Standers
What to think about when determining if a standing frame is appropriate for your child
Standing frames provide an opportunity for your child to get into a sustained upright or weight-bearing position.
Weight-bearing is important for many reasons:
To help improve bone density
To help shape the joints by muscle activation
To improve circulation, respiration, cardiovascular function
For bowel and bladder regularity
To provide proprioceptive input for safe and coordinated play
To decrease risk of joint contracture (esp. at hips, knees and ankles)
Give an opportunity to be eye level with their peers
Rule out contraindications to standing
It is important to determine if a standing frame is more appropriate over another piece of equipment (such as a gait trainer) as the stander will need to be used for 5 years and it is difficult or unlikely insurance will cover another “standing” device (gait trainer or walker) during this time.
Gait trainer vs. standing frame?
If your child is unable to move their lower extremities-consider a stander
If your child requires maximal assistance to remain upright with little engagement of their leg muscles-consider a stander
If the child able to accept weight through their lower extremities when positioned in standing by “bouncing” or extending their knees-a gait trainer could be a possibility
If your child attempts to take steps when positioned in standing-a gait trainer might be a possibility
Children start to purposefully accept weight through their legs around 6 months anything earlier than that can be due to a reflex children are born with
If your child currently using a gait trainer but is having more difficulty taking steps and requires more assistance in and out of it- consider a stander
If space within the home a concern-consider a stander
Discuss with the family how much room they have available within their home. Standing frames can bulky; however, if there is not much room a stander may be more appropriate than a gait trainer.
How will the child be transferred in and out of the standing frame? What features are important for safe use of the stander? (see bullet points below where standers are listed)
Standers to consider
Download quick info sheet
Comes in three different sizes
Allows 90/90 sitting, fully supine and full standing and any position in between
Extra small: 28”-40”, seat depth 7”-12”, up to 50 pounds
Small: 36”-54”, seat depth 11”-16”, up to 100 pounds
Medium: 4’- 5’6”, seat depth 15”-20”, up to 200 pounds
Remove tray and open transfer from the front
Independent knee adjustments
Multiple accessories available: additional laterals, more supportive headrests, harness options, incontinence covers, foot rests and ankle prompts, front casters and lift mechanisms and more
Comes in one size only: 3’6”- 5’6”, up to 200 pounds
The adult Symmetry goes up to 6’5” and 275 pounds
Swivel seat option for easy transfers
Moderate positioning needs
Independent adjustable knee supports with ROHO cushion option
Multiple accessories available: different height backs for more or less support, hip guides, harness options, calf panel and foot straps
These standers are the smallest option available coming in two sizes
From infancy to 36” or 44”, size two up to 60” and 150 pounds
Prone, supine and vertical options
Up to 30 degrees of unilateral hip abduction option
Swing away tray in the front
Portable option for easy transport with one of the standing frames
Multiple accessories available
Available in one size
From 21.6”- 43.3” with a max user weight of 48 pounds
Prone, supine and vertical options
Additional sternum pad for prone positioning to allow for upper extremity motion
Multiple accessories available
The Squiggles+ allows for 30 degrees of unilateral hip abduction
Can be used by anyone between 3 feet to 6 feet 5 inches tall
No transfers required
Child is positioned in front of the stander and brought to standing with the use of a sling behind their hips
Able to achieve some hip extension
Multiple accessories are available for this product
Comes in three sizes
From size one: 39.9”- 55.1” with a max user weight of 110 pounds to size three: 61”- 70.8” with a max user weight of 220 pounds
Designed for larger teen to adult with larger hip pad and chest width
Prone, supine and vertical options
Multiple accessories available
Product weight 97-110 pounds
Comes in the Superstand and Superstand Youth (prone only)
Ranges from 26” to 50 inches, max weight is 125 pounds in supine and 150 pounds in prone
Multiple accessories available
Sample letters of medical necessity
Medicaid general guidelines
Please note: Medicare does not fund standing frames
One of the biggest issues with getting standing frames through insurance is that insurance usually will only pay the vendor a certain dollar amount. Vendors usually do not make any money off of the sale of a standing frame or is most instances will lose money because the cost of the stander is more than what the insurance will pay. Some vendors will not even submit to insurance companies for certain standing frames for this reason, even if your insurance will approve it- the vendor will lose money.
HOME STANDING SYSTEMS—General Guidelines:
Standers are durable medical equipment (DME) designed to assist a child or adult in attaining and maintaining an upright position.
Standers may provide medical and functional benefits to otherwise bed or chair-bound individuals.
DMEPOS providers must provide documentation that the member has tried more cost-effective alternatives and still requires a stander.
A glider component does not qualify as DME, as it is non-medical in nature and is primarily used for exercise purposes.
Clinical Coverage:
The member is unable to stand or ambulate independently due to conditions such as, but not limited to, neuromuscular or congenital disorders, including acquired skeletal abnormalities.
The member is at high risk for lower extremity contractures that cannot be appropriately managed by other treatment modalities (i.e., stretching, active therapy, home programs, etc.).
The alignment of the member’s lower extremities are such that they can tolerate a standing or upright position.
The member does not have orthostatic hypotension, postural tachycardia syndrome, osteogenesis imperfecta, osteoporosis and other brittle bone diseases, or hip and knee flexion contractures of more than 20°.
The member has demonstrated improved mobility, function and physiologic symptoms or has maintained status with the use of the requested stander (when other alternatives have failed) and is able to follow a home standing program incorporating the use of the stander (as documented by clinical standing program or home trial with the requested stander).
The member is unable to stand or ambulate with caregiver assistance or ambulatory assistive device a sufficient duration/distance to achieve a medical benefit.
The member does not have, and it is not anticipated they will require, a walker or gait trainer. Provision of both a walker/gait trainer and standing device is typically considered a duplication of service, as both type devices address the medical need for weight bearing.
There is a home therapy plan outlining the use of the requested stander.
The member is able to self-propel the mobile stander (code E0642 only), the documentation establishes the specific medical need(s) that will be met while using the mobile stander, and why these medical needs must be met while utilizing the mobile stander.
Documentation Requirements:
A prescription including the stander and any modifications/accessories requested.
A detailed letter of medical necessity (LMN) that includes:
A comprehensive history and physical exam by a licensed physician, physical therapist or occupational therapist.
A summary of the existing medical condition, age at diagnosis, prognosis and co-morbid conditions.
The member’s functional and physical assessment including strength, range of motion, tone, sensation, balance, ADLs, and functional status.
Documentation of failure of less costly alternatives (include make and model of alternatives tried as well as the length of the trial with each alternative).
A home therapy plan outlining the planned use of the requested stander.
Documentation that the member does not have sufficient access to equipment in an alternative setting, e.g., clinic, outpatient therapy, etc.
Documentation regarding the level of caregiver assistance available/needed on daily basis
Documentation that the member’s home can accommodate the requested stander and that the family/caregiver has been trained in the use and maintenance of the requested stander.
Documentation the member does not have, and it is not anticipated they will require, a walker or gait trainer. Provision of both a walker/gait trainer and standing device is typically considered a duplication of service, as both type devices address the medical need for weight bearing.
Documentation that the member is able to self-propel the mobile stander (code E0642 only), the specific medical need(s) that will be met while using the mobile stander, and why these medical needs must be met while utilizing the mobile stander.
The fees listed for home standing systems include all necessary prompts and supports.