A standing frame is a piece of assistive technology that allows individuals with significant mobility impairments, such as those resulting from a spinal cord injury, to assume an upright, weight-bearing position. This equipment provides the necessary support to stand safely when independent standing is not possible. The device is used by people with a range of conditions, including paraplegia and quadriplegia.
Health Rationale for Standing
After a spinal cord injury, prolonged sitting can lead to secondary health complications that a regular standing program can address. A primary concern is the loss of bone mineral density, which can lead to osteoporosis and an increased risk of fractures. Applying weight through the legs via standing is an intervention intended to counteract this bone density loss.
Standing also improves circulatory function, as immobility can lead to poor circulation in the lower extremities. This upright posture promotes blood flow and can help reduce the risk of blood clots. It also benefits respiratory health by allowing the diaphragm more space to expand, which can lead to more effective breathing.
The force of gravity can aid in stimulating bowel regularity and promoting more complete bladder emptying, helping to prevent urinary tract infections. Standing is also a method for pressure relief, shifting weight off areas susceptible to pressure sores from constant sitting. Many users report that standing helps manage spasticity by providing a sustained stretch to muscles, and it can enhance psychological well-being by allowing eye-level social interaction.
Types of Standing Frames
Standing frames are available in several designs, each catering to different levels of physical function and support needs. The main categories are passive, active, and sit-to-stand standers.
Passive standers are designed to hold a person in a stationary standing position. These frames, which may be prone (forward-leaning) or supine (backward-leaning), provide extensive support at the feet, knees, pelvis, and trunk. They are often used by individuals with limited head and trunk control or those who are in the early stages of a standing program.
Active standers allow for movement of the arms or legs while the person is upright. Some models feature a gliding mechanism that creates a reciprocal movement in the legs, facilitated by the user moving handles with their arms. This type of frame introduces an element of exercise to the standing session, engaging muscles and enhancing circulatory benefits.
Sit-to-stand frames are designed to assist a person in moving from a seated position, often directly from their wheelchair, into a standing position. These devices often use a manual or powered lifting mechanism, which can reduce the need for caregiver assistance during transfers. They are well-suited for individuals who have enough upper body strength to participate in the transfer but require support to achieve and maintain a full standing posture.
Considerations for Use
Implementing a standing program requires professional guidance to ensure safety. A clinical evaluation by a physical or occupational therapist is the first step. The therapist assesses the individual’s physical condition, including joint range of motion, muscle tone, and cardiovascular stability, to determine if they are a suitable candidate.
A primary safety concern during standing is orthostatic hypotension, a sudden drop in blood pressure upon moving to an upright position. Therapists create a gradual standing protocol, often starting with short durations and slowly increasing the time as tolerated, while monitoring blood pressure. Tilt tables are used initially in a clinical setting to help a person acclimate to an upright position.
The schedule for using a standing frame is highly individualized and prescribed by a healthcare professional. While some research suggests benefits from standing 30-60 minutes, five times a week, the optimal duration varies. The user and their caregivers will be trained on how to safely transfer into and out of the device and perform regular checks to ensure all supports are secure.
Acquiring a Standing Frame
A standing frame is medical equipment and requires a prescription from a physician. The process begins with the rehabilitation team, where a physical or occupational therapist performs an evaluation to determine the need for the device. This evaluation is used to write a detailed letter of medical necessity, justifying the need for a specific type of standing frame.
This documentation is then submitted to the individual’s insurance provider, such as Medicare or a private health plan, for prior authorization. Insurance coverage for standing frames can vary significantly, and if a claim is denied, an appeals process can be pursued.
If insurance does not cover the cost, or only covers a portion, there may be out-of-pocket expenses. Families may need to seek alternative funding sources. These can include state waiver programs, charitable organizations, or community groups, and sourcing refurbished equipment may be another option.