefits of standing include:

•Prevention of contractures (ankles, knees, and hips)
•Improvement of range of motion (spine, hips, knees and ankles)
•Reduction in spasticity
•Prevention or reversal of osteoporosis and resultant hypercalciuria
•Improvement of renal function, drainage of the urinary tract, and reduction in urinary calculi
•Prevention of pressure ulcers through changing positions
•Improvement in circulation as it related to orthostatic hypo-tension
•Improvement in bowel function
•Normalization of respiratory function
•Improve hip integrity
•Develop or improve motor skills
•Maintain or re-gain bone density

Other specific reasons that people stand include:
•Facilitation of a natural symmetrical standing posture
•Development & improvement of upper body strength & balance
•Alleviation of pain caused by prolonged or inappropriate position
•Development of standing tolerance & endurance
•Lessening progressive scoliosis
•Assisting with skeletal development (in children)

Psychological Benefits of Standing
Although funding sources rarely recognize the psychological benefits of standing, they can be some of the most important reasons to stand, especially for kids. Clinicians, parents, and stander users also recommend standing for the psychological benefits, including:

•Stimulate play
•Increase independence self-image
•Being active and mobile while standing
•Be more alert
•Increase cognition
•Enhance social development & interactions with peers
•Participate in activities that are meant to do standing up
•Increase activities of daily living
•Be more vocal & responsive
•Encourage inclusion in school
•Decrease fatigue from inactivity
•Help prevent depression

Finally it is extremely important to understand that with the amount of justification and supportive documentation, a stander can be readily funded. Of course there are certain funding sources that can be difficult, but taking the time to document the alternatives of not having a standing program available to your patient should carry a great deal of weight with the funding source. Be sure to research articles and websites that may help you with this documentation. I found that this standing frame article has a great wealth of information.

Do you agree that standing frames are often overlooked despite their numerous benefits? Share a client specific story if you have one.

This article was re-posted with revisions from the Complex Rehab Network, an online community and resource for those folks involved in Rehab Seating and Positioning for adult and geriatric markets. Sponsored by Active American Mobility.

Katie Hohman, PT, DPT with client Melissa using the EasyStand Glider for weight bearing, strengthening, and endurance.

Melissa has progressed from being wheelchair dependent, to becoming ambulatory with a therapist’s assist. She is using the EasyStand Gilder, a dynamic stander at home for weight bearing, strengthening, and endurance. She requires minimal assist to push and pull the handles of the stander to enable her lower extremities to move in a back and forth motion as well. She uses her upper extremity strength to provide passive movement to her lower extremities. 

John was able to decrease his lower extremity spasticity and improve upper extremity function. John uses the EasyStand StrapStand for weight bearing during physical therapy. This type of stander allows for easy donning of the sling in his wheelchair by his caregiver; John is a dependent transfer, and any other type of stander would require much more assistance to transfer into. When John is in the stander two times per week during therapy, he is assisted to work on gentle upper extremity strengthening and stretching exercises for improvement in overall endurance, flexibility, and spasticity reduction.” 

Sit-to-stand devices provide individuals who are unable to stand and weight bear the opportunity to dramatically reduce risk factors related to inactivity and improve their overall quality of life.  Read more about John and Melissa’s rehabilitiation in “Upstanding Benefits” an article written by their therapist Katie Hohman. Printed in the March Issue of Rehab Management. 

Read More Articles on Standing 

Have you found that standing benefits each of your clients in similar or different ways based on their diagnosis?

“A 1992 study examined assistive positioning as a control parameter of interactions between students with physical and cognitive impairments and classroom staff. Communication is a common goal for these children to allow them expression of wants and needs and the ability to exert power over physical and social environments. Adults initiated communication with the students more frequently when the students were positioned closer to the adults’ eye level.

Stephenie Labandz not only uses standers with students in the classroom, here she is using the Bantam Mobile to do some fun activities in the gym!

Standing may have a positive impact on the child’s level of arousal, and also affects a care provider’s perception of the child’s receptivity and readiness to participate in interactions.

