People with Spinal Cord Injuries (SCI) have used different forms of passive and active standing for several decades now, however the evidence supporting what the benefits are have been unclear in the past. There are many different ways to achieve standing as a SCI depending on your level of ability;
- Tilt tabling
- Passive assisted standing, often in a frame – for example the Evole Easy Stand
- Active standing with orthotics or calipers
- Standing wheelchair
On reviewing the current literature there is no significant supporting evidence regarding maintaining or improving bone mineral density with passive standing. There is some research to support standing with muscle activation via Functional Electrical Stimulation, which can have a positive effect on bone density. This is an area where research has focused and there has been limited research into other potential benefits of prolonged standing. Studies have shown that people with SCI have reported more qualitative and quality of life changes.
Some of the benefits of prolonged standing include;
- Improved bowel and bladder management
- Improved circulation to lower limbs
- Reduced spasticity
- Increased sense of well being
- Pressure care by regular change of position
- Reports also of improved breathing, improved fatigue, and reduced pain
There is no specific evidence based guidelines currently set for frequency or duration of standing. However a majority of studies have measured subjects standing for a minimum of 20min 3 times a week. As long as standing is safe for the SCI person and in the correct biomechanical alignment with no blood pressure concerns there are no restrictions on length or frequency of standing if benefits are reported. Most therapists encourage standing most days of the week for 30-60mins. Pressure care still needs to be maintained so regular changes of position are encouraged.
Eng, J,J; Levins, S,M; Townson, A,F; Mah-jones, D, et al. 2001. Use of prolonged standing for individuals with spinal cord injuries. Physical Therapy Aug 81 8
Dudley-Javoroski, S; Saha, P, K; Liang, G; Li, C; Gao, Z; and Shields, R. K. 2012. High dose compressive loads attenuate bone mineral loss in humans with spinal cord injury. Osteoporos International 23:2335–2346
The Evole Easy Stand
We have recently supplied this standing frame to an incomplete C7 SCI, they are able to sliding board transfer independently on and off the frame seat. Then using the pump handle they can bring themselves up into standing in their own time. Here is a short clip of the client using the equipment.