Easy and low-tech may be the reputation of pediatric standers, but do not dismiss these devices because they lack the bells and whistles of more sophisticated forms of equipment, say rehabilitation device providers and physical therapists.

Pediatric standers play an important therapeutic role, says Elizabeth Claerhout, a physical therapist with Easter Seals DuPage, in DuPage, Ill. Putting a child into a pediatric stander as early as possible aids with weight-bearing and stretching, and, depending on the child’s diagnosis, it can help with the proper formation of the hip joint. Furthermore, these devices can help teach mobility skills, build bone density, and improve respiratory and bowel and bladder function, as well as let children gain important emotional and social support by enabling them to interact with the rest of the world from a “normal” position.

“Kids want to be upright and parents like to see their child in a standing position,” Claerhout says. “A supported standing position puts children at eye level with their siblings or their peers. That is a common position children should be in, and if they can’t do it themselves, they should have equipment to help them do it.”

Consequently, standers often are one of the first pieces of equipment that families invest in for their children, says Chris Galietta, ATS, CRTS, whose rehabilitation equipment sales and rental company, Metro Rehab Services, in Alsip, Ill, works with Claerhout.

“Parents are trying to deal with all the facets of their child’s disability, and the stander is an easy piece of equipment for them to accept ... in part because standers are low-tech and they are so easy to use,” Galietta says.

Standers can be used for very young children and for children with a range of health problems. “You especially want the ones with cerebral palsy, hypotonia, or spina bifida to use them,” Claerhout says.

In particular, the devices help parents work on therapeutic goals at home by encouraging weight-bearing through the legs and stretching lower extremity muscles.

“Standers don’t replace therapy; they work with therapy,” Galietta says. “These are tools for families to use when they are between therapy sessions, which typically are no more than once a week.”

There are several types of standers on the market, most of which fall into either the prone or supine versions. In the supine versions, users enter the devices on their backs, then they are strapped in and brought upright. The prone version loads from the chest, and patients are strapped from behind. It is used more frequently for cases that need greater head and trunk control. More recently, multi-positioning upright standers have been added to the mix, offering greater versatility.

“If a child is using the prone version to work on their head and trunk control, they can convert to the supine style more easily and cost-effectively if they are using a stander that does both,” Galietta says.

Naturally, the more support that the stander offers and the more things it does, the more expensive it becomes. But just because a device is more expensive up front does not mean that it will be the most costly overall, Galietta says.

“The level of adjustability is really the thing that separates some of the standers, and the multi-positioning types of standers are more cost-effective,” he says. “Rather than buying a stander and a corner/feeding chair, this is one piece that suits both those needs. Likewise, as children age, their health conditions may change. They may have begun with a basic stander when they were smaller and had no orthopedic issues, but as their tone increases, their orthopedic needs may change. Then they will have to look at another kind of stander to accommodate those changes.”

But no matter what type of stander a customer chooses, if the device does not have sufficient headrest or trunk support, it can be easily customized—either by the manufacturer or by companies such as Metro Rehab Services.

“We often add support by using the headrest from a wheelchair or other mobility base,” Galietta says. “We can also custom-design the straps or create more support for those who can’t bear a lot of weight by taking out the foam and using gel inserts instead.”

Purchasing a stander typically is covered by insurance if there is medical justification for the device, such as hip and spine x-rays that confirm the benefit of such a weight-bearing device.

Standers are similar to mobility devices or seating and positioning systems in that patients and their caregivers, therapists, and physicians must be involved in the selection. According to Claerhout, Easter Seals DuPage recommends that an orthopedic surgeon evaluates each patient before their positioning clinic appointment to make sure the patients’ hips are able to handle standing, and to see if they need ankle or foot orthotics to help with positioning. The therapists can then evaluate the patients’ range of motion, sitting balance, muscle tone, and whether they have significant sensory issues.

“Do they have trouble with movement in space? Can they move up slowly into a standing position? Do they have respiratory or cardiac issues? Those play into the type of device that will best suit them,” Claerhout says.

Therapists then incorporate the goals they are trying to accomplish with the standers, and based on the therapists’ evaluations, suppliers, such as Galietta, can recommend the most effective type of stander, do the fitting and adjustments, and show the family how to use it.

However, although most patients will benefit from the use of a stander, there are certain health conditions that make it impossible for patients to fit into the device, or tolerate the weight-bearing.

“We recently had a patient who was on a ventilator and had lots of other medical issues,” Galietta says. “We tried to put her in a multi-purpose stander, but because of all the extra equipment she required, it was difficult to position her correctly. For her, the stander just wasn’t useful.”

The highly specialized nature of fitting a stander to a patient points out just how important it is to have a skilled therapist and provider involved in the process.

“Just because standers are seen as ‘easier’ pieces of equipment doesn’t mean that they should be treated with a lower level of professionalism,” Galietta says. “You need a good supplier and a good therapist to get the correct stander, one that will work for the long-term in accomplishing therapeutic goals. These are items that most families buy only once in a while, and if their child outgrows the stander in a year, insurance will probably not cover another stander. Customers want a high level of professionalism for many HME products, and standers should not be any different.”

Elizabeth Finch is a contributing writer for Dealer/Provider.