Proper postural support allows an individual to direct energy toward attention and learning. Good supported alignment eliminates the fear of falling and the need to fight gravity to maintain a desirable position. It also provides proximal stability for greater success with fine motor tasks, such as accessing communication devices. An appropriate standing program eliminates the dilemma of determining whether a child’s time is better spent on a physical or mental task by allowing them to occur simultaneously.”

Stephenie Labandz, DPT has noticed several of these benefits with students at her school. This excerpt was taken from her article “Heightened Awareness“, printed in the Janurary 2011 Issue of Advance for Physical Therapy & Rehab Medicine.

Standing stimulates learning in kids of all abilities, because it helps release energy, promotes participation in classroom activities, and increases the student’s level of alertness, so they can focus and be at their best!

Read More Posts by Stephenie Labandz, DPT

Has standing at school had an impact on your child’s education? Have you noticed learning improvements with students standing in your classroom?

• The client is too disabled (Even people who are C1-C2 vent dependent quadriplegics can use the EasyStand)
• The client is not disabled enough (anyone, even active paraplegics, can benefit from standing)
• The client has not stood for several years (start by talking to your doctor, they may want a DEXA scan done)
• The client needs a new wheelchair, so we do not want to jeopardize the funding (a cap on lifetime benefits or durable medical equipment would be the only thing to take into consideration)
• The caregivers will not be able to handle it (there are many different standers and options to help with transferring & compliance)

Not everyone is appropriate for a standing program, but 90% of these reasons mentioned are inaccurate or wrong. We have people benefiting from standing that are ambulatory but they need the strengthening and balance that standing provides. We have others that have little, to no voluntary movement that stand every day. Also, requesting a stander from a funding source has little bearing on getting other medical equipment. Most speculation about how the stander will work out with the family or school is best addressed by bringing them into the evaluation.

If a doctor withheld information from you that could improve your health and alleviate adverse symptoms, you would likely change doctors. Individuals and parents need to have all the care options explained and it is the responsibility of the health care provider to put them all on the table.

Did your perceptions change about who is/is not a candidate for standing? What do you think the greatest misconceptions are?

Below is a sample letter of medical necessity for an EasyStand Glider (youth/medium size), graciously shared to us by Lauren Rosen, PT, MPT, MSMS, ATP/SMS. It is also available to download as a PDF.

(Clients Specs – See PDF for more detail)
To Whom It May Concern:

History: D.L. is a 7-year-old with a diagnosis of quadriplegia.  Due to an unknown cause, he has a gap in his spinal cord from C5 to T1.  He is incontinent of bowel and bladder.  His hearing and vision are both intact.

D.L. has decreased trunk strength.  Without trunk support, he is unable to sit.  He can actively move his upper extremities.  He has no active movement of his lower extremities.  Bilaterally, he has ankle clonus and Ashworth 1-2 spasticity.

Currently, D.L. does not have any spinal or pelvic deformities.  His lower extremity passive motion is within normal limits.

Standing has been shown to delay the appearance of contractures and improve those that already exist (1).  Because he lacks the strength to stand, the standing frame will help to keep him in a good position to stretch these muscles for extended periods.  This stretch will maintain and improve his lower extremity range of motion.

D.L. has spasticity throughout his lower extremities.  Standing has been shown to decreased spasticity (2).  Decreasing his spasticity will assist in maintaining range of motion and improving his overall level of function.

Children without disabilities stand between 8-10 months of age.  This standing helps with the forming of the acetabulum (3).  It is very important in children with disabilities to get them standing at a young age.  Because of D.L.’s diagnosis and his spasticity, he is already at increased risk of developing hip subluxation as he grows.  Standing will increase the depth of his acetabulum and decrease his risk of subluxation.

D.L. will benefit from a standing frame that can position him properly in standing. Standing also facilitates better emptying of his bladder, which can decrease his risk of developing urinary tract infections (4)

D.L. is at increased risk of developing osteoporosis due his inability to stand independently (5, 6).  Gudjonsdottir, and Mercer studied the effects of dynamic versus static standing on bone mineral density in children with cerebral palsy. All subjects were non-ambulatory. Half the subjects underwent dynamic standing, the other half static standing. All but one of the subjects showed an increase in bone mineral density in the lumbar spine, proximal femur and distal femur (7).  Additionally, Goemaere et al.9 compared SCI individuals who conducted standing 1 hour, 3 times per week with those that did not. It was found that bone mineral densities were significantly higher in the long leg bones of the standing group (8).

