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Thread: standing frames

  1. #1
    Senior Member nevada's Avatar
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    standing frames

    hi was wondering what experiences anyone has had with standing frames either good or bad,my pt thinks one will be a plus. I have no idea as I am only 4 months into my injury C6 C7 incomplete thanks for any information that you can provide

  2. #2
    I agree with your PT. I list some studies below. In general, the literature is not particularly convincing that standing improves bone mineral density, particularly during the first 12 months after injury. However, there are some anecdotal reports that it improves bowel function, reduces bladder infections, etc. The study by de Bruin, et al. (1999), however, reports what is widely accepted in the field, that early mobilization after spinal cord injury does reduce bone loss. Whether this is related specifically to standing or not is unclear. Wise.

    • Eng JJ, Levins SM, Townson AF, Mah-Jones D, Bremner J and Huston G (2001). Use of prolonged standing for individuals with spinal cord injuries. Phys Ther. 81 (8): 1392-9. Summary: BACKGROUND AND PURPOSE: Prolonged standing in people with spinal cord injuries (SCIs) has the potential to affect a number of health-related areas such as reflex activity, joint range of motion, or well-being. The purpose of this study was to document the patterns of use of prolonged standing and their perceived effects in subjects with SCIs. SUBJECTS: The subjects were 152 adults with SCIs (103 male, 49 female; mean age=34 years, SD=8, range=18-55) who returned mailed survey questionnaires. METHODS: A 17-item self-report survey questionnaire was sent to the 463 members of a provincial spinal cord support organization. RESULTS: Survey responses for 26 of the 152 respondents were eliminated from the analysis because they had minimal effects from their injuries and did not need prolonged standing as an extra activity. Of the 126 remaining respondents, 38 respondents (30%) reported that they engaged in prolonged standing for an average of 40 minutes per session, 3 to 4 times a week, as a method to improve or maintain their health. The perceived benefits included improvements in several health-related areas such as well-being, circulation, skin integrity, reflex activity, bowel and bladder function, digestion, sleep, pain, and fatigue. The most common reason that prevented the respondents from standing was the cost of equipment to enable standing. DISCUSSION AND CONCLUSION: Considering the many reported benefits of standing, this activity may be useful for people with SCI. This study identified a number of body systems and functions that may need to be investigated if clinical trials of prolonged standing in people with SCI are undertaken. School of Rehabilitation Sciences, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5.janicee@interchange.ubc.ca.
    • Hoenig H, Murphy T, Galbraith J and Zolkewitz M (2001). Case study to evaluate a standing table for managing constipation. SCI Nurs. 18 (2): 74-7. Summary: Standing devices have been advocated as a potentially beneficial treatment for constipation in persons with spinal cord injury (SCI); however, definitive data are lacking. A case of a patient who requested a standing table to treat chronic constipation is presented as an illustration of a method to address this problem on an individual patient level. The patient was a 62-year-old male with T12-L1 ASIA B paraplegia who was injured in 1965. The patient was on chronic narcotics for severe, nonoperable shoulder pain. His bowel program had been inadequate to prevent impactions. A systematic approach was used to measure the effects of a standing table on frequency of bowel movements (BMs) and on length of bowel care episodes. There was a significant (p < 0.05) increase in frequency of BMs and a decrease in bowel care time with the use of the standing table 5 times/week versus baseline. For this patient, the use of the standing table was a clinically useful addition to his bowel care program. Duke University Medical Center, Durham, North Carolina, USA.
