STAND UP AND FUNCTION

STAND UP AND FUNCTION!

Kathryn Fisher, BSc.O.T., ATS, OT Reg(Ont.)

Brenlee Mogul-Rotman, BSc.O.T., OTR, ATP,OT Reg (Ont.)

WHY DO WE STAND? We stand to greet one another, to extend courtesy and acknowledgement. We stand in order to reach, to dance, and to enhance our view of our surroundings. We lean when we stand, we shift when we stand. We stand to redistribute pressure, to move, to exercise and to complete daily functional tasks. Now consider the wheelchair dependent individual. This individual loses out on all of the above mentioned social and functional benefits of standing. As assistive technology specialists, we strive to ensure that our wheelchair dependent clients are seated with optimal posture and functional ability. Medical, functional, lifestyle and social considerations all point to standing as an alternate posture and manner in which to function.

There are numerous medical benefits to standing. Reasons that assistive technology specialists prescribe standing products include:

Prevention of muscle atrophy in lower extremities

Reduction and prevention of contractures

Improvement of circulation

Reduction of spasticity

Positive effects on bone density

Reduction of edema

Strengthening of cardiovascular system

Prevention of pressure ulcers (redistribution of pressure and forces)

Positive effect on kidney, bladder, bowel and respiratory functions

Although standing is medically and functionally desired, there are cautions that need to be considered. Cautions include malformation of weight bearing joints, excessive contractures, medical complications (G-Tubes, O2 use, bone density, cardiac related conditions, seizures etc), length of time as dependent sitter, transfer ability and need for supervision/assistance, muscle tone, client compliance.

How will standing improve the quality of our clients’ lives? What activities does the client want to achieve in standing?

Occupational therapy is based on the use of occupation or activity. There is overlap with numerous professions with the use of activity and "holistic" approach to treatment. Activities are categorized within three basic performance areas: self-care, work and school, play and leisure. Although some activities are unique to a specific performance area, other activities are carried out in all three performance areas, for example, standing. We stand to perform self-care tasks, stand to complete work and school tasks and stand for to play and complete leisure activities. Life roles and goals of that individual determine the specific activities that an individual performs. A person can have multiple roles simultaneously and these roles change throughout the person’s lifespan.

Activities can be broken down into smaller tasks. For example, the activity of setting the table involves standing to reach the cupboard of dishes, moving to the table and setting the dishes out on the table. There are many physical and cognitive abilities needed in order to produce the functional outcome of the activity and each individual may complete the task in slightly different ways. It is important as assistive technology specialists that we are aware of the different components of activities and are able to break the task down into smaller pieces. By identifying the life roles and goals the individual has, activities can be determined, broken down and analyzed. Enhancement of the client’s abilities and use of appropriate technology will assist in successful completion of the outlined task at hand. The combination of client goals, physical needs and cautions will ensure the optimal match of technology with function and lifestyle and successful completion of an activity.

The traditional static standing frame presented limitations and challenges to clients:

Transfers- assistance often required to position client in device with the necessary supports
Assistance to stand- clients often unable to independently move from sitting to standing and back to sitting
Size of equipment- standing frames are large in order to distribute clients’ weight and maintain stability
Storage- large equipment is difficult to move and store
Funding- difficult to obtain funding for multiple pieces of equipment
Function- limited opportunity for functional, purposeful activity while standing

In recent years, standing technology has developed so that our clients no longer have only the option of standing in a static position. The newest technology now includes products that provide the opportunity to move from sitting to standing within the same piece of equipment, to exercise while standing, to complete daily, vocational and avocational activities and to have a range of positions between sitting and standing. Such products include dynamic standers, mobile standers, gliders (range of motion and exercisers) and standing manual/power wheelchairs.

The need for postural support in standing should be assessed and provided as appropriate. Areas of the body that may require external support in standing include the feet, knees, hips, pelvis, trunk, shoulders and head. There are various accessories available with the newest standing technology to meet unique needs of each individual. With dynamic systems, the transition from sitting to standing must ensure that the client’s posture and positioning needs are met and that pressure/shearing forces are limited. The clinical assessment and determination of needs will identify issues, cautions, client goals and physical needs in order to assist with the choice of standing product that will meet the needs. Once clinical considerations are determined then functional implications and goals for the user must also be determined and met.

Wheelchair dependent individuals benefit from standing both medically and functionally. Lifestyle, social and self esteem needs can be addressed through meaningful activity while standing, thus optimizing physical and psychosocial potential. Purposeful activity is a necessary factor in goal achievement, client compliance and enhancement of quality of life. Therefore, it is essential to include purposeful, meaningful activity in the consideration of standing technology.

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