I was talking with a mom last week during the IFSP (Individualized Family Service Plan) meeting, about getting her child into a stander now that he is approaching 9 months old. This little boy has increased tone in his extremities with decreased head and trunk control, very limited use of his arms and hands yet. Mom knew about standers from her private therapist; in fact they were also planning to try one in private therapy that same week we discussed standing. Mom was all ready to try one, but wondered what the stander was going to help him do.
I launched into a basic explanation of what benefits I specifically had in mind for her young son, beginning with how a stander might prevent secondary hip issues, especially if we tried one with hip abduction. Before I could get into the other benefits I’ve seen from other kids being in standers, my teammates jumped in to talk about what they have seen in other kids we have worked with together. Our team works collaboratively using a routine based approach (RBI) with one person being the primary provider for each student with developmental delays. So for this particular meeting, I was on the IFSP as a consult role, our occupational therapist being the primary provider. What a good feeling knowing my teammate had already talked about standers a bit ahead of time, clearly understood many of the benefits, and was even excited to share what we hoped the stander might do for this little boy in terms of trunk and head control in relation to functional abilities.
This little boy was just going on 9 months, and this IFSP review held a lot of information to absorb for a new parent with a child who is demonstrating physical disabilities. Not wanting to overwhelm mom with too much information, I plan to slowly revisit and talk about the reasons for standing at some upcoming appointments.
As therapists, the “why” of standing comes naturally for us, but we need to remember the multitude of standing benefits can be overwhelming to new parents. Our district uses home visit notes that include opportunities to gather reports from parents, and next steps to work on that were decided upon during that visit. This has been a great spot to highlight the “why” of standing. I like that I can jot down my reasons for standing along with the dosage amounts for parents to refer back to when too much is thrown their way all at once.
For this little guy, we hope standing in abduction will provide a mode to maintain his hip flexibility despite his increased muscle tone. Recent research gives us hope that if we can maintain flexibility we can also maintain hips with good integrity, preventing hip subluxation or dislocation. I also know from clinical use that kids I work with who used standers have improved their trunk and head control and upper body strength. This leads to improved ability to participate in functional skills such head control for social play, upper body control for reaching and playing with toys, or independent sitting to play.
Whether a child I work with has Cerebral Palsy, Spina Bifida, Down Syndrome, or another diagnosis leading to a physical motor delay, I like to use standers around 9 months old if they are unable to do standing at the couch. For some kids, stander use might be something that continues throughout their life to help with bone density, maintaining their range of motion, good hips, and bowel regularity as they grow; and opportunities to be upright for pressure relief and social interaction. For other kids, stander use might be a stepping stone to gaining better motor skills and they will go on to stand and walk on their own eventually. What ever the purpose of standers, let’s make sure we remember to explain the “why” of standers. Maybe we need to bring it up a few times throughout the life span so we, as therapists, don’t lose sight of the purpose of standers and assume everyone else knows why already!