[kimgilaby]

Hi can any of yu share the benefits of using a standing frame outside of PT or OT. I know it helps with pressure relief. But I have heard it also helps with bladder and bowel issues is this true?

[Stickman]

Never heard of that but yeah, helps relieve that "pain in the ass" and supposed to help bone strength too.

[ems]

I have not stood for over 6 yrs, but I think out of all the benefits to standing, phycologically its supposed to be good.

I use FEMS instead of standing. ( functional electrical muscle stimulation).

[russ1]

It's definately supposed to help with bone density, bladder and (especially) bowel function and also with stretching those pesky tendons at the back of your knees.

All the same benefits of using it in PT/OT basically. Does your PT/OT not tell you why you're doing it?

[Izziwhizzi]

ems, on Sep 5 2008, 07:03 AM, said:

I have not stood for over 6 yrs, but I think out of all the benefits to standing, phycologically its supposed to be good.

I use FEMS instead of standing. ( functional electrical muscle stimulation).

Hi Ems

What sort of FEMS do you use? who recommended it to you and how?

I xx

[ems]

Mine is from Salisbury (odstock) hospital.. I used one similar at stoke for a couple of years, and gave it back as it was part of a trial. Then got my new one (well now is 6 yrs old!) from Salisbury Hospital. Ive got a link somewhere to the studies they are currently doing with it.... I'll go find it. Ive got a four channel stim btw.
I dont use any other machinery with it ie cycling.. rowing the only ting I use are weights on my ankles. I just either do it from my chair, or on the bed. In my chair I stick to doing quads and my calfs, and have pillow on my footplate. My legs will straighten up and and drop back down onto the pillow I do that for around 15 mins a day for each leg. I use it also on bum, and under my legs, and on my calfs. In all I try to do an hour a day. I do have cycling thing you can strap your feet to .. but dont really see the point in watching them go round and round.

I personally think that the benefits of using electrical muscle stimulation outway the benefits of standing. I never really enjoyed standing in my frame. I used muscle stimulators while in stoke, and have jsut allways done it. To me, what is the purpose of 60% weight bearing? When I could be pumping blood into the muscles and into the bones to keep them strong. It also keeps a small percentage of muscle toned. The tops of my thighs are not rounded, but they are certainly better than had I never used this stim! I think its good for the little extra padding on my bum, muscle is better than fat.. fat splays out and leaves you on bone. I dont spasm generally. So this I think is a good way of keeping my legs with a good supply of pumping blood.

There is currently no scientific evidence to say that standing improves bone density. But I do agree it helps by use of gravity and you being fully stratched out, your bowels.


found it...... http://www.odstockmedical.com/FES.htm

[russ1]

Quote

There is currently no scientific evidence to say that standing improves bone density. But I do agree it helps by use of gravity and you being fully stratched out, your bowels.

Benefits (or not) of standing

So it would appear that all they're telling us in rehab is just so much hocus pocus with no real basis! Live and learn, not sure why I'm bothering now!!!

[kimgilaby]

The reason I'm asking is my husband is going to be getting Botox treatments in his legs and until that happens his Pt and OT therepists are having him stop coming in for a month or so until theBotox kicks in. I honestly wish they wouldnt do that, right now going to therepy 3 times a week is the only thing that gets my husband out of the house dueing the week while I work. I was looking into a standing frame for at home just so he can get up and stretch his legs for a while in the evening when I'm there. I just need to gather up some facts to present to his insurance company as to how having one will benefit him. Thanks for your help.

[City Girl]

I bought a standing frame when I was discharged from rehab and spent hours in the thing. I can walk now, when I'm not falling, with forearm crutches and when I"m really concentrating with two canes.

Aside from working to walk, standing frames are extremely beneficial for people with SCI's for weight bearing (bone density), circulation. digestion and rectal elimination.

I have only good things to say about standing frames.

[ems]

I'm sure everyone that does use a standing frame thinks that they benefit in some way, I just wonder if you feel more benefits because you were told that it would help by people who you think know what their talking about ;) I'm sure 'something is better than nothing'.
I dont stand, as for me the benefits dont seem to add up. I do excercise though, and I do keep my legs nice and bendy.

