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Standing aids.

The ability to stand lets people interact with others eye to eye, offers a change from sitting, allows greater access to social, vocational, and recreational activities, and promotes better physiological function. While many people who use wheelchairs for positioning and mobility are unable to stand without assistance, there are a number of devices which can help a person rise to and maintain a passive standing position. Funding sources for medical equipment have not consistently paid for this type of device in the past, but new legislation mandating access to public services and to employment is increasing the opportunity for people to use new devices at home, work and school. Standing devices may be more cost-effective than customizing a job site or home by helping the person to adapt more easily to the environment. Determination of a person's need for and ability to use a standing device requires careful evaluation by clinical professionals, including a physical or occupational therapist and the user's physician, with demonstration and trial use of different devices in the setting in which it will be used. Manufacturers will often provide a qualified durable medical equipment dealer with a demonstration model for this purpose.

Physiological Benefits

Weightbearing in a standing position has many physiological benefits. People who are immobilized and nonweightbearing for even just a few weeks show abnormal losses of bone calcium, reduced bone density, pathological fractures, kidney stones, and calcium deposits in muscles. Standing reduces compression of digestive and respiratory organs, allowing more complete emptying of the bladder and more relaxed breathing. It prevents contractures by stretching out muscles of the legs and back, and can decrease muscle spasms and spasticity. Standing also relieves pressure on skin areas at risk for developing pressure sores while sitting; regular standing provides a more sustained period of relief than can be achieved by doing push-ups.

People with spinal cord injuries often have problems regulating their blood pressure and cardiac output. A gradual program of standing improves circulation, strengthens the heart and allows the cardiovascular system to adapt to the changes in position more effectively.

Children with cerebral palsy often develop hip problems because of abnormal muscle tone and poor positioning. Standing helps to promote proper alignment of the hips and stimulates growth and density of weightbearing bones. Some experts believe that the socket of the hip actually deepens with regular weightbearing, making the hip joint more stable. Prolonged periods of sitting foster a posture of flexion (bending of joints), internal rotation, and adduction of the legs and can cause contractures at the knees and hips. Supported standing provides opportunities for stretching or extension of the trunk and legs and can help children develop better head and trunk control. Some children are even fed while standing because of improved oral motor control in a upright position.

Psychological Benefits

Standing is an active position, connoting readiness to face the world and to live independently, reflected in our everyday language and in the way our environment is built. Although architectural barriers are gradually being modified, attitudinal barriers are slower to break down. "Stand up and be counted," "Stand up for yourself," "Don't take that sitting down" all imply that a person has to stand to be important, to be heard. Standing allows face-to-face conversations, and can improve the self-image of the individual and the response of others.

Vocational Benefits

Providing a person with equipment which allows him or her to stand can reduce the number of site modifications required for many jobs. Employment possibilities increase when specific barriers are reduced. A person who can stand up can stock shelves, open file cabinets, operate a drill press, style hair, or perform surgery. Some vocational rehabilitation programs have purchased standing equipment for people to use on the job, recognizing it may be less expensive than architectural or on-site modifications.

Daily Living and Recreational Activities

The increased range of reach achieved in standing greatly enhances independence. Access to upper shelves and cabinets, and a better view while using a stove can allow a person to prepare meals and perform other homemaking tasks with less assistance. Dancing, archery, darts, pool and golf require standing. An appropriate standing device may allow a person to compete or interact more equally with others.

Types of Standing Devices:

* Prone Standers

Prone standers provide support to the front of the body, with lateral supports to maintain symmetry and posterior straps or pads to hold the feet, knees, buttocks and trunk in place. They usually adjust to a reclining angle, with adjustment of supports for growth and change in condition. Some are free-standing units while others are designed to lean against a table or a counter. The free-standing units usually have a more stable base and can be placed anywhere in a room independent of other furniture. Some models have small casters for easier movement, but they are not intended for outdoor mobility. The lean-to units are usually lightweight and more portable, but they tip over more easily and must be leaned on a stable piece of furniture. Most free-standing units have an activity tray at arm level, while the lean-to units rely on a table or counter for a work surface.

* Supine Standers

Supine standers provide support to the posterior surface of the body with lateral supports to maintain symmetry and anterior straps or pads to position the feet, knees and trunk. Most supine standers have adjustable angle trays in front to support the arms and provide a work or play surface, and the entire stander can be adjusted in angle from horizontal to vertical. Most have casters for easier mobility. Supine standers are useful when the user cannot assume a fully upright position, and they are similar to tilt tables used in clinical settings to achieve a passive standing position.