    • Dauty M, Perrouin Verbe B, Maugars Y, Dubois C and Mathe JF (2000). Supralesional and sublesional bone mineral density in spinal cord-injured patients. Bone. 27 (2): 305-9. Summary: This study was performed to evaluate supra- and sublesional bone mineral density (BMD) in spinal cord-injured (SCI) patients after 1 year postinjury, and to correlate the BMD to the neurological level; to correlate the sublesional demineralization to functional parameters (duration postinjury, duration of the initial bedrest); and to assess the role of classic methods of prevention such as walking or standing. Thirty-one SCI patients, all male, were studied vs. 31 controls (age matched). The mean age of the population was 36 years (range 18-60 years). Eleven were tetraplegic and 20 were paraplegic. Twenty-six patients dysplayed a complete motor lesion. The BMD was measured by dual-photon absorptiometry on the lumbar spine and on the femoral neck, and the bone mineral content (BMC) on whole-body scans. Particular attention was paid to the distal femur and proximal tibia upper third. Blood samples and urine samples included phosphocalcic parameters, with determination of urinary hydroxyproline and deoxypyridinoline. SCI patients showed a decrease of sublesional BMD of 41% in comparison with controls. This loss of bone mass is higher at the distal femur (-52%) and proximal tibia (-70%), which are the most common sites of fracture. The degree of demineralization for the lumbar spine, the pelvis, and the lower limbs is independent of the neurological level. The duration of acute posttraumatic immobilization (mean 43.3 days) and the time postinjury increase the loss of bone mass for lower limbs (p = 0.04) and particularly for the proximal tibia (p = 0.02). The study of biomechanical stress (i.e., standing, walking, sitting) does not influence the sublesional BMC. This study underlines the major role of the neurological lesion on the decrease of sublesional BMC in SCI patients and the absence of influence of biomechanical stress. Rehabilitation Department, Hopital Saint Jacques, Nantes, France. marc.duaty@chu-nantes.fr.
    • Frey-Rindova P, de Bruin ED, Stussi E, Dambacher MA and Dietz V (2000). Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography. Spinal Cord. 38 (1): 26-32. Summary: OBJECTIVE: To evaluate the loss of trabecular and cortical bone mineral density in radius, ulna and tibia of spinal cord injured persons with different levels of neurologic lesion after 6, 12 and 24 months of spinal cord injury (SCI). DESIGN: Prospective study in a Paraplegic Centre of the University Hospital Balgrist, Zurich. SUBJECTS AND METHODS: Twenty-nine patients (27 males, two females) were examined by the highly precise peripheral quantitative computed tomography (pQCT) soon after injury and subsequently at 6, 12 and in some cases 24 months after SCI. Using analysis of the bone mineral density (BMD), various degrees of trabecular and cortical bone loss were recognised. A rehabilitation program was started as soon as possible (1-4 weeks) after SCI. The influence of the level of neurological lesion was determined by analysis of variance (ANOVA). Spasticity was assessed by the Ashworth Scale. RESULTS: The trabecular bone mineral density of radius and ulna was significantly reduced in subjects with tetraplegia 6 months (radius 19% less, P<0.01; ulna 6% less, P>0.05) and 12 months after SCI (radius 28% less, P<0.01; ulna 15% less, P<0.05). The cortical bone density was significantly reduced 12 months after SCI [radius 3% less, P<0.05; ulna 4% less, P<0.05). No changes in BMD of trabecular or cortical bone of radius and ulna were detected in subjects with paraplegia. The trabecular BMD of tibia was significantly reduced 6 months [5% less, P<0.05) and 12 months after SCI [15% less, P<0.05) in all subjects with SCI. The cortical bone density of the tibia only was decreased after a year following SCI [7% less, P<0.05). No significant difference between both groups, subjects with paraplegia and subjects with tetraplegia was found for tibia cortical or trabecular BMD. There was no significant influence for the physical activity level or the degree of spasticity on bone mineral density in all subjects with SCI. CONCLUSIONS: Twelve months after SCI a significant decrease of BMD was found in trabecular bone in radius and in tibia of subjects with tetraplegia. In subjects paraplegia, a decrease only in tibia BMD occurred. Intensity of physical activity did not significantly influence the loss of BMD in all subjects with para- and tetraplegia. However, in some subjects regular intensive loading exercise activity in early rehabilitation [tilt table, standing) can possibly attenuate the decrease of BMD of tibia. No influence was found for the degree of spasticity on the bone loss in all subjects with SCI. Paraplegic Centre, University Hospital Balgrist, Zurich, Switzerland.