This standing frame will allow D.L. to bear weight through his lower extremities.  Because it is easy to move the frame from a seated to a standing position and it is a dynamic stander, his parents will be able to change his position frequently.  Lanyon and Rubin compared static versus dynamic loads and their influence on bone remodeling in animal models (9). They found that static loads did not have an effect on remodeling where as a similar load that was applied intermittently in a dynamic manner was associated with a substantial increase in bone mass. The dynamically loaded group instead of bone loss demonstrated a mean increase in bone cross-sectional area.

Kawashima, Nakazawa, and Akai performed a study to see if passive leg movement in standing was sufficient to improve the oxygenation of lower limb muscles in populations with SCI (10). They compared SCI patients to neurologically normal controls. Passive movements were performed at different frequencies for 3 minutes each and then EMG activity and oxy and deoxy hemoglobin were measured. They discovered that passive leg movements did induce not only EMG activities but also an increased oxygen perfusion to the muscle in SCI populations whereas the controls showed no changes. This study demonstrates a significant benefit to individuals like D.L. for dynamic standing.

With the glider, he will get dynamic loading of his bones rather than just static loading.  Research has shown that more dynamic weight bearing results in less of a loss in bone mineral density (11).  This will provide him with the maximal benefits from standing.

The other benefits of standing are well established.  In addition maintaining his lower extremity range of motion, which is important for him, a standing frame has many benefits.  Standing has been shown to improve circulatory, gastrointestinal, bowel and bladder, and respiratory functions (3,4).   Walter et al. sent questionnaires to individuals with SCI who had purchased standing frames from two different companies (12). The data was analyzed for perceived benefits. These included improved quality of life, decreased urinary tract infections, and decreased spasticity among others. Those that stood greater then half an hour per day and a statistically significant improvement in secondary complication rates. They also quoted a study by Warren et al. that showed that compliance for standing with frames or tilt tables is greater than compliance for standing with KAFO’s in the home environment.

D.L. cannot move himself independently to shift his weight.  This puts him at an increased risk of developing decubitus ulcers (4).  People who stand for at least 30 minutes a day have less pressure sores than those who do not stand (12).

Current Program and Standers Considered:

At this time, D.L. has an EasyStand Magician stander.  He uses the stander daily. Because of the good trunk support, he uses it while he works on different reaching activities, such as turning pages in books and playing with toys.

His mother transfers him independently at home and she continues to need a standing frame that can be operated by only one person.  It would be unsafe and impractical to try to lift and position him into a prone or supine standing frame.

D.L. has outgrown this stander.  Without a new stander, he will not be able to continue his standing program.  As a sit-to-stand stander remains the most appropriate type of stander for him, this is the least costly and most medically appropriate device to allow him to continue to stand and to get the most medical benefits from standing.

Equipment Trial

EasyStand Evolv Glider: D.L. used this unit on numerous trial occasions with excellent results.  Video can be provided if necessary.  His mother was able to set up the system and complete transfer and positioning help as needed.

Recommended Equipment: D.L. is currently at the shortest height range for the recommended stander once the conversion is made so he has maximal growth capability with this stander and it will last him a longer amount of time.

Standing challenges the cardiovascular system by requiring the heart to pump the blood flow against gravity in an upright position. The EasyStand Evolv Glider also provides and upper body strengthening that D.L. is able to complete while he is standing further conditioning the cardiovascular system.  The increase in cardiovascular function further decreases skin breakdown risk due to increased oxygenation to the tissues.

As discussed above, D.L. is at high risk for long term osteoporosis due to lack of weight bearing and muscle stress on long bones. The increase in calcium can contribute to renal stones, which can lead to significant debilitation and increased cost of care.  Normalizing weight bearing and stress on the long bones as provided by the Glider may assist in reducing these medical complications.