The circulation issue, I'm not sure about. For me, blood seems to pool alot more in my legs when I stand, which is an immediate blood pressure issue, I know that the fainting thing is fixable over time if you have not stood for a long time, but even when I was doing it regulary, my legs would go a deep purple after a few minutes of standing. I dont think that keeping deoxygenated blood in the legs for a considerable amount of time does much for my bones. I would rather push the blood in and out of my legs with a stimulator which pumps the muscles, and in turn pumps those blood vessels through the bones harder, than have my legs sit still, muscles doing nothing. Electrical stimulation mimicks *normal* muscle function, which in turn can keep your bones producing marrow and platelets properly, also soft tissue will be healthier than standing can.

The only thing I miss about standing is being able to reach into high places, and seeing other people on the same level as myself. But I would say that standing for me as a complete paraplegic, and given what I've found out from the trials I've been on is 95% phycological and only 5% health based.

Sure, if your Motor Incomplete, and are using the standing frame to promote/relearn balance for your walking skills etc, and you do the excercises such as rocking from one foot to another, and using your hip flexors, I can see how there could be benefits. You will know how much weight your putting through your legs, and can possibly contract and relax different muscle sets producing the same effect as me using FEMS. Yours not standing static, which someone who is complete is. Static is still static if your pushing yourself off the table part and stretching your back. Stretching mucles is not contracting them, your just pulling a relaxed muscle, which does not pump blood.
Standing for people that are incomplete will add to the involuntry movements of thier muscles that they will do without noticing through the day. It is a completely different kettle of fish. Using it as an aid to learn to walk, is completely diferent reason for using a frame as it would be using your muscles voluntarily, and are using the frame for under 100% support, and any percentage that you are putting in is helping you gain motor skills and allowing you brain to fine tune them.

As for bowel eliminations, again 90% diet, and 10% physical. Excercise, diet, medication, routine and voluntry controll all play a role. Gravity does help with bowels, but not so much more than sitting that you cant phyically go to the toilet without standing. Positioning while going to the toilet is more important. Digestion uses smooth muscles,and they are an involuntry muscle. They are responsible for breaking up and moving the food that you have eaten round your digestive tracts. They are not affected by which way up you are.

I'd better leave it there <grin>

But I will just repeat what I said before. There is no evidence to say that standing promotes your bone density, or circulation or bowel elimination. There is evidence to say it promotes your wellbeing, and if it is enough reason for you to stand, at least your getting something out of it!

[disjointed]

ems, on Sep 7 2008, 04:21 AM, said:

But I will just repeat what I said before. There is no evidence to say that standing promotes your bone density, or circulation or bowel elimination.

I thought weight-bearing is what promotes bone density.

[ems]

Weight bearing alone is not enough for the production of the Parathyroid Hormone to get to work.

[curbyi]

I'm approching 10 years post C6 complete.
Is it too late to get involved with FENS standing frame activity?

[ems]

I'd give them a ring, and see where your nearest clinic is so you can go and talk to them On this page below it gives the list of FEMS clinics around the UK.
http://www.odstockme...com/clinics.htm

[megatrig]

Apparently .. can't recal where I heards this .. But it makes sense!

It DOES NOT improve bone density!

In order to do so you need to "bounce" on your feet. So the actual movement reacts with bones, etc tum te tum .. science!

This then causes the calcium, etc, etc to make bone density happen!

Otherwise there is no need for the bones to do anything. As just putting "some" weight through them has little effect!

[ems]

At last, someone that understands!

[rymann]

Hi Kim,

I have a standing frame. I try and use every other day if i can. It helps with those things you listed as well as promote good blood flow which in turn helps the heart and circulation. Standing is what we are born to do not sitting all day every day. I get a good stretch as well. Some other things to consider are, if your brain is receiving messages that you are standing it could be sending messages back down the cord which is a positive thing. It could be getting blocked, but one time it could go through and maybe you get a sensation or felling in your legs. It can also help with bone density. Putting pressure on your joints and bones helps keep them strong. I have been told that the standing frame is the next most important thing to have next to the FES bike. Any way there are a lot of positive things that can come from a standing frame. I guess it comes down to what is important to you. If it helps and works then go with it. 95% of being in a wheelchair is phycological right. Power of the mind. Hope this helped.

[curbyi]

Any Quads using them or are they for para's only who can pull themselves up!
Ems Salisbury was my unit too.
Do you use FES at home, if yes how much is the kit?

Cheers

[ems]

heheh.. I was in stoke.. but salisbury is my nearest now

It cost me 200 quid 6 yrs ago

[rymann]

curbyi, on Sep 8 2008, 07:10 PM, said:

Any Quads using them or are they for para's only who can pull themselves up!
Ems Salisbury was my unit too.
Do you use FES at home, if yes how much is the kit?

