Benefits of Standing in Upright, Prone and Supine Positioning

There are many benefits of assisting children with complex disabilities in standing. In previous articles we have looked at the positive outcomes standing in abduction, the relationship between bone mineral density and weight bearing in an upright position, as well as the psycho-social benefits from adopting alternative positions.

Standing can play an important role within a 24 hour postural management plan. Not every child will have the ability to stand unaided in an upright position, and the use of a standing frame may be warranted. Different anterior and posterior angles can be used to assist a child in standing, each having their own merits.

Upright positioning

Standing in an upright, aligned position is widely known to aid in the development of children’s hip joints. Weight bearing through the hips, knees and ankles along with dynamic movement has shown positive benefits in bone mineral density. Being in a completely upright position, this allows the optimal amount of weight and pressure to go through the hips. Therefore trying to achieve the best outcomes in bone mineral density and hip formation, an upright position is ideal. Gaining body and spacial awareness from weight bearing through the feet is also of huge benefit in an upright position. However, depending on the specific needs and challenges of the individual child, adopting a different position may be more appropriate.

Prone positioning

Not every child is able to attain or tolerate a fully upright position, however standing with a degree of prone might be achievable. Although weight bearing through more anterior aspects of the body is not as ‘effective’ for bone mineral density, there are a number of benefits to standing in a prone position. In order to build and develop neck and head control, a prone position can be used therapeutically (similar to that of a therapy wedge). Also, by offering anterior support of a tray whilst standing in prone can help improve and engage trunk extension, allowing the child to engage in midline activities concurrently. Standing in Prone has also been shown to reduce spasticity in children with Cerebral Palsy.

Supine Positioning

Standing in Supine has a number of benefits and is absolutely the correct preference for certain children. If manual handling is a concern, having the ability to safely hoist a child into a standing frame can be an important factor. This means that children with a higher GMFSC level, less trunk control, head control and overall physical ability are still able to benefit from a standing position. Standing with the lower limbs in a full extension is a tried and tested method to maintain hamstring length, and contributes to mitigating contractures. The cardiovascular, digestive and respiratory systems have to work differently in a standing position. This can lead to healthier and more functional bodily systems.