The pelvis can be the key to postural alignment as it can dictate the position of the trunk, head, legs, and extremities

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1 The pelvis can be the key to postural alignment as it can dictate the position of the trunk, head, legs, and extremities BES Rehab Ltd 11

USER GUIDE FOR HIP BELTS Posterior Pelvic Tilt Uncorrected Posture Assessment ü Sacral sitting - most common tendency ü ASIS (Anterior Superior Iliac Spine) higher than ü PSIS (Posterior Superior

shown Centre Pull Dual Pull Causes Wheelchair Issues: Canvas back, no PSIS block, seat depth too long, back support too short, footplates too low.

2 USER GUIDE FOR HIP BELTS Posterior Pelvic Tilt Uncorrected Posture Assessment ü Sacral sitting - most common tendency ü ASIS (Anterior Superior Iliac Spine) higher than ü PSIS (Posterior Superior Iliac Spine) ü Tends to slide out of chair ü Flexed lumbar spine ü Thoracic kyphosis ü Shoulders protracted ü Increased cervical extension ü C type posture Improved positioning with Hip Belt (18574) shown Centre Pull Dual Pull Causes Wheelchair Issues: Canvas back, no PSIS block, seat depth too long, back support too short, footplates too low. Physical Conditions: Tight hamstrings, muscle weakness, kyphosis. Hip Belt Options The objective of the belt is to prevent sliding. Two-Point Centre-Pull Hip Belt Two-Point Dual-Pull Hip Belt Attachment Position the padded belt anterior and inferior to the ASIS across the thighs and attach at an angle that brings it anterior to the greater trochanters (see illustration). Note: a block at the level of the PSIS is required. Pelvic Obliquity Uncorrected Posture Assessment One ASIS is higher than the other Compensatory C-shaped curve in the lumbar and thoracic spine Lateral tendency A shoulder tends to be elevated May involve rotation Improved positioning with Hip Belt (18741) shown Causes Wheelchair Issues: Sling back/seat upholstery, wheelchair too wide, seat too short. Physical Conditions: Irregular trunk muscle tone, muscle imbalance, scoliosis. Rear Pull Hip Belt Options The objective of the belt is to bring the pelvis down and back into the seating system. Two-Point Rear-Pull Hip Belt Attachment Position the padded belt anterior and inferior to the ASIS across the thighs and attach at an angle that brings it anterior to the greater trochanters (see illustration). Note: a block at the level of the PSIS is required. 12 BES Rehab Ltd

USER GUIDE FOR HIP BELTS Anterior Pelvic Tilt Uncorrected Posture Assessment ASIS lower than PSIS Thoracic kyphosis is reduced or reversed Increased lumbar lordosis Shoulders retracted Trunk

Centre Pull Dual Pull Hip Belt Options The objective of the belt is to resist forward tilt of the pelvis.

Attachment Position the padded belt over the ASIS and attach directly back to the wheelchair back posts.

Pelvic Rotation Uncorrected Posture Assessment ü One ASIS is more forward than the other One hip abducted and one hip adducted Appears to have leg length discrepancy or a wind-swept appearance

3 USER GUIDE FOR HIP BELTS Anterior Pelvic Tilt Uncorrected Posture Assessment ASIS lower than PSIS Thoracic kyphosis is reduced or reversed Increased lumbar lordosis Shoulders retracted Trunk extension Improved positioning with Hip Belt (18772) shown Causes Wheelchair Issues: Seat to back angle too small. Physical Conditions: Tight hip flexors, weak abdominal muscles, Lordosis. Centre Pull Dual Pull Hip Belt Options The objective of the belt is to resist forward tilt of the pelvis. Four-Point Centre-Pull Hip Belt Four-Point Dual-Pull Hip Belt For wheelchair occupants adjusting their belts for themselves, the rear pull option is usually easier to adjust. Attachment Position the padded belt over the ASIS and attach directly back to the wheelchair back posts. Anchor the secondary straps to the seat as illustrated to stop the padded belt from rising up into the soft tissues of the abdomen. Pelvic Rotation Uncorrected Posture Assessment ü One ASIS is more forward than the other One hip abducted and one hip adducted Appears to have leg length discrepancy or a wind-swept appearance Improved positioning with Hip Belt (18789) shown Causes Wheelchair Issues: Seat depth too short or too wide. Physical Conditions: Irregular trunk muscle tone, muscle imbalance, spinal deformities, varying leg length Rear Pull Hip Belt Options The objective of the belt is to bring the pelvis back into position and hold it there Four-Point Rear-Pull Hip Belt Attachment Position the padded belt over the ASIS and attach directly back to the wheelchair back posts. Anchor the secondary straps to the seat as illustrated to stop the padded belt from rising up into the soft tissues of the abdomen. BES Rehab Ltd 13

