Clinical UM Guideline

This document addresses the use of standing frames, which are assistive devices that provide an alternative position for individuals confined to supine, prone, or sitting positions. These devices allow the individual to achieve a standing position and then support the person in the standing position. Standers can be integrated to use with wheelchairs for those in a sitting position. Other types of standing frames are designed to aid individuals in a prone or supine position to achieve a standing position.

Note: Please see the following related documents for additional information:

• CG-DME-25 Seat Lift Mechanisms
• CG-DME-34 Wheeled Mobility Devices: Wheelchair Accessories

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

Medically Necessary:

A non-powered standing frame is considered medically necessary when a written assessment by a physician or other appropriate clinician demonstrates criteria 1, 2 and 3 are met:

1. The individual has a neuromuscular condition (such as multiple sclerosis, cerebral palsy, spinal cord injury or stroke) which impairs their ability to stand independently, but they are able to maintain a standing position due to residual strength in the hips, legs and lower body with the aid of a standing frame device; and
2. The individual has completed appropriate standing device training and has demonstrated an ability to safely use the device in the home setting; and
3. Use of the device can be reasonably expected to provide therapeutic benefits or enable the individual to perform certain tasks that he or she is unable to undertake otherwise due to the neuromuscular condition.

Replacement of a non-powered standing frame is considered medically necessary when both of the following criteria have been met:

1. The medically necessary criteria above have been met; and
2. The device is out of warranty and cannot be refurbished or adequately repaired.

Not Medically Necessary:

A non-powered standing frame is considered not medically necessary when the criteria above are not met and for all other indications.

Replacement of a non-powered standing frame is considered not medically necessary when the criteria above have not been met.

A powered standing frame is considered not medically necessary.

This document describes clinical studies and expert recommendations, and explains whether standing frames are clinically appropriate. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

A standing frame, also called a stander, is a device that helps a person move into and stay in a standing position when they cannot stand on their own. It is used by people with conditions that affect movement, such as multiple sclerosis, cerebral palsy, spinal cord injury, or stroke. Some standers are manual, while others use power to assist movement. These devices may help improve bone strength, joint movement, and daily function. They may also help a person take part in activities they could not do while sitting or lying down. However, powered versions have not been shown to provide added health benefits compared to non-powered devices. Standing frames also require training to use safely, and not all people will benefit from them.

What the Studies Show

Research shows that standing frames may provide some health benefits, but results vary and are not always strong. In people with multiple sclerosis, one study found small improvements in movement, but the changes did not reach a level considered clearly meaningful. In people recovering from stroke, a small study showed better balance with added standing practice, but changes in movement were less clear.

In children with cerebral palsy, studies suggest more consistent benefits. These include improved bone strength, better joint movement, and improved ability to take part in daily life. Some studies also suggest benefits for bowel function, muscle stiffness, and posture. However, many studies are small or of lower quality, so better studies are needed to know how much standing frames improve health. Risks may include strain, fatigue, or possible heart and lung effects in some people, such as those with spinal cord injury. Powered standing frames have not shown extra health benefits and are mainly for ease of use.

When is a Standing Frame Clinically Appropriate?

A non-powered standing frame may be appropriate in these situations:

• The person has a condition that affects nerves or muscles, such as multiple sclerosis, cerebral palsy, spinal cord injury, or stroke; and
• The person cannot stand on their own but can stay standing with support from the device; and
• The person has been trained and can use the device safely at home; and
• The device is expected to improve health or help the person do tasks they otherwise cannot do.

Replacement may be appropriate if:

• The above criteria are still met; and
• The device cannot be repaired or is no longer under warranty.

When is this not Clinically Appropriate?

A non-powered standing frame is not clinically appropriate if the conditions above are not met. This is because the benefits depend on the person being able to safely use the device and gain functional or health improvements. Powered standing frames are not clinically appropriate because studies have not shown that they improve health more than non-powered devices.

Standing frames are not clinically appropriate in scenarios other than those listed above.

