EasyStand Glider

Position Change to Facilitate Functional Outcomes

Metabolic Syndrome is the medical consequences of obesity, such as high blood pressure, high cholesterol (high levels of triglycerides), type 2 diabetes, stroke, heart disease and several other serious health conditions. This is one of the main reasons the disabled community have poorer general heath than the general public. Many people with a disability have what they call normal weight obesity, which means their fat cells out number their muscle cells, so although they are not large in weight, they have the problems resulting from metabolic syndrome.

The only way to combat metabolic syndrome is good nutrition and exercise. Most people who use a wheelchair do not have the opportunity to exercise to increase their cardiovascular output.
Pushing a wheelchair does not burn calories as much as walking and may increase the risk of should injury. Research on the health benefits of using standing frames.Equipment like hand cycles, FES cycling, and active standing in the EasyStand Glider, work large muscle groups to produce higher cardiac output and burn more calories. If a person is unable to exercise aggressively, then standing while playing the Wii or other active games can also be a good form of activity.

When a person moves from sitting to standing the pelvis moves from a posterior tilt to a slight anterior tilt, this creates a lordodic curve in the spine bringing the head and shoulders back. This position can help with better lung capacity, better cough, and for some people better swallowing, because the neck is in extension.

Position change can open up tremendous opportunities for cognitive and developmental improvement. Head control and improved upper extremity motor skills are the key to this improvement. Many disabled individuals have visual impairments, so it is important for them to bring their head into a controlled alignment with what they want to see. Many people are in tilt wheelchairs because of poor head control, but the consequences are that they never gain strength in the neck muscles to control their head, so their visual field is up in the air. Also, if a person is sitting all the time their upper extremity ROM is limited and the opportunity to reach is limited.

When a person is standing, or the seat has a plus 15 degree incline, many people have increased head control and rotation of the neck for better visual field. Studies have shown that standing improves motor function, providing more opportunities for play and social interaction while at eye level with peers or classmates. A standing system should offer multiple position changes for multiple therapy opportunities but also to provide relief when the individual fatigues, such as a slight recline when a child is standing to help as head control become difficult.

Sadly funding sources do not cover exercise equipment, so no mention of exercise should be in the written justification. Medicaid and private insurance focus on the physical medical benefits of the device, they will not pay for equipment for cognitive benefits. But schools districts will buy standers for this reason if it is written into the students IEP or they purchase the stander using the stimulus money recently allocated. One study that helps with justification for education is:

The effect of positioning for children with cerebral palsy on upper-extremity function: a review of the evidence.
Author: Stavness C. cstavness@cogeco.ca
2006 Hamilton Health Sciences, Complex Medicine Rehabilitation Unit, Canada.
The study states that children that have their pelvis tilted forward have better head control and functional motor skills for learning.

On the EasyStand website there are many studies that give strong justification for the physical benefits of standing but here are two good ones:

The use of standing frames for contracture management for nonmobile children with cerebral palsy.
Authors: Gibson SK, Sprod JA, Maher CA
Publication: International Journal of Rehab Research 2009,Vol 32
One hour of standing 5 days per week, led to significant improvement in hamstring length. It is possible that a standing intervention lasting longer than 6 weeks (which was the duration of the study) may have led to more sizable functional improvement.

Follow-up assessment of standing mobility device users.
Dunn RB, Walter JS, Lucero Y, Weaver F, Langbein E, Fehr L, Johnson P, Riedy L.
Rehabilitation Research & Development Center, Edward Hines Jr. Veterans Affairs Hospital, Illinois 60141, USA.
Publication: Assistive Technology. 1998;10(2):84-93.
This is a survey of people with SCI that found standing beneficial. There was a favorable response by individuals on the effects of the standing devices on bowel regularity, reduction of urinary tract infections, leg spasticity, and number of bedsores.

Play deprivation in children with, and without, disabilities is becoming a recognized developmental drawback. Standing, because of improved visual field and motor skills, facilitates more play activities and opportunities. This is also true with adult recreation. Peer, spouse and sibling interaction is improved with standing. Pediatric standing products that do not require a tray for support, encourage other people to play or interact in a more normal fashion with the child in the stander.

Standing can help with improving ADL tasks through better motor skills that can also help in sitting and laying skills. Standing and frequent position changes can help provide better educational and developmental opportunities through a better visual field, better motor skills and more endurance throughout the day.

Did you find this research and overview of the benefits of standing helpful? Does is help justify standing for your current or future clients?

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