Standing powerchairs: the latest insight from Recare

Estimated reading time: 12 minutes

The powered options are the most requested route, as they offer a wealth of fully adjustable seating and standing positions that can be configured to individual requirements. Recare provides a complete range of standing powered wheelchairs, including innovative standing powerchair models, for those who need to sit or lie to stand. Our renowned rehabilitation expertise provides Permobil, Karma Mobility or Quickie standing solutions. The manual wheelchair range can come with powered assisted seating, but is not as bespoke as a fully functional powerchair.

When considering the benefits of manual and power products, it is also necessary to consider the disadvantages of being unable to use them. The negative impact of prolonged sitting has been well researched, and the evolution towards standing desks makes this point clear to non-disabled people, helping prevent adverse effects on their health. 

So why is it that disabled patients are still expected to sit?

The studies show that standing with assistive technology improves physical and psychological rehabilitation outcomes. Access to this normal bodily function in a client's rehabilitation may depend on the essential requirement to stand safely, whether in a clinical rehabilitation facility or at home without safe support. Standing technology reduces fatigue and physical burden whilst providing all the outlined benefits. Evidence shows that the benefits of standing reduce the need for additional healthcare services and costs to the healthcare system.

Why is the need to stand so important?

• Allows independent weight bearing multiple times a day, essential to reducing osteoporosis, reducing the risk of joint contractures, and facilitating normal bone and joint development.
• Transfers pressure away from the scapulae, sacrum, coccyx, and ischial tuberosities, reducing the risk of skin breakdown.
• Assists with digestion, respiration, bowel and bladder management and appropriate bladder and bowel emptying; reduces the risk of constipation and urinary tract infections.
• Improves psychosocial status and participation, allowing the client increased access and independence to perform mobility-related activities of daily living.
• Provides improved compliance with the patient standing programme by having the power standing technology readily available for active, independent use while the patient is safely and securely in their everyday mobility product. This reduces the risk of harm and falls, improving ongoing safety for the patient, all clinicians, and family members assisting with daily physical therapy.
• Increases reach for functional access and makes patients more productive at home, school and work. Reduces overhead reaching and the risk of a shoulder injury.
• Improves access to toilets, sinks, counters, cabinets, and wardrobes, enhancing independence with mobility-related daily activities in the home, community, or workplace.
• When slowly standing from a reclined position, pausing at a choice point reduces the risk of orthostatic hypotension. It controls abnormal reflexes and manages spasticity.
• Reduces depression and other psychosocial issues, enhances interaction with others and allows clients to connect face-to-face with friends, family, and peers.
• Powered standing technology allows the user to stand and drive, enhancing client mobilisation whilst providing an effective means of pressure relief that reduces the risk of skin breakdown.

In 2021, Permobil, the renowned F5 Vs Corpus standing power manufacturer, conducted a study that culminated in a review of 363 studies conducted since 2010 to summarise the available data. This systematic overview examines the clinical, functional, and psychosocial benefits of standing and its effects on disabled people. 

It is important to note that there is a circular correlation between these separated groups.

Clinical benefits:

• Motor ability
• Range of motion
• Spasticity
• Muscle length
• Pain
• Bowel and Bladder
• Bone mineral density
• Skin: pressure relief 

Functional benefits:

• Independent mobility-related activities and daily living
• Communication
• Education

Psychological benefits:

• Mental health
• Self-esteem
• Happiness

Power standing or manual standing

There is significant research on why standing, with or without standing aids, is necessary for individuals' primary rehabilitation therapy at home and in clinical facilities. The typical rehabilitation static standing frame does allow people to stand. Such devices enable clients to access the clinical and functional benefits of standing. However, to comply with their rehabilitation therapy standing plan, using these devices means clients are stuck and immobilised in one place. This reduces the likelihood that clients will fulfil all their standing therapy in the short term, but, more significantly, it reduces their long-term compliance with standing. 

"79% of subjects highly recommended standing devices to people with a spinal cord injury."

Dunn RB, Walter JS, Lucero Y, et al. 
1998 The follow-up study of standing mobility device users.

