Life from a Different Perspective: Why do we stand?
Published: 17 November 2023
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Written by Mellinda Fitzgerald Bachelor of Physiotherapy (BPhty) Astris PME Clinical Educator
The human body is inherently structured for an upright posture. From the initial stages of development, the progression is directed towards achieving an upright stance—beginning with the ability to roll over in the first few months, followed by crawling at approximately 9 months, and culminating in the act of pulling oneself to stand at around 10 months. This developmental trajectory is driven by the overarching aim of attaining the distinct perspective and autonomy afforded by independent standing and mobility.
Moreover, assuming an upright position plays a pivotal role in facilitating the optimal functioning of various physiological components, including bones, muscles, internal organs, and the nervous system. This fundamental alignment not only reflects the natural course of human development but also underscores the significance of an upright posture in supporting overall health and functionality.
If we examine the musculoskeletal system, the benefits of standing are multiple:
Promotion of Hip Stability: Standing contributes to the development of the hip joint, fostering better foot and knee alignment. Notably, children with cerebral palsy (CP), though initially possessing normal hip anatomy (Mayson T. 2011), face an increased risk of hip displacement due to limited standing (Hägglund G. 2014). Development of extensor muscle strength, with an opportunity for enhancement of postural control of the head and upper body and reduction of the risk of atrophy.
Development of Extensor Muscle Strength: The act of standing offers an opportunity to enhance extensor muscle strength, thereby improving postural control of the head and upper body. This engagement also diminishes the risk of muscle atrophy.
Spasticity Management: Standing has been observed to effectively manage spasticity, leading to a notable reduction in the effects of tone after the activity (Paleg et al 2013).
Enhancement of Bone Mineral Density: Regular standing contributes to improved bone mineral density, consequently reducing the risk of fractures (Uddenfeldt, 2013)(Kim S, 2017).
Reduction of Contracture Risk and Improved Range of Motion: The upright position reduces the risk of contractures and improves the range of motion compared to being seated in a flexed position (Paleg et al 2013).
Promotion of Spinal Alignment: Standing promotes spinal alignment, thereby reducing the risk of orthopedic deformities such as hip dislocation and scoliosis. This, in turn, helps alleviate associated pain.
Enhanced Musculoskeletal Growth and Development.
From a participation view, being upright can show improvements in:
Functional reach and hand function
The opportunity for improved head control and ease of eye contact
Normalisation of field of vision and enhanced visual field input
Age-appropriate position to interact with peers and adults, providing enhanced social development
Psychological well-being; psychosocial benefits of positioning at peer-level; improved self-concept
Increased alertness, with standing stimulating the limbic/reticular activating system.
Various factors can contribute to delayed standing or the need for additional support during the standing process. These delays or requirements for support may stem from the effects of neurological conditions, motor impairments, or genetic factors.
In the case of children presenting with diverse neurological conditions falling under the umbrella term Cerebral Palsy (CP), the utilisation of standing frames is considered a best practice, particularly for those classified at GMFCS levels IV and V.
Research findings within this population endorse the use of standing frames, emphasising the importance of abduction of at least 30 degrees (Martinsson C. 2011) (Paleg G. 2013) for stable hip development, especially among those with the most limited mobility within their programme.
Standing Frame Options:
When we look at the options for supported standing, there are broad categories of standers, with the choice depending on the capabilities of the user and their support needs.
Vertical/Upright Standers have the user positioned fully upright in the frame and requires a certain degree of trunk and neck postural control and the ability to use an assisted standing transfer. This is generally where children who only need a little bit of support may start their exploration into being upright.
Prone Standers have a slightly forward tilted position, offering slightly more support than the upright stander but still needing head control for use. An assisted standing transfer is still generally required too but this depends on the degree of forward tilt used. They are excellent for stimulating extension of the hip and trunk and improving reach capacity with the upper limbs.
