Standing wheelchairs are transforming lives

Standing wheelchairs and robotic mobility devices are changing the lives of people with paraplegia. Standing mobility devices are being engineered to assist all people with function mobility problems in the lower limbs to manoeuver in small and confined spaces and perform standard daily life routines independently. (1)
A standing wheelchair allows the user to, at the push of a button, achieve the standing position and move forward whilst upright.  This technology has been recently developed to allow standing within the electric wheelchair structure.
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Australian research into the viability of standing wheelchairs is currently been undertaken by the Duchenne Foundation of Australia. The project aims to provide evidence that can be used to justify funding this expensive equipment for all boys (and rare girls) with Duchenne. Perth-based researcher Dr Jenny Downs is leading this study that will be conducted at Curtin University, Telethon Kids Institute and Princess Margaret Hospital for Children.
According to the Duchene Foundation, ‘standing wheelchairs give users the freedom to move easily from sitting to standing and be at eye level with their peers. This is thought to offer psychological benefits and allow greater participation in activities. Enhanced participation in social, educational and recreational activities with family and friends could have a large impact on mental health and quality of life.’
In other parts of the world, the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) has released a paper outlining their position that wheelchair standing devices are often medically necessary, as they enable certain individuals to:

• Improve functional reach and access to enable participation in Activities of Daily Living (ADLs) (e.g. grooming/hygiene, cooking, toileting, reaching medication)


• Improve mobility and lower limb function in those with preserved muscle strength in lower limbs


• Improve range of motion and reduce the risk of contractures


• Promote vital organ capacity including pulmonary, bowel and bladder function


• Promote bone health


• Improve circulation


• Reduce abnormal muscle tone and spasticity


• Reduce the occurrence of pressure ulcers


• Reduce the occurrence of skeletal deformities


• Provide numerous psychosocial and quality of life benefits (2)

Case Study (RESNA)

Zach is a 14-year-old boy with Duchenne Muscular Dystrophy. He is beginning to have difficulty with ambulation, and is highly susceptible to falling. When he stands, his posture is asymmetrical and is not considered therapeutic. Furthermore, he requires bilateral upper extremity support for balance, which limits his independence with ADLs in the standing position.
After an extensive trial, a power standing wheelchair (as well as power tilt/recline/elevating leg rests) was prescribed for Zach to provide independent, safe, functional mobility and allow him greater functional independence. By having the standing system, he is also able to achieve therapeutic, symmetrical standing – ultimately decreasing the overall rate of progression of contractures, scoliosis, and the secondary complications that arise from such deformities (respiratory compromise, pain, etc).
At a 4 year follow up, Zach was still using the standing system regularly, and was able to stand at his high school graduation ceremony with his classmates.
SAFETY
A licensed medical professional (i.e. physical or occupational therapist) must be involved with the assessment, prescription, trials and training in the use of the equipment. Special precautions must be exercised when utilising standing wheelchairs in order to avoid the risk of injury, such as fractures.
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Robotic mobilisation devices take things a step further with a completely new platform that may eventually save on the cost of some of the more expensive home modifications such as widening doorways. It’s a new concept that will surely improve but already holds much promise.

(1) Abdul Ghani NM, Tokhi MO. J Biomech Eng. 2016 Apr 1;138(4). doi: 10.1115/1.4032800. Sit-to-Stand and Stand-to-Sit Control Mechanisms of Two-Wheeled Wheelchair.

(2) RESNA position on the application of wheelchair standing devices: 2013 current state of the literature.