Standing with Standers.....Training at Active Mobility Center

Benay Britton and Joe Navarro

This week, Benay Britton, from Active Mobility Center presented on Standing Equipment for people with mobility impairments.  Benay led the presentation saying that anyone not independently standing, and who has a mobility challenge needs to be standing. 

Benay clearly noted that anyone requesting a Standing device needs to be cleared by their physician and issued a prescription for standing.  Many people have skeletal and tendon/ligament limitations that may be aggravated or injured.

She went on to say that there are many benefits of standing from

• Builds Cardiovascular Endurance
• Improves Respiration
• Normalizes Bowel Function
• Improves Urinary Drainage
• Improves Motor Function
• Reduces the Risk of Pressure Sores
• Decreases Abnormal Muscle Tone
• Increases Circulation
• Maximizes Weight Bearing on Long Bones
• Increases Bone Density
• Increases Range of Motion

All of these helps reduces the negative affects of sitting in a wheelchair, scooter, powered wheelchair or bed.

There are many types of standing devices and they come in pediatric through adult sizes. The main types of standers are Prone, Supine, Upright and Sit to Standers. These systems come in manual or powered operation. The Prone/Supine standers come in fixed angle standers or tilt table standers. The fixed angle systems are generally for small children that are easy to transfer and where a specific angle is desired by the physician/clinician.  In many cases, it takes time to achieve more upright standing, and where an adjustable table stander is used in either prone or supine. These larger tilt tables allow the caregiver to be loaded on a flat table and then adjusted to the angle of standing tolerated or prescribed.

As the user becomes heavier and taller, transferring can be more difficult and using a table type stander. Additionally these tables for adults become very large and the user's environment may not accommodate the footprint. 

The Sit to Stand systems offer a smaller footprint, and allow for easier transfers for larger users.The

sit to stand systems can be used from sitting through standing and can be operated by the user themselves.  There are emerging studies that show increased benefits to bone density going from sit to stand. The drawback to the sit to standers is that they place force through the knees to achieve standing, and where the user needs to be able to tolerate this pressure

There are several manual and powered wheelchair standers that are commercially available. For many people standing affects their vocation, their ability to cook, access the home and interact with people.  Many times the need to stand cannot wait until one transfers into a separate standing device. 

What's Required from Insurance for Funding?

Like all Medical Equipment, a Prescription from a physician, explaining the need for standing, and most insurances now require a clinician to perform a specialty evaluation. The clinician may be a physiatrist (physical medicine doctor), a physical or occupational therapist.  These clinicians will perform a functional assessment which will determine whether a stander is medically necessary, and which type/orientation is most appropriate.  Many times it can require trialing equipment to determine what is most appropriate. Today, an ATP (Assistive Technology Provider), or SMS (Seating and Mobility Specialist) can help make recommendations once the user has been cleared for standing.

Who Funds Standers?

Technically any insurance should if medically necessity is established; however Benay explained that Medicare is very difficult to achieve approval. She explained that Medicaid, Vocational Rehabilitation, Worker's Compensation and most Private Insurances do approve these items.  Benay further explained that many insurances look at Standers and Gait Trainers as same or similar equipment, so when discussing options with one's physician and clinician; ensuring the most appropriate equipment is being provided.  Typically like all DME, there is a five year life expectancy on this equipment by the insurance provider.

This article was written by Carey Britton, Seating and Mobility Specialist for Active Mobility Center, and Complex Rehab and Assistive Technology Provider in South Florida. Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .