Standing Aids

This article contains selected excerpts from the ABLEDATA FACT SHEET ON STANDING AIDS, reprinted with permission from ABLEDATA.

Introduction

People rarely think about the ability to stand and how it affects their daily lives. Standing is an alternative to sitting. It gives us greater access to social, vocational, and recreational activities. It improves the body's physiological functioning. The right standing aid may also be more cost effective than customizing a job site or home because one of its primary functions is to assist people in adapting to their surroundings.

There is a vast array of standing devices to choose from. Some devices allow a person to move upright from place to place with either manual or powered propulsion. Others are stationary. Most standing aids can be adjusted for growth or changes in physical condition; most can be used by more than one person. Some devices are fairly simple, built out of plywood with foam support pads that can easily be constructed by a handy relative or friend. Others are complicated, heavy, expensive products made with high technology. Try to find out as much as you can about the standing aids that might fit your needs, and be an active participant in the selection of any product that you use.

Components of Standing Aids

Standing aids are available in three basic types: prone, supine, and vertical. All three types of standers share certain components. A list of those basic components, with brief descriptions, appears below:

• Growth rods for back and torso areas allow a stander to be adjusted to accommodate changes in the user's height.
• Back tilt adjustment increases or decreases the degree of incline. Feet stabilizers permit proper foot positioning and minimize internal or external hip rotation.
• Footplates offer added stability by bearing weight and pressure. They make it easier for users to flex and extend of the ankles (dorsiflexion and plantar flexion).
• Adjustable chest pads encourage the user to bear weight on the lower extremities by supplying varying degrees of chest support.
• Adjustable knee blocks improve posture by controlling the knees’ ability to bend while the user is in a passive standing position.
• Adjustable head and neck support serves two purposes, to accommodate changes in growth and to position the head and neck properly.
• Adjustable torso support and torso tilt knobs adjust the degree of support and the degree of incline in the user's torso area.

Types of Standing Aids

As mentioned above, there are three categories of standing aids. Each type of stander has its advantages and disadvantages, and it is possible for more than one type of stander to be appropriate for an individual consumer. A discussion of each kind of standing aid—prone, supine, and vertical—follows.

Prone Standers

Prone standers support the front of the body; they lean the user forward at varying angles to keep him/her upright. To further steady the user there are lateral (side) supports as well as posterior straps or pads that hold the feet, knees, buttocks, and trunk in place. The angle at which a user stands can usually be varied. The supports can be adjusted for growth or a change in the user's physical condition.

Some prone standers are freestanding units. Others, called "lean-to standers", are designed to lean against a table or counter. The freestanding units usually have a more stable base, can be placed anywhere in a room regardless of other furniture, and may have small casters for easier movement (though they are not intended to offer mobility outdoors). The lean-to units are usually lighter weight and more portable, but they tip over more easily and must lean against a stable piece of furniture. Most freestanding units include an activity table at arm level, whereas lean-to units rely on a table or counter for a work surface.
Lean-to prone standers can help both adults and children develop skills in standing and endurance. A lean-to unit adjacent to a standing table positions the users to take advantage of space for work or play and encourages them to use both hands. Lean-to models are to be leaned against a wall, a standing table, or some other structure for support. Most of them have chest and knee supports with straps, and their standing platforms come equipped with heel and toe-ankle straps as well as removable abduction wedges (foam cushions that aid in support and positioning).
For children with mild or moderate neuromuscular limitations, adaptive prone standers may be helpful. Their purpose is to help children to adjust gradually to weight bearing. A folding crank allows infinite angle adjustments, from 0 to 71 degrees. Their rear casters are extended, for added stability.
Certain prone standers also can be used as supine or vertical standers.

Supine Standers

Supine standers support the posterior (back) surface of the body and offer lateral supports to maintain symmetry as well as anterior (front) straps or pads to position the feet, knees, and trunk. Most supine standers have an adjustable angle tray in front to support the arms and provide a work or play surface. Usually, the angle of the entire stander can be adjusted from horizontal (with the user on his/her back) to vertical. Most have casters for easier mobility. Supine standers, which are similar to tilt tables used in clinical settings to achieve a passive standing position, which stand fully upright are useful for users cannot stand fully upright. The supine category includes both frames and tables or boards.

The Large Supine stander from Rifton Equipment, is a padded supine standing table for children and adults 46 to 72 inches tall. It is designed to support the user in a standing position when prone standing does not allow optimum positioning. This board is different from tilt tables; it gives users much greater control of the head, trunk, pelvis, knees, and feet, while it allows partial weight bearing. A person who lacks the strength or ability to lift or control the head and shoulders may find this standing aid ideal.

Vertical Standers

For people who have fairly good balance and trunk control, vertical standers, standing boxes, and standing tables are often recommended because they generally provide less support than a prone or supine stander. Vertical standers, which usually provide three-point stabilization in a fully upright or vertical position, with supports at the knees, hips, and lower torso, are suited to children who have postural insecurity or are developing lateral weight-shifting skills. Vertical standers come in three types:

1. A standing frame consisting of two uprights with pads or straps to provide a little extra stability.
2. A standing box that enables the user to stand in a contained area.
3. A standing table with a box-like area for standing support or stability, and a high table surface with a cutout for the trunk.

Of those three types of vertical standers, the standing frame and the standing table are the most common. It is rare to find a standing box sold without a table.

Mobility in Standing

People who spend a great deal of time standing, or who need maximum access to their environment while standing can benefit from a mobile stander. A number of products available for both children and adults allow self-propulsion while the user is in a standing position. You should consult the ABLEDATA database and the other consumer information from ABLEDATA and other assistive technology information sources as well as your physician or a rehabilitation professional, to select a mobile standing unit appropriate for you.

Rifton Mobile Standers are pre-ambulatory mobile standing aids for children 30 to 37 inches tall, 37 to 47 inches tall, and 47 to 60 inches tall respectively. The devices have a strapping system and contoured body support for a range of 0 to 100 percent weight bearing with optimal positioning for the user. The child stands on a platform supported by two rear casters and one front caster. The two large hand-propelled wheels on either side of the body board will roll in response to a slight, minimal effort. An adult version of the Mobile Stander, is also available.

Sources of Funding

No matter what type of standing aid is chosen, it is always a major investment. The financial assistance the user can qualify for depends on his or her medical insurance, eligibility for medical or social services, or income support from various sources. ABLEDATA’s Informed Consumer Guide to Funding for Assistive Technology is available to help people explore funding options. Other information may be available from the State Assistive Technology Act program in each State.

Conclusion

This ABLEDATA Fact Sheet is an introduction to the various kinds of standing aids available to enable people with mobility disabilities to take advantage of all of the benefits of the ability to stand. ABLEDATA publications are available in alternative formats (Braille, large print, cassette, and PC-compatible diskette) upon request. It is recommended that the information in this fact sheet be used in conjunction with consultations with medical professionals and/or physical and occupational therapists.