Standing up for Standing
Photo Credit: https://easystand.com/product/bantam-extra-small/
How important is standing and standing frames? Do you still need to use a standing frame if your child is walking? How often should they be used and what's the best way to do it?
Standing is SO important. Not only does it protect developing hips, it strengthens bones, stretches muscles, improves breathing and circulation, improves alertness and engagement, decreases spasticity and helps with bowel and bladder function. In fact, standing is so good for you that everyone is being encouraged to use standing desks instead of sitting all day.
Anyone who spends more than 4 hours a day in a wheelchair needs to spend time in a standing frame to counter the negative effects of sitting for extended periods. If standing is not done regularly, it can quickly become difficult and painful to do and when this happens, it can lead to increasing difficulty with positioning in bed (making sleep more difficult) and the beginning of a downward spiral of deformities, skin health problems and even breathing problems. It sounds so serious, because it is – our bodies need to stretch out and take weight to stay healthy.
What about children who can walk but have difficulties with movement like hemiplegia, diplegia and toe-walkers?
These children also benefit enormously from some dedicated standing time in positions that counter the uneven pull caused by muscle spasticity or bad movement habits. Children with balance difficulties requiring a walker or walking sticks should use a standing frame to get the best benefit from their standing sessions, but otherwise a wedge board is a good option.
Research shows improved walking speed and endurance in children who use standing frames regularly and if you are short on time, helping your child to stand in good positions has been shown to be much more effective than doing passive stretching (where your child lies down and you stretch the muscle for them).
In children where one leg is more affected, standing time on the more affected leg (good leg on the step) can prevent muscle shortening and even affect differences in leg-bone growth (which is common in hemiplegia). This is called step standing and can be done with or without hand support, depending on your child's skill level.
Tips for step standing:
To stretch the calf muscles: Put the step further away from the standing leg so your child leans forwards into it. Make sure the heel stays down.
To stretch the hips: Use a higher step (foot above the knee) and keep the step out to the side so the hip joint opens out.
HOW TO GET THE MOST OUR OF STANDING TIME
30 minutes is enough to decrease spasticity
45 minutes is good for stretching muscles.
To get all the benefits of standing:
For children in wheelchairs: Stand a minimum of 10 hours/week or 1.5 hours/day. Time spent in active standing during transfers counts as double time so make it a habit to practice a good upright stand for at least 30 seconds each time you transfer in and out of the wheelchair.
For children who are able to walk: Stand on a wedge board and /or in step standing for 5 hours / week (ie 30 - 45 minutes on most days). Time spent in active movements (like climbing stairs, squats or 1 leg balancing) where attention is focused on good positioning of hips, knees and feet counts double.
Usual walking and running around does not count for standing time because this is the time where muscles are being used in their shortened positions and the body is usually in a not-so-great posture. Actually it's the reason we need to use the standing frame or wedge board in the first place.
THE FUN ZONE
Some Fun Zone Activities to help nail standing time...
Lava Lamp (fun for anyone but especially good for children with more complex difficulties and visual impairment)