Cheers

rymann, on Sep 8 2008, 07:24 PM, said:

curbyi, on Sep 8 2008, 07:10 PM, said:

Any Quads using them or are they for para's only who can pull themselves up!
Ems Salisbury was my unit too.
Do you use FES at home, if yes how much is the kit?

Cheers

quads can use a standing frame.

I use my FES bike at home. cost is about 12,000. You put pads on your legs and the bike fires your muscles in a biking pattern.

[curbyi]

ems, on Sep 8 2008, 07:15 PM, said:

heheh.. I was in stoke.. but salisbury is my nearest now

It cost me 200 quid 6 yrs ago

Sorry Ems and the good people of Stoke!
So do you use it in conjuction with some sort of cycling rig?

[ems]

I just use it on its own with weights, but I sometimes use it with a rowing machine.

This post has been edited by ems: 08 September 2008 - 07:47 PM

[disjointed]

Might I mention that if you do not have an adaptive kitchen, another benefit of the standing frame is that you can more easily cook dinner (for your girlfriend!) It's just a thought... ;)

[disjointed]

megatrig, on Sep 8 2008, 10:42 AM, said:

Apparently .. can't recal where I heards this .. But it makes sense!

It DOES NOT improve bone density!

In order to do so you need to "bounce" on your feet. So the actual movement reacts with bones, etc tum te tum .. science!

According to a medical journal, science says this:

"Two years after SCI patients in standing group had significantly higher leg BMD (Bone Mineral Density)—1.018 g/cm2 (95% CI, 0.971–1.055 g/cm2) than in the non-standing group—0.91 g/cm2 (95% CI, 0.872–0.958 g/cm2) (less than or equal .0001).

Conclusion:
SCI patients who performed daily standing greater than or equal to 1 h and not less than 5 days per week, had significantly higher BMD in the lower extremities after 2 years in comparison to those patients who did not perform standing."

29 April 2008; doi: 10.1038/sc.2008.36
Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years

[ems]

Sorry, if your going to quote from *science* at least tell us who wrote the science, who? when? where? how? A study does not mean that "science says", it means the researches found out something through the use of science. They are using science to reach an answer from a question.

Wikipedia .....
Science (from the Latin scientia, meaning "knowledge" or "to know") is the effort to discover, and increase human understanding of how the physical world works. Through controlled methods, scientists use observable physical evidence of natural phenomena to collect data, and analyze this information to explain what and how things work. Such methods include experimentation that tries to simulate natural phenomena under controlled conditions and thought experiments. Knowledge in science is gained through research.


Your quoted resource....
http://www.nature.com/sc/journal/vaop/ncur.../sc200836a.html
=========================================================================
Original Article

Spinal Cord advance online publication 29 April 2008; doi: 10.1038/sc.2008.36
Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years

V Alekna1,2, M Tamulaitiene1,2,3, T Sinevicius1,4 and A Juocevicius1,4

1. 1Faculty of Medicine, Vilnius University, Vilnius, Lithuania
2. 2Institute of Clinical and Experimental Medicine at Vilnius University, Vilnius, Lithuania
3. 3National Osteoporosis Center, Vilnius, Lithuania
4. 4Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania

Correspondence: Dr V Alekna, Medical Faculty, Vilnius University, Zygimantu street 9, Vilnius LT-01102, Lithuania. E-mail: vidmantas.alekna@ekmi.vu.lt

Received 3 August 2007; Revised 5 March 2008; Accepted 26 March 2008; Published online 29 April 2008.
Top of page
Abstract
Study design:


Prospective study on patients with spinal cord injuries.

Objectives:
To evaluate the loss of bone mineral density (BMD) in various body regions of patients with spinal cord injury (SCI) and its dependence on weight bearing activities during 2 years post injury.

Methods:
BMD of the whole body was measured in patients with SCI. Baseline measurement was performed in 6–16 weeks after SCI, the second and the third—respectively 12 and 24 months after injury. Fifty-four subjects were selected and divided into two groups: standing and non-standing. From these groups 27 pairs were made according to gender, age and height.

Results:
There was found to be a well-marked decrease in BMD values for lower extremities, but there was no significant difference between paraplegic and tetraplegic patients 1 and 2 year after injury. Leg BMD reduced by 19.62% (95% CI, 17–22% ) in the standing group and by 24% (95% CI, 21–27% ) in non-standing group during the first year. Two years after SCI patients in standing group had significantly higher leg BMD—1.018 g/cm2 (95% CI, 0.971–1.055 g/cm2) than in the non-standing group—0.91 g/cm2 (95% CI, 0.872–0.958 g/cm2) (Pless than or equal to0.0001).