After a full examination by the rehabilitation team and D.L.’s family, the following equipment is deemed medically necessary:

1. EasyStand Evolv Youth Glider that comes standard with includes chest pad, glide handles, adjustable resistance cylinders, flip-up kneepads, and adjustable footplates.

Additional Glider options necessary to maximize D.L.’s function:

1.       Quad Grip Handle Extension: Given D.L.’s decreased ability to grip the actuator to raise or lower himself, this grip extension is necessary so that he can hold onto the actuator.  Without this, he will not be able to hold the actuator and he will be completely dependent to raise or lower the system.

2.       Secure Foot Straps: With D.L.’s spasticity, it is difficult to keep his feet positioned properly.  The foot straps will assure that his feet stay on the footplates so that he gets the necessary benefits of standing.  With the glider feature, it is especially important that his feet remain properly positioned to prevent injury from falling out of the system.

3.       Hip Supports-Medium: With D.L.’s decreased trunk control, he needs lateral hip support to maintain upright standing in the stander.  These will work with the lateral supports to properly position him and allow him to remain in the stander for extended times.

4.       Glide Handle Extensions: Given D.L.’s height and size, he requires the extension so he can reach the handles to use the glider function on the stander.  Without these, he will not be able to use the dynamic feature of the stander.

5.       Contoured Back 19”: This is the contoured back support is similar to the contoured back on his wheelchair.  It is needed to provide him with the necessary postural support.  Without this option, he will have no support behind his back, which will make using the stander unsafe and impossible for him.

6.       Velcro Positioning Belt: This basic positioning belt will keep him properly positioned in the stander.  This is an important safety device.  Without it, he will be at increased risk of falling out of the stander.

7.       Lateral Supports 9”-15” W: With D.L.’s decreased trunk control, he needs lateral trunk support to maintain upright standing in the stander.  These will work with the hip supports to properly position him and allow him to remain in the stander for extended times.  With the glider, he especially needs the trunk supports to prevent him from falling out as he moves his upper extremities.

Thank you for your assistance in maximizing D.L.’s function.

Sincerely,

_____________PT______                                                               ______________Physician__

(List References – See PDF for more details)

A special thank you again, to Lauren Rosen, PT, MPT, MSMS, ATP/SMS for sharing this successful letter of medical necessity with us.

Thank you so much for allowing me a two week trial for the EasyStand Evolv. The purchase of the adult model has brought me great physical comfort and emotional improvement. I suffer from Multiple Sclerosis and am dealing with severe spasticity and neuropathic pain on a daily basis.

After suffering a debilitating attack in 2008 I could no longer walk, stand nor transfer without the support of a turning disc. I became physically incapacitated and emotionally distraught. For years I was basically bedridden and wheelchair bound until I discovered the EasyStand Evolv.

I use the product 6 times a week and stand passively for between 1 to 2 1/2 hours daily. Being in the upright position has improved my body’s range of motion. After I use the stander my hips move more easily and my ankles which constantly turn outward no longer do so. The spasticity in my legs has been reduced considerably and when I return to my wheelchair they no longer twitch nor pulsate uncontrollably. This leg relaxation may last for the entire day. By maintaining an upright position, my breathing and my bowel and bladder function have improved. Also, I hope to prevent deterioration of my bone density leading to osteoporosis, as I am aware of how standing aids this possibility. As of yet, I have not had bed sores, but am well aware of how changing positions can prevent this. Overall, from a physical perspective, this device has facilitated a natural standing posture and reduced both my MS pain and pain caused by sitting or lying in a prolonged or inappropriate position.

Emotionally, this journey has been a difficult one for both me and my family. Although I belong to a support group and have very understanding and compassionate doctors, I often remain in a saddened state of mind. When using the stand, it helps me regain some of my independent feelings and sense of humor. I am often more alert and cognitively aware and focused when reading and doing crossword puzzles. As humans we are meant to stand and when I do so, my family notices I am less depressed and more involved socially and intellectually.

