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 used not only for medical benefit, but also to increase independence, mobility, and self-esteem.

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. Mobile standers encourage exploration of an area, which is especially beneficial for children.
 * Active stander: An active stander creates reciprocal movement of the arms legs while standing. Promotes active range of motion of hips, knees, and ankles while strengthening the upper extremities.  Altimate Medical, based out of Morton, Minnesota, is the only company that makes an active stander (EasyStand Glider)

Diagnoses & Users
Standing equipment is available for children as small as 28" tall, up to adults 7' tall and 400 lbs.

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. In regards to spinal cord injury, it is most beneficial for an individual to begin a standing program in rehab, and continue a standing program at home, for the greatest health benefits.

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. There are many secondary complications associated with prolonged immobility of people with SCI. It is very common for SCI rehabs to incorporate standing as part of their client's initial rehab program. However, to receive the long-term benefits of standing, a standing frame should also be prescribed for home use upon discharge from rehab. When therapists or physicians prescribe a stander with their client's initial equipment purchase (e.g. wheelchair,shower commode) they also increase the likelihood of their client obtaining funding.

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.

Medical Benefits
Physiological Benefits of Standing- Individuals who use a wheelchair for mobility use a standing device to prevent secondary complications that often result from prolonged use of a wheelchair. Physicians and therapists recommend standing for these medical benefits: Facilitate a natural symmetrical standing posture, develop and improve upper body balance and strength, improve range of motion in spine, hips, knees, and ankles, decrease abnormal muscle tone and reflexes (spasms, contractures), reduce pressure sores (decubitis) through changing positions, improve systemic functions (bladder, digestive, respiratory and circulatory), lessen progressive scoliosis and assist with skeletal development, stabilize and prevent loss of bone mineral density, alleviate pain caused by prolonged and/or inappropriate position, develop standing tolerance and endurance.

Psychological Benefits of Standing- In addition to the physiological health benefits, many people also experience psychological benefits from being in the upright standing position, such as improved self-esteem and social development. Although the psychological benefits are important, especially for children, insurance companies do not recognize the psychological benefits of standing. When writing a letter of medical necessity, it is important to focus on the physical health benefits that the individual will receive from standing.

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. Effective documentation includes:
 * Detail the client: Who is this person medically, functionally, and socially.
 * Explain how the stander will help achieve functional goals/outcomes.
 * Describe trial use of the proposed stander.
 * List alternatives that were considered & rejected. Both least costly and most costly.
 * Provide the client's history of standing compliance.
 * If needed, present photos & videos to convey the information along with written documentation.
 * Be complete, but concise: reviewers do not have time to read a novel.
 * Include supporting material: clinical studies, papers and a resource list.
 * Re-submit and appeal when necessary.

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

''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).''