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A standing frame (also known as a stand, stander, standing technology, standing aid, standing device, standing box, tilt table) is assistive technology used by a child or adult who uses a wheelchair for mobility. A standing frame provides alternative positioning to sitting in a wheelchair by supporting the person in the standing position. Standing frames are used for the medical benefits, but also to increase independence, mobility, & self-esteem.
Stander Pediatric EasyStand.jpg
Types of Standing Devices/Function of Standing Devices
Common types of standers include: sit to stand, prone, supine, upright, multi-positioning standers, and standing wheelchairs. Long leg braces are also a standing device but not used often today.
- Passive (static) stander: A passive stander remains in one place, sometimes has casters but cannot be self-propelled.
- Mobile (dynamic) stander: User can self-propel a mobile stander if they have the strength to push a manual wheelchair. Some standers are also available with powered mobility. Mobile standers encourage exploration of an area, which is especially beneficial for children.
- Active stander: An active stander creates reciprocal movement of the arms legs while standing. Promotes active range of motion of hips, knees, and ankles while strengthening the upper extremeties. Altimate Medical, based out of Morton, Minnesota, is the only company that makes an active stander (EasyStand Glider)
Diagnoses
Standers are used by people with mild to severe disabilities including: spinal cord injury, traumatic brain injury, cerebral palsy, spina bifida, muscular dystrophy, multiple sclerosis, stroke, rett syndrome, post-polio syndrome and more. In regards to spinal cord injury, it is most beneficial for an individual to begin a standing program in rehab, and continue a standing program at home, for the greatest health benefits.
Spinal Cord Injury - Standers are used by people with both paraplegia and quadriplegia since a variety of support options are available to accommodate for mild to severe disabilities. There are many secondary complications associated with prolonged immobility of people with SCI. It is very common for SCI rehabs to incorporate standing as part of their client's initial rehab program. However, to receive the long-term benefits of standing, a standing frame should also be prescribed for home use upon discharge from rehab. When therapists or physicians prescribe a stander with their client's initial equipment purchase (e.g. wheelchair,shower commode) they also increase the likelihood of their client obtaining funding.
Common Settings & Applications
Standing devices are used in a variety of settings including: In the home & workplace, Early Intervention Centers, Schools (Special Education Classes or the inclusive classroom), adaptive physical education classes, Children's Hospitals & Therapy Centers, Rehabalition Facilities & Hospitals, Extended Care Units, Nursing Homes, Assisted Living Centers & Group Homes, and Veterans' Hospitals.
Medical Benefits
Individuals who use a wheelchair for mobility use a standing device to prevent secondary complications that often result from prolonged use of a wheelchair. Physicians & therapists recommend standing for these medical benefits: Facilitate a natural symmetrical standing posture, develop and improve upper body balance & strength, improve range of motion in spine, hips, knees, and ankles, decrease abnormal muscle tone & reflexes (spasms, contractures), reduce pressure sores (decubitis) through changing positions, improve systemic functions (bladder, digestive, respiratory & circulatory), lessen progressive scoliosis & assist with skeletal development, stabilize and prevent loss of bone mineral density, alleviate pain caused by prolonged and/or inappropriate position, develop standing tolerance & endurance.
Steps to Obtaining a Stander
1. Always start by getting approval from your physician. Make sure that it is medically safe for you to stand.
2. Once your physician has given approval, gather your team (therapist(s), supplier, caregivers & yourself) and trial the appropriate standing equipment. Document the trial process (this will be needed for justification to your payers).
- If you are paying for the stander out-of-pocket, place an order with your supplier after product trial. Once received, your supplier will deliver and set up the stander for you.
3. Normally, your therapist will write the letter of medical necessity/justification including the trial process, with the physician co-signing the letter.
4. The letter is then given to your supplier, who will submit for prior authorization from your funding sources.
- If your prior authorization is denied, it is encouraged that you appeal the denial. Many resources are available to assist you through the appeal process and/or offer alternative funding sources.
5. Once approved, the stander is ordered, received, delivered and set up for you by your supplier.
Funding & Documentation
Funding for standing equipment is achievable, but usually requires medical justification and a letter of medical necessity (a detailed prescription). Standers have been covered through state Medicaid programs, private insurance (such as Blue Cross), Worker's compensation programs, vocational rehab, and Health Maintenance Organization (HMO's). Most states have resources such as PAAT (Protection Advocacy for Assistive Technology) and State Technology Assistance Projects that are resources for consumers seeking funding or going through the appeals process.
Sit to Stand standers are billed as DME (Durable Medical Equipment) to both Public and Private insurance companies and are routinely purchased. Standers are designed to maintain function and design characteristics for repeated daily use by the patient for whom it is originally prescribed. As of January 1, 2004 sit to stand standers are HCPCS coded as E0637 (Combination sit to stand system, any size with seat lift feature, with or without wheels).
External links
EasyStand standing frames for kids and adults *
Families USA - The Voice of Healthcare for Consumers *
National Registry of Rehabilitation Technology Suppliers - NRRTS *
Sources
Able Data Fact Sheet on Standing Aids, *
Altimate Medical Inc. Funding Guide to Standing Technology. Sixth Edition, 2005. *
Holland, Diane and Tom. "Taking a Stand." Rehab Management. Mar. 2006. *
Standing 101 Seminar & Workbook. SMART Seminars. 2005. *
Assistive technology | disability Accessibility | Medical equipment
"Standing frame"