Standing frame

A standing frame (also known as a stand, stander, standing technology, standing aid, standing device, standing box, tilt table) is assistive technology used by a child or adult who uses a wheelchair for mobility. A standing frame provides alternative positioning to sitting in a wheelchair by supporting the person in the standing position. Standing frames are advertised as increasing independence, mobility, and self-esteem.

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Types of Standing Devices/Function of Standing Devices

Common types of standers include: sit to stand, prone, supine, upright, multi-positioning standers, and standing wheelchairs. Long leg braces are also a standing device but not used often today.

• Passive (static) stander: A passive stander remains in one place, sometimes has casters but cannot be self-propelled.
• Mobile (dynamic) stander: User can self-propel a mobile stander if they have the strength to push a manual wheelchair. Some standers are also available with powered mobility.
• Active stander: An active stander creates reciprocal movement of the arms legs while standing.

Diagnoses & Users

Standers are used by people with mild to severe disabilities including: spinal cord injury, traumatic brain injury, cerebral palsy, spina bifida, muscular dystrophy, multiple sclerosis, stroke, rett syndrome, post-polio syndrome and more.

Spinal Cord Injury - Standers are used by people with both paraplegia and quadriplegia since a variety of support options are available to accommodate for mild to severe disabilities.

Doug Betters and Mike Utley are both former NFL football players who are quadriplegics due to spinal cord injury. They both stand using active standers.

Common Settings and Applications

Standing devices are used in a variety of settings including: In the home and workplace, Early Intervention Centers, Schools (Special Education Classes or the inclusive classroom), Adapted Physical Education classes, Children's Hospitals and Therapy Centers, Rehabilitation Facilities and Hospitals, Extended Care Units, Nursing Homes, Assisted Living Centers and Group Homes, and Veterans' Hospitals.

Documentation and Funding

Effective Documentation- Funding (government funding or insurance) for standing equipment is achievable, but usually requires medical justification and a letter of medical necessity (a detailed prescription) written by a physical therapist or medical professional.

Funding Sources- In the U.S. there are various funding options for purchasing durable medical equipment (DME) such as standing technology:

• Public Insurance/Government Funding (i.e. Medicaid, Waivers, etc.)
• Private Insurance Companies (i.e.Blue Cross, Health Maintenance Organization (HMOs), PPOs, etc.)
• Worker's compensation
• Disability Insurance
• Liability Insurance (i.e. car, home, etc.)
• Out-of-pocket (cash or credit card)
• Possible payment plan through supplier
• Child’s school purchase for use at school (i.e. standing is part of child’s Individualized Education Program (IEP))
• Purchase by workplace for use while on the job
• Purchase through your VA Hospital
• Assistance from local groups such (i.e. Rotary clubs, Lions, etc.)
• Assistance from disability groups (i.e. MDA, MS Society, etc.)

Most states have resources such as PAAT (Protection Advocacy for Assistive Technology) and State Technology Assistance Projects that are resources for consumers seeking funding or going through the appeals process.

Sit to Stand standers are billed as DME (Durable Medical Equipment) to both Public and Private insurance companies and are routinely purchased. Standers are designed to maintain function and design characteristics for repeated daily use by the patient for whom it is originally prescribed. As of January 1, 2004 sit to stand standers are HCPCS coded as E0637 (Combination sit to stand system, any size with seat lift feature, with or without wheels).

Sources

• Able Data Fact Sheet on Standing Aids[1]
• Holland, Diane and Tom. "Taking a Stand." Rehab Management. Mar. 2006.[2]