After 33 years of having to use a wheelchair for all mobility needs, I now can stand up when I arrive at my destination. No, I have not had a paralysis cure. No surgery. No medications. No miracle. Technology! People in wheelchairs now have the option to stand up to greet others, stretch, reach items, pursue more career options, prevent medical complications and certainly live a more normalized lifestyle! People who use wheelchairs can instead be thought of as individuals who sit while moving around, but also are standers!

I’ve been fortunate enough to use the Levo standing wheelchair for over a year now and I am pleased to report interesting observations. There are various types of manual and power wheelchairs, which have standing features. My wheelchair is manual, with a gas hydraulic lifting device, which is easily controlled under the armrests by a short unobtrusive lever. Not in a million years, could I ever imagine going back to a wheelchair that does not have this standing feature. I can, without hesitation, say that, paralysis cure aside; the standing wheelchair is the next best thing. This is a powerful statement, but after sitting for every mobility effort in four decades as a result of an auto accident in 1969, I truly believe it is revolutionary and will dramatically enhance the quality of life for those of us who rely on a wheelchair to get around. Sure, the wheelchair has required repairs, it is not cambered and the wheelchair, although lightweight, is heavier than I expected. But these flaws are slight and are currently being rectified.

So what’s the rub? Very few individuals have these types of wheelchairs even though standing wheelchairs have been available for over 25 years! How can this be if they are so impactful, so powerful for individuals using a wheelchair for mobility? How can any reasonable person not agree, that anyone who has to use a wheelchair for their mobility device and does have the ability to stand, should experience the empowerment a standing wheelchair offers?

Imagine never being able to stand and stretch after long trips in an automobile, even without diagnosed lumbar issues. Imagine waking up in the morning, sitting up to get ready to go to work and feeling the lower back pain already, working all day, attending children’s functions after school, sitting up in the evening involved in hobbies, a second job or working around the house, and finally lying down only late in the evening. Now let’s see, that’s seventeen hours of sitting per day. After years of this routine, one begins to search for a way out, if you will, a way up or a cure or something to alleviate the oppression of sitting, sitting, and more sitting. Then this wheelchair, which easily allows one to stand, materialized. How could I not have this wheelchair? How could any informed medical professional not recommend such a mobility device for a patient who can bear weight and sits day in and day out? I raced to see my rehabilitation physician and discussed advantages a standing wheelchair could have on my medical/health situation. It was time to replace the wheelchair I had for six years. He concurred that a standing wheelchair would be ideal for my T-8 spinal cord injury, accompanied by complications due to heterotropic ossification of the hips, which causes wrenching back pain.

After a protracted process, I received this innovative standing wheelchair and my quality of life has sky rocketed! Not only was the standing wheelchair viewed as medically necessary, but common sense prevailed. Insurance companies recognize standing wheelchair’s valuable, preventative uses and those of us stuck seated can now easily stand up and smell the roses!

Who wouldn’t jump at the prospect of standing throughout the day as an option? Practical issues haven’t been touched on, such as adjusting the wheelchair to heights of tables, increased career and recreational options, reaching items high out of reach from a sitting position, putting an arm around our child’s shoulder or giving warm upright embraces! Is there something I just don’t get, other than it costs more? That’s it! OK, I admit it. It does cost more. Or does it? This is a no brainer….stand up right!

I realize there are cases where physician prescribed standing wheelchairs have been denied by insurance companies. However, upon appeal, there is a very good case to be made for standing wheelchairs as medically necessary. As with any new medical device, there may be a reluctance to approve them, especially when there is a perceived cost increase over the standard wheelchair. However, the medical cost savings can be dramatic when a person is for the first time allowed to stand and stretch during his/her work day. People are more productive and suffer from fewer complications associated with life in a standard wheelchair. With the right advocacy, everyone should see the light and view standing wheelchairs as appropriate in light of progressing technology and medically beneficial. Here are a few tips to consider when acquiring a wheelchair fit for your needs.

1. Write down features one would want in a wheelchair, i.e., power, manual, reclining, standing, light weight, power assist wheels, and etc. Research options which may be critical to your new wheelchair. Communicate concerns with medical professionals who work with persons in wheelchairs, i.e., physicians, physical therapists, occupational therapists and wheelchair vendors. Talk to other wheelchair users with similar conditions regarding important components of a highly functional, effective wheelchair. This is especially true for first time users of wheelchairs, who, in most cases, are clueless regarding necessary features.

2. Discuss these wheelchair features with your Rehabilitation/Orthopedic physician. Request the doctor to write a letter documenting the specific components required for the prescribed wheelchair. The physician’s letter is the most critical component to the entire process of obtaining an appropriate, medically necessary wheelchair. For example; a standing wheelchair can prevent decubitus ulcers, stretch hamstrings and tendons, increase bone density, increase muscle, decrease spacticity, decrease back pain, help decompress the lower back while partially or fully in the vertical position. If your specialist does not agree with you, seek other opinions!

3. Hopefully the wheelchair will be approved, the wheelchair user is fitted, measured and the wheelchair is ordered. Make sure every option the physician approved is on the order form. Ask for a copy of the completed form.

4. If the wheelchair is not approved, there is an appeal process which can be approached with or without an attorney’s assistance. Basically, there are a number of forms to be completed and time frames to comply with. The appeal may go to arbitration where an arbitrator will make a determination. When faced with the medical evidence, the correct determination will be made.

5. It is important to press for and advocate for the wheelchair even if at first it is denied. The facts and the medical evidence are on your side. In order to succeed, you must appropriate documentation from your physician, and follow the appeal procedures carefully. In the end, you will receive the prescribed wheelchair. In fact, if the chair is unreasonably denied, individuals may receive damages resulting from medical conditions worsened as a result of the delay. The bottom line is you must press on even if you are initially denied the chair.

Health Benefits: pressure relief, bladder function, contractures, digestion, respiration, spasticity, bone mineral loss, circulatory activity and exam tables in clinical settings make transferring much safer and easier. In this light, standing is not a luxury.

Functional Benefits: Integrated activities at school, work, for leisure, home, trimming landscaping, therapy, easier transferring as the standing wheelchair adjusts to heights of beds, chairs, exam tables in clinical settings, comfortable access at raised tables in restaurants and everyday life opportunities.

Psychological Benefits: communication, interaction eye to eye, quality of life, socially integrated in the vertical mainstream, self esteem, independence and from physical relief comes mental relief.

Economical Benefits: less hospitalization/medical issues, reduced physical assistance, fewer household modifications, and increased chance of employment.

Dunn, Robert B, Ph.D.. and Langbein, Edwin, Ph/D. Follow-up Assessment of Standing Mobility Device Users. Applied Research, 1998.

Garvey, Kim. Standing Aids: Options & Opportunities: Today’s state-of-the-art standers can provide strength and mobility for a wide range of users. PN/Paraplegia News, December, 2001.

Koch, Kay Ellen, OTR/L, ATP. Taking a Stand. REHAB Management International: The Interdisciplinary Journal of Rehabilitation, August/September 2002

Shields, Richard, P.T., Ph.D. University of Iowa. Report of his studies about standing habits of Levo standing wheelchair users.

Strobl, Michael Walter, M.D., Ph.D. Senior Physician, Head of the Austrian Society Neuroothopaedics at the Vienna Orthopedic Hospital Vienna-Speising. The Significance of Standing.

Wahl, Margaret. MDA Publications. Taking a Stand., 1998.

Jack Robertson, Ed.D., is a freelance writer who teaches; special education to graduate students at the University of San Diego, National University and K-12 at the San Diego Unified School District. Dr. Robertson may be reached at jrobert4@san.rr.com