Standing frames for children and adults

Physiotherapists can assist someone to identify the most appropriate standing frame and support the person and their family to integrate standing programs into their daily lives.

Cerebral Palsy Alliance offers a service where our physiotherapists assist people who have lower limb and mobility difficulties with strategies to prevent and manage hip displacement.

Therapy - fees will apply for a physiotherapist to complete an assessment, prescribe the appropriate standing frame and support the implementation of the standing frame in daily life. The cost will depend on the service provider and the number of sessions required.

You should also check with your provider to see if there will be additional costs to prepare a home program, write reports and travel to therapy sessions.

Equipment - standing frames range in price from approximately AUD$750 to AUD$15,000, depending on their complexity.

Ask the service provider if you are eligible for funding to assist with therapy fees and standing frame costs. People with a disability living in Australia may be eligible for health care rebates through Medicare or funding under the National Disability Insurance Scheme (NDIS).

The time it takes a person to be comfortable using a standing frame varies. It will be based on their skills, limitations, support network and frequency of use. Generally, it is recommended that a standing frame is used for between 30 and 90 minutes per day. This can be achieved in one or more sessions throughout the day while the person is at school, socialising and playing.

• Different types of standing frames are available to meet the individual needs of people with cerebral palsy. They can support someone in a forward or backwards leaning or vertical position
• Padding and straps ensure a person is comfortable and safely supported
• Close supervision is required for many people who use a standing frame. The amount of supervision will depend on their level of cognitive and motor impairment, age and engagement level
• All children with cerebral palsy should participate in an active hip surveillance program to monitor for hip displacement. For further information see the Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 2014⁴

A musculoskeletal assessment is essential to ensure the correct standing frame is chosen. This includes assessing the range of motion of their hips, knees and ankles, and a postural assessment of the spine and pelvis. Following this assessment, the person will trial different standing frames to find the correct fit.

Factors to consider include:

• Environments where the standing frame will be used
• The individual’s mobility level
• How they plan to transfer in and out of the standing frame
• The activities that will be undertaken using it

A physiotherapist will regularly review the standing frame to check it fits correctly, is comfortable and meets the needs of the individual with cerebral palsy.

We searched the allied health and medical literature to find research evaluating the effects of standing frames for children, adolescents and adults with cerebral palsy.

We aimed to find the best available evidence about whether standing frames improve a range of outcomes including those related to the musculoskeletal system, bowel and cardio-respiratory function, and bone strength. The search excluded studies which examined whole body vibration and loading forces applied to legs.

The best available evidence was in a systematic review³, a retrospective cohort study⁵ and a single case research design study⁶. No literature was found looking exclusively at standing frames for adults with cerebral palsy.

Overall, there is currently limited research to support the use of standing frames, however research evidence is just one piece of information to help decide if a standing frame is the right choice.

This lack of research evidence should not deter people with cerebral palsy, their families, caregivers and health professionals from trialling a standing frame and measuring the outcomes.

Standing frames may have a positive effect on hip stability

A systematic review³ evaluated the effects of standing frames for young people (aged 0-21 years old) with a range of motor impairments including cerebral palsy. They were interested in exploring outcomes across the International Classification of Functioning, Disability and Health, Child and Youth Version (ICF-CY) categories. These included musculoskeletal outcomes, mental function, bone health, bowel and digestive function, and activities and participation. This review evaluated 30 publications of different methodologies, from randomised controlled trials through to expert opinion. Overall, there were insufficient high-quality studies to be able to draw definitive conclusions from the evidence. However, the results from this systematic review suggested that standing frames may have a positive effect on hip integrity, range of motion and spasticity in the lower limb, and bone mineral density in the lower limb and spine. No conclusions can be drawn about the effects of standing frames on the other ICF-CY categories as either low quality studies or no studies addressed these outcomes.

A standing program from 12 months old could improve hip alignment

The retrospective cohort study⁵ examined hip migration and the risk of hip displacement in two groups of children with diplegic cerebral palsy (GMFCS III) at age five. One group used standing frames from the age of 12 months old and the other group didn’t. Children who used the frames stood daily in a custom-made standing frame with their legs in abduction (feet wide apart). The authors concluded that a standing program commencing at 12 months of age improves hip joint alignment (hip migration percentage) by age five, compared with children who do not participate in a standing program. While the results from this study support the use of standing frames for reducing the risk of hip displacement and dislocation, it is of very low level and should be interpreted with caution.

A standing frame helped reduce constipation in one child

The final study⁶ evaluated the effects of standing on constipation in one child with cerebral palsy. For this child, the standing frame appeared to reduce the frequency of enema use, pain from constipation and bowel movements, and reduced some aspects of caregiver burden associated with managing the constipation. This study is considered very low level evidence on the impact of standing frames on constipation and the results should be interpreted with caution.