Numotion's COVID-19 Response: What you Need to Know

The addition and implementation of standing, as part of an individual’s postural repertoire, can positively impact physical and mental health in many ways.

 
The value and importance of standing for individuals with disabilities are well documented as part of the 24-hour posture management approach. This approach encompasses lying, sitting and standing. These postural orientations are all linked and have an impact on each other. Individuals with movement limitations, unable to independently reposition themselves, may be at greater risk of developing secondary complications such as body-shape asymmetry, pressure injuries, constipation, bowel incontinence, and respiratory issues.
 
Our bodies were never designed to be in a single position all day. Standing can facilitate musculoskeletal, respiratory, digestive, and urinary system functioning.
 
Standing Devices
 
There are several types of standing AT; each of which should be accompanied by a consultation with a physician and clinical team - who are vital in the assessment and determination of the most appropriate solutions for achieving a vertical posture. The devices are varied in their nature, and function ranging from static to dynamic standing frames to mobile standing AT devices. Determination of precautions, along with an individually-tailored standing and weight-bearing the regime, should always take place under the supervision of the healthcare team. A home program, along with follow-up and review is necessary to ensure optimal set-up, adjustment, and maintenance of equipment.
 
The Benefits of Standing
 
The opportunity to change posture and position through the introduction of standing allows for pressure redistribution between the body and the supporting surfaces. The pressure between sitting and standing are re-distributed to different weight-bearing surfaces. This can help to reduce the risk of developing pressure injuries. For those with injuries, standing can assist with improved blood circulation, and with the healing process. Furthermore, the ability to stand allows gravity to assist with digestion, colon motility, and regularity of bowel movements. Evidence shows that individuals with disabilities who use standing devices may be able to reduce the number of urinary tract infections (UTIs).
 
Standing can play an important part in the reduction of skeletal asymmetries, specifically the reduction of contractures that can occur at the heel cords, knees, and hips. A reduction in back and neck pain, associated
with prolonged periods of sitting, was reported with the incorporation of vertical positioning.
 
In addition to the physical health benefits noted, improved mental health, social interaction and confidence levels are associated with standing. Individuals who have the ability to stand with Assistive Technology (AT) report improved mood when they are able to stand and communicate with others. The psychological benefits of standing have been reported as improved self-esteem and a decrease in depression.
 
Standing can promote independence at home and in the community. With activities of daily living such as grooming and cooking, standing can make facilitate the ease of these tasks and by providing access when
compared to executing tasks from the seated orientation. Accessing and reaching items located in higher cabinets, the top shelf or back of the refrigerator, reaching elevator buttons, grocery shopping, and other everyday vertical-tasks which may have required the assistance of others, can be completed independently when an individual has access to standing AT.
 
Types of Standing Devices
 
Standing frames: These can be static or dynamic. Many of these devices have a tray or a platform and can accommodate a tablet or laptop. Others offer the option to be able to do upper body exercises while standing.

Stand and drive devices: Several standing devices on the market are battery-powered and give the individual the ability to be mobile within their home, while in a standing position. The ability to move while standing improves the person’s ability to complete functional tasks around the house.
 
Exoskeletons: These devices are battery-powered, externally worn walking AT. Some of these are FDA approved, and only for in-clinic use. Some are available for use at home or in the community. The use of this type of device is dependent on several factors such as the individual’s ability to stand safely, fracture risk-status, joint range and integrity, upper body strength, and overall endurance.
 
Powered wheelchairs with standing function: Several powered wheelchairs have the functionality to assist an individual to stand. As with all other standing devices, careful assessment of the individual is required by the healthcare team to ensure safe standing and correct set-up of the equipment.
 
Manual standing wheelchairs: There are several manual standing wheelchairs on the market. Manual standing wheelchairs can be an option for people with good upper body strength. An advantage of having a manual wheelchair with a standing feature is that they are lighter than a standing power wheelchair and easier to
transport. They don’t need to be charged and require less maintenance than a power wheelchair.
 
Pathways to Access Standing AT
 
Various pathways exist to access appropriate funding for individuals requiring the use of standing equipment. Each funding source will have a set of eligibility criteria for accessing AT and standing related technology. State programs, trust funds, and sources such as vocational rehabilitation may be viable options to explore.
 
Complex Rehabilitation Technology (CRT) resources are also available to help guide decision making. Clinician advocacy groups, such as the Clinician Task Force (CTF), equipment specialists such as Assistive Technology Professionals (ATPs), healthcare teams, and individuals who make use of standing AT can help to provide input and information...
 
If you have any questions about standing or would like to discuss funding alternatives, you can reach us at karen.roy@numotion.com or lee.ann.hoffman@numotion.com


References
 
Ágústsson, A., Jonsdottir, G. Posture Management 24/7. (2018.) In Lange, M.L., & Minkel, J.L., Eds. Seating and Wheeled Mobility: A Clinical Resource Guide. (pp.121-136) SLACK Incorporated, Thorofare, NJ.
 
Arva, J., Paleg, G., Lange, M., Lieberman, J., Schmeler, M., Dicianno, B., Babinac, M., Rosen, L. (2009). RESNA. Position on the Application of Wheelchair Standing devices.
Assistive Technology, 21, 161-168. https://www.resna.org/ sites/default/files/legacy/resources/position-papers/ RESNAPositionontheApplicationofWheelchairStanding. pdf
 
Dunn, R.B., Walter, J.S., Lucero, Y., Weaver, F., Lanbein, E., Fehr, L., Johnson, P. Riedy,L. (1998). Follow up assessment of standing mobility device users. Assistive Technology,10, 84-93.
 
