Page 27 - Mobility Management, February 2018
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                                components for detailed alignment and support throughout the sit-to-stand, prone or supine transition and the weight-bearing position.”
Reaping the Bene ts
“The primary goals of the standing frame are to provide a safe and stable base to promote improvement in multiple areas of body function,” Detterbeck said. “Standing frames have been shown to improve such body functions as bone density, digestion, respiration,  exibility, as well as in some cases to reduce tone. While the functions and goals of the standing power wheelchair are the same as the standing frame, it differs in that
in addition, it provides mobility. The standing power wheelchair allows for greater interaction with one’s environ- ment when in the standing position, as the patient can continue with their daily functional activities.”
“Clinical goals will vary depending on the clients,” Perlich said, “but a standing frame enables a prolonged weight-bearing program. Range of motion (ROM) will probably be the initial goal for many users, as most standing frames provide full extension of the hips and knees, with the weight-bearing (hips over knees, over ankles) being a critical part of the equa- tion. Other health bene ts could include change of position or pressure relief, bone density maintenance in the long bones
of the legs, improved circulation, and improved bowel and bladder function.”
Where standing frames and standing wheelchairs do show similarities is in the wide range of bene ts from standing.
“The bene ts of improved respiration, digestion and bone density accom- plished during a standing regimen can
be obtained using either a standing
frame or standing power wheelchair,” Detterbeck said. “The advantage that standing power wheelchairs bring to the table is combining these amazing bene ts with function. More often with standing frames, patients tend to have to stand idle in one location for a set period of time. With standing power wheelchairs, the addition of mobility allows the patient to
not only perform their standing regimen, but in addition be able to move around and perform functional activities, partici- pate in school or work functions, or social gatherings. Standing power wheelchairs allow for a socially more acceptable standing program that can be done anywhere and at any time.”
Knowing the Mechanics
While both standing frames and standing wheelchairs achieve upright positioning, they arrive at those positions in different ways.
Perlich explained, “Standing frames focus on getting the person to stand in a
are very similar.
For standing, Perlich said the main
indication for a standing frame is “need for a weight-bearing program. If the person is having issues with contractures or is having dif culty maintaining ROM, the standing frame is the product that will do it. Also, if the person is thinking of participating in a walking program, they may want to consider a standing frame over a standing wheelchair. They may also want to consider a standing frame with active movement, e.g., the [EasyStand] Glider.”
For standing wheelchairs, “The patient needs to have the desire to stand along
Standing frames do a more accurate job of mimicking true standing with the hips over the knees over the ankles — Nancy Perlich
more natural position with the hips, knees and ankles being ranged. Sit-to-stand standers tend to focus on the pivot points at the knees and hips to make sure all are as closely aligned as possible when going from sitting to standing, which reduces shear during the sit-to-stand transition that occurs in both types of devices. Standing frames also are more adapt-
able to  tting users with issues such as leg-length discrepancies and contractures because of the support and positioning components available. Standing frames tend to have more components to accom- modate the most dif cult cases.”
“Standing frames typically are either set up for sit-to-stand or supine-to-stand with very little adjustment,” Detterbeck said. “The standing power wheelchair, on the other hand, can move the patient into the standing position through movements of their choice and tolerance. Often,
this programming can be altered, as the patient’s needs may change, allowing them to utilize the equipment for a much longer period of time.”
Indications & Contraindications
Detterbeck and Perlich agreed that indications and contraindications for both types of CRT standing technology
with being medical stable for standing,” Detterbeck said. “Often, power standing wheelchairs are considered to promote more frequent standing for patients. The independence with the equipment to come to standing and reduced need for transfers in and out of the equipment make it more user friendly.”
“Standing frames tend to have more components to accommodate for standing the more complicated cases,” Perlich said. “A supine or multi-position standing frame should allow for more  exibility
of position to accommodate the  exible deformities, where a standing wheelchair would need both standing and tilt or recline to accommodate postural deformi- ties if it can support in standing also.”
“The contraindications for a standing regimen are the same with both a standing frame and a standing power wheelchair,” Detterbeck said. “You should always be aware of postural hypotension and skeletal deformities when beginning or proceeding with a standing regimen, regardless of the device. The standing power wheelchair allows for the patient to independently come to standing or partial standing for short periods of time, which may allow for better tolerance with a standing regimen in the beginning.

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