* Vertical Standers, Standing Boxes and Tables

People who have fairly good balance and trunk control may be able to use a vertical stander, which provides less support than a prone or supine stander. Vertical standers are appropriate for children with postural insecurity or those developing lateral weight shifting skills. These aids usually provide three-point stabilization in a fully upright or vertical position, with supports at the knees, hips and lower torso. This may be achieved through the use of: a standing frame, which consists of two uprights with pads or straps to provide a little additional stability; an upright stander, which has a solid supine support, but in a fully vertical position; a standing box, which enables the user to stand within a contained area; or a standing table, a high table surface with a cutout for the trunk and a box-like area for standing support or stability.

* Mobility in Standing

People who spend a great deal of time standing or who would like maximal access to their environments while standing can benefit from a mobile stander. There are a number of devices for both children and adults which allow users to propel themselves while in a standing position. Some of these are simply prone standers with large wheels which can be propelled by the user like a manual wheelchair. Others are more like standing boxes with handrims which connect to the wheels using a sprocket and chain drive. Some standing boxes are propelled by electric motors controlled by a joystick. Several of these standers also have mechanisms which allow the user to adjust the angle in space through a powered inclining system, increasing the user's ability to reach objects and work surfaces at different heights.

* Assisted Standing

There are several standing devices which have systems to assist the user in moving to a standing position through the use of a hydraulic or electric lift. Most rely on a sling hooked behind the person, with some type of foot positioner and knee block to help achieve extension of the hips and knees. The ability of the person to use this independently will depend on the style of the mechanism and his or her trunk strength and balance; sometimes these devices are prescribed to increase safety and decrease the amount of work an attendant must do to stand the user up. Once the person is standing, there is generally an additional safety strap or positioning pad placed behind to maintain a safer standing position.

* Stand-up Wheelchairs

People who want the freedom to choose between sitting and standing at any time wherever they are, will probably want a wheelchair they can raise to a standing position. These chairs are available in both powered and manual models, but both types are substantially heavier than their nonstanding counterparts. While all the manufacturers of the manual versions claim they can fold for transporting, they are more difficult to fold up and heavier to lift into a car. The manual versions use several different lifting mechanisms: gas struts, similar to those used to open the overhead back door on a station wagon; wire springs; or small battery-powered motors. Some of the mechanisms allow the user to lock into a position at any point of the range between sitting and standing. The selection of the mechanism and the adjustment of the system to the user will depend on how much upper extremity strength and trunk balance exists. None of the presently available manual stand-up wheelchairs can be propelled in the standing position.

There are two power wheelchairs which offer a stand-up option, with only one allowing propulsion in the standing position. Again, these chairs are larger, heavier and more expensive than nonstanding wheelchairs, but they offer users a much greater range of positions and greater access to their environments.

As with all standers, it is imperative for the user to try each model before selecting the most appropriate one. This is important in determining not only how well the standing mechanism can be activated, but also to ensure the following: that the user can propel the chair efficiently; that it will fit in the home, workplace and car; and that it is comfortable in both standing and sitting positions.

Pros & Cons of Passive Standing By Cheryl Chanaud, Ph.D. Director, PVA Research and Education

Strangely, medical literature has little to say about passive standing, especially considering the numbers of standing frames that are bought and the number of rehabilitation specialists who encourage passive standing as a form of therapy for individuals with paralysis. Despite the lack of documentation by physicians and researchers, many clinicians and paralyzed individuals agree on some or all of the following benefits:

* Reduced osteoporosis

* Improved bladder and bowel function

* Reduced spasticity and contractures

* Prevention of pressure sores

* Improved self-image and communication with people who do not use a wheelchair for mobility

* Workplace benefits with use of standing wheelchair.

However, there are criticisms of passive standing: Standing frames are boring; stand-up chairs are expensive; and passive standing does not provide activity or movement stress on bones or muscle, thereby limiting its usefulness. Despite these criticisms, most clinicians believe that passive standing is better for one's health than no standing, just as some physical activity is better than no physical activity.

Incontinence Aids Buyer's Guide

Access Medical Supply nationwide home delivery now available for Attends, Depend, Serenity. Buy by the case to save time and money. Call (800) 242-2460 -- mention this ad to receive our catalog, free sample of Attends Youth Brief and $2 coupon. Access Medical Supply.

Adaptive Design Shop bath chairs & toilet supports. The toilet support "grows." Adjusts to fit toddlers through adults. Custom built for each child; designed to keep children from slipping out. Adaptive Design, 12847 Point Pleasant Dr., Fairfax, VA 22033, (703) 631-1585.

