Changes in User Satisfaction and Quality of Life Following 4 Weeks of Instrumented Standing Frame Intervention in Children With Disabilities - a Feasibility Intervention Study

Most children stand independently by the age of 11 month, allowing them to apply different loads on their bones, joints, and muscles, and experience their surroundings from a new perspective. Children who do not reach the motor milestone "standing" in early childhood should have access to assistive medical devices such as standing frames, which enable them to gain benefits of the standing position as typically developing children.

Standing frames have existed for a long time and are well-established medical devices used to allow weight bearing in standing for persons who are unable to stand independently. The frame supports the child with upholstered plates and straps around the legs, trunk and/or head and is often positioned in an almost vertical posture, allowing the user partial weight bearing on their lower extremities. The devices are widely used as part of postural management for persons with disability and a population-based study in Sweden shows that 31% of all children with cerebral palsy use external support to stand.

Documenting the effectiveness of interventions using standing frames is complex. The current evidence base for their use is limited due to studies of low to moderate quality and small effects documented. A systematic review and recent studies on the potential benefits of using standing frames indicate improvements in a range of functions and activities including: mental functions, bone and joint development and health, cardiovascular and respiratory systems, digestive systems and urinary functions, neuromusculoskeletal and movement related functions, pain, mobility, the ability to maintain a sitting or standing position, and major life areas, including interaction with peers. Importantly, the studies did not report adverse events or serious harm.

The above studies reveal a large variety in dosing in terms of frequency and time of use of the standing frames from <1 to 7 days per week, 1 or more sessions per day and <30 min to >120 min per session. Importantly, none of the studies document dosing in terms of intensity assessed as the degree of weight bearing while using a standing frame. Multiple variables such as type of frame, use of supports, inclination, activities performed while standing and inclination of the frame have been suggested to affect weight bearing in standing frames. Instrumented standing frames have been used in experimental settings and have documented a large variation in percentage of body weight from 23-133%, which could indicate serious issues of controlling the intensity or even misuse and/or measurement error. To our knowledge, instrumented standing frames that can assess force and position during the use of a standing frames is currently not available for use in clinical practice.

The lack of information about force and position during the use of standing frames in clinical settings makes it impossible to document the potential setup for optimal support and potential association between the intensity and positive effects of the standing frames and, moreover, whether the intensity of the intervention should be tailored to the individual child.