When an infant first stands up in her crib, her parents celebrate. But what about a child with a medical condition who is unable to achieve this milestone? Regardless of diagnosis, a child or adult who spends most of their day sitting is subject to health risks.
Fortunately, manufacturers worldwide are committed to designing standing devices that provide medical and functional solutions to meet evidence-based recommendations for postural management. Postural management provides intentional, comfortable positioning opportunities in standing, sitting, and lying, plus movement where possible, throughout the 24-hour day. When implemented throughout a client’s lifespan, postural management prevents secondary complications and improves function and participation.
A recently published international clinical practice guideline cites adaptive standing before age two as an intervention to prevent musculoskeletal impairment for children with cerebral palsy.¹ Children with neuromotor conditions such as cerebral palsy or other complex syndromes are born with perfect body symmetry; their joints and muscles are intact and flexible. The effect of gravity on the body, as the child is immobile and spends prolonged periods in asymmetrical positions during growth, results in deformity.² Today, adaptive positioning devices such as standers can make all the difference.
Before adaptive standers became more widely available, allowing caregivers to initiate standing before age one, the consequences of immobility-induced bodily distortion resulted in inevitable and costly hospitalizations. Surgical muscle-tendon releases, orthopedic osteotomies to restructure the hip joint, and complex spinal fusion surgeries are examples of the corrective medical procedures now effectively avoided through proactive early-intervention adaptive standing.
Using adaptive standers, therapists can coach family caregivers to start age-appropriate developmental standing opportunities in manageable intervals during the child’s daily routines. Therapists can also educate family caregivers on the value of 24-hour postural management, providing specific instructions for standing position and dosage. Often, parents will discover their child’s positive response to the upright position and their child’s standing time will increase. This approach has outcomes beyond musculoskeletal health: children experience an age-appropriate position that positively impacts their visual field, social interaction, and potentially their cognitive growth.
Standing opportunities continue throughout early childhood and the school years: a critical time for standing protocols. Growth spurts will predispose a child with a neuromotor condition to an increased risk of contracture and other deformities. Consistent, regular standing will maintain and improve joint range of motion and bone mineral density, thereby improving the child’s posture and movement function and reducing their risk of fracture. Far from being the only intervention, adaptive standing offers activity in a natural position and is a valuable adjunct that can alternate with and support the child’s adjacent therapies for mobility and learning. Under the guidance of a therapist, a planned approach for standing can occur at home and in school, embedded naturally into daily activities and routines as a child-centered, participatory opportunity.
Adolescents and adults also benefit from supported standing. It is never too late to stand. To begin with, a client of any age will need medical clearance or referral from a knowledgeable healthcare provider. Then an accommodation trial period assures that the individual will build tolerance over time and that standing is feasible and medically safe. At the same time, special care and instruction will be provided should there be a risk of fainting or a case of bone fragility. The individual’s cognitive function and the support required for safe transfer to the standing position will inform decision-making on which standing device to choose.
Recent overviews of the literature co-published by the Clinician’s Task Force offer a comprehensive review of available peer-reviewed research on standing for children and adults. ³ ⁴ Whether the client has had a condition since infancy or has acquired a condition through circumstances or a medical event, supported standing not only offers positive outcomes for neuromuscular, cardiovascular, respiratory, digestive, and mental/cognitive domains, as well as reducing skin pressure issues and pain levels; but also improves psychosocial well-being and activities of daily living.
With the wide variety of standing device options now available, therapists can select and trial a device whose characteristics align with the evaluated needs of the client. Whether a multi-position, mobile, sit-to-stand, or powered wheelchair stander, a standing device is designed to meet specific goals that address the client’s hip integrity, bone density, muscle length, joint range of motion, spasticity, bowel/bladder function, respiration, and circulation. But beyond the remarkable reductions in healthcare complications and costs that accompany properly prescribed standing, there is something just as important to clients and families: immeasurable gains in social and cognitive engagement.
Healthcare funding sources around the globe are re-examining and revising policy and coverage for adaptive standers considering these up-to-date research-based outcomes. Continued advocacy, education, and experience will secure the place of adaptive standing in best practice today and for the future as a standard of care.
Lori may be reached at loripotts@ccimail.com Lori Potts, PT, obtained her degree at Upstate Medical University College of Health Professions in 1995. Since 1998, Lori has been a certified MOVE International Trainer (Mobility Opportunities Via Education). She currently works at Esopus Medical, PC, with pediatric clients. Since 2005, Lori has worked with Rifton, consulting product design and providing resources for consumer and client education. She is a regular contributor to Rifton’s online Education Center and conducts equipment-related workshops throughout the US, Canada, Europe, and Australia. Potts is a member of the American Physical Therapy Association and the Academy of Pediatric Physical Therapists Association.
References:
¹ Morgan, C., Fetters, L., Adde, L., Badawi, N., Bancale, A., Boyd, R. N., Chorna, O., Cioni, G., Damiano, D. L., Darrah, J., de Vries, L. S., Dusing, S., Einspieler, C., Eliasson, A. C., Ferriero, D., Fehlings, D., Forssberg, H., Gordon, A. M., Greaves, S., Guzzetta, A.,Novak, I. (2021). Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatrics, 175(8), 846–858. https://doi.org/10.1001/jamapediatrics.2021.0878
² Sato H. (2020). Postural deformity in children with cerebral palsy: Why it occurs and how is it managed. Physical Therapy Research, 23(1), 8–14. https://doi.org/10.1298/ptr.R0008
³ Masselink, C.E., Clayback, D., Huleatt, Z., LaBarge, N., Paleg, G., Percich, N. (2021, July). Evidence-Based Response to Insurance Denials of Standing Devices. Clinician Task Force. https://www.cliniciantaskforce.us/resource/evidence-on-standing-frames-for-insurance-denials
⁴ Masselink, C. E., Detterbeck, A., LaBerge, N. B., & Paleg, G. (2024). RESNA and CTF position on the application of supported standing devices: Current state of the literature. Assistive technology: the official journal of RESNA, 1–18. Advance online publication. https://doi.org/10.1080/10400435.2024.2411560
