Standing frames for children and adults

Last update: 13 Dec 2016

A person with cerebral palsy who cannot bear weight on their legs may be able to stay in an upright posture using a standing frame
Benefits can be wide-ranging – including improved posture, digestion, hip stability and cardio fitness
A standing frame can even improve someone’s social life by giving them opportunities to engage with friends and family at eye level.

Who are these for?

Standing frames are suitable for people with cerebral palsy who have difficulties standing and walking (GMFCS III, IV, V). They offer some people important health benefits that can only be gained in positions other than sitting. They can even help prevent serious health problems if a person is vulnerable to hip displacement and dislocation.

Standing frames may be suitable for people with cerebral palsy with the following characteristics:

Type of cerebral palsy : Bilateral cerebral palsy, Diplegia, Hemiplegia, Quadriplegia, Triplegia, Unilateral cerebral palsy

More information about cerebral palsy is contained in the What is CP? section.

Mobility : GMFCS III, GMFCS IV, GMFCS V

Gross Motor Function Classification System (GMFCS) – classifies severity of mobility difficulties of children and adolescents with CP.

GMFCS Level I
Walks without limitations in the home and community, climbs stairs and can run and jump, difficulties with speed and coordination.

GMFCS Level II
Walks with limitations, difficulties with long distances and uneven surfaces, uses a railing for climbing stairs, limited running and jumping.

GMFCS Level III
Walks using a hand-held mobility device such as crutches or walking frame, may use wheeled mobility for long distances.

GMFCS Level IV
Usually relies on wheeled mobility with assistance, may use powered mobility, usually needs special seating and assistance with transfers.

GMFCS Level V
Usually transported in a manual wheelchair, requires specialised seating and full assistance for transfers.

See full glossary

Arm ability : MACS I, MACS II, MACS III, MACS IV, MACS V

Manual Ability Classification System (MACS) – classifies severity of upper limb impairment: how children with cerebral palsy use their hands to handle objects in daily activities in the home, school, and community settings.

MACS Level I
Handles objects easily and successfully.

MACS Level II
Handles most objects but with somewhat reduced quality and/or speed of achievement.

MACS Level III
Handles objects with difficulty; needs help to prepare and/or modify activities.

MACS Level IV
Handles a limited selection of easily managed objects in adapted situations.

MACS Level V
Does not handle objects and has severely limited ability to perform even simple actions.

See full glossary

Communication ability : CFCS I, CFCS II, CFCS III, CFCS IV, CFCS V

Communication Function Classification System (CFCS) – classifies severity of everyday communication of people with cerebral palsy.

CFCS Level I
Effective Sender and Receiver with unfamiliar and familiar partners.

CFCS Level II
Effective but slower paced Sender and/or Receiver with unfamiliar and/or familiar partners.

CFCS Level III
Effective Sender and Receiver with familiar partners.

CFCS Level IV
Inconsistent Sender and/or Receiver with familiar partners.

CFCS Level V
Seldom effective Sender and Receiver even with familiar partners.

See full glossary

Movement disorder : Ataxia, Athetosis, Dystonia, Hypotonia, Spasticity

More information about movement disorders can be found on our websites.

Intellectual ability : No intellectual disability, Mild intellectual disability, Moderate intellectual disability, Severe intellectual disability

A person’s thinking skills – ability to understand ideas, learn and solve problems. People with intellectual disability have difficulty with intellectual functioning which may influence learning, communication, social and daily living skills. Intellectual disability may be mild to very severe.

See full glossary

Physiotherapists can assist someone to identify the most appropriate standing frame and support the person and their family to integrate standing programs into their daily lives.

Cerebral Palsy Alliance offers a service where our physiotherapists assist people who have lower limb and mobility difficulties with strategies to prevent and manage hip displacement.

Find a Cerebral Palsy Alliance service

Therapy - fees will apply for a physiotherapist to complete an assessment, prescribe the appropriate standing frame and support the implementation of the standing frame in daily life. The cost will depend on the service provider and the number of sessions required.

You should also check with your provider to see if there will be additional costs to prepare a home program, write reports and travel to therapy sessions.

Equipment - standing frames range in price from approximately AUD$750 to AUD$15,000, depending on their complexity.

Ask the service provider if you are eligible for funding to assist with therapy fees and standing frame costs. People with a disability living in Australia may be eligible for health care rebates through Medicare or funding under the National Disability Insurance Scheme (NDIS).

The time it takes a person to be comfortable using a standing frame varies. It will be based on their skills, limitations, support network and frequency of use. Generally, it is recommended that a standing frame is used for between 30 and 90 minutes per day. This can be achieved in one or more sessions throughout the day while the person is at school, socialising and playing.

More about standing frames

Standing frames can be used in home, school and community environments.

They are recommended for various reasons, including to:

  • Encourage hip development and improve hip stability
  • Maintain a straight and symmetrical posture
  • Prevent contractures of the hip, knee and ankle
  • Promote health by reducing sedentary behaviours1
  • Increase a person’s metabolic rate2
  • Improve bone strength, cardiovascular, respiratory, digestive and bowel function, and general well-being3
  • Support face-to-face social interaction with peers by supporting a person’s upright position
  • Different types of standing frames are available to meet the individual needs of people with cerebral palsy. They can support someone in a forward or backwards leaning or vertical position
  • Padding and straps ensure a person is comfortable and safely supported
  • Close supervision is required for many people who use a standing frame. The amount of supervision will depend on their level of cognitive and motor impairment, age and engagement level
  • All children with cerebral palsy should participate in an active hip surveillance program to monitor for hip displacement. For further information see the Australian Hip Surveillance Guidelines for Children with Cerebral Palsy 20144

Assessments

A musculoskeletal assessment is essential to ensure the correct standing frame is chosen. This includes assessing the range of motion of their hips, knees and ankles, and a postural assessment of the spine and pelvis. Following this assessment, the person will trial different standing frames to find the correct fit.

