Page 13 - Mobility Management, February 2019
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           wheelchairs for people with spinal cord injuries.”
In the study that Perlich referenced, “Load redistribution in
variable position wheelchairs in people with spinal cord injury,” published in the Journal for Spinal Cord Medicine, Sprigle and co-authors Chris Maurer and Sharon Sonenblum concluded, “Standing and recline offered similar seat load reductions at their respective terminal positions. Standing also reduced loading on the backrest... the results of this study indicate that tilt, recline, and standing systems should be considered as a means of weight shifting for wheelchair users.”
Tiskus, another advocate for the benefits of standing, explains, “In a seated position, about 70 percent of the patient body weight is situated over their ischial tuberosities, those two butt bones that stick out. That’s a lot of pressure on small surface areas. Tilting allows them to redistribute those pressures over a larger surface area. Combining tilt and recline [is] even better.
“But ultimately, standing — the way our body was designed is to stand — really maximizes pressure redistribution, essentially offloading those key areas of concern, and focuses those pressures on the lower extremities, which are designed to accommodate a patient’s body weight. So it’s very effective in terms of pressure management and just makes sense from the anatomy of the human body.”
With pressure relief and weight shifting, a client’s risk for pressure wounds significantly decreases, saving the client from painful and costly medical experiences. Perlich cites a 2018 review of current management for pressure injuries published in Advanced Wound Care. Authors Tatiana V. Boyko, Michael T. Longaker and George P. Yang found that “In the United States, an estimated $11 billion is spent on pressure ulcers yearly, with $500 to $70,000 being spent on a single wound.”
Considering the cost of pressure wounds compared to the cost of standing frames and wheelchairs, Perlich said, “If you’re talking about wound treatment — that’s not even surgery — and you’re spending $70,000 and the average standing frame is somewhere between $3,000 to $7,000, which can totally offload the person, I don’t get it. I don’t get why [standing technology] wouldn’t be considered.
“Usually, if you look at payor policies, skin health is one of those benefits of standing. If there’s any issues with pressure ulcers, definitely, I think it needs be in the justifications of a letter of medical necessity.”
For clients, Medicaid programs are becoming more reliable payors for standing. “I think there’s been some more lobbying efforts at the state level for Medicaid programs to look at this as a possibility for the patients that they serve. We’re starting to see
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