A traditional standing frame requires transferring between products with or without assistance onto the stander. The study of children and their behaviour reflects the overall approach by most people towards the continuous demands of regular static standing frame use. The acceptance and utility of these standing frames at any age can become challenging to use in confined spaces and can pose an additional risk to caregivers’ safety. As children gain independence, standing rehabilitation compliance is reduced. This demotivation escalates when they are required to physically transfer to another piece of equipment every time they need to stand. This is reflected in adherence studies in adults, including the need to protect caregivers' health and safety.

Standing regimes no longer need to feel like a chore, with the need to transfer, hold on to and time themselves waiting on a static frame. What happens when they aren't having a good day, don't feel well, or are even too tired? It feels like it requires an overwhelming amount of effort to achieve multiple times a day. It is easier not to do it at all. The static standing frame takes up considerable space in client home environments and limits the client to complying with their standing regime only whilst at home. This affects them when they are on holiday, when they go to work, and even when they spend time socialising. In the environments they encounter daily, they have no access to the standing capability. 

"The difference is fewer people are involved and not getting hurt (like transferring to a standing frame or walker), it is safer and socially better, just not to have to make a scene rather than stand up."

Anonymous

Why aren't people standing during everyday activities?

The main reason, as mentioned above, is that most people don't have integrated standing capability in their mobility products and can only stand in their home environment or with professional or caregiver support.

Both standing manual wheelchairs and powerchairs incorporate design features that enhance the biomechanical benefits of standing. This built-in technology means the client can experience the benefits of significant load distribution, with continuous access to assisted repositioning and pressure relief at any time. All standing devices help the client reduce the load on their seat and backrest.

The key benefit of the modern manual and powered standing devices available today is that they no longer distinguish between standing and everyday mobility. Today, technology offers users a combination of these in one product, fulfilling more of the client's rehabilitative requirements. Compliance with standing rehabilitation programs increases as it becomes easier for clients to integrate standing into daily activities and at home. It also benefits from integrating standing into their social, economic and educational environments. 

Why is the Permobil F5 VS the market-leading recommended standing powerchair?

The Permobil brand is renowned for designing advanced, long-lasting, and reliable powerchairs. They invest in the latest technology, research, and high-quality materials to create a standing powerchair with features and benefits suitable for many clients and that can be adapted to their personalised mobility solutions. The Permobil F5 VS has a vast range of configurability. Let us investigate some of the unique features that make the Permobil standing powerchair the ideal choice for clients.

An integrated Intelligent Computer System (ICS) as standard on the powerchair works alongside the controller power module, operating multiple functions simultaneously to provide the smoothest, most natural biomechanics of standing from sitting, or from lying flat to standing. We personalised postural support to assist with moving through all seating positions and powerchair functions. To maintain this postural support and ensure safety whilst standing, the powerchair has a padded chest support bar, a pelvic belt (or an alternative safety belt or harness if more suitable), and secure, padded knee supports. These are the minimum essential requirements for standing securely whilst ensuring safe repositioning. The consumer feedback on these standard positioning supports is available below.

The Permobil powerchair has many possible seating positions to choose from. The joystick can operate them or, as many prefer, operate the multiple functions with a switch box on hand, making changing positions significantly easier. Depending on their preference, these controls can be on either side of the client and have attendant controls. Alternatively, they can be operated only as attendant control. With any of the controls, including repositioning and standing, the movement is not continuous. Once the control is released, the chair will stop in position, and the operator will have complete control of any function of the powerchair. 

You may be questioning why the Permobil F5 VS (vertical standing) powerchair has standing, anterior tilt and 14" seat lift features in one powerchair. Even with the powerchair's standing capacity, people still need choice, and often can't stand for as long as they would like.

If in a social environment, such as at a bar with friends, standing in their powerchair and engaging in positive social interaction, clients most noticeably see a change in how people engage with them. They see others seeing them and making eye contact before they see their powerchair and their disability. This new feeling of inclusivity in their social environment is essential to maintain, even if they cannot stand physically the whole time.

This is when the powerchair's 14" seat lift can be used to raise the user to that same eye level, with the comfort and postural support of their choice of seating position and be able to adjust this and mobilise the powerchair.

The Permobil F5 VS has the same anterior tilt capability as the PDG Mobility Elevation manual wheelchairs. Unique advanced technology that lifts the seat forward provides more positioning options for pressure relief. Additional opportunity for boosting circulation and bone density if patients don't always feel they can use the complete vertical stand (VS) capability every time.