(Return to Description)

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.=

When services may be Medically Necessary when criteria are met for non-powered systems:

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met for initial or replacement or when specified as powered, and for the following code:

Summary

Standing frames, or standers, are assistive devices that allow individuals with significant mobility limitations to achieve an upright position. Standers are used to address complications of immobility, including reduced bone density, contractures, muscle weakness, and decreased participation. Across populations, the evidence base is limited and variable, but generally suggestive of benefit. Randomized and pilot studies in multiple sclerosis and post-stroke populations show modest improvements in motor function and balance. The strongest evidence exists in children with non-ambulant cerebral palsy, where reviews and clinical trials demonstrate benefits in bone mineral density (BMD), range of motion (ROM), and participation, although overall evidence quality remains low to moderate. A 2024 review similarly concludes that the evidence is not definitive but supports benefits, particularly for bone health and contracture prevention. In Duchenne muscular dystrophy, no high-quality trials exist, but the DMD Care Considerations Working Group recommends standing devices based on expert consensus. Broader systematic reviews using Oxford Centre for Evidence-Based Medicine (CEBM) and American Academy of Neurology (AAN) evidence frameworks report moderate support for improvements in bone density, ROM, spasticity, and bowel function despite the lack of high-level evidence. Overall, the literature is heterogeneous and not definitive, but it consistently supports standing frames as a clinically reasonable intervention for individuals who cannot stand independently but can maintain a standing position once standing.

Discussion

General Considerations

Impaired mobility is associated with multiple secondary complications including muscle wasting, decreased bone density, reduced skin integrity, spasms, constipation, depression, lowered self-esteem as well as an increased risk of mortality. Therapies such as passive standing have been used to improve motor function and minimize the detrimental effects of immobility, and to enhance hip alignment, bone mineralization, urinary function, respiratory functioning and psychosocial functioning.

A sit-to-stand device allows the individual with upper body strength to achieve a standing position from a sitting position without assistance. A sling is slipped behind the buttocks and hooked onto the frame of the standing device. The person’s legs and feet are placed in supports on the frame. The person lifts themselves to a standing position, either manually or by use of a motor. A back support is rotated in place to support the individual’s back.

A prone or supine stander is positioned next to the individual, usually next to a bed. The individual is either rolled or transferred to the device with the help of a sling lift. Once positioned on the device, the person’s extremities are secured, and the device is moved to a vertical (standing) position. These devices provide varying levels of support to the user which is dependent upon an individual’s level of head and trunk control.

Standing frames can be categorized by types:

• Passive (static) stander: A passive stander remains in one place, sometimes has casters but cannot be self-propelled.
• Mobile (dynamic) stander: User can self-propel a mobile stander if they have upper body strength to push a manual wheelchair.
• Active stander: An active stander creates reciprocal movement of the arms and legs while standing.
• Powered Stander: A stander that includes a motorized, power operated component to assist in the transfer of an individual to and from the device or to allow for powered mobility once an individual is in the stander.

Multiple Sclerosis (MS)

In a 2019 pragmatic, multicentre, superiority randomised controlled trial (RCT), Freeman and colleagues assessed the clinical effectiveness of a home-based, self-managed standing frame program. Individuals with MS and severe mobility impairment were randomly assigned to either a standing frame plus usual care group (n=71) or usual care only (n=69). The individuals in the intervention group were asked to use the standing frame for 30 minutes, 3 times/week for 20 weeks. These individuals had two home-based physiotherapy sessions, six follow-up phone calls and access to paper-based, DVD and online resources. Participants in the control group received no additional interventions. Motor function, as assessed by the Amended Motor Club Assessment (AMCA), was measured in all participants at baseline, at 20 weeks and at 36 weeks. The primary clinical outcome was set as the AMCA score at 36 weeks, and a 9-point AMCA change was considered clinically meaningful a priori. At 36 weeks post-randomisation, the AMCA score was significantly higher in the standing group compared to the usual care group with a between-group mean difference of 4.7 points. While motor function, as measured by the AMCA score, was significantly improved in the intervention group, the improvement did not reach the predetermined minimal clinically meaningful level of improvement. The positive results of this study suggest that modest improvement in one functional area is achievable.

Post-Stroke

In a pilot RCT, Allison and colleague (2007) studied 17 post-stroke individuals in a rehabilitation unit. Individuals were allocated to a control group (conventional physiotherapy) or a treatment group (conventional therapy plus an additional session of standing practice). The duration of study was variable depending upon the length of time the individual was inpatient, from 14 to 28 days. Balance, gross motor function and trunk control were assessed upon admission, weekly during the intervention stage and 12 weeks following discharge. At week 12, the treatment group reported a statistically significant improvement (p<0.05) in balance scores compared to the scores of the control group. The treatment group also reported an improvement in motor function scores over the control group, although that difference was not statistically significant. This small pilot study indicates that participants who received additional standing practice in addition to standard physiotherapy achieved higher median scores in motor function measures.

