Benefits of Standing

When a person experiences an accident, a prolonged illness, or a chronic medical condition, they often spend a much of their time in bed or sitting in a chair.  My previous post regarding the Hazards of Inactivity addresses the risks involved with prolonged immobility and now I'd like to discuss the benefits of standing.

Benefits of Standing:

• Increased bone density: A guided standing program maximizes weight bearing through the long bones and assists in skeletal development, which may prevent or stabilize osteoporosis.  
• Improved cardiovascular functioning:   People who stand can build cardiovascular endurance and reduce swelling and pooling of blood in the lower extremities. Ongoing standing has also been shown to increase circulation and reduce orthostatic hypotension.
• Improved digestion and bowel function
• Increased integrity of the hip joint
• Prevention of contractures: A guided standing program helps to prevent contractures of the lower extremity.
• Increased strength
• Improved respiratory function: A guided standing program may help increase oxygen intake by allowing lungs to completely expand, which in turn can reduce the incidence of upper respiratory infections such as pneumonia.
• Preventing skin breakdown: Frequent positional changes, including standing, can reduce the risk of pressure sores and other forms of skin breakdown.  
• Reducing spasticity
• Benefits people with diagnoses of Multiple Sclerosis, stroke, traumatic brain injury, cerebral palsy, spina bifida, etc.

What does a standing program entail?
A guided standing program is tailored to each individual.  Usually, a person's rehab and medical team will collaborate to develop the most appropriate standing program which includes the type of stander, the ideal positioning to accommodate the patient's unique needs, the amount of time spent in the stander, and where this program will take place (home, school, PT clinic, etc.).

What is a standing frame?
A standing frame is a piece of medical equipment that allows those with physical limitations to stand with support, while ensuring proper alignment and positioning.  There are several types of standers such as prone standers, sit-to-stand standers, and mobile standers.

Prone Stander (image from www.theradapt.com)

Sit-to-Stand Stander (image from www.easystand.com)

MobileStander (image from www.rifton.com)

Contraindications:
People should consult a physician before initiating a standing program if they have the following medical conditions, because prolonged standing may have an adverse effect:

• orthostatic intolerance
• severe contractures
• weakened skeletal structure such as Osteogenesis Imperfecta, or severe Osteoporosis
• hip subluxation

Pediatric PT Toolkit - Footstool

from www.ikea.com

 A simple footstool is a great tool to include in your pediatric therapy toolkit.  I use mine all the time!

Here's how I use a footstool in my pediatric PT sessions:

•  For children who are just learning to sit with trunk control, I like to have them 90-90 sit on the stool so that they can practice sitting without trunk support, but with proximal stability.
• A footstool is a perfect height for small children to use to support themselves as they practice tall kneeling.  I have found that using a coffee table just encourages them to pull to stand.
• I will have children practice seating themselves on the stool to develop body awareness and motor planning skills.
• I have children step up onto the stool to build lower extremity strength and to help them learn how to step up onto curbs and up stairs.
• I have children step down off of the stool to work on eccentric control of their lower extremities so that they can step down from curbs or stairs safely.
• When families don't have stairs in their homes, I use a footstool and a piece of study furniture to mimic 2 steps.
• I'll have kids stand with one foot on the floor and the other on the stool to introduce single-limb stance.
• When testing with the Peabody Developmental Motor Scales - II, or when practicing jumping down from an elevated surface, the footstool comes in handy.  If you can, try to find one that is 7 inches high (or as close as possible) so that you can use it for standardized testing.

Ikea has a nice, sturdy, inexpensive (only $4.99!) footstool, but if you don't have an Ikea near you, footstools are relatively easy to find.  I keep mine up-side down in my therapy bag so that I can nest my other goodies inside of it.

This one is nice because it folds, but it's 8 1/2" high, so you can't officially use it for the PDMS-II.

 

This one is nice and safe and sturdy, but a bit pricey.  It's only about 6" high, so again, you can't officially use it for the PDMS-II unless you place it on a 1" high surface first.

Pediatric PT Toolkit - Bubbles!

As inexpensive and simple as they may be, I love using bubbles during my therapy sessions.  It doesn't hurt that most young children love bubbles, as well!

Here's how I like to use bubbles:

•  Blow bubbles, then have kids practice kicking them to help them with single-leg balance.  As their balance improves, have them stomp on them.
• Likewise, older children can jump on the bubbles to pop them.
• Give kids a paddle or racket and have them work on hand-eye coordination by whacking the bubbles.
• Blow a bubble, then catch it on the wand.  You now can control the height of the bubble, so children can practice standing up on their toes to pop it.
• I also use them as a reward.  If children perform a PT-directed task, they can be rewarded by being allowed to play with the bubbles as they wish for a minute or two.

I must say that some parents have complained about my using such as simple tool to motivate their children, since they expect to see sophisticated therapy equipment such as ball pools, trampolines, and suspended swings, but when working in the schools or in a child's home, complex equipment is not at all practical or realistic.  Bubbles are a fun, cheap, and easy way to help children learn their gross motor skills!

Pediatric PT Toolkit - Beads!

A favorite item in my Pediatric PT toolkit is a string of Mardi Gras beads.  Not only are they shiny and brightly colored, but they are easy for young children to grasp.  They are a small, inexpensive treatment tool, which is great for therapists who perform home visits.  I use them to achieve several goals during my treatment sessions:

• When performing a procedure that children do not like or are reluctant to perform, such as stretching, balance training, or positioning, the beads serve as a useful distraction while the therapist works with the child.
• Since infants and young children are attracted to the beads, they are a great motivator for reaching tasks and early mobility such as rolling, crawling, and creeping.
• I use beads to help with squatting and pulling to stand by alternately placing them on the floor, then on a table.  When children are a bit older, they can squat down to pick up a string of beads, then stand up to put them into a container.

These are just a few examples of the myriad of uses for Mardi Gras beads during pediatric PT sessions.  Be creative and find other uses for them!  I'd love to hear how you use them in your comments.

*Since the beads can be a choking hazard if the string breaks, please make sure that children are closely supervised at all times while using the beads!

   

This link is from amazon.com, where you can buy Mardi Gras beads year-round.  Seasonally, you can also find them at OrientalTrading.com or at party stores.

Safe Sleep for Infants -- Don't Trust Everything You See Online!

I read an interesting article today about how the information that people find online about safe baby sleeping configurations may not be accurate, or correct.  (Web Information on Safe Infant Sleep Often Wrong)  Yes, we all know that we can't trust everything we see online, but when reading parents' blogs, health websites, and childrearing websites, we can't help but trust those with plenty of experience raising children.

I just wanted to share that we co-sleep with our babies, but we use a co-sleeper.  Basically, it's a rectangular bassinet that attaches to our bed so that baby is nearby, but not in the bed.  One of the sides folds down so that the baby is easily accessed during the night.  When baby gets a bit more mobile, you can put the side back up and still have baby nearby so you don't have to trudge down a dark hallway in a semi-alert state.  Our particular co-sleeper has a strap that you run under the mattress and pull taut to prevent a gap between the co-sleeper and the mattress that baby can fall into.  A photo of it is below:

As parents, we have the right to make your own decisions regarding childrearing, but our decisions must be prudent and in our children's best interest, safety included.