Standing wheelchairs and other standing devices -- loosely known as "standers" -- have come a long way in the last decade, and rehabilitation experts agree they're great for almost everyone with mobility impairment.

"Human beings were made to stand," says Shree Pandya, a physical therapist at the University of Rochester (N.Y.) Medical Center, where she sees patients in the MDA clinic. "We want weight bearing because that keeps the bones strong. In addition, standing helps the gastrointestinal system, definitely helps prevent or forestall contractures [fixations of the joints] and helps with pulmonary function."

Chairman Stander by Permobil. EasyStand 7500 Mobile Magician by Altimate Medical Inc. Handstand by Prime Engineering. Personal Folding Stander by Rand-Scot Inc. The Active-Easy LAE by Levo USA.

Pandya recommends that the average child with Duchenne dystrophy or spinal muscular atrophy who is no longer walking stand as much as possible, usually about three or four hours a day, an hour or two at school and another hour or two at home.

Standing has also been noted to improve kidney function and circulation, and it certainly gives some relief to the buttocks, thighs, coccyx (tail bone) and seat bones. In so doing, it can relieve discomfort and help prevent pressure sores, a serious complication of prolonged sitting in one position.

"If I had a kid with Duchenne dystrophy, I would want him to have a standing, motorized wheelchair," says John Bach, a specialist in physical medicine and rehabilitation who serves as director of the MDA clinic at the University of Medicine and Dentistry of New Jersey in Newark. "These allow some weight bearing, stretch tight joints and provide some very important psychological benefits."

Gregory Carter, also a physical medicine specialist, co-directs the MDA clinics at St. Peter's Hospital in Olympia, Wash., and Mary Bridge Hospital in Tacoma. "There are many benefits of standing frames and standing wheelchairs," says Carter, although he says they're slightly more difficult to use for people with weakness than for people with spasticity. "They're a bit harder to use in the neuromuscular disease population, since there usually is no spasticity to help facilitate standing up, as there is in spinal cord injury, head injury or cerebral palsy."

Carter agrees with the benefits of standing with regard to kidney function, contracture prevention and all the reasons cited above but, he says, "standers are expensive, and the person may need considerable help getting into the standing frame."

It's obvious that there are some activities where you just have to stand, and a stander can make these activities possible for someone who can use his arms and hands in a way that no other device can.

Almost everyone agrees that it's just plain convenient to be able to reach a library book, get a dish down from a cabinet shelf or use an "inaccessible" pay phone. Many also think there are psychological advantages to being able to stand.

"Standing promotes peer interaction and socialization," says Carol Stumpf, a physical therapist at University Medical Center in Tucson who sees patients in the MDA clinic there. (Stumpf also notes the physical benefits of standing for bones, joints, muscles and internal organs.)

"The psychological benefits of standing can be enormous," says occupational therapist Mia Chin in the May 1994 issue of TeamRehab Report. "When standing, a child is better able to see other children face-to-face and interact with them and adults. ... The increased social interaction and independence often improve the child's self-image and self-esteem."

"Depression associated with negative self-image has disastrous effects on the individual (with or without disability), psychologically as well as physically," says literature distributed by Altimate Medical, which makes EasyStand standers. "The standing posture projects a proactive image of the whole person in the general social environment. It allows face-to-face conversations, eye-to-eye contact, with positive results."

These kinds of statements often appear in the literature on standing, especially with regard to children, and they may well have merit. But it should be noted that some disability rights advocates would like parents and wheelchair users to concentrate on the physical benefits of standing, saying you shouldn't have to stand up to be respected in this world.

There's no question that standing wheelchairs and standers are expensive and are seldom fully covered by insurance. The simplest device is about $800, and high-end, multipositional power wheelchairs can exceed $20,000.

MDA pays $1,700 toward a wheelchair every three years for people under 18 and every five years for people over 18. That allowance includes wheelchairs that have standing devices but not "stand-alone" standers. With limited funds available, MDA focuses on devices that improve vital mobility.

Bach makes the point that braces, which accomplish some of the same things as standing devices, are also expensive and may not be as comfortable. "When children with muscular dystrophy can no longer stand unassisted, bracing can help, but bracing is usually very expensive and the kids aren't too happy about it," he says.

And the complications of prolonged sitting -- pressure sores, joint contractures that may require surgery and bone degeneration with possible fractures -- are expensive, too.

"It's important to have the opportunity to stand," says physical therapist Pandya. "Our bodies were made to function in a standing position."

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