Birth & Beginnings offers the NIKKY diaper -- 100% cotton inner padding & breathable waterproof shell. Machine wash & dry. VELCRO[TM] diaper covers & industrial strength diapers. Fits infants and adults. Birth & Beginnings, 6828 Rte. 108, Laytonsville, MD 20882, (301) 990-7975.

Columbia Medical Mfg. Corp. offers several products that make bathing & toileting easy & comfortable: toilet supports, soft-flex splash guard, wrap around bath support and reclining bath chairs. Columbia Medical, P.O. Box 633, Pacific Palisades, CA 90272, (310) 454-6612.

Concepts In Confidence offers the "Magic Bullet," a faster-acting, safe and sure suppository. Compare it to Dulcolax and others. Designed to minimize the excessive time involved in most programs. A few minutes after insertion, the "Magic Bullet" stimulates the bowel. The sooner the stimulation begins, the sooner the movement is complete -- meaning less time on your bowel program. Our users have found that they have better evacuations in shorter periods of time. For more information and free catalog on incontinence products: Concepts In Confidence, 203 Commack Rd., Suite 1023 EP, Commack, NY 11725, (800) 822-4050.

Diskreet Products, Inc. is an Incontinence Products Catalog that provides our customer confidentiality, convenience, quality products and service. A toll-free call delivers orders directly to the customer's door, eliminating the nuisance of shopping at the drugstore. Customer names are given to no one and all orders arrive in plain packaging. Buying by the case saves up to 25%. Orders are processed the same day as received. We handle disposable products, reusable items, external catheters, bags and tubing, and incontinent skin care products. Sizes: youth to adult. Diskreet Prod., Inc., 30878 Riviera Ln., Westlake, OH 44145, (800) 422-7431.

DRipride. Experience the protection of the Provide Total Care System, the most complete and effective line of incontinence products available today. Designed by a team of health care professionals, the Provide Total Care System uses super absorbent materials to provide maximum absorbtion, dryness, containment, odor elimination, comfort, convenience and security. Regular disposable briefs, ultra disposable briefs, incontinent pads and cotton pants. For more information or ordering instructions please contact: DRipride, Direct Delivery Services, P.O. Box 79603, Houston, TX 77279-9603, (800) 659-8037.

Duraline Medical Products carries most major disposable brands of incontinent products as well as a complete line of reusable diapers, inserts, pads, pants and underpads. Also available are all the skin care products you may need, including powders, creams, and washcloths. To request a free catalog or inquire about services provided by Duraline, call and talk with one of our friendly customer service consultants. A customer is not an outsider in our business; he is our business. Give Duraline a try; we stand behind our business. Duraline Medical Products, 324 Werner St., Leipsic, OH 45856, (800) 654-3376 or (419) 943-2044.

HDIS offers a full range of absorbent products -- briefs, undergarments -- as well as catheters and skin care. Our fast doorstep delivery is always dependable so you don't have to worry about running out of supplies. HDlS, 325 Paul Ave., Ferguson, MO 63135, (800) 538-1036.

Humanicare offers the Dignity(R) Plus, a complete selection of reusable garments, liners, shaped inserts, diapers and underpads for bladder/bowel protection. Available in genderized or unisex styles, for adults & children; in ambulatory and nonambulatory styles. Humanicare, (800) 631-5270.

Ortho-Kinetics introduces the TLC Bath Chair in pediatric and adult sizes; perfect for outdoor use as a lounge chair. The Adaptive Commode/ Shower Chair is adjustable for use over toilet and wheels into shower. Ortho-Kinetics, P.O. Box 1647, Waukesha, WI 53187, (800) 824-1068.

Fred Sammons 12-position pediatric bath chair is comfortable, fast-drying, & easy to adjust. Fabric is mounted on a lightweight, waterproof PVC frame. Foam pads cushion head and knees. Safety straps provide extra support for children up to 100 lbs. Sammons, (800) 323-5547, Dept. C62.

Top Drawers, a division of the R. Duck Co., offers waterproof products for all ages. Products are made of soft, waterproof nylon taffeta. They will not crack and they come in assorted bright colors. Free catalog. Top Drawers, 9011/2 Mainstreet, Hopkins, MN 55343, (612) 933-8231.

WoodBury Products delivers baby and adult disposable diapers right to your door. Offered at savings of up to 60%. Although some diapers may have slight irregularity, they are sold with a money-back guarantee. WoodBury, 4410 Austin Blvd., Island Park, NY 11558, (800) 879-3427.
COPYRIGHT 1992 EP Global Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes related article
Author:Chanaud, Cheryl
Publication:The Exceptional Parent
Date:Jul 1, 1992
Previous Article:Incontinence.
Next Article:A flag-flying 4th.

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