Conclusion:
SCI patients who performed daily standing greater than or equal to1 h and not less than 5 days per week, had significantly higher BMD in the lower extremities after 2 years in comparison to those patients who did not perform standing.

==============================================================================

I'm not telling people dont stand, I'm saying that there are a lot of other biological and phycical events which need to take place for the whole process to be of any benefit. You have to remember that looking at an average change in bone density, does not suggest that you personally will have the same results. There are plenty of studies to browse through, I suggest you keep reading and learn more about the whole process of bone regeneration and placement. You will never maintain your bone density by standing alone, or with any other therapy, you are just slowing it down, but not considerably.
I've had three bone density test as part of a trial.. I was in the non standing group FES group with 39 others. What was said at the end of the trial in a consultants room was alot different to the published pdf I was mailed 6 months later! Theres alot more in it than just standing or not standing, using FES or not using FES.
Most studies are coralated using the percieved positives and negatives from a series of check boxes that the patient ticks, do you think that is scientific? You might check all the positive boxes, because you believe thats it does benefit you in all those areas, because thats what you were told.. you were conditioned to believe in something because someone told you it was fact. How often do you see these words in the studies....percieved, may benefit, could benefit, possible benefits, modest.

Another thing to explore is Fowlers Survey Research Methods, which are now commonly used in research. It suggests that the observations, (the amount of people to take part in a research study), need to be adequate to overcome sampling error (ie, variation about the true value from chance samples differing from file whole population. It also states "Fowler found that sampling error is reduced as sample sizes increase to 150, but after that point, there are only modest gains from increasing sample size". In the study you quoted from there were only 54, which in a study this important, most would say is inadiquate. Also .. only using gender, age and height, rather general, not enough to calculate from. Were they para or quad, what was the asia level average of the group, any on medication, any using active standing as apposed to passive standing.. it does not say.

There are so many factors to consider there has never been CONCLUSIVE evidence from any study conducted.

This post has been edited by ems: 09 September 2008 - 07:45 AM

[disjointed]

I guess it just seemed a little harsh the way you insulted all the laypeople with SCI who have been provided information from the medical profession, telling them that they do not have a grasp on real science. So, I provided a scientific article in response to one non-medical professional's unsubstantiated opinion. Research, for those interested in science, is how science is done. I guess if you want to snap all of us out of what you perceive to be our un-scientific ignorance, there might have been a more respectful way of doing so. Alternatively, you could have cited research to support your opinion if you were concerned about preserving any scientific integrity to your claim.

As far as the who/what/where, I did in fact include the essentials for APA citation but without bogging down the forum entry with the entire study as the majority of the posts on this forum are relatively brief, thus not everyone would necessarily want to plough through an entire article or more details than the essential. As you noticed, my having included the full article title along with the date of the study yielded an immediate search return for you as well as anyone wishing to pursue more details on the study.

[ems]

Sorry, but I don't think that I insulted anyone. If your told something and you believe it.. when someone tells you anything otherwise, is insult the word you would use to decribe another point of view? This is a shared opinion with many of the medical world. I am also NOT saying that standing is no good for anything, its great for some to reduce spasms, and other annoyances.
I dont think that anyone here only has Laymans knowledge of anything related to SCI, and I didnt say that only if you were a scientist could you understand anything to do with this subject. What I did say, is its beneficial to understand the process of bone regeneration and bone loss.

Just because one article says there is a possible benefit, I dont want people to make the assumption that that is fact for all cases. It does takes alot more than standing to maintain bone density. Sorry but its common sense. How would an hour of standing a day maintain something that took 8 hours and more before sci!? Another thing to think about is the summer and winter statistics. High doses of VIT D in the Summer (well not this yr in the UK!!!), as opposed to low doses in the winter... If perhaps they took readings in teh summer it may look like there was a shift in density.

What I'm saying is that there is NO conclusive study ever done that say's the things we were all told in Stoke and in any Spinal centre. I have asked my consultant so many times... his response is the same every time, its helps people stay active, which can in turn promote good health.

I was not "concerned about preserving any scientific integrity to my claim". I don't need to support my claim, which is not even mine to make. It is cited amoung all spinal centers that standing does indeed NOT have any documented evidence in support of it being as positive as they make out for bone density. But it is advised that you partake in activities that may improve your health. Sheffield Hospital for one have been trialing standing versus drug therapy and other therapies for years. and they started with research into brittle bones, and osteoporosis. There is more a lot more research outside the SCI community than within.