It took me quite a while to find this product as I surfed the internet on a regular basis for something that would be appropriate for my needs. Although my doctors, occupational therapists and rehab coordinators are very knowledgeable and competent, none recommended the EasyStand Evolv.  Frustrated, after spending about 20 hours on the internet and telephone, I contacted Invacare directly and was finally helped. If I was not a persevering and tenacious person, I would have given up, feeling I had exhausted all avenues.

Certainly, there are many others who would like the stander but are unaware of its existence. In my opinion, it would be prudent for all those in the medical profession and rehabilitation facilities to recommend this product to the appropriate people. Posting pamphlets, pictures and contacts would further promote knowledge.

In conclusion, I am thrilled to have the EasyStand Evolv. I believe the standing frame will prevent any physical secondary complications that could result from my prolonged inactivity. My psychological and emotional aura has also improved. By being in the upright position, I feel more positive and more in control of myself. My self-esteem has improved to the point that I want to pursue in a limited way some of the activities I was involved in when able bodied. Hope has once again entered my life. Thank you.

Best regards,

Randi Daniels
Canada

Have you had similar experiences as Randi? Are you able to find the rehab equipment you need thru talking to your doctors or therapists, or do you have to do your own research online?

Photo Credit:  Kirstea

I am a physical therapist working with a 14-year old young lady who is now trying the EasyStand Bantam after experiencing much discomfort in her prone stander.  She stands 3 times per day after each meal.  She was at the point where she could tolerate standing in her prone stander for no more than 2 to 10 minutes at a time and she would end up crying.  Since she has been using the EasyStand, she is able to stand for an hour and 45 minutes per day with no problems whatsoever, and the change in her quality of life is truly remarkable!

1. She no longer cries in the stander
2. She has required no pain medication since she started using the EasyStand
3. Her sleep has improved
4. Her ability to swallow has improved
5. Her lungs are clear
6. Her oral secretions have decreased
7. She is generally much happier
8. She can stand for much longer periods of time

We are all so happy for the positive changes that have taken place for her since she has been using your wonderful stander.  Thank you!

Karen Legnini, PT
www.rackercenters.org

Thank you Karen for sharing your positive experiences with us. This is the type of feedback that makes all of us at Altimate Medical Inc. proud because we are making a difference!

Have you had similar experiences as Karen? What equipment have you found that has made a difference to you or a child with a disability?

Are we stifling or limiting proprioception feedback with wheelchair seating and positioning, as we focus on containment? Much of the seating components (chest harness, three point pelvic belts, hip guides) are designed to hold a part of the child in place, from head to toe. Most clinicians and suppliers understand that there is a time for positioning, but there also has to be a time for movement. Using less whenever possible to allow for the child’s voluntary movement can provide them with more opportunities to move and explore.

The EasyStand Bantam helps Lily easily change positions throughtout the school day.

When a child stands or walks periodically throughout the day, they can often feel more freedom of movement and a greater sensory experience. Standing can allow them to feel the pressure on their feet, the weight shift in their legs, the movement in their hips and the balance of their trunk and head working with gravity. Voluntary movement through changing positions provides their body with improved kinesthetic and proprioception awareness. Realistically many of these children may be weak in the beginning of a standing program and will need support and positioning components. But when given the opportunity to stand for longer periods, frequently throughout the day, they will gain strength, need less support, and reap the benefits of more voluntary movement.

Here is a video case study about a woman I met in New Jersey, Margaret Laino.  Margaret is an elderly woman with Cerebral Palsy, who lives in a developmental center. Some of the benefits that her therapists have noticed include better socialization, more strength, and better range of motion.

1. Describe what happens to the body when a person moves from a sitting to a standing position in terms of weight redistribution, changes in posture, etc.

When moving from a sitting position to the standing position, the weight shifts from the client’s seat and back  to the legs and feet. You see an opening of the thoracic area, with the hips over the knees and feet, and the shoulders and head over the pelvis. Changes can also be noted in posture, breathing, increased alertness and visual focus.

2. Describe how a standing frame mechanically provides support and balance to enable a wheelchair user to stand. Mechanically, is the sit-to-stand motion the same or similar to how an able-bodied person moves from sitting to standing? Describe any differences.