    • Walter JS, Sola PG, Sacks J, Lucero Y, Langbein E and Weaver F (1999). Indications for a home standing program for individuals with spinal cord injury. J Spinal Cord Med. 22 (3): 152-8. Summary: Additional analyses were conducted on a recently published survey of persons with spinal cord injury (SCI) who used standing mobility devices. Frequency and duration of standing were examined in relation to outcomes using chi square analyses. Respondents (n = 99) who stood 30 minutes or more per day had significantly improved quality of life, fewer bed sores, fewer bladder infections, improved bowel regularity, and improved ability to straighten their legs compared with those who stood less time. Compliance with regular home standing (at least once per week) was high (74%). The data also suggest that individuals with SCI could benefit from standing even if they were to begin several years after injury. The observation of patient benefits and high compliance rates suggest that mobile standing devices should be more strongly considered as a major intervention for relief from secondary medical complications and improvement in overall quality of life of individuals with SCI. Edward Hines Jr. Veterans Affairs Hospital Research Service (151L), Hines, IL 60141, USA.
    • de Bruin ED, Frey-Rindova P, Herzog RE, Dietz V, Dambacher MA and Stussi E (1999). Changes of tibia bone properties after spinal cord injury: effects of early intervention. Arch Phys Med Rehabil. 80 (2): 214-20. Summary: OBJECTIVE: To evaluate the effectiveness of an early intervention program for attenuating bone mineral density loss after acute spinal cord injury (SCI) and to estimate the usefulness of a multimodality approach in diagnosing osteoporosis in SCI. DESIGN: A single-case, experimental, multiple-baseline design. SETTING: An SCI center in a university hospital. METHODS: Early loading intervention with weight-bearing by standing and treadmill walking. PATIENTS: Nineteen patients with acute SCI. OUTCOME MEASURES: (1) Bone density by peripheral computed tomography and (2) flexural wave propagation velocity with a biomechanical testing method. RESULTS: Analysis of the bone density data revealed a marked decrease of trabecular bone in the nonintervention subjects, whereas early mobilized subjects showed no or insignificant loss of trabecular bone. A significant change was observed in 3 of 10 subjects for maximal and minimal area moment of inertia. Measurements in 19 subjects 5 weeks postinjury revealed a significant correlation between the calculated bending stiffness of the tibia and the maximal and minimal area moment of inertia, respectively. CONCLUSION: A controlled, single-case, experimental design can contribute to an efficient tracing of the natural history of bone mineral density and can provide relevant information concerning the efficacy of early loading intervention in SCI. The combination of bone density and structural analysis could, in the long term, provide improved fracture risk prediction in patients with SCI and a refined understanding of the bone remodeling processes during initial immobilization after injury. Department of Material Sciences, Laboratory for Biomechanics ETH, Zurich, Switzerland.

  3. #3

    nevada

    I use a standing frame every day. It really helps to maintain the range of motion in my ankles. If I don't use it my ankles start to turn in. It's also a great way to stretch my hamstrings and lower back.

    I have a Stand-Aid and love it. http://www.blvd.com/standaid/
    There are other types, others will post for ya.

    Insurance paid fo mine. Here's a link to a letter of medical necessity you can use- http://carecure.org/forum/showthread.php?t=4576

    Good luck if you decide to get one.

    jim

    ... ...

  4. #4
    Senior Member Josh's Avatar
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    I agree with JLB. I'm in my standing frame at least an hour a day. I watch tv or read while I'm in it. It really helps with range of motion! I was under the impression that it helped more with bone density. I'm a little disappointed with what Dr. Young had to say.

  5. #5
    I think the main benefit of a sf is to keep the tendons fully streched. This will be extremely important should advances in SCI's lead to breakthroughs. If you don't use or can't afford a sf, at least make sure you keep yourself flexible. (as much as possible)

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