Benefits of a Standing Frame for SMA Patients Taking Physical Therapy
A standing frame is a chair attached to a device that raises the chair into an upright position and has support for legs and feet as well as a table for upper extremity support once in a standing position. Standing frames can be used to reach many different goals by assisting in tolerating standing in an upright and erect position. For example, these can be used post-stroke to initiate weight bearing through the affected extremities. In the case of Michael, our patient with SMA, we are exploring using this device for many different reasons.
One benefit of Michael getting into this device would be to increase the dorsiflexion or toe-up movement of Michael’s ankles by putting weight through his feet while on a stationary platform. Since Michael is lacking a significant amount of dorsiflexion in his ankles and they are not able to obtain a neutral position, we will make modifications to the standing frame prior to putting Michael on it to ensure he gets a good stretch, while ensuring this activity isn’t painful and is tolerable for him. Another benefit will be to get some weight bearing through his lower extremities, which will be beneficial for overall strength and circulation, and provide a good challenge for his lower extremity bones.
While in the standing frame, there will need to be adjustments and modifications made due to the lack of range of motion in Michael’s knees and hips. At this time, Michael is unable to achieve an upright and erect posture, so we will need to be able to adjust as needed to ensure he is safe and comfortable while obtaining benefits from the device. He will also benefit from weight bearing through his upper extremities as he tolerates, with support, to increase the strength and tolerance of his arms as well.
If someone you are working with has close to a neutral range of motion in ankles, hips, and knees, this would be a great tool to work on weight-bearing goals and tolerance, without significant modifications made to the device. In our case, we will need to be flexible throughout this activity for the first few attempts and make sure there is an open line of communication between Michael and everyone that is working with him. We will ensure there are plenty of hands able to help ensure Michael’s safety and comfort throughout this activity. He will be confident about the activity and what will happen prior to attempting it. It is important to have the patient comfortable with the equipment and the people assisting and to know that they, the patient, are ultimately in charge and can always stop the activity as soon as they become uncomfortable.
**** Patient Perspective ****
As a patient with SMA, a standing frame can look very similar to a medieval torture device, and over the past 4 years, while working with Emily, she had mentioned the idea of eventually getting me into a standing frame. When I went to physical therapy a few weeks ago, imagine the look on my face when she told me that her clinic had purchased a standing frame. She took me into the workout room and showed it to me, and I can tell you that my heart actually skipped a few beats. I had seen a few of these standing frames on the Internet, and some of them looked like they were constructed from PCP pipe and some nuts and bolts. The standing frame that her clinic had purchased looked to be solidly built, but there were still a few butterflies flying around in my stomach. In a previous article that Emily wrote regarding trust between the therapist and the patient, she mentioned that I probably needed at least a week to warm up to the idea of being transferred from my wheelchair to the standing frame. While I trust Emily with my life, I was, and still am a bit nervous as to how my body is going to respond. These are the types of moments that will challenge any physical therapy patient, but it’s a challenge that I’m going to take when going to physical therapy today. Even though I may be nervous about how my body is going to respond, I know that I’m in good hands while working with Emily and her associates.
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