A sit-to-stand standing frame, by its very nature, becomes the support for the user because it provides both anterior and posterior support giving the user front and back stability that they do not have on their own. It holds the feet, knees, hip area, and torso in the correct geometry to safely transition the user from the sitting to the standing position.  This is done (in an EasyStand Evolv or EasyStand Bantam) with foot plates, knee blocks, seating surface, anterior support for the upper body, and in most cases, a back surface.  In addition, other peripheral supports such as thoracic and hip supports and headrests can be added, depending on the individual need of the user. The user transitions to standing with a gas cylinder assist or manual hydraulic pump. In some cases a  battery powered actuator is available as an optional transition method.

When an able-bodied person rises from a chair to the standing position, the torso is moved forward to change the center of gravity so that the body’s muscles can overcome the weight of the body to accomplish the standing motion.  For a person with a disability who can not use all of these same muscles, this center of gravity shift is not necessary.  When using a sit-to-stand standing frame, the torso remains more or less vertical, which is an added benefit to help the user maintain their spatial orientation.  The fear of falling forward is dispelled by providing the back support and remaining in a vertical position.

3. Once a person in a standing frame is standing, what percentage of their body weight is being borne by the client, and what percentage by the standing frame? Does this weight-bearing percentage vary from client to client or diagnosis to diagnosis?

There are many variables which affect this.  How much of a “hug” to the body that the various support options are providing is the chief factor of this.  Some say up to 95-98% weight bearing by the user can be attained in the right circumstances (structural body type and support options).There will be cases where a doctor or therapist may not want full weight bearing, and this can be achieved by positioning the sit-to-stand standing frame in a partially upright stance, if that is what’s desired.  More weight is born by the combination of the seating surface and knee blocks as the user is further from being completely upright.

4. Do standing frames work differently for clients with different diagnoses? For instance, are the mechanics of movement from sit to stand or the weight-bearing percentages different for someone with cerebral palsy vs. someone with paraplegia?

The basic mechanics of movement are the same for all sit to stand standers, they support and align the user from sitting to standing for a weight bearing program. The effect on the clients can be different for different persons, not just by diagnosis, but even within the same diagnosis, as we all have different body sizes and and different needs. Thus the importance of individual assessment and trial. Consumers use standers for various reasons, some stand for loading of bones to prevent osteoporisis, others to maintain L/E ROM and or L/E tone reduction, others to improve upper body and head control, etc.

5. Which clients can benefit from standing regimens? What physical and cognitive prerequisites does a client need to have? Are there any diagnoses that prohibit standing?

Many clients’ can benefit from a standing program; most clients with diagnoses from congenital disorders,  degenerative or progressive neuromuscular disease, or from an injury or trauma can benefit from weight bearing in a stander. Again, clinical recommendations as to the safety of weight bearing for the “individual client” are necessary, as not every body is an appropriate candidate for a standing program. Some contraindications and precautions include (but are not limited to); existing contractures, non-flexible skeletal deformities, osteoporosis- existing bone loss that could cause fracture, and postural hypotension.

6. What are the physical, cognitive and emotional/social benefits of standing?

Physical benefits of standing include: Prevention of contractures (ankles, knees, and hips), Improving range of motion, Reduction of spasticity, Prevention or reversal of Osteoporosis, Improvement/normalization in renal function, circulation, respiratory and bowel function.

Cognitive benefits of standing include: Increased cognition, being more alert, enhanced social participation with peers (when standing both in a static and in a mobile stander), and eye-to-eye status. Standing can lift the client’s mood which helps prevent depression. With better upper body positioning many find it easier to be more vocal.

Do you have any specific questions about implementing a standing program for your clients? Please share your comments or questions below.

Sitting in a wheelchair is somewhat similar to motorcycling, it can be “Bad for the Bones” and other parts of the body, but in many cases standing can help.  Check out this video featuring none other than Shawn Dean…and yes you have probably read a few of Shawn’s posts right here on the EasyStand Blog.

In this video “Wheelchair: Bad for the Bone” he tells his story on what he would have done different after his SCI rehab had he known he was vulnerable to Osteoporosis.

What benefits have you seen from standing?  Did you start standing soon after rehab?