Life from a Different Perspective: Why do we stand?
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.
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- 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.
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