Guidelines for Functional Use of the Rifton Dynamic Stander

The Rifton Dynamic Stander is more than an upright wheelchair. It is also entirely different from prone and supine boards, which are passive positioning devices. With optimum use of the prompts and with prompt reduction, a child can show improved standing ability.

Children who are dependent can be helped to gain the weight-bearing and postural control needed for standing. The adjustability of the Dynamic Stander allows for prompts reduction and removal. In this way, many children are able to achieve virtually independent standing.

The benefits of standing include improved bone density, prolonged stretch for tight muscles at hips, knees, and ankles, and improved function of the pulmonary and digestive systems. There are also immeasurable social benefits for a child who is at the same level as his peers. With opportunity and practice, the child’s ability to participate in activities of daily living expands. Independent mobility and choice making positively affect cognitive growth. It is exciting to see the increasing functional ability of a child who has been using the Dynamic Stander regularly.

Body Support: This stander is beneficial for the low-tone, dependent child. The body support is comfortably padded and is in a slightly forward-leaning position. The height is adjustable, to maximize support up to the nipple level of the child. Heavier children are accommodated by the width adjustment. In the Dynamic Stander, the child is encouraged to develop active head control and upper trunk strength. Early progress toward more independent standing has begun.

Seat Pad: The Dynamic Stander comes with one seat pad, usually placed at an angle under the child’s seat, to assist weight bearing. The seat pad is available in two sizes, and it attaches with four independently adjustable straps onto multiple hook options. The seat pad can be adjusted up and down and angled in a variety of ways. For the child non-weight-bearing child, the seat pad can be placed horizontal, taking all the weight off the child’s legs. In this case, a second seat pad can be used simultaneously against the lower back, providing additional security. Similarly, a child with hip or knee contractures can be positioned in this stander in a flexed stance, with the seat pads adjusted at the appropriate angles.

Reverse Position: When a child can actively extend his hips and knees to bear his own weight, he can be placed in the reverse position. With the body support behind him, the child’s postural control is challenged to develop further. In some cases, two seat pads are used: one supports the knees, while the other can support the trunk. A physical therapist or other professional should direct positioning for more involved children. Even uniquely challenging instances, such as children with scoliosis, can be accommodated in this reverse position. Children with significant scoliosis and lordosis can be positioned with the child’s back to the body support. While the one seat pad supports at the knees, the other is at the chest and can be angled to accommodate the spinal curve. This can even help stretch the hip flexors, as well as increase trunk strength as the child’s standing ability improves further.

Fleece Strap: The soft fleece strap can be used for upper back support or even for head control. For a child with low tone, placed with their front against the body support, this fleece can be placed under one armpit and over the opposite shoulder and tightened snugly to support the upper back. With children demonstrating improved ability, or when minimal support is required, the fleece can be positioned more loosely straight across the upper back. It is also possible to set the fleece strap up behind a child’s neck for a child who perpetually hyperextends the head and neck while standing.

Knee Strap: The knee straps adjust up and down in vertical slots on the body support to secure the legs in extension, and provide abduction if needed, without compromising development of the child’s weight-bearing potential.

Arm Prompts: The arm prompts allow for shared weight-bearing through the upper extremities, and are a key asset for promoting head, shoulder, and trunk control. The arm prompts can be angled up or down, or rotated in and out as needed to allow for customized positioning. Many have found that for a child with low tone, having these prompts angled forward and upward will help stimulate the child to lift up their head. For a child with high extension tone, having the prompts angled downward can help bring them forward into flexion. With the added arm prompts, the Dynamic Stander is used very effectively as a standing practice device, rather than mobility equipment.

Accessibility: When the large wheels of the Dynamic Stander are removed, the child can easily access many places and activities in the classroom: easels, sinks, tables, computers, the water fountain - places they could not reach in their wheelchairs or from other standers. Peer interaction increases. The children don't even realize they are working on weight shifting, balance, and postural control as they reach and play! A communication tray can attach to the front of the Dynamic Stander as a surface for lightweight table activities as well. The wide, low foot platform makes it easy to transfer the student in and out of the stander. Sandals and wedges can be positioned to accommodate leg length discrepancies or ankle contractures. 

Mobility: With the large wheels in place, the Dynamic Stander can enable independent movement, depending on the child’s upper extremity function. The hand rims on the wheels allow children to self-propel the Dynamic Stander. The large wheels are high enough to allow easy propelling. Children unable to propel their own wheelchairs can often discover independent movement when upright. The activity of self-propelling encourages weight shifting, upper trunk and upper extremity strength, range of motion, and balance and righting responses. Independent mobility can improve spatial awareness and may even stimulate language gains. The big casters and large wheels can accommodate level outdoor surfaces. The locks on the large wheel can be reached and operated by children with good hand use, or by the caregiver. Transparent plastic guards over the wheel spokes ensure safety. Gym teachers love how the Dynamic Stander allows children to participate in many games and sports. Low-level amputees, children with spina bifida, or post-op hip surgery, can be upright to move freely among their peers.

The Dynamic Stander can provide standing practice opportunity: Many dependent children have shown improved head and trunk control and weight-bearing ability with daily standing practice. In time, the various prompts are reduced or removed.

• A child who initially required the arm prompts to maintain an upright position, may gain sufficient strength to maintain head and upper body control with only the body support, seat pad, and the soft fleece strap.
• The nearly horizontal angle of the seat pad is gradually adjusted to promote increased weight bearing through the lower extremities. It is placed more vertically against the pelvis and lower back, as the child bears weight on his own.
• Eventually, the soft fleece strap may no longer be needed against the child’s upper back. The body support can be lowered from nipple level down close to waist level as the child establishes upper trunk stability.

A child can have the opportunity to develop front-back weight shifting and postural control when placed in the reverse position, with seat pads utilized for support at the knees and trunk, and the body support positioned as high as needed. In this position the child also has easier access to many of the activities around him

In time, the child may be able to bear his own weight without the stander. With some hands-on support for balance, or by leaning against a table or wall, he may learn to stand on his own. By this time, many children are able to participate in walking activities as well, using a Rifton Pacer or similar gait-training device.

Teachers, therapists, parents, caregivers, and families will benefit by understanding the full possibilities of the Dynamic Stander. Using this piece of equipment as part of a function-based program and child-centered plan will bring the best results. The MOVE program, Mobility Opportunities Via Education, is an excellent resource for teaming the expertise of teaching and therapy to achieve sitting, standing, and walking skills for adulthood.