PT/OT

Choosing Between Adaptive Standers

July 01, 2014 by Elena Noble, MPT

Many people with compromised musculoskeletal systems can benefit from adapted standing programs. Ranging from diagnosis of cerebral palsy to spinal cord injury or muscular dystrophy, research shows that standing can help improve pulmonary function, musculoskeletal development, postural control, intestinal motility and reduce tone.

Rifton produces a line of adaptive standers which are known for their simple design, adjustability and manufactured quality. Here are guidelines to assist with choosing the most appropriate adaptive stander.

A child supported in the Rifton Supine Stander accompanied by a caregiver.

Rifton Supine Stander

The Supine Stander offers standing opportunities for patients who are medically complex, allowing greater social interaction and involvement in a wide range of therapeutic or recreational activities.  Ideal for individuals who have been bedridden for a long time or who have significant musculoskeletal weakness, the angle adjustments on this stander allows a user to be safely assisted into the standing position. At the same time, weight-bearing through the lower extremities can be initiated. Standing changes how individuals see and experience the world.

Why use a supine stander?

  • Standing option for medically involved patients: The firm mainboard of the Supine Stander allows users with significant musculoskeletal weakness secondary to prolonged immobilization the opportunity to be positioned upright. Stability is provided posteriorly making it a comfortable option for users with tracheotomy.
  • For gradual progression to an upright position: The angle-adjustable stander is effective for assisting individuals to a standing position who have been bedridden for a long time. Ranging from horizontal to upright standing, it is a good option for people with orthostatic hypotension to lessen the adverse haemodynamic response from a rapid change in position.
  • Upright interaction: With the ability to reach 85 degrees of upright positioning, a user in the stander can be at eye-level with their peers, participating in activities and initiating communication.
  • For improving head control: The head support on the stander can be flipped down to allow the user opportunities to initiate and maintain head control.
  • Easier transfers: The large Supine Stander provides horizontal adjustments of the mainboard from 21 to 30 inches, allowing for easier transfers to the stander from a wheelchair or bed.

A young boy in a Prone stander gives a wave as he participates in classroom activities. Rifton Prone Stander

As a therapeutic progression from the Supine Stander, the Prone Stander gives users the added challenge of working their trunk and neck muscles against gravity for better postural control. The angle-adjustable mainboard provides anterior stability while encouraging gradual weight-bearing and hip range of motion. In the prone position, users are able to work with both hands and interact at eye-level with their peers. Therapists and caregivers love the Rifton Prone Stander as well because its design makes it exceptionally easy to operate, adjust and interact with the user.

Why use a prone stander?

  • For upright social interaction: With adjustability from horizontal to 85 degrees of upright positioning, the prone stander offers users the opportunity to be at eye-level with their peers and participate in class activities while still being adequately supported at the trunk.
  • For improving head and trunk control: The prone tilt of the main board engages the pull of gravity on the head and upper trunk cueing the use of the neck and trunk extensor muscles in maintaining an upright head position. The main board can also be lowered to increase the postural challenge to the upper trunk.
  • To minimize extensor tone: The prone tilt of the main board engages the pull of gravity to counteract extensor tone and thrust.
  • For pressure relief: A prone stander can offer a great temporary alternative to wheelchair positioning, relieving pressure on the ischial tuberosities and other areas susceptible to skin breakdown.
  • For gradual increase in weight-bearing: The zero to 85 degree angle adjustment is calibrated for accurate positioning making it easy to monitor and adjust the rate and amount of weight-bearing the user can manage comfortably. 
  • For better hip extension and alignment: Hip range of motion and integrity can be maintained in the prone position with the firm anterior support and the abductor options.

In a classroom setting, a young girl in a Dynamic stander cheers and smiles along with her therapist, raising their arms up in the air.

Rifton Mobile Stander

As a therapeutic progression from the Rifton Prone Stander, the Mobile Stander facilitates a more vertical posturing with weight-bearing and balance challenges similar to those experienced with independent standing. This is especially true if the device is used in reverse. With the large wheels in place, the Mobile Stander provides self-propelled exploration and freedom.  When the large wheels are removed, the stander makes accessing a table or countertop a cinch. With this range of possibilities, users can busily interact with their peers and their environments, not even realizing they’re working on weight-shifting, balance and postural control at the same time—all skills needed for independent standing.

Why use a mobile stander?

  • For social interaction: Users are placed in an upright and mobile position, facilitating eye-level interaction with their peers and participation in class activities.
  • For independent mobility: With the large wheels, the Mobile Stander can be self-propelled providing the user opportunities to independently explore their environment.
  • To improve weight-bearing: With the use of the seat pad, the Mobile Stander can support users with partial to full weight-bearing abilities and those with lower extremity contractures to help improve musculoskeletal development.
  • To improve weight-shifting and postural control: The self-propelled mobility offered by the Mobile Stander stimulates postural righting reactions and weight shifting.
  • To improve trunk control: The adjustable body support on the Mobile Stander can be lowered to promote independent trunk control. Additionally, the Mobile Stander can be used in the reverse position to further challenge trunk control.

Learn More About Adaptive Standers

Adaptive standing can clearly improve quality of life in the physical, emotional and social areas of persons with disabilities. A full understanding of the benefits of therapeutic standing can help a practitioner provide this quality of care as well as acquire funding for appropriate adaptive standing equipment

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Reply by charlene on July 07, 2014 at 6:49 PM
I have a question about the mobile stander. How do you use it in reverse? Thanks.
Reply by Erna Albertz on July 09, 2014 at 10:53 AM

Hello Charlene,

The way to use a Rifton Mobile Stander in reverse is to reverse the sandals and wedges (if you’re using wedges) so that they are pointing outward from the padded body support. It may be helpful to lower the body support slightly so that it comes up to the child or client’s mid back instead of their upper chest. To secure the client in the stander, fasten the seat pad across their stomach or abdomen. You may also want to fasten the fleecy strap across their chest, attaching it to the stander’s body support beneath the client’s armpits. Knee straps can also be used in this configuration just as you would use them for a forward-facing client, to provide abduction. Using the stander in reverse requires greater core strength so is recommended only for a client who requires less support. Have a therapist assess your child or client to make sure a reverse position is appropriate.

If you go to this page http://www.rifton.com/products/standers/mobile-standers?tab=features and scroll down to the “Removable wheels” segment, you can see an example of a young woman using the Mobile Stander in reverse.

Hope this helps. Feel free to call us at 800.571.8198 if you have further questions on this.

Regards,

Erna

For the Rifton team online