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Introduction[edit | edit source]
Children with severe motor impairment tend to be more sedentary and participate in less physical activity than their peers. These children face many barriers to participation, including inaccessible environments, negative attitudes, stigma and a lack of motor skills. Utilising an assistive device can be one option for overcoming these barriers, leading to more physical activity. The handheld walker is commonly prescribed to promote independent locomotion. However, these types of walkers may not be practical for children with severe motor impairment as they lack the strength and control to stand upright.
Support Standers[edit | edit source]
Support walkers/standers are an assistive mobility device for children who require more support than a handheld walker. A support stander is composed of a rigid frame with a wide base that supports the child in standing. Support walkers (also known as gait trainers) provide assistance at the trunk, pelvis and/or head and have alterations in seating, size, and steering with a range of accessories.
Benefits of Standers[edit | edit source]
In addition to facilitating ambulation, support walkers offer a host of other benefits to children with severe motor impairments. These include improvement in bone mineral density, bowel function, pulmonary function, independence, participation and social function.  Research shows that a lack of independent standing can increase the risk for hip dislocations, osteopenia, and lower extremity contractures. A lack of standing may be linked to issues with gastrointestinal and respiratory health. The use of standers has been shown to reduce pain, contractures and hip dislocations.
Complexchild.org (a resource for children with disabilities or those who are medically complex) lists an extensive range of benefits associated with standing:
- Improved leg muscle strength
- Improved endurance and cardiovascular health
- Prevention or improvement of contractures in the legs as standing provides a gentle stretch
- Reduced leg spasticity
- Improved bone mineral density and bone strengthening
- Prevention of fractures
- Prevention or minimisation of hip dislocation / the development of hip dysplasia
- Prevention of pressure sores as standing provides relief from the child's static position
- Improved circulation
- Improved breathing
- Reduced constipation
- Improved urinary function
- Improved hand use as the child can use their hands in a supported position
- Improved sleep and fatigue
- Improved self-esteem and social interaction as the child can be in a similar position as their peers
Standers and Range of Motion (ROM)[edit | edit source]
Research has shown that standing can increase hip ROM in children who are non-ambulatory. As summarised by Capati et al.:
- Children aged 1–5 years with a Gross Motor Function Classification System (GMFCS) of Level III who stood for 9 hours per week had an average increase of 1 degree of hip abduction - they were expected to lose of 4–7 degrees of motion.
- Children aged 2–6 years with GMFCS Levels III–IV, who stood for at least 30 minutes per day, had no contractures in their lower extremities.
- School children with GMFCS Levels IV and V who used a stander had an average improvement in knee popliteal angle of 3 degrees each week - their baseline popliteal angle was over 20 degrees. Parents and carers found that at the end of each standing phase, there were small improvements in the ability to perform activities of daily living.
The increased ROM associated with the use of standers is most likely due to the prolonged stretch achieved while standing. Short duration stretching or ROM exercises in children with cerebral palsy are commonly believed to be ineffective. Research has shown that non-weight bearing prolonged stretches can take up to 6 hours to improve ROM. The use of a stander in a weight-bearing position decreases this time to between 60 and 90 minutes.
Supine Standers[edit | edit source]
Supine standers are similar to tilt tables used in acute care, but they are more adaptable. Children are placed in the stander from a supine position. Adjustable straps are usually placed around the child's knees, pelvis and chest. The stander is then cranked into an almost upright position.
These types of standers are good for children with poor head control as gravity and upper extremity support can facilitate head control.
Prone Standers[edit | edit source]
Prone standers are used for children with good head control and minimal to no spinal deformity. Prone standers are similar to supine standers except that the anterior body is supported by the stander rather than the posterior portion. Most of the time, prone standers will have an upper extremity tray for weight bearing through the arms. Some prone standers allow for weight bearing through the knees in cases of knee flexion contractures.
Sit-to-Stand Stander[edit | edit source]
A sit-to-stand transfer begins with the child sitting in the stander. This means that a dependent lift is not necessary. The child may be able to transfer to the stander via a sliding board or independently. Once the child is in the seat, knee blocks are positioned and the straps are fastened. A hydraulic pump moves the device from a sitting to a standing position. These standers have a smaller footprint than the supine, prone or multiposition standers. Thus, they are more applicable for home use.
Dynamic Stander[edit | edit source]
Dynamic standers (also known as mobile standers or dynamic-mobile standers) are upright standers with anterior support and large wheels which are used to propel the stander along. These standers are more typically used in hospitals, outpatient clinics and schools than at home. Because the stander is in an upright position, it can be challenging to transfer a child with poor motor control and strength into this device.
Box Stander[edit | edit source]
Box standers are used with children who have good head and trunk control, but need prolonged standing time for bone density and strengthening. Box standers allow for more weight shifting and small feet movement.
Multiposition Standers[edit | edit source]
Another type of stander is a multiposition stander. This type of stander may helpful for children who would benefit from various positions in standing and/or who have significant variability in their head control. This type of stander can be manipulated by removing the headrests, footrests and tray table.
Standing Programmes[edit | edit source]
What is the frequency and duration of a typical standing programme? Some of the current research has been summarised by Dana Mather below:
|Children with CP Level IV, V||2-3 times a week||45 min||Prevention of contractures|
|Children with CP Level IV, V||4-5 times a week||45-60 min||Bone development|
|Peadiatrics||5 times a week||60-90 min||Help with bone mineral density|
|Paediatrics||5 times a week||45-60 min||Improved ROM in hips, knees and ankles|
|Paediatrics||5 times a week||30-45 min||Help with spasticity|
|Children with CP||daily||40-60 min||Decreased hip migration|
|Adults with stroke, SCI and other neurological conditions||daily||60 min||Increased mental function and bone mineral density|
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 1.2 George C, Levin W, Ryan JM. The use and perception of support walkers for children with disabilities: a United Kingdom survey. BMC pediatrics. 2020 Dec;20(1):1-1.
- ↑ Goodwin J, Lecouturier J, Crombie S, Smith J, Basu A, Colver A, Kolehmainen N, Parr JR, Howel D, McColl E, Roberts A. Understanding frames: A qualitative study of young people's experiences of using standing frames as part of postural management for cerebral palsy. Child: care, health and development. 2018 Mar;44(2):203-11.
- ↑ Murphy KP, Gueron L, McMillin C, Marben KB. Health Parameters in Standing and Nonstanding Nonambulatory Adults With Cerebral Palsy. Archives of rehabilitation research and clinical translation. 2021 Jun 1;3(2):100110.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Ward M, Johnson C, Klein J, Farber JM, Nolin W, Peterson MJ. Orthotics and Assistive Devices. Pediatric Rehabilitation: Principles and Practice. 2020 Nov 2:196.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Capati V, Covert SY, Paleg G. Stander Use for an Adolescent with Cerebral Palsy at GMFCS Level with Hip and Knee Contractures. Assistive Technology. 2019 Apr 4;32(1):1-7.
- ↑ 6.0 6.1 Complex Child. Why you need to get your child standing! [Internet]. 2019 [cited 17 October 2022]. Available from: https://complexchild.org/articles/2019-articles/december/get-child-standing/
- ↑ 7.0 7.1 7.2 Mather D. Standers Course. Plus. 2022