Policy analysis on power standing systems

RESNA and CTF position on the application of supported standing devices: Current state of the literature

Supported standing devices are often used to maintain a standing position by people with difficulty or inability to ambulate or stand for a period of time. Supported standing programs are first implemented by healthcare professionals with goals to impact health and function. This paper intends to update previous position on wheelchair standing devices by the Rehabilitation Engineering and Assistive Technology Association of North America, and was written in conjunction with the Clinician Task Force. The current paper expands the previous focus on wheelchair standing devices to all types of supported standing devices. A scoping review methodology found 42 studies examining outcomes of supported standing programs in the International Classification of Functioning, Disability, and Health framework in five areas of body functions, seven areas of activities and participation, and one body structure. Patterns in outcomes related to standing device type, as dynamic, or mobile, standing devices contributed to independent daily activity performance and static standing devices impacted neuromuscular capacity. Studies support engaging consistently in supported standing from nine months of age, or as soon after onset of ambulatory disability as possible, to maximize benefits. Clinical reasoning is required to apply the information in this document to unique individual cases.

Enabled to Stand: A Single-subject Research Design Study Exploring Pediatric Power Wheelchair Standing Device Use

PURPOSE

To investigate the influence of powered wheelchair standing device (PWSD) use on changes in activity/participation in children with neurodevelopmental conditions.

METHODS

A mixed methods A-B-A single-subject research design was replicated with participants. The target behavior was parental perceptions of changes in children's performance of activity/participation goals measured via the Canadian Occupational Performance Measure (COPM). Secondary outcome measures included the COPM with children, an interview, and a 3-measure implementation survey. COPM data related to the target behavior were analyzed using the split-middle celeration line method.

RESULTS

Four child-parent dyads participated in the study. All participants achieved statistically and clinically significant increases in COPM performance ratings for the 5 parent-identified activity/participation goals.

CONCLUSIONS

For the participant dyads in this study, use of the PWSD appeared to positively influence parental perceptions of improvements in their child's performance of activity/participation goals.

Standing power wheelchairs and their use by children and youth with mobility limitations: an interrupted time series

Standing power wheelchairs (PWSDs) expand positioning and mobility options for individuals with motor impairments. Although more available, little is known about how PWSDs are used in everyday life.

PURPOSE

to describe children's use of PWSDs in the first three months post-wheelchair delivery and the impacts on satisfaction with participation in daily life.

MATERIALS AND METHODS

An interrupted time series of purposefully sampled children aged 5-18 years who were receiving a PWSD. The Wheelchair Outcome Measure for Young People (WhOM-YP) documented satisfaction with patient-reported meaningful participation outcomes. Data loggers objectively measured wheelchair mobility outcomes including distance travelled, bouts of mobility, and duration. Data were measured over two sessions pre-wheelchair-delivery and at one week, one month and three months post-wheelchair-delivery.

RESULTS

Six children aged 7-18 years participated, four diagnosed with cerebral palsy, two with spina bifida. Analyses of individual data illustrated positive change in overall WhOM-YP satisfaction scores after PWSD provision though change varied across time, as did, distance, bouts of mobility and duration of use. Participants identified 14 in-home and 16 out-of-home unique participation outcomes, although several commonalities existed.

CONCLUSION

PWSDs hold promise for increasing children's satisfaction with participation in daily life, in addition to possibly increasing mobility outcomes. IMPLICATIONS FOR REHABILITATIONFor children with mobility limitations, PWSDs may promote participation in daily life and increased mobility.Data logger technology provides valuable information about children's PWSD use and how this varies over time.Benefits and challenges exist with implementing PWSD and data logger technologies.When implementing PWSD use, it is critical to consider context, training and support needs of clients and caregivers.