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Taking a Stand: Overcoming Obstacles to Improve Outcomes

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Taking a Stand: Overcoming Obstacles to Improve Outcomes 23/02/2021 Taking a Stand: Overcoming Obstacles to Improve Outcomes Thomas Halka, OTR, ATP Regional Clinical Education Manager Short bio if you’re that interesting. Continuing Education Approvals 1 23/02/2021 Continuing Education Credits: 0.1 CEU (1 hour) AOTA approvals Permobil Academy is an AOTA Approved Provider of professional development. This live lecture is offered at .1 CEUs, Educational level: intermediate; Category: OT Service Delivery. AOTA does not endorse specific course content, products or clinical procedures. Other PT State approvals The Permobil Academy has also met the criteria for various individual states that do not accept ProCert for PT. Please visit permobilus.com/onsite-events for other state approvals and Permobil Academy completion requirements and cancellation policy. ©Permobil Continuing Education Completion Requirements In order to obtain CEU credits, each participant must complete all 3 criteria Failure to complete each step will result in NO CEUs being awarded Attend the Entire CourseSign in/Out Complete Course Assessment https://permobilus.com/academy ©Permobil Virtual Continuing Education Completion Requirements In order to obtain CEU credits, each participant must complete all 3 criteria Failure to complete each step will result in NO CEUs being awarded Attend the Entire Course Sign-in and Sign-out Complete Course Assessment bitly http://bit.ly/Handi022321 ©Permobil 2 23/02/2021 By the end of the presentation, participants will be able to: 01 03 Discuss the functional basis for standing and why Discuss and justify 3 different ways to provide it’s important standing options for people who are not able to independently stand 02 04 Discuss 3 negative impacts of not standing Discuss 3 different case examples of how using standing wheelchair improves functional status and independence. http://bit.ly/Handi022321 ©Permobil Poll Question #1 ©Permobil Poll Question #2 ©Permobil 3 23/02/2021 ©Permobil https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwi4- NGWzKnmAhVIJKwKHTtxB0gQjRx6BAgBEAQ&url=https%3A%2F%2Fwww.healthline.com%2Fhealth%2Fbab y%2Fsigns-baby-will-walk-soon&psig=AOvVaw3usXBTxro0n2Wr3_ydYmCm&ust=1576016212426571 ©Permobil ©Permobil 4 23/02/2021 ©Permobil https://www.google.com/url?sa=i&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjv8ZyXyqnmAhVEM6wKHWFSAogQjhx6BAgBEAI&url =https%3A%2F%2Fwww.brides.com%2Fstory%2Fis-there-really-a-perfect-age-to-get-married&psig=AOvVaw2RPX0- ©Permobil hHRm4owJMVPTjQCp&ust=1576015705982925 ©Permobil 5 23/02/2021 ©Permobil ©Permobil https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwi635T4y6vmAhVGKawKHfZmDTkQjRx6BAgBEAQ&url=https%3A%2F%2Fdissolve.com%2Fstock-photo%2FFriends- walking-city-carrying-shopping-bags-texting-cell-royalty-free-image%2F101-D145-299-280&psig=AOvVaw159UBWhvYJ3_7AtVaeWD47&ust=1576084812268036 ©Permobil 6 23/02/2021 Do we have a sitting problem? ©Permobil http://bit.ly/Handi022321 What does the Research say? • More than ½ the people in the US spend most of their waking hours sitting (Mathews et al 2004) • Both the total volume of sedentary time and its accrual in prolonged, uninterrupted bouts are associated with all-cause mortality, (Diaz et al 2017) • Sedentary lifestyle leads to harmful health outcomes (Biwas et al 2015) • “There is reasonable evidence for a likely causal relationship between sedentary behavior and all-cause mortality based on the epidemiological criteria of strength of association, consistency of effect, and temporality.” (Biddle et al 2016) ©Permobil People who cannot stand on their own • 3.6 Million people use wheelchair for mobility in the US (2010 US Census Bureau) • People with SCI have lower energy expenditure at rest Shea, Shay, Leiter, & Cowley (2018). • People burn more energy just by standing (Saeidifard et al 2018) ©Permobil 7 23/02/2021 People who cannot stand on their own Sales (Koontz, Ding, Jan, de Groot, & Hansen 2015) ©Permobil Worldwide US UK Canada Benefits of standing for people with disabilities ©Permobil Guiding our Decision • Body Structures and Function • Long Term prognosis • Endurance/Motor Control • Motivation/learning style • Activities and Participation • Functional abilities • MRADLs/IADLs • Environment • Transportation • Accessibility • Home and Community 8 23/02/2021 Benefits of standing (Dicianno., Morgan, Lieberman, & Rosen, 2013) ©Permobil Improves Breathing • Body Function and Structure • Respiratory System • Benefits of Standing • Improved breathing when standing (Eng et al 2001) ©Permobil Improves Breathing • What about speech??? • Lagier et al (2010) found postural control and positioning had a direct correlation between vocal effort with speaking ©Permobil 9 