Garrett, G., Benden, M., Mehta, R., Pickens, A., Peres, C., Zhao,H., (2016). Call center productivity over 6 months following standing desk intervention. IIE Transaction on occupational ergonomics and human factors. 2-3,188-195.
 
Gericke, T. (2006). Postural management for children with cerebral palsy: consensus statement. Developmental Medicine and Child Neurology. 48: 244.
 
Hamer, M., Stamatakis, (2014). Prospective study of sedentary behavior, risk of depression and cognitive impairment. Med Sci Sports Exer. 46 (4), 718-723.
 
Henson, J., Davies, M.J., Bodicoat, D., Edwardson, C., Gill, J., Stensel, D., Tolfrey K., Dunstan, D., Khunti,K., Yates, T., (2016). Breaking up prolonged sitting with standing or walking attenuates the postprandial metabolic response in post-menopausal women: Randomized acute study. Diabetes Care. 39(1), 130-138.
 
Humphreys, G., Poutney, T. (2006.) The development and implementation of an integrated care pathway for 24- hour postural management: a study of the views of staff and carers. Physiotherapy. 92 (4) 233-239.
 
Marlow, J. (2018). Numotion NuDigest: Benefits of standing. Retrieved from: https://www.numotion.com/ blog/april-2018/benefits-of-standing.
 
Obnibene, G.T., Torres, W, Von Eyben, R., Horst, K., (2016).
Impact of a sit-stand workstation on chronic low back pain. Journal of Occupational and Environmental Medicine. 58 (3) 287-293.
 
Paleg, G., Livingstone, R., Rodby-Bousquet, E., Story, M., & Maitre, N., L. (2019) Central Hypotonia. Retrieved from: http://www.aacpdm.org/publications/care-pathways Pope, P.M. (2007). Severe and Complex Neurological

Disability: Management of the Physical Condition. Elsevier, Ltd.
 
Pountney, T.E., Mulcahy, C. M., Clarke, S.M. & Green. M. (2000). The Chailey Approach to Postural Management. Birmingham: Active Design ltd.
 
Pronk, N.P., Katz, A., Lowery, M., Payfer, J., (2011). Reducing occupational sitting time and improving worker health.
Preventing Chronic Disease. 9, 154.
 
Saeidifard, F., Medina-Inojosa J.R., Supervia, M., Olson, T., Somers, V., Erwin, P., Lopez-Jimenez, F., (2018). Difference of energy expenditure while sitting versus standing: A systematic review and meta-analysis. European Journal of Preventative Cardiology. 25 (5) 522-538.
 
Taylor, S.J. (2017). Numotion NuDigest: Factors to consider when choosing powered seating tilt, recline, and standing features. Retrieved from: https://www.numotion.com/blog/ june-2017/nu-digest-factors-to-consider-when-choosing- powered
Thorp, A.A., Kingwell, B.A., Owen, N., Dunstan, D., (2014). Breaking up workplace sitting time. Occup Environ Med. 71(11) 765-771.
 
Tigbe, W.W., Granat M., Satter N., Lean, M., (2017). Time spent in a sedentary posture is associated with waist circumference and cardiovascular risk. Int J Obes. 41(5) 689-696.
 
Trudel, G., Uhthoff, H. K., & Brown, M. (1999). Extent and direction of joint motion limitation after prolonged immobility: An experimental study in the rat. Archives of Physical Medicine and Rehabilitation. 80, 1542-1547.
 
Trudel, G., Uhthoff, H. K., & Brown, M. (2000). Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee. Archives of Physical Medicine and Rehabilitation. 81, 6-13.

karen.pngKaren Roy, Numotion Brand Ambassador


 Karen Roy is a Licensed Clinical Social Worker with 20 years of experience. Most of that time was spent as a Case Manager for an in-patient rehabilitation hospital. She was the victim of an armed robbery in 1987 and has been a wheelchair user for the last 31 years. She had 3 kids after her injury. Caroline, Austin and Joseph are all in currently attending college. As Ms. Wheelchair America 2019 Karen’s platform was “Stand for Life”. Her platform is about the use of standing technology and other devices that improve the health and well-being of people with disabilities.
 

lee-ann-thumbnail.png Lee Ann Hoffman, OT, ATP, Director of Clinical Education 


As Numotion’s Director of Clinical Education, Lee Ann is focused on lifelong learning. She qualified as an Occupational Therapist in South Africa, and obtained her Masters of Science degree in Rehabilitation (posture management) in the United Kingdom. She is RESNA ATP certified and holds a 2019-2020 vice-chair position for 24-hour Posture Care and Management as part of the RESNA special interest group. She is passionate about 24-hour posture management for individuals with complex rehab needs and enjoys publishing, training and presenting at both national and international annual conferences.
Lee Ann Hoffman, OT, ATP, Director of Clinical Education and Karen Roy, Numotion Brand Ambassador

Author

Lee Ann Hoffman, OT, ATP, Director of Clinical Education and Karen Roy, Numotion Brand Ambassador