What Is a Standing Frame and Who Should Use It?
Children who use a wheelchair for daily mobility should also have an opportunity to change positions throughout the day. Standing in a standing frame is a way to decrease the risk of complications that can result from prolonged use of a wheelchair or from immobilization. Since the late 1950’s, physicians and therapists have recommended standing programs for the variety of medical and health benefits that occur when maintaining an upright standing posture. However, in addition to the physiological benefits (decreased risk of leg or foot contractures, increased or maintained range of motion, decreased leg spasticity, improvement in bowel and bladder function, aides respiratory function, decreased risk of skin ulcers, maintained or regained bone density, etc…) many children also experience significant psychological benefits from being in the upright standing position, such as improved self-esteem, increased cognitive and social development.
Children are usually assessed for a standing program by their private or early intervention physical or occupational therapist. This may take place as early as 10-12 months of age; about the same time that their normally developing peers would be starting to stand. Assessment can also be at an older age in cases of degenerative or progressive neuromuscular disease, or from an acquired injury or trauma. If the physician agrees and there are no contraindications to weight bearing found for the child, the clinician will discuss with the family the specific benefits for a home standing program. When all are in agreement on the need for a standing frame, they will proceed towards acquisition.
For the greatest success in getting a standing frame paid for by the child’s funding source, its best to utilize the “Team Process”. The team usually consists of the consumer/child, their caregivers/family, current clinician(s) (PT/OT), and the DME/CRT (durable medical equipment/complex rehab technology) supplier. The team should first meet to discuss all of the standing frame technology available that meet the child’s needs. A trial of different types of standing frame may happen at this time.
When the best standing technology to meet the child’s need is determined, the clinician(s) involved will write a (LMN) letter of medical necessity for the standing frame and get it to the child’s physician for approval and co-signature. When the letter of medical necessity is signed by the physician it is sent to the DME/CRT supplier for submission to the payer source to determine coverage and payment.
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