23/02/2021 Improves Circulation • Body Function and Structure • Circulatory system • Benefits of Standing • Improve circulation when standing results in reduced edema. (Paleg & Livingstone, 2015) ©Permobil Improves Bladder Function • Body Structure and Function • Urinary system • Benefits of Standing • Standing reduces incidence and recurrence rate of calculi in the kidneys and bladder • Standing reduces the risk of urinary tract infections (Eng et al, 2001) ©Permobil Improves Bowel Function • Body Structure and Function • Digestive system • Benefits of Standing • Standing allows gravity to assist creating natural urge for bowel movement • Standing reduce the incidence of constipation (Kwok et al 2014) ©Permobil 10 23/02/2021 Bowel Function • Standing in a dynamic fashion allows for the stretch of the colon and stimulates bowel movement within the colon. • It is best for a patient to participate a sit to stand motion then to remain stationary in a seated position (Kwok et al 2014) ©Permobil Bone Strength • Body Structure and Function • Skeletal System • Benefits of Standing • Maintains bone mineral density • Reduces risk for fractures (Goktepe, Tugcu, Yilmaz, Alaca, & Gunduz, 2008). ©Permobil Bone Strength • Body Structure and Function • Skeletal System • Benefits of Standing • Maintains bone mineral density • Reduces risk for fractures (Dicianno et al 2013) ©Permobil 11 23/02/2021 ROM and Spasticity • Body Structure and Function • Musculoskeletal system • Benefits of Standing • Improves ROM • Reduces spasticity • May Reduce risk of contractures (Walter et al, 1999) ©Permobil Contractures (Dicianno et al 2013) ©Permobil Reduces Risk of Pressure Injury • Body Structure and Function • Skin integrity • Benefits of Standing • Body weight loaded on lower extremities • Maximum reduction of pressure from ischial tuberosities (Sprigle, Maurer, & Sorenblum, 2009) ©Permobil 12 23/02/2021 Standing Devices ©Permobil Standing Devices Standing Manual Standing Power Standing Frame Wheelchair Wheelchair ©Permobil Standing Frame One Position (E0638) • One Position – prone, supine or upright • May have wheels or be stationary • Primary purpose = upright position Sit-to-Stand (E0637) • Transitions from sit-stand • Allows for independent transfers ©Permobil 13 23/02/2021 Standing Frames Prone Stander Supine Stander ©Permobil Standing Frames Sit-to-Stand Sit-to-Stand ©Permobil Standing Manual Wheelchair • Benefits of Standing • Eliminates need for transfers • Improves standing frequency • Manual wheelchair portability • Quick sit/stand using struts • Active users ©Permobil 14 23/02/2021 Standing Manual Wheelchair • Limited standing sequence options • Unable to move when standing • Heavier than ultralight weight manual wheelchairs ©Permobil Standing Power Wheelchairs • Increases independence • Transfer Assist • Stand/sit transitions • Pump versus joystick/switch access • Adjustments while standing • Environmental Access ©Permobil Standing Recommendations • “30 min 5 times a week for positive impact on most outcomes such as self-care and standing balance, ROM, cardio-respiratory, strength, spasticity, pain, skin and bladder and bowel function” • “60 min 4–6 times a week may be required for positive impact on BMD and mental function” (Paleg &Livingstone, 2015) ©Permobil 15 23/02/2021 Standing Frame Integrated Standing ©Permobil Integrated Standing –Static to Dynamic Integrated standing Devices Dynamic Easy Stand/ Wheelchairs Stationary Static Frames ©Permobil Dynamic Standing Non-ambulatory children with CP (n=9) 4 in passive standers; 5 in dynamic standers Followed for 15 months - 30 minutes/day; 5 days/week Dual energy x-ray absorptiometry scans of the distal femur obtained at 3-month intervals Bone Mineral Density (BMD), Content (BMC), and Area Dynamic standing – increased BMD Passive (static) standing – maintained baseline BMD Both improved BMD (dynamic with greater results) (Damcott, Blochlinger, & Foulds, 2013) ©Permobil 16 23/02/2021 Integrated Standing - Benefits Transfers Standing Independence Duration Space considerations Programing ©Permobil Transfers • Eliminates need for transfer • Decreases risk of injury • Decreases caregiver assist needed • Decreases • Pain • Spasticity • Anxiety • Time https://moiramunro.photodeck.com/media/0f3a91f1-8d56-43cc-afc9-c47aec43ab4a-two-nurses-drag-lift- a-patient-up-the-bed-unsafe-lift-moving ©Permobil Duration • Increases ability to stand for longer total time/day • Many sets • Many environments • Home • Work • School ©Permobil 17 23/02/2021 Independence • User has more control over when they want to stand • Increases empowerment • Improves adherence to standing program • Independently change position when standing ©Permobil Space Considerations • 2 functions with one device • Wheelchair • Stander ©Permobil Programmability • Stand sequence designed for user • Wheelchair adapts
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