1. How to talk about the clinical benefits of standing. How to Talk Clinical The Benefits of Standing Objective: Altimate Medical, Inc.

2. I. Talk Clinical A.Preaching to the choir 1.Third party approach a) Open in-service with Alan’s story b) Alan’s medical team utilized standing program for treatment and prevention of secondary complications. c) Alan was taught that compliance with a standing program helped prevent… give medical benefits.

3. I. Talk Clinical 2.Site clinical studies in AMI Funding Guide. a) Chapter 3 pages 37 – 65 3.Relate information gathered from other therapists a) Get permission 4.Nancy Perlich is an awesome resource

4. I. Talk Clinical B.The Basics 1.Standing reduces and/or prevents secondary complications. a) Helps maintain range of motion (1) Helps decrease hip, plantar & ankle flexion contractures. (2) Sustained, weight bearing, passive stretch b) Reduces the incidents of urinary tract infections (1) Increased bladder pressure, more complete drainage (2) Decreased calcium output in urine

5. I. Talk Clinical c) Helps maintain bowel regularity (1) Upright, aligned weight bearing helps prevent constipation d) Reduces the incidents of upper respiratory infections (1) Upright alignment allows for increased respiratory volume. (2) Rib cage not fixed, facilitates better coughing e) Helps maintain cardiovascular system (1) Decreased orthostatic hypotension (low blood pressure) (2) Increased blood flow

6. I. Talk Clinical f) Helps Maintain symmetrical posture (1) Helps develop head, neck, and upper body muscle control (2) Helps control abnormal tone and muscle reflexes g) Helps reduce lower extremity spasticity (1) Prolonged, weight bearing stretch (2) Range of motion key factor in decreased spasticity h) Helps with maintenance of bone density (1) Specific to acquired trauma (2) Time is of the essence, 3 – 6 month window.

7. I. Talk Clinical i) Helps maintain skin integrity, decreased physical risk factor (1) Change in position (2) Pressure redistribution (3) Circulation j) Psychological, social, emotional benefit (1) Funding doesn’t recognize (2) Increased functional ability (3) Self esteem, self image (4) Improved overall well being (5) Improved quality of life

8. II. Standing Posture is Key A.What is good standing posture? 1.Upright position is the optimal goal a) Head over b) Shoulders over c) Hips over d) Knees over e) Ankles

9. II. Standing Posture is Key B.Upright vs. Supine/Prone 1.Therapists prescribe supine standers typically for clients with poor head and trunk control 2. Therapists prescribe prone standers typically for clients with developing head and trunk control 3. Therapists prefer upright standing when proper alignment and support is available.

10. II. Standing Posture is Key D. What is good upright standing posture 1.Foot position needs to support the body a) The foundation is key b) Shoulder width apart c) Planter, Dorsi flexion d) Abduction e) Rotation

11. II. Standing Posture is Key 2.Knee position a) Over ankle b) Watch hyperextension c) Not too far forward to ensure full extension

12. II. Standing Posture is Key 3.Hip Position a) Over knee b) Full extension if possible c) Hips should be aligned (1) Adjust footplates to accommodate leg length discrepancies d) Rotated Hips e) Contracted Hips

13. II. Standing Posture is Key 4.Shoulder Position a) Over Hips and over feet b) Table positioning c) Chest pad positioning d) Shoulders are base for head

14. II. Standing Posture is Key 5.Head Position a) Over shoulders b) Supports available for varying levels of control

15. II. Standing Posture is Key E. Perfect posture won’t always be achievable but we should know what it looks like and work towards it. Altimate Medical, Inc.