Engineered for comfort and performance, this new design offers a range of improvements that therapists and users

The patented construction allows for removal of the buckle cover for easy cleaning, or to change to the desired

The spring-assisted release, with buckle resistance has been set from clinical research for optimum pressure.

4 THE NEW BODYPOINT PUSH- BUTTON BUCKLE A change from the old chunky buckle to a new sleek and low profile buckle. The NEW Bodypoint Buckle is SLEEK and LOW-PROFILE. Engineered for comfort and performance, this new design offers a range of improvements that therapists and users have requested for years. The patented construction allows for removal of the buckle cover for easy cleaning, or to change to the desired access hole. The spring-assisted release, with buckle resistance has been set from clinical research for optimum pressure. There are three buckle options in a single design. Lightweight Durable Low Profile Easy to Clean Assisted Spring Release Standard Access Cover (22mm) Lighter weight (30% lighter than comparable push-button models). Rounded edges that improve comfort and prevent snagging on clothing. Chrome-plated steel construction for superior strength and durability. Lower profile for a less bulky appearance. Anti-slip device to hold buckle in place. Cover Options Standard Access Cover (22mm), Reduced Access Cover (14mm), Security Cover (6mm). Each available separately 14 BES Rehab Ltd

5 Belt Selection Guide. Follow these 5 Easy Steps 1. SELECT BELT TYPE 2. TWO OR FOUR POINT (refer to user guide on pages ) 1A Padded 1B Hook-and-Loop Compatible Padded 1C Non-Padded 2A TWO-POINT HIP BELT Two points of attachment to the wheelchair. Suitable when the belt is supporting users with low tone or weakness. 2B FOUR-POINT HIP BELT Four points of attachment to the wheelchair. Primary straps position the belt like two-point hip belt and secondary straps anchor the belt in position to prevent it from riding up into the abdomen or twisting. 3A 3. SELECT PULL TYPE CENTRE-PULL HIP BELT OPERATOR: User or caregiver ADJUSTMENT: Tightens at the centre buckle. BUCKLES: Available in the full buckle range. APPLICATIONS: Clients with low muscle tone or weakness. 3B DUAL-PULL HIP BELT OPERATOR: User or caregiver ADJUSTMENT: Tightens from both sides of the centre buckle. BUCKLES: Side-release buckle only APPLICATIONS: Clients requiring greater adjustment range to accommodate clothing and weight changes. 3C REAR-PULL HIP BELT OPERATOR: Caregiver ADJUSTMENT: Tightens from the rear of the pad pulling toward the centre. BUCKLES: Available in full buckle range except for XS metal. APPLICATIONS: Clients with high tone. Counters pelvic rotation by allowing the caregiver to position one side of the pelvis, lock it in place and then position the other side. 4. SELECT BUCKLE 4A 1 Buckle Low-profile, smooth, snag-free corners. Removable cover for changing release hole size and easy cleaning. Select Cover: 1. Standard Access Cover 2. Reduced Access Cover 3. Security Cover each, also available separately. Optional Push Button Buckle Covers 2 Reduced Access Cover /2", Ø14mm hole for use with small and medium belts ", Ø14mm hole for use with large belts. 3 Security Cover /2", Ø6mm hole for use with small and medium belts ", Ø6mm hole for use with large belts. 4B Plastic side-release Lightweight, secure snap action. 4C Rehab latch Buckle Lightweight, strong, lowprofile, easy to operate with limited hand function. 4D Extra Small Metal Strong, secure, child-sized buckle. Buckle Security Cover also available Extra Small Buckle Security Cover Snap securely onto our XS metal Push- Button Buckle: limiting access by even the smallest fingers. Open instantly with a pen tip. 4E Compact Firm button action prevents accidental release. 5. END FITTINGS AND FRAMESAVER 5A. Cinch-mount Each Bodypoint belt is supplied with Cinch- Mount end fitting hardware and FrameSaver Clamps. Cinch-Mount Hip Belts Include FrameSaver (Note: 19mm (3/4 ) shims available as optional extras) ADJUST BELT LENGTH IN THREE EASY STEPS WITH A CINCH-MOUNT 1 3 The Alternative to a Cinchmount 1.0 plastic 1.0 steel 1.5 steel 2.0 steel Tri-end Fitting Steel slides BES Rehab Ltd 15