Cerebral palsy (CP)

A scoping review by McLean and associates (2023) focused on the potential benefits of supported standing interventions for children and young adults with non-ambulant cerebral palsy. The authors noted that supported standing is associated with improvements in BMD, hip stability, and lower-limb ROM, along with fostering psychosocial advantages such as enhanced social participation and reduced sedentary behavior. Although much of the evidence is rated as low quality, the body of evidence suggests positive impacts on physiological outcomes like postural alignment and muscle activity, and psychological outcomes such as health-related quality of life.

Hough and colleagues (2010) systematically reviewed the published literature addressing the efficacy of interventions (for example, medical and physical) to improve low BMD in children and adolescents with CP. Out of the eight studies included in the review, three studies included weight bearing interventions. The authors found that the most promising interventions for decreased BMD were weight bearing and bisphosphonates.

Caulton and colleagues (2004) studied severely disabled children with CP to determine whether participation in 50% longer periods of standing (in either upright or semi-prone standing frames) would lead to an increase in the vertebral and proximal tibial volumetric trabecular BMD (vTBMD), which affects low trauma fractures. A heterogeneous group of pre-pubertal children with CP (n=26) participated and were matched into pairs using baseline vertebral vTBMD standard deviation scores. Children within the pairs were randomly allocated to control (regular standing duration) or intervention (50% increase in the regular standing duration) groups. The median standing duration varied from 80.5% (range, 9.5%-102%) and 140.6% (range, 108.7%-152.2%) of the baseline standing duration in the control group and intervention group respectively. The mean vertebral vTBMD in the intervention group increased by 8.16 mg/cm³, a 6% mean increase in vertebral vTBMD. There was no change in the mean proximal tibial vTBMD. The authors found that a longer period of standing in non-ambulant children with CP improves vertebral, but not proximal tibial vTBMD. The authors concluded that such an intervention might reduce the risk of vertebral fractures, although it is unlikely to reduce the risk of lower limb fractures in children with CP.

A 2024 review by Paleg focusing on children with non-ambulant cerebral palsy indicates that while the overall quality of evidence for standing frames remains limited and heterogeneous, the available literature suggests clinically meaningful benefits that support their medical use in this population. The strongest evidence, derived from experimental studies, supports maintenance of BMD and prevention of contractures through regular weight-bearing, outcomes that are directly relevant to reducing secondary complications associated with immobility. Additional reported benefits, including improvements in hip stability, bowel function, spasticity, and functional abilities, as well as enhanced participation and psychosocial well-being, are supported primarily by lower-level or observational evidence. Taken together, the review reflects a body of evidence that is not definitive but consistently suggestive of benefit, supporting the position that standing frames may be medically necessary as part of a comprehensive management approach for individuals with severe motor impairments.

Duchenne Muscular Dystrophy (DMD)

Pedlow and associates (2019) conducted a Cochrane review in order to assess the positive and negative effects of standing devices and orthoses on musculoskeletal impairments and quality of life in individuals with DMD. The review planned to include RCTs and quasi RCTs. However, the authors did not identify any studies which met the inclusion criteria. Based on insights from existing research on assisted standing therapy for other neurological conditions, the authors concluded:

Although there is a lack of conclusive evidence for the use of standing devices in DMD, clinical opinion and research from other neurological conditions (such as cerebral palsy), highlight the proposed benefits. These benefits include preservation of muscle length and range of joint movement via the stretch that occurs during standing (predominately of the hip and lower-limb muscles), delayed onset of scoliosis, increased bone density (thereby reducing the risk of fractures), fewer muscle spasms and better respiratory function (including voice control). Research on standing for other conditions has also suggested improved circulation, digestion, and bowel and bladder function…Standing devices are considered to be an essential component of the therapy management of DMD (both physiotherapy and occupational therapy).

In 2010, the DMD Care Considerations Working Group, a group of experts selected by the Centers for Disease Control and Prevention (CDC) developed a comprehensive set of management strategies for DMD. The report notes that passive standing devices in late ambulatory and early non-ambulatory stages are necessary when there are no or mild hip, knee or ankle contractures. In addition, the continued use of a passive device or a power device into the late non-ambulatory stage if the contractures are not too severe and devices are tolerated was advocated. This recommendation is based upon the collective judgment of the experts.

Additional Studies

There have been two systematic reviews assessing the available evidence and providing recommendations for supported standing programs. A 2010 systematic review by Glickman and colleagues included 39 studies, 10 pediatric and 29 adult studies. The majority of the studies were comprised of less than 50 participants and described or compared supported standing to another intervention or took measurements prior to and following the interventions. Studies were grouped based upon outcomes in BMD, cardiopulmonary function, muscle strength/function and ROM. The authors noted that for both pediatric and adult populations, the available evidence moderately supports standing programs in BMD, ROM, spasticity and bowel function. For those with spinal cord injuries, there was a potentially negative cardiopulmonary side effect. The authors noted that conclusions were difficult to reach as the literature varied greatly in terms of design, intervention and outcome measures. The authors recommended that practicing therapists should combine the results of this systematic review with sound clinical judgement based on supported stander usage rationale in their specific setting.

Paleg and colleagues (2013) addressed the use of standing support systems in the pediatric population. A total of 30 studies were reviewed, along with the authors’ opinions, to obtain recommendations for minimal dosages needed to maintain body function and structures. These areas included, but were not limited to, mental, cardiovascular and respiratory, digestive and urinary functioning and structures of the bones. The evidence was evaluated and recommendations made based upon the Oxford CEBM Levels of Evidence and the AAN Levels of Evidence. Evidence levels range from the highest level (1: systematic review of randomized controlled trials) to lowest (5: expert opinion without critical appraisal). The authors noted that although none of the evidence was rated as level 1 evidence, the strongest available evidence-based literature supported the use of standing devices to positively affect BMD.

Standing frames are generally accepted as a standard of medical practice when used for individuals with neuromuscular conditions who have an impaired ability to stand independently. Powered standing frames are used primarily for the convenience of the individual or caregiver and have not been shown to provide additional clinical benefit.

Amended Motor Club Assessment (AMCA): Tool used to measure motor function in multiple sclerosis. The tool is comprised of two sections, a functional activity subscore and a lower limb subscore. Scores range from 0 to 76 points, with higher scores denoting better motor function.

Bone mineral density (BMD): Term used to describe the amount of calcium present in bone.

Duchenne muscular dystrophy (DMD): A type of muscular dystrophy which results in progressive muscle degeneration and weakness. Onset of symptoms is generally in early childhood between the ages of 3 to 5.

Prone: Lying with the front or face downward.

Reciprocal movement: Alternate movements of arms and legs seen in walking and other normal movements.

Seat Lift: An assistive device used in the home to lift a person’s body from a sitting position to a standing position or to lower the individual from a standing to a sitting position.

Supine: Lying on the back or having the face upward.

Peer Reviewed Publications:

1. Allison R, Dennett R. Pilot randomized controlled trial to assess the impact of additional supported standing practice on functional ability post stroke. Clin Rehabil. 2007; 21(7):614-619.
2. Bagley P, Hudson M, Forster A, et al. A randomized trial evaluation of the Oswestry Standing Frame for patients after stroke. Clin Rehabil. 2005; 19(4):354-364.
3. Bushby K, Finkel R, Birnkrant DJ, et al.; DMD Care Considerations Working Group. Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and pharmacological and psychosocial management. Lancet Neurol. 2010a; 9(1):77-93.
4. Bushby K, Finkel R, Birnkrant DJ, et al.; DMD Care Considerations Working Group. Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care. Lancet Neurol. 2010b; 9(2):177-189.
5. Caulton JM, Ward KA, Alsop CW, et al. A randomized controlled trial of standing program on bone mineral density in non-ambulant children with cerebral palsy. Arch Dis Child. 2004; 89(2):131-135.
6. Eng JJ, Levins SM, Townson AF, et al. Use of prolonged standing for individuals with spinal cord injuries. Phys Ther. 2001; 81(8):1392-1399.
7. Freeman J, Hendrie W, Jarrett L, et al. Assessment of a home-based standing frame programme in people with progressive multiple sclerosis (SUMS): a pragmatic, multi-centre, randomised, controlled trial and cost-effectiveness analysis. Lancet Neurol. 2019; 18(8):736-747.
8. Glickman LB, Geigle PR, Paleg GS. A systematic review of supported standing programs. J Pediatr Rehabil Med. 2010; 3(3):197-213.
9. Goktepe AS, Tugcu I, Yilmaz B, et al. Does standing protect bone density in patients with chronic spinal cord injury? J Spinal Cord Med. 2008; 31(2):197-201.
10. Gudjonsdottir B, Stemmons Mercer V. Effects of a dynamic versus a static prone stander on bone mineral density and behavior in four children with severe cerebral palsy. Pediatr Phys Ther. 2002; 14(1):38-46.
11. Hendrie WA, Watson MJ, McArthur MA. A pilot mixed methods investigation of the use of Oswestry standing frames in the homes of nine people with severe multiple sclerosis. Disabil Rehabil. 2015; 37(13):1178-1185.
12. Hough J, Boyd R, Keating J. Systematic review of interventions for low bone mineral density in children with cerebral palsy. Pediatrics. 2010; 125(3):670-678.
13. Kunkel CF, Scremin AM, Eisenberg B, et al. Effect of "standing" on spasticity, contracture, and osteoporosis in paralyzed males. Arch Phys Med Rehabil. 1993; 74(1):73-78.
14. Kwok S, Harvey L, Glinsky J, et al. Does regular standing improve bowel function in people with spinal cord injury? A randomised crossover trial. Spinal Cord. 2015; 53(1):36-41.
15. Macias-Merlo L, Bagur-Calafat C, Girabent-Farrés M, Stuberg WA. Standing programs to promote hip flexibility in children with spastic diplegic cerebral palsy. Pediatr Phys Ther. 2015; 27(3):243-249.
16. McLean LJ, Paleg GS, Livingstone RW. Supported-standing interventions for children and young adults with non-ambulant cerebral palsy: a scoping review. Dev Med Child Neurol. 2023; 65(6):754-772.
17. Mercuri E, Finkel RS, Muntoni F, et al.; SMA Care Group. Diagnosis and management of spinal muscular atrophy: part 1 recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018; 28(2):103-115.
18. Mergler S, Evenhuis H, Boot A, et al. Epidemiology of low bone mineral density and fractures in children with severe cerebral palsy: a systematic review. Develop Med Child Neurol. 2009; 51(8):773-778.
19. Paleg G, Livingstone R. Systematic review and clinical recommendations for dosage of supported home-based standing programs for adults with stroke, spinal cord injury and other neurological conditions. BMC Musculoskelet Disord. 2015; 16:358.
20. Paleg GS, Smith BA, Glickman LB. Systematic review and evidence-based clinical recommendations for dosing of pediatric supported standing programs. Pediatr Phys Ther. 2013; 25(3):232-247.
21. Paleg GS, Williams SA, Livingstone RW. Supported standing and supported stepping devices for children with non-ambulant cerebral palsy: an interdependence and f-words focus. Int J Environ Res Public Health. 2024; 21(6):669.

Government Agency, Medical Society, and Other Authoritative Publications:

1. Center for Medicare and Medicaid Services (CMS). National Coverage Determination for: seat lifts. NCD #280.4. Effective May 1, 1989. Available at: https://www.cms.gov/medicare-coverage-database/. Accessed on April 8, 2026.
2. Masselink C, Detterbeck A, LaBerge N, et al. RESNA and CTF position on the application of supported standing devices: current state of the literature. Assist Technol. 2024: 1-18.
3. Pedlow K, McDonough S, Lennon S, et al. Assisted standing for Duchenne muscular dystrophy. Cochrane Database Syst Rev. 2019; 10:CD011550.
4. U.S. Food and Drug Administration 510(k) PMA Premarket Notification Database. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm. Accessed on April 8, 2026.
   • EasyStand Evolv^™. No. K062402. Rockville, MD: FDA. September 21, 2006.
   • Rabbit Mobile Standing Frame^™. No. K030882. Rockville, MD: FDA. April 4, 2003.
   • Rifton Mobile Prone Standers^™. No. K921894. Rockville, MD: FDA. May 26, 1992.
5. Wang CH, Bonnemann CG, Rutkowski A, et al. Consensus statement on standard of care for congenital muscular dystrophies. J Child Neurol. 2010; 25(12):1559-1581.

EasyStand Evolv
EasyStand Glider
Meerkat Dynamic Stander
Tek RMD M1 (Matia Mobility, Salt Lake City, UT)
Rabbit Mobile Standing Frame
Rifton Standers
Standing Frames

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

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