Anterior tilt does have functional benefits; forward seat tilt and lift provide patients with additional height to reach cupboards and shelves. Tilting forward offers clients reach over the front of the manual and powered wheelbase. This provides better reach, as they can get closer to worktops, sinks, bars, desks, kiosks, and tasks such as using a cash machine.

Whilst most powerchairs boast these functions using the standard seat lift, the reach and positioning support of the anterior seat tilt provides unparalleled advantages. While operating these products in the anterior tilt, they can also be mobilised whilst in that position, enabling greater manoeuvrability during mobility-related daily activities.

Resisting the supportive positioning aids?

Suppose clients struggle with the Permobil F5 VS having the rigid padded chest bar or using the knee blocks. In that case, they provide postural support whilst seated, in anterior tilt, and it is a significant safety necessity when operating the standing function.

If the client doesn't want the bars in place, they are both removable by the powerchair user whilst using the Permobil F5 VS If they are functionally able, they can equally put the two bars onto the powerchair. Many F5 VS powerchair users offer positive feedback on having the option and flexibility, giving them greater independence whilst doing everyday activities.

Examples include: getting washed and changed, transferring out of the powerchair, or even mobilising their upper body, and were able to maintain flexibility, strength and stability.

One of the design features of the powerchair and the way the bars slot in place securely, users report that adding and removing the support bars requires minimal grip strength. The powerchair user can adjust the knee block leg supports, if needed, for comfort or positioning, to alter how close the knee blocks are to their lower legs. The powerchair's adjustability means you don't need to remove the support entirely, so you don't have to store it when using the powerchair in all environments.

Now you've learned of some great technology and advanced, unique features of the Permobil F5 VS powerchair. The industry leader in biomechanical and postural vertical standing. Combined with the technology to drive and reposition the powerchair in an upright standing position. Reposition the powered wheelchair by mobilisation whilst using the 45º anterior tilt position.

The powerchair technology allows one to stand vertically from the seated position and from the 180º lay flat position. Permobil powerchairs also have leading biomechanical and positioning capabilities in vertical standing. With the powered backrest, the powerchair seating position can be adjusted even when lying flat. Also powered independently is the powered leg rest. Of course, the legrests have the powered elevating leg rest function.

More unique is the technology to raise and lower the height of the leg rests, giving the advantage of lowering the front of the F5 VS. With the powerchair's front-wheel drive, this means the client can get closer to a broader range of desks and tables.

The Permobil F5 VS is a high-cost powerchair. However, consider the extensive technology and features built into this market-leading, impressive powerchair. This powerchair is available in endless configurations. It takes on the integrational role of multiple products, an advanced multi-function powerchair. Replacing equipment in their environment, saving virtual space, for example, not needing a bulky standing frame in their home environment. Safety and risk reduction for clients and caregivers reduces the need to transfer to other equipment.

Sit Right, Lie Flat, Stand Tall, and Live Life Better

As you have seen, there are many reasons for clients to independently add standing powerchair functionality into their everyday lives. There is substantial research and development in technology, and we have outlined many big questions. There are many more reasons why it is necessary, and how today's technology enables the ideal biomechanical standing function. With the combination of clinical, functional and psychosocial benefits, every client should have the opportunity to stand.

Get in touch if you're unsure whether the client would be a good fit for an everyday integrated standing mobility solution. Recare has experience with advanced complex rehabilitation consults within our team. If you would like to explore more about powerchairs and their functions, you can explore the Recare powerchair guide.

We offer various services, including educational demonstrations for professionals with access to standing products, and we provide showrooms, clinics, homes, hospitals, or other preferred locations throughout the UK. Recare is adaptable to you. For anything you have to ask, get in touch, and we will assist you in accessing and learning more. Remember, we have our Pressure Mapping equipment and significant product access. Recare is your one-stop shop for a complete, integrated mobility and rehabilitation solution.

From initial enquiry to maintenance throughout the product's lifetime, Recare has engineering specialists who source, combine, and create any modification or adaptation. Recare provides a genuinely personalised mobility solution that gives clients access to optimal independence and helps them live their lives as fully as possible. Every client can access funding support. Every client deserves the key to standing safely with their mobility solution.

Get in touch today to request a demonstration for your organisation, professional, or client on 03303202492 or email us at info@recare.co.uk.