6 TWO-POINT PADDED HIP BELTS Pull Type Size Plastic Standard Security Side-Release Cover Cover Centre-Pull Dual-Pull Rear-Pull *Also accepts the Reduced Access or Security Covers Accepts Buckle Security Cover. Hip belts include Cinch-Mount end fitting hardware and FrameSaver clamps. Rehab Latch Extra Small Metal XS Compact S 18666* M 18574* L 16679** XS S M L XS S 18758* M 18741* **Also accepts Reduced Access or Security Covers. FOUR-POINT PADDED HIP BELTS Pull Type Size Plastic Standard Cover Side-Release Rehab Latch Extra Small Metal Compact Centre-Pull Dual-Pull Rear-Pull XS S 18802* M 18772* L 18765** XS S M L XS S 18796* M 18789* *Also accepts the Reduced Access or Security Covers **Also accepts the Reduced Access or Security Covers. Accepts Buckle Security Cover. MEASURING FOR A HIP BELT XS 5 9" (13 23cm) S 7 11" (18 28cm) M 9 15" (23 38cm) L 13 19" (33 48cm) Measure hip width across the greater trochanters with the person seated. If the hip width falls between sizes on our chart, consider other factors such as growth, weight changes, and clothing. C D B A A B C D XS 1" (25mm) 1-3/4" (44mm) 6" (15cm) 50" (127cm) S 1-1/2" (38mm) 2-1/4"(57mm) 7" (18cm) 55" (140cm) M 1-1/2" (38mm) 2-1/2"(64mm) 9" (23cm) 60" (152cm) L 2" (50mm) 3" (76mm) 11" (28cm) 65" (165cm) 16 BES Rehab Ltd

HOOK-AND-LOOP-COMPATIBLE BELT Combined with Sub-ASIS pads, our hookandloop-compatible belt provide two firm points of contact with the pelvis.

Two-Point belts Four-Point belts HOOK-AND-LOOP - COMPATIBLE BELTS Pull Type Size Push Button Plastic with Standard Side-Release Access Cover Rehab Latch Centre-Pull M 18833* 13937 L 13913 Rear-Pull M

away from the abdomen (reducing pressure on the bladder), while firmly controlling the pelvis just below the ASIS.

7 HOOK-AND-LOOP-COMPATIBLE BELT Combined with Sub-ASIS pads, our hookandloop-compatible belt provide two firm points of contact with the pelvis. The result is greatly enhanced stability and improved control of obliquity and rotation while minimizing abdominal compression. Two-Point belts Four-Point belts HOOK-AND-LOOP - COMPATIBLE BELTS Pull Type Size Push Button Plastic with Standard Side-Release Access Cover Rehab Latch Centre-Pull M 18833* L Rear-Pull M Extra Small Metal Push- Button Centre-Pull XS M 18857* L 18840** Dual-Pull XS Rear-Pull M SUB-ASIS PADS The teardrop-shaped gel pads comfortably space the belt away from the abdomen (reducing pressure on the bladder), while firmly controlling the pelvis just below the ASIS Extra Small/Small Medium/Large Sub-ASIS pad *Also accepts the Reduced Access or10035 Security Access Covers **Also accepts the Reduced Access or Security Access Covers. Accepts Buckle Security Cover. NON-PADDED HIP BELTS Pull Type Size Push Button with Standard Access Cover Centre-Pull Plastic Side-Release XS S Rehab Latch Compact M 18826* L 10363** L SLIP-ON PADS Allows you to add cushioning where additional relief is needed on belts and harnesses Small Fits webbing: 1"(25mm) Length: 8"(20cm) Medium Fits webbing: 1.5"(38mm) Length: 10"(25cm) Large Fits webbing: 2"(50mm) Length: 12"(30cm) Centre-Pull Quad Belt *Also accepts the Reduced Access or Security Access Covers **Also accepts the Reduced Access or Security Access Covers. BES Rehab Ltd 17

PIVOT-MOUNT BELTS Provides direct mounting to rigid surfaces, requiring only a 1/4 (6mm) hole. Ideal for use with moulded seats, shells, and Bodypoint Hip- Grip.

solve difficult physical positioning problems discretely.