Supine Standers are typically used for individuals with poor head and trunk control. The posterior trunk support together with the use of rearward tilt facilitates an upright position with graduated changes towards more upright standing. Vertical height adjustment can make transfers into supine standers easier if using more heavily assisted transfers or hoisting and provide versatility and easy adaption for individualised higher postural support needs.
Multi-Positional Standers are a single stander which offer the benefits of ease of change from supine to prone and upright. Many models now also incorporate adjustable hip abduction as well. Given the wide range of positioning options available, the majority of standers now come in this category. There are a range of accessories to support varying levels of support needs, including de-rotational trunk supports, independent adjustments for limb length discrepancies and in some, angle adjustment for variable range of movement.
An alternate option includes the Sit To Stand Frame where an individual is transferred from a seated position and transitions to a tolerable standing posture. By regularly changing through a variety of standing positions, the user may be able to stand for longer periods overall.
Selecting the stander that works best for your client requires consideration of a few factors such as physical support needs, transfer method, positioning requirements, and ease of adjustment.
Astris PME have a vast range of Standers. If you are looking for any support in this area or keen to know more, reach out to us at www.astris-pme.com.au or 1300 131 884.
Ensuring optimal performance and longevity of your Assistive Technology (AT) equipment is essential for maintaining independence and safety. Small issues can escalate if left unaddressed, potentially leading to major problems. By enrolling in our Programmed Maintenance Plan, you can proactively address these issues and prevent avoidable downtime.
AT Equipment is usually highly complex, with multiple moving parts, often performing under the stress of daily use. Doing routine inspection checks with the backup of the Astris PME Programmed Maintenance Plan will help prolong the life of your equipment and enhance safety for users.
We’re thrilled to announce that the annual Astris PME CLINICAL SUMMIT is returning to Melbourne in May! This is a not-to-be missed opportunity for Allied Health Professionals to glean insights from industry leaders, staying abreast of the latest advice and cutting-edge equipment.
We invite all Allied Health Professionals to join us at our major clinical education event for the year – the Astris PME 2024 Clinical Summit:
Date: Tuesday, 14 May 2024
Venue: Victoria Pavilion, Melbourne Showgrounds
In the wake of updated World Health Organization (WHO) guidelines emphasizing the importance of physical activity for individuals with chronic conditions or disabilities, adaptive cycling emerges as an exciting avenue to promote both physical and mental well-being. The WHO recommends 60 minutes a day of moderate-to-vigorous intensity, mostly aerobic, physical activity, across the week and that sedentary time should be limited. Cycling embodies all of this. Let's explore how trikes, particularly the Rifton Adaptive Tricycle and Schuchmann Momo Trike, play a crucial role in making cycling a reality for children facing unique challenges.
We are thrilled to release TWO new Product Selection Guides for 2024 in Paediatric and Adult editions. Explore our vast range of Standers, Alternative Indoor Seating, Positioning/Sleep Systems, Supportive Pushchairs, Walkers, Hygiene, Hoists/Support Systems, Car Seats and Exercise Equipment.
The human body is inherently structured for an upright posture. From the initial stages of development, the progression is directed towards achieving an upright stance—beginning with the ability to roll over in the first few months, followed by crawling at approximately 9 months, and culminating in the act of pulling oneself to stand at around 10 months. This developmental trajectory is driven by the overarching aim of attaining the distinct perspective and autonomy afforded by independent standing and mobility.
It's time to get moving! We are excited to launch our NEW 12-page wheelchair brochure featuring a range of Active Manual & Sports Wheelchairs, Power Add-Ons, and Full Power Wheelchairs. Unleash mobility and discover freedom and empowerment!
This could be for a number of reasons such as reducing the stress on shoulder joints, insufficient strength, fatigue, independence, or accessing powered seating functions. Overall, there are likely several goals for wheelchair users and their families as well as the clinical considerations of their therapy team to take into account.
A systematic review in 2016, explored factors influencing participation of wheelchair users in their social and community environments. The scope to change outcomes by addressing some factors or accommodating for others was also identified. When looking at the “modifiable” factors, there is a wide range where the use of a power add-on unit can improve participation and access. Some examples include:
