**Abstract**

The standing posture is one of the most important factors in the maturation of the neuromotor system, and it is an evolutionary necessity that phylogenetically makes possible the differentiation of functions between the upper and lower limbs, influencing a greater development of the latter; with a fundamental change in the shape of the foot: it increases the importance of the tarsus and metatarsus and reduces the work of the fingers, which facilitates the movement, transfer and independence of the individual in their activities of daily life. The design and production of the prototype of the device, the judgment of the experts, as well as the results of the physiotherapeutic evaluation before and after the standing program, are the threads that are woven in this research proposal. This study seeks to propose a prototype of a standing frame for pediatric patients with spina bifida. The design of a device for standing is proposed based on the individual characteristics of the users, which was evaluated by experts to later perform a case study on a standing program with this type of device in pediatric patients with spine bifida. The designed prototype seems to offer adequate conditions for maintaining standing and on some musculoskeletal conditions of the patient studied. The study concludes that assisted standing should be promoted through inexpensive, functional and continuous monitoring devices. A user-applied design is proposed and not a generic device model.

**Keywords:** standing, device, children, spinal dysraphysm, stander, Congenital abnormalities

## **1. Introduction**

Children and adults who due to their motor disability situation, who cannot adopt the bipedal position, have a greater propensity to complications related to the decrease in bone mineral density, development of myo-tendon contractures, greater risk of gastrointestinal problems, less support of the diaphragm by the effect of gravity; increasing the risk of pressure ulcers because by not having the adequate redistribution of pressure in the ischial tuberosity, sacrum, spinous processes, scapulae and other bony prominences, blood perfusion that the tissues need is not allowed, thus increasing the risk of rupture of the skin in a seated individual. In addition, the possibility of presenting problems in the functioning of the bladder and greater predisposition to urinary tract infections [1].

One of the causes of disability is neural tube defects, which are the most serious congenital malformations of the central nervous system and the spine. They are the second major congenital anomaly after cardiac malformations, with a frequency that ranges between 0.5 and 2 per 1000 pregnancies, although in some geographical regions, for example, in northern China, frequencies of up to 10 per 1000 births. Furthermore, they account for up to 29% of neonatal deaths associated with congenital anomalies in low-income settings. Both the clinical manifestations and the resulting disabilities and mortality depend on its level and extent [2]. The structural defect occurs at any level of the neuraxis, from the brain to the sacrum; These neural tube defects located in the spine are classified as occult spina bifida and open or cystic spina bifida, in the latter, spina bifida is present, but accompanied by a protrusion of a meningeal sac with cerebrospinal fluid with neural tissue inside or without it and are classified as Meningocele, Myelomeningocele and Rachischisis with Mieloschisis. Myelomeningocele is the most serious form of spina bifida cystica that presents as a chronic disease, it produces a strong psychosocial impact on the child and their family since the child may present motor, urological, orthopedic and sometimes cognitive impairment [3, 4]. This can be done damaging effects on a child's well-being, education, and social engagement [5, 6].

Failure to adopt bipedal position implies the limitation of voluntary motor skills such as locomotion, transfers and self-care, sphincter involvement, restricting social and school participation. This is the reason why orthotic attachments or devices to achieve the maintenance of the bipedal position, have been proposed since time immemorial [7].

Recent research even recommends a "24-hour postural management program that you should consider including both a passive standing component and an active component using a stander that steps, vibrates, oscillates, sways, turns, bounces, moves from sit-to-stand under users' own power, allows users to self-propel, and so on, or other devices that combine weight-bearing and movement such as a gait trainer/support walker" [8].

Assisted standing involves using a device to help place load through a person's feet. Standing devices and orthoses provide a stable mechanical support for weight bearing in the supine, prone or upright positions, depending on the device chosen; however, a precise and timely evaluation of individual needs must select the most appropriate design of standing device, orthoses, or both. These benefits include preservation of muscle length and range of joint movement via the stretch that occurs during standing (predominantly of the hip and lowerlimb 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. Clinical opinion on standing indicates other benefits, including pressure relief (which improves skin integrity), improvement of well-being and better sleep [9, 10].

In addition, for these people, there is the social stigma of depending on others for functional mobility, which is why an assistive device is necessary that facilitates the bipedal position, ambulation in the environment and development of activities typical of age, without assistance from another person and who contribute positively to society as a whole [11, 12].

One of the fields of the human body movement professional is precisely the design, prescription and evaluation of the use of this type of device for standing,

**79**

*Design of a Standing Device for Children with Spinal Dysraphysm*

known as Standing Stands. However, the limited and timid research that researchers

The approach to the design of machinery that was proposed in this project considered for its realization the steps of the engineering design flow [14], that

2.Specifications and requirements that the machine must meet to solve the need.

The purpose of the probability study is to verify the possible success or failure

In this phase of design, researchers must act as physiotherapists, "empirical

Drawings of the machine as a whole and of the specific parts of it, the dimensions and important notations, as well as auxiliary sectional views, that fully explain the proposed design. In addition, kinematic studies are conducted, which include the design of the machine and the possible move-

Detailed design refers to the actual rigging and sizing of all individual components, both purchased and manufactured, that make up the total product, device, or system. The assistance of experts in the different areas was necessary

At this stage, the parts were manufactured, the commercial components were purchased and the machine or system, after the assembly, is ready for evaluation and testing. After the necessary changes and/or modifications have been made, the new components are incorporated into the prototype assembly to continue with the tests and evaluations. This process was performed until the designer, in this case the researchers, were satisfied with the stipulated

8.Production design, this stage is not part of this project as it is a pilot test.

This was the prototype of the standing frame that was used in the case, which was subjected to evaluation in the prototype workshop of the Faculty of Engineering of the National University, and to an expert judgment (**Figure 1**).

of a proposal, both from a technical and economic perspective.

engineers," inventors, and artists, to create the machine.

in order to carry out the stander on the right track.

*DOI: http://dx.doi.org/10.5772/intechopen.97758*

have found in this field is surprising [13].

**2. Material and methods**

1.Recognition of a need.

3.Study of the possibilities.

4.Synthesis of creative design.

5.Preliminary design and development.

ments that it should conduct.

7.Prototype construction and testing.

6.Detailed design.

specifications.

is to say:

known as Standing Stands. However, the limited and timid research that researchers have found in this field is surprising [13].