Factors to consider include:

  • Environments where the standing frame will be used
  • The individual’s mobility level
  • How they plan to transfer in and out of the standing frame
  • The activities that will be undertaken using it

A physiotherapist will regularly review the standing frame to check it fits correctly, is comfortable and meets the needs of the individual with cerebral palsy.

Best available research evidence

We searched the allied health and medical literature to find research evaluating the effects of standing frames for children, adolescents and adults with cerebral palsy.

We aimed to find the best available evidence about whether standing frames improve a range of outcomes including those related to the musculoskeletal system, bowel and cardio-respiratory function, and bone strength. The search excluded studies which examined whole body vibration and loading forces applied to legs.

The best available evidence was in a systematic review3, a retrospective cohort study5 and a single case research design study6. No literature was found looking exclusively at standing frames for adults with cerebral palsy.

Overall, there is currently limited research to support the use of standing frames, however research evidence is just one piece of information to help decide if a standing frame is the right choice.

This lack of research evidence should not deter people with cerebral palsy, their families, caregivers and health professionals from trialling a standing frame and measuring the outcomes.

Standing frames may have a positive effect on hip stability

A systematic review3 evaluated the effects of standing frames for young people (aged 0-21 years old) with a range of motor impairments including cerebral palsy. They were interested in exploring outcomes across the International Classification of Functioning, Disability and Health, Child and Youth Version (ICF-CY) categories. These included musculoskeletal outcomes, mental function, bone health, bowel and digestive function, and activities and participation. This review evaluated 30 publications of different methodologies, from randomised controlled trials through to expert opinion. Overall, there were insufficient high-quality studies to be able to draw definitive conclusions from the evidence. However, the results from this systematic review suggested that standing frames may have a positive effect on hip integrity, range of motion and spasticity in the lower limb, and bone mineral density in the lower limb and spine. No conclusions can be drawn about the effects of standing frames on the other ICF-CY categories as either low quality studies or no studies addressed these outcomes.

A standing program from 12 months old could improve hip alignment

The retrospective cohort study5 examined hip migration and the risk of hip displacement in two groups of children with diplegic cerebral palsy (GMFCS III) at age five. One group used standing frames from the age of 12 months old and the other group didn’t. Children who used the frames stood daily in a custom-made standing frame with their legs in abduction (feet wide apart). The authors concluded that a standing program commencing at 12 months of age improves hip joint alignment (hip migration percentage) by age five, compared with children who do not participate in a standing program. While the results from this study support the use of standing frames for reducing the risk of hip displacement and dislocation, it is of very low level and should be interpreted with caution.

A standing frame helped reduce constipation in one child

The final study6 evaluated the effects of standing on constipation in one child with cerebral palsy. For this child, the standing frame appeared to reduce the frequency of enema use, pain from constipation and bowel movements, and reduced some aspects of caregiver burden associated with managing the constipation. This study is considered very low level evidence on the impact of standing frames on constipation and the results should be interpreted with caution.

Date of literature searches: July 2016

  1. Verschuren, O., Peterson, M. D., Balemans, A. C. J., & Hurvitz, E. A. (2015). Exercise and physical activity recommendations for people with cerebral palsy. Developmental Medicine and Child Neurology, 58(8), 798-808.
  2. Verschuren, A., Peterson, M. D., Leferink, S., & Darrah, J. (2014). Muscle Activation and Energy-Requirements for Varying Postures in Children and Adolescents with Cerebral Palsy. The Journal of Pediatrics, 165 (5), 1011-1016.
  3. Paleg, G. S., Smith, B. A., & Glickman, L. B. (2013). Systematic review and evidence-based clinical recommendations for dosing of pediatric supported standing programs. Pediatric Physical Therapy, 25(3), 232-47. See abstract
  4. Wynter, M., Gibson, N., Kentish, M., Love, S. C., Thomason, P., Willoughby, K., & Graham, H. K. (2014). Australian Hip Surveillance Guidelines 2014. Accessed here.
  5. Macias-Merlo, L., Bagur-Calafat, C., Girabent-Farres, M., & Stuberg, W. A. (2015). Standing Programs to Promote Hip Flexibility in Children With Spastic Diplegic Cerebral Palsy. Pediatric Physical Therapy, 27(3), 243-9. See abstract
  6. Rivi, E., Filippi, M., Fornasari, E., Mascia, M. T., Ferrari, A., & Costi. S. (2014). Effectiveness of standing frame on constipation in children with cerebral palsy: a single-subject study. Occupational therapy international, 21(3), 115-123. See abstract
Find out about CP Check-Up™

Cerebral Palsy Alliance offers a service called CP Check-Up™ which provides ongoing surveillance of the health and well-being of our clients aged 0-18 years.
The information on this page was developed using the best research evidence combined with the expertise of clinicians and people with cerebral palsy and their families. It is provided to help people with cerebral palsy, their families and caregivers, clinicians and service providers make decisions about suitable interventions. This information is intended to support, but not replace, information exchanged, and decisions made, between people with cerebral palsy, their families and health professionals.