Five years after first issuing a position paper on the potential benefits of standing devices for people who use wheelchairs, the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) has released an updated version.
The new position paper is called “The Application of Wheelchair Standing Devices: 2013 Current State of the Literature.”
The paper’s authors are Brad Dicianno, M.D., University of Pittsburgh, Department of Physical Medicine & Rehabilitation; Jenny Lieberman, MS, OTR/L, ATP, Mount Sinai Hospital; Amy Morgan, PT, ATP, Permobil; and Lauren Rosen, PT, MPT, MSMS, ATP/SMS, St. Joseph’s Children’s Hospital of Tampa.
Mobility Management asked lead author Dicianno about the significance of the new paper. Download the paper at resna.org.
Mobility Management: What are the most significant changes between the original position paper and the one released in 2014?
Brad Dicianno: The new paper contains additional studies and evidence that expand upon the previous paper. The most significant area of research has been in the area of bone density.
MM: As you examined the newer research, what struck you most about it?
BD: Of all the medical benefits of standing, the scientific evidence for improved bone health is the strongest, and this may be due to the fact that technology for measuring bone density has improved over time.
Standing has been shown to improve bone mineral density of bones such as the vertebral bodies and femurs, and some work has been done to begin to suggest dosing strategies. There are trends in current research that suggest vibration added to a standing program — and dynamic weight bearing, where reciprocal loading is used to achieve forces similar to those during ambulation — may confer more benefit than passive standing alone.
MM: Based on the research you examined as well as your own experiences, do you think more healthcare professionals are becoming knowledgeable about the benefits of standing?
BD: While clinicians recognize the benefits of standing because they see the effects on a daily basis in their patients, unfortunately, I do not think that insurance companies and other funding sources yet recognize these benefits. More well-designed research studies are critical for demonstrating the many medical and psychosocial benefits of standing before third-party payors will align with current clinical consensus.