The augument in question is whether or not *standing* improves or maintains bone density to significant level. I'm not trying to say to people that it's unimportant, more to look at the actual physical benefits. It, as part of your routine, if it works for you, thats great, whether or not if it is purely the feeling of well being. The feeling of well being is positive one under any circumstance, and if standing helps you achieve that, thts brilliant.

There are drugs out there which can do so much more than standing will for any of us, not many of us will fit their criteria though. Most of these drugs are used for brittle bone disease and very severe osteoporosis. If we were all upright and walking around with such severe bone loss, we would be with the top priorities. My friend Adam, who has brittle bones has been on trial with this drug for years, he has had 14% improvement over the last two years. But he is 16 and still in teenage bone mode. He has had 134 reported breaks in his lifetime.

If you can get a chance some time, when you stand.. see if you can get someone to put a pair of scales beneath your feet and see just how much weight you are putting through. If you are a complete injury theres little doubt that not all your weight will be going through your feet, as you are being supported, and need to be. If you are complete, you can experiment with rocking side to side and forwards nad backwards get someone to watch the weight... and you!!!
I have a complete injury .. I have never been able to get more and 4.5 stone through the scales.. and this was in Stoke mandeville with a physio, we tightened and loosened straps, we tryed loads of things... but I was never actually managed to get the scales to show my true weight.

This post has been edited by ems: 09 September 2008 - 12:43 PM

[paul1404]

I think that standing has a real health benifit how ever standing static in a frame is not the best way because the calf mucles are not being contracted which isneeded to help the blood return up the leg by way of the valves in the leg. I would recomend if you level is T 10 and below to use crutches and callipers as walking / hopping increases everthing from bone density. bowel, bladder, and cardiac function. plus the added advantage of being able to do alot more things. I will never understand why more people do not use them is it because the physio do not have the time to teach them propley

[ems]

Totally agree, I gave up the caliper training way too early, my mind was not in the right place at the time. I have since asked to have calipers, but my PCT would not agree on the HKAFO as it was too costly a way of standing, and I would have to go back to Stoke for training. I since contacted Brighton Hospital how have an OttoBock department there, but still no good.
I would use them around the house if I had a chance now, but I would not trust them completely. They were hard work to use, and I never actually managed to use them off the bars. But here is an excellent expample of active standing!

[megatrig]

rymann, on Sep 8 2008, 05:51 PM, said:

Hi Kim,

as well as promote good blood flow which in turn helps the heart and circulation. Standing is what we are born to do not sitting all day every day. I get a good stretch as well. Some other things to consider are, if your brain is receiving messages that you are standing it could be sending messages back down the cord which is a positive thing. It could be getting blocked, but one time it could go through and maybe you get a sensation or felling in your legs. It can also help with bone density. Putting pressure on your joints and bones helps keep them strong. I have been told that the standing frame is the next most important thing to have next to the FES bike. Any way there are a lot of positive things that can come from a standing frame. I guess it comes down to what is important to you. If it helps and works then go with it. 95% of being in a wheelchair is phycological right. Power of the mind. Hope this helped.

How does it promote good blood flow? yournot moving anymore than sitting? A good sprint in your whellchair would be more effective!!!

Standing is what we were born to do!!! Deeeep sigh!! Ok as a wheelchair user how do you recreate the types of movement you would as an able bodied person?? For that matter how do you compare a very fit athletic person who cycles to work, goes to the gym, eats healthily, etc, etc ... and a fat couch potato who eats rubbish, constantly has takeaways and only excercise is to turn the TV on and off!! Jeeeeez again!!
Yes a good stretch is nice .. health benifits?? NIL!

Brain reciveing messages your standing .. oh my .. wheres the nearest church they can "lay there hands on me"!

bone density! already covered

pressure on joints and bones .. just by standing? hmmmm hmmm . b....ks

standing frame MOST important??? by who?? I get lots of salesmen phoning me telling me that I need a phone/etc from them as its MOST IMPORTANT!

I think I agree with FES bike but don't know enough to comment!

95% of being in a wheelchair is phycological?? Well out of 100 people I've nevber seen 5 people go blimy I'll walk today!

Hope this helped?? helped who??

Jeeeez!!

This post has been edited by megatrig: 12 September 2008 - 04:51 PM