Page 28 - Mobility Management, February 2018
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                                ATP Series
Standing Frames & Standing Wheelchairs
Multiple loading and unloading into the standing position for short increments of time often assists in building the standing tolerance and mimics how we as able- bodied humans function during the day.”
The Funding Factor
In addition to sharing clinical bene ts, indications and contraindications, standing frames and standing wheelchairs also have funding challenges in common.
“Securing funding for a standing power wheelchair can be a lengthy process that requires not only evaluation from a skilled PT/OT, but interaction from an experienced dealer and manu- facturer’s rep,” Detterbeck said. “Standing trials, home trials, and sometimes driving trials are performed to ensure that the decision to place the patient in the system is the right one.
“Procurement of a standing frame is a lengthy process depending on third-party funding; however, the length of time to secure the standing frame is consider- ably shorter in comparison to a standing power wheelchair.”
“Justi cation is somewhat similar, yet dependent on payor,” Perlich said. “Most companies provide funding and
justi cation assistance, whether that is funding guides, templates or a tool like Justify It from EasyStand or Permobil’s LMN generator.
“Standing frames tend to follow stricter medical justi cation, where standing wheelchairs tend to focus on mobility-re- lated activities of daily living (MRADLs) or functional needs. From a funding and a cost-comparison perspective, a standing frame can be 1/10th the cost of a standing wheelchair and can be used regardless of the wheelchair. That presents the oppor- tunity to provide an optimal wheelchair platform and optimal standing program.”
Choosing the Better Option
So, is a standing frame or a standing wheelchair the better choice?
“Both will help to a degree in achieving clinical goals,” Perlich said. “Standing frames tend to do a better job of standing the individuals to maximize the health bene ts because of the support and alignment components and by maxi- mizing the weight-bearing position.
“A lot is dependent on the client, their individual needs and what each device has to offer for those needs by priority, be they functional or medical. The problem
with choosing function is that typically it’s at the cost of at least some of the health bene ts — i.e., in exchange for the functional gains a standing wheelchair provides, one will typically sacri ce range of motion if a standing wheelchair is the exclusive provider of range of motion/ weight-bearing stretch.”
Since there is something of a trade-off in choosing one device over the other, Perlich said the  nal decision should be made on a client-by-client basis.
“Most standing frames are static and don’t allow the same degree of functional activities that a wheelchair would,” she pointed out. “Yet the wheelchair does
not provide the same amount support
that the standing frames provide. It’s not necessarily which is better by design, but instead the decision is driven by indi- vidual needs, either medical or functional. Transfers into a standing frame or standing wheelchair are similar — a transfer must be completed for use of either device and should not be the deciding factor when choosing a product. The deciding factor should be whether the user is looking for health bene ts or functional bene ts. The product that does the best job is the right product to choose.” m
 Standing: A Manufacturer’s Perspective
For all the bene ts of standing — and there are many, including the priceless opportunity to be face to
face with able-bodied adults — Rob Travers,
VP of sales and marketing for Amysystems/
Amylior, mentioned one that might not be top of mind.
“Skin health,” he said. “We do all sorts of
headstands trying to prevent pressure sores,
and we all know the costs associated with treating a
sore. You can tilt, you can recline, but there’s nothing better really than standing. So skin health is de nitely number one.”
It might be a little unexpected to hear this from a power wheelchair manufacturer who’s also offered power tilt and recline systems for a long time. But Travers is also familiar with the numbers behind tilt and recline, and how often powered seating clients abide by repositioning best practices.
“The problem with tilting is that to get proper blood ow and circulation, your legs have to be above your heart,” Travers said. “Not everybody tilts properly. Not everybody tilts all the way
back. Some people get scared. That doesn’t mean that you’re going to get a pressure sore if
you’re not tilting properly, but if a person is able to stand and a physician can clear
standing as a bene t....”
Standing is a powered seating option
on Amysystems order forms, and Travers acknowledges that standing isn’t typically
the  rst positioning option mentioned in seating discussions.
“In Europe, in certain countries, if you’re in a complex situation, you get a stander no matter what,” he noted. “Because they strongly believe in it. It’s just not recognized that way in North America because of the cost.”
As for that other standing-height powered positioning option — seat elevation, which Amysystems also offers — Travers said, “The bene t of a seat lift is to get you to a certain level. It brings you to that level, but it doesn’t really bring you skin health. Why not just stand?” m

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