8 PIVOT-MOUNT BELTS Provides direct mounting to rigid surfaces, requiring only a 1/4 (6mm) hole. Ideal for use with moulded seats, shells, and Bodypoint Hip- Grip. XS Metal Extra Small Small Rehab Latch Medium Large Extra Large LEG HARNESS Designed in conjunction with Physiotherapist Dr Cheryl Burditt-Footer, the Leg Harness helps solve difficult physical positioning problems discretely. The Leg Harness offers assistance with leg abduction, reduces rotation and obliquities, and controls thrusting, while permitting upper body movement. It also permits anterior/posterior range of movement of the pelvis: often a desirable activity, while reducing the movement of the ischial tuberosities. Low profile and unobtrusive Distributes pressure evenly throughout laminar pads, reducing the risk of skin irritation Avoids pressures on abdomen, groin area, G-Tubes, or catheters Less risk of abnormal development of hip socket than with e.g. knee blocks Easily adjustable Contraindications: Pelvic fractures, open wounds in the groin/upper thigh area, unstable hip joint, skirt wearers Small Medium Large 9" (23cm) 13" (33cm) 15" (38cm) EXAMPLES OF APPLICATIONS LEG ABDUCTION Counters adverse affects of sling seating Discrete unobtrusive way to obtain abduction Top strap attaches to back post at a level slightly inferior to ASIS and PSIS Bottom strap passes under the thigh and attaches to seat rail Degree of abduction influenced by how far forward along the seat rail the bottom strap is attached D ring-pull tightening devices help to position user firmly into back of seat MEASURING FOR A LEG HARNESS THRUSTING Leg harness prevents hip extension by holding the femurs into the seat Top strap attaches to back post at a level slightly inferior to ASIS and PSIS For more aggressive positioning, attach top strap lower down the back post Bottom strap passes under the thigh and attaches to seat rail Laminar padding along the soft tissues of the thigh dissipates the thrusting energy Measure from the Anterior Superior Iliac Spine (ASIS) to the point where the inner thigh touches the seat. S Fits 8 11" (20 28cm) M Fits 11 14" (28 36cm) L Fits 14 16" (36 41cm) 18 BES Rehab Ltd

REACH BEYOND THE CHAIR with the Bodypoint Hip Grip HIP GRIP 2 Following the success of the original Hip Grip in providing postural support and improved reach for many wheelchair users, Bodypoint has

The Hip Grip allows the user to reach forward, and an elastomer spring then helps bring the pelvis back into a neutral position.

The Sub-ASIS Pads fit in the Sub-ASIS notch and create firm circumferential support Gel injected sacral pad resists deterioration from compression and provides optimal user comfort Hip Grip 2

Instead of a long strap fed through a cinch mount, the Pivot Belt terminates on the inside of the Hip Grip, thereby allowing more accurate positioning across the ASISs.

The two smaller sizes come with Push Button buckles, and the larger three sizes with Rehab Latch buckles. Note: the Pivot Belt could also be usefully applied to moulded seating systems.

9 REACH BEYOND THE CHAIR with the Bodypoint Hip Grip HIP GRIP 2 Following the success of the original Hip Grip in providing postural support and improved reach for many wheelchair users, Bodypoint has now launched Hip Grip 2. The concept is that of a pelvic exoskeleton which brings to the user increased stability and control at the pelvis the seat of posture control for the seated person. The Hip Grip allows the user to reach forward, and an elastomer spring then helps bring the pelvis back into a neutral position. An added advantage is that, at the same time, the lateral wings of the Hip Grip provide added lateral stability, allowing improved sideways and downwards reach. The Sub-ASIS Pads fit in the Sub-ASIS notch and create firm circumferential support Gel injected sacral pad resists deterioration from compression and provides optimal user comfort Hip Grip 2 innovations In Hip Grip 2, new Pivot Belts by Bodypoint have been introduced. Instead of a long strap fed through a cinch mount, the Pivot Belt terminates on the inside of the Hip Grip, thereby allowing more accurate positioning across the ASISs. The Pivot Belt also incorporates Velcro lining by Bodypoint, allowing the addition of Sub-ASIS pads. The two smaller sizes come with Push Button buckles, and the larger three sizes with Rehab Latch buckles. Note: the Pivot Belt could also be usefully applied to moulded seating systems. Pivot Brackets provide dynamic motion increasing functional reach The second crucial difference is that the pivoting point of the Hip Grip has been moved from the ischial tuberosities (ITs) to the trochanters. This means that the individual ends up with even better reach, and the opportunity to offload the ITs. US and International patents pending Quick Releases allow easy removal for transport or transfer between chairs Finally, installation has been made much more simple with new hardware. The stylish quick release mechanism (14637) is still a valuable option for this device, and for other uses around the wheelchair. Clinical trials Clinical trials of the Hip Grip in the US showed that from a group of 23 subjects, 67% showed an improvement in forward reach, with an average increase of 6.2 cm. 74% showed an improvement in lateral reach, with an average increase of 5.0 cm. 79% showed an improvement in downward reach, with an average increase of 5.1 cm. Across 86% of subjects who showed a decrease in pelvic obliquity, the average was a 32.4% decrease. In the UK, one of the pilot studies, at the West Midlands Rehabilitation Centre, was published in Posture & Mobility, 34-36: see Appropriate medical conditions Muscle weakness, including Multiple sclerosis Muscular dystrophies ALS/MND Cerebral palsy Spinal injury Contraindications Care should be taken if prescribing for users with Obesity Osteogenesis Imperfecta No pelvic mobility Pressure sores Implants, GI tubes, etc in the pelvic area JUDITH Judith, a former champion equestrian, became disabled in a car accident at age 17. She is a founding member of the AXIS Dance Company, one of the world s leading ensembles integrating dancers with and without physical disabilities. Judith is both the Artistic Director and a performer. She teaches dance and lectures at community organizations, schools and conferences. Judith was one of the earliest recipients of the Hip Grip and has been using one since She uses the Hip Grip in her performances and tours with it nationwide. I ve been using the Hip Grip system for five years, and I love the added stability and range it gives me for dance. BES Rehab Ltd 19

Item and Part No. 1 Pad Set Description 14361 Small 8.25-10.

4 Pivot-Mount Belt Pair 14095 X-Small, Push Button 13-18 (33-46cm) 14088 Small, Push Button 16-21 (41-54cm) 14118 Medium, Rehab Latch 16-21 (41-54cm) 14101 Large, Rehab Latch 20-25 (51-64cm) 14125

8cm) 14897 Large, 4 5/8 (12cm) 6 Quick Release 2 needed per kit 14637 Do not use with 14262(below) 7 Adapter Plates 2 needed per kit 14224 Flat, Multi Hole 14231 13mm (0.

14279 Spreader Plate 5 (13cm) (Pair) 14316 Spreader Plate 6 (15cm) (Pair) 5 3 MICHAELA Michaela is an active 12-year-old girl with cerebral palsy.

10 Item and Part No. 1 Pad Set Description Small (21-22cm) Medium (28-33cm) Large (36-41cm) 2 Pivot Bracket Pair Pivot Bracket Assembly 3 Tension Springs Pair Light Medium (included in 14323) Heavy 4 Pivot-Mount Belt Pair X-Small, Push Button (33-46cm) Small, Push Button (41-54cm) Medium, Rehab Latch (41-54cm) Large, Rehab Latch (51-64cm) X-Large, Rehab Latch (61-74cm) 5 Sub-Asis Pads Pair Small, 3 7/8 (9.8cm) Large, 4 5/8 (12cm) 6 Quick Release 2 needed per kit Do not use with 14262(below) 7 Adapter Plates 2 needed per kit Flat, Multi Hole mm (0.5 ) Offset per side mm (1 ) Offset per side 8 Frame Hardware Frame Clamp, 7/8 (22mm) (4 each) Frame Clamp, 1 (25mm) (4 each) Mounting Brkt Kit, L-Shaped, with fasteners Spreader Plate 5 (13cm) (Pair) Spreader Plate 6 (15cm) (Pair) 5 3 MICHAELA Michaela is an active 12-year-old girl with cerebral palsy. She has been using the Hip Grip for several months and shows significant improvement in her posture and functional reach. Her forward and downward reach have