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Timestamp: 2019-04-21 14:36:06+00:00

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This is a RESNA (Rehabilitation Engineering Society of North America) position case study on the benefits of regular standing when paralyzed with the assistance of a standing wheelchair or other standing device.
wheelchair base also enables standing to enhance functional activities.
Special precautions must be exercised when utilizing standers, in order to avoid the risk of injury, such as fractures. A licensed medical professional (i.e. physical or occupational therapist) must be involved with the assessment, prescription, trials and training in the use of the equipment. The purpose of this document is to share typical clinical applications as well as provide evidence from the literature supporting the application of this seat function to assist practitioners in decision making and justification. It is not intended to replace clinical judgment related to specific client needs.
A standing feature integrated into a wheelchair base allows the user to obtain a standing position without the need to transfer from the wheelchair. A mechanical or electromechanical system manipulated via levers or the wheelchair’s controls moves the seat surface from horizontal into a vertical or anteriorly sloping position while maintaining verticality of the legrests and backrest, thus extending the hip and knee joints. A full vertical standing position can be achieved directly from sitting, or through gradual angle changes from a laying position, or a combination of these p ositions. Most wheelchair standers allow for full or partial extension of the hip and knee joints, and full upright or partially tilted positions. Wheelchair standers are available on manual or power wheelchair bases.
functional and medical benefits. A standing position can be assumed as needed, both for indoors and outdoors activities – it can aid productivity and integration at work, school, church, or enhance independence for example when shopping for groceries. Being able to perform standing from one’s wheelchair also minimizes transfers, thereby enhancing safety, conserving energy and reducing dependency. Research suggests that in addition to expense and lack of awareness, the major reasons for not using stationary standers for wheelchair users with Spinal Cord Injury (SCI) is time constraints, lack of assistance, and/or lack of space for an extra device.
should not be considered as a substitute for therapy.
secondary complications so often seen in wheelchair users.
Many users experience improved lung capacity when standing often.
improved respiratory volume 2. Standing can help also reduce congestion and coughing 5.
caregiver, increasing the risk of developing pressure sores.
Users of standing devices reported that they were able to empty their bladders more completely than prior to using the device 1.
shown to reduce the occurrence of UTI for wheelchair users 1, which could lead to kidney infections.
in a user, standing can be an effective mean to help prevent this secondary complication.
quantify the negative effect of weightlessness and lack of weightbearing on BMD 13- 17.
the benefits of frequent passive standing and weight bearing/exercise on BMD 22- 25.
with disabilities often heal slower, as well. Fractures may limit short and long term function.
of calcium and/or vit amin D, have not proven effective at minimizing disuse bone loss 28.
some impact or force being transmitted to the skeleton during weight bearing.
extremities carry the entire weight of the body therefore loading is most efficient.
most prone to bone degeneration due to reduced or limited weight bearing.
multitude and varied magnitude), in order to fully prevent loss of BMD.
allow for frequent loading of the bones throughout the day by just performing partial standing.
appears to be superior in BMD loss prevention.
consequence of utilizing a wheelchair stander 2. Some benefits are reduced swelling in the legs and feet.
comfort, minimize further range of motion losses, improve function and conserve energy.
and significant effect on spasticity 40.
When fully standing, pressure is 100% relieved off the Ishial Tuberosities (ITs).
have suffered fewer pressure sores while using standers 41, or integrated wheelchair standers1,2.
promote proper development of the acetabular socket.
enhance their independence, improve vocational, and enable recreational activities.
Ability to access vending machines, payphones, high elevator buttons, coffee shop counters, etc.
Enhance recreational activities, for example by standing up with others on a ball game.
suggests that some clients find this position to improve their alertness and/or improve their upper extremity function.
standing programs. They often have a stander at school and one at home.
equipment, and ensures more frequent and independent initiation of standing.
alleviate problems with orthostatic hypotension, especiall y with clients after prolonged bedrest.
by others is perceived to be higher, and depression is often reduced.
may cause harm if attempting to overstretch contracted muscles.
deformities are not flexible. Skeletal alignment is to be carefully observed while standing.
warranted, such as X-rays and bone density assessment.
prematurely and without a well designed progressive standing program.
Postural hypotension: check for blood pressure and dizziness while standing up, especiall y for new clients with recent injuries. Some amount of sacral shearing might occur while standing up or sitting down – attention must be paid to skin integrity in the sacral region.
Frequency and duration of standing routines are recommended on an individual basis.
sores and skeletal deformities ; and enhancing psycho-social well-being.
and tolerance to staying in the wheelchair all day.
Mr. D. is a 36 year old male with a diagnosis of tetraplegia due to a C7 spinal cord injury.
complaints of shoulder pain and improved upper extremity function.
device users. Assist Technol, 10 (2), 84-93.
by patients with Spinal Cord Injury. Level IV.
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standing frame for a single client. Level V.
table for managing constipation. Sci Nursing. 18(2):74 -7, 2001 Summer.
Case study describing the use of a tilt table for a single client with SCI.
Review of medical records at various time points post SCI. Level III.
calcium output, performed with healthy males. Level II.
9. Thompson CR. Figoni SF. Devocelle HA. Fifer-Moeller TM. Lockhart TL.
extremity bone mineral density in children with neuromuscular impairment.
Canadian Medical Association Journal. 136(6):587 -93, 1987 Mar 15.
Review of controlled experimental trials on the effects of calcium intake and physical exercise. Level V.
Sports Sciences. 5(2):155-63, 1987 Summer.
Review of controlled trials on the effects of dynamic weight loading in osteogenesis. Level V.
12. Ehrlich PJ. Lanyon LE. Mechanical strain and bone cell function: a review.
[Review] [225 refs] Osteoporosis International. 13(9):688-700, 2002 Sep.
Review of controlled trials on t he effects of mechanical strain on bone cell function. Level V.
musculoskeletal system. Physiologist. 25(6):S41-4, 1982 Dec.
Summary of experience with the effects of weightlessness on calcium metabolism. Level II.
14. Whedon GD. Lutwak L. Rambaut P. Whittle M. Leach C. Reid J. Smith M.
effects of earth long-term recumbency. Life Sciences & Space Research. 14:119- 27, 1976.
Experimental study of astronauts in space. Level III .
Nutritional Science & Vitaminology. 31 Suppl:S41 -4, 1985 Dec.
Review of the effects of lack of weight bearing and mecha nical loading on BMD. Level V.
Review of the effects of immobilization on bone structure. Level V.
Balance Reverse by Weight Bearing Exercise, Aviation, Space, and Environmental Medicine 58:308-314 (1987).
Controlled experimental study of rats in hypokinetic situation vs. regular weight bearing. Level II .
insufficiency by controlled dynamic loading. [Journal Article] Calcified Tissue International. 38(4):209-16, 1986 Apr.
Controlled experimental study of turneys on a calcium-insufficient diet. Level II.
various metabolic and physiologic functions of normal men. American Journal of Medicine, 4, 3.
Experkental study of normal males analyzing the effects of immobilization. Level III .
bone mineral. Metabolism, 19, 1071. Experimental study of healthy males. Level III.
6(3), 579-594, Philadelphia: W.B. Saunders Company.
Review of disuse causes and contributing factors to osteoporosis. Level II.
Physical Medicine & Rehabilitation. 59(10):447 -50, 1978 Oct.
patients and observing the effects of early ambulation post injury on their calcium balance. Level II.
Strengthening Exercises. Paraplegia 19:289-293 (1981).
observing the effects of weight bearing exercises on their calcium balance. Level II.
paraplegic patients who do or do not perform standing. Osteoporosis International. 4(3):138-43, 1994 May.
Controlled non-experimental study of paraplegics who do and not not perform standing. Level III.
of "standing" on spasticity, contracture, and osteoporosis in paral yzed males.
Archives of Physical Medicine & Rehabilitation. 74(1):73 -8, 1993 Jan.
Experimental study measuring the effects of standing on paraplegics. Level III .
Physical Medicine & Rehabilitation. 65(9):537 -41, 1984 Sep.
develope d and demonstrated on four children with Osteogenesis Imperfecta. Level V.
mobility management. Clinical Orthopaedics & Related Research. (159):111-22, 1981 Sep.
Osteogenesis Imprerfecta, and results demonstrat ed with twelve children. Level V.
III (eds)., Osteoporosis: Etiology, Diagnosis, and Management,435-473. Philadelphia: Lippincott-Raven Publishers.
Review of osteoporosis and its management. Level I .
combat the thinning bones of osteoporosis. London: Prion.
Review of osteoporosis and the effect of exercise to help combat it.
30. Bonnick, S.L. (1994). The Osteoporosis Handbook. Dallas: Taylor Publishing Company.
Management of osteoporosis, effect of weight bearing. Level V.
uniformity and self -similarity of low-magnitude strains. [Journal Article] Journal of Biomechanics. 33(3):317-25, 2000 Mar.
occurring on three different species of animals during normal activities. Level III.
American Journal of the Medical Sciences. 316(3):176-83, 1998 Sep.
Comprehensive review of bone adaptation d ue to skeletal stresses. Level V.
remodelling. [Journal Article] Journal of Biomechanics. 17(12):897-905, 1984.
Experimental controlled study assessing the remodeling properties of the avian ulna under various loading conditions. Level II .
34. Rubin CT. Lanyon LE. Regulation of bone formation by applied dynamic loads.
[Journal Article] Journal of Bone & Joint Surgery - America n Volume. 66(3):397- 402, 1984 Mar.
Miner Res. 2004 Mar;19(3):360-9. Epub 2004 Jan 27.
mechanical loading on bone condition in children with disabling conditions. Level II.
(SATMU) --Redefining Wolff's Law: The bone modeling problem. The Anatomical Record, 226, 403-413.
Description of bone modeling theory. Level V.
and lumbar bone mineral content in postmenopausal women. Annals of Internal Medicine, 108:824- 828.
women and the effect of exercise on their lumbar bone mineral content. Level III .
physical activity play a role in preventing osteoporosis? Research Quarterly for Exercise and Sport, 65(3), 197-206.
Review article on the effects of exercise on osteoporosis. Level V.
in patients with spastic paraplegia. Scandinavian Journal of Rehabilitation Medicine. 13(4):117-21, 1981.
Experimental study on the effects of stretching with or without weight loading in paraplegic patients. Level III .
40. Bohannon RW. Tilt t able standing for reducing spasticity after spinal cord injury.
Archives of Physical Medicine & Rehabilitation. 74(10):1121-2, 1993 Oct.
Case study with a single client with SCI on the effect of tilt table use on spasticity. Level V.
body-seat interface. J Rehabil Res Dev. Fall;29(4):21-31.
Experimental study on tilt-recline systems and their effect on pressure. Level III .
Transactions on Neural Systems and Rehabilitation Engineering 2001; 9: 215- 224.
Experimental study on repositioning and its effect on pressure. Level IV.
Case study description of a client utilizing a standing wheelchair. Level V.
Level I: Evidence is obtained from meta-analysis of multiple, well -designed, controlled studies.
Level II: Evidence is obtained from at least one well -designed experimental study.
technology; and by supporting the people engaged in these activities.

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