In-House Modification of the Variety Village Standing Frame

BY BETH TOLLEY, R.P.T.*, LINDA COHEN, O.T.R.**AND JAY NOGI, M.D.***Children's HospitalRichmond. Virginia


Summary

The upright posture is a goal to strive for with all children. A standing frame is usually prescribed for those children in whom weakness and delays in acquiring gross motor skills prevent independent standing.

Cases are presented illustrating the ease with which Variety Village standing frames were adapted with materials found in most Occupational Therapy Departments. With these "in-house" modifications of the frame, additional alignment stability was provided. This stability allowed these children to increase their standing time.

Introduction

The ability to maintain a standing posture is felt to be important in the continued growth and development of children with multiple handicapping conditions. Standing provides these children with some concepts of normal vestibular and spatial experiences1. The use of a standing orthosis provides the lower-extremity and trunk support necessary to free the child's hands for purposeful activities and assists in his socialization2.

At Children's Hospital, Richmond, Virginia, we have fitted the Variety Village standing frame to children with significant muscle weakness, if they are unable to stand by 18 months of age. The standard orthosis3 has been quite satisfactory for our children with varied neuromuscular diagnoses and motor delay.

The purpose of this report is to describe two children whose standing frames required special modifications to obtain a better fit and increase successful "wear" time of their orthoses. These modifications were performed in our Occupational Therapy Department using readily available supplies.

Case Reports

Case No. 1--W. S., a 17-month-old male, underwent repair at birth for a large thoracolumbar myelomeningocele. He has an upper thoracic paraplegia. He has no contractures of the joints of the lower extremities. After head control and upper-trunk control were obtained, he was fitted with a conventional Variety Village standing frame. The frame did not provide sufficient pelvic and lower-trunk support in this child with a high-level neurologic deficit. Fitting and brace tolerance were unsuccessful. The frame was modified by bolting a 10-cm- (4-in.)- wide band of perforated orthoplast to the hip-support panel. This band was formed to mimic the function of a pelvic band on conventional hip-control orthoses. Anterior support was provided by a 5-cm- (2-in.)- wide velcro strap attached to the orthoplast pelvic band (Figs. 1-A and 1-B ). W. S. is now in a standing frame daily for several hours and has adapted to the upright position in a most satisfactory fashion (Fig. 2 ).

Case No. 2-A. C., a 4-year-old female with congenital muscular dystrophy, had developed severe fixed bilateral hip and knee-flexion contractures despite an extensive exercise and splinting program. In an attempt to stand her, surgical releases of the hip and knee contractures were performed. Fitting a conventional Variety Village frame was unsuccessful. She continued to slump forward because of weakness of the upper trunk and shoulder-girdle musculature. Additional shoulder and upper-thoracic support was provided by modifying the standing frame. An additional hip-support panel was bolted to the top of the frame, and "D" rings and 2-in.-wide webbing straps with Velcro closures were used to make a shoulder harness in a criss-cross configuration (Figs. 3-A and 3-B ). This arrangement has provided enough additional support to allow A. C. to stand daily and maintain the range of motion in her hips and knees (Fig. 4 ).

*Assistant Director, Department Physical Therapy

**Director, Department Occupational Therapy

***Director, Pediatric Orthopaedic Surgery

References:

  1. Holt, K. S., Developmental Pediatrics. Butterworth 8c Co., London, 1977.
  2. Bunch, W. H., Treatment of the Paralytic Spine. In Atlas of Orthotics, Biomechanical Principles and Application. C. V. Mosby Co., St. Louis, 1975.
  3. The Standing Orthosis, pg. 233. Atlas of Orthotics, Biomechanical Principles and Application. C. V. Mosby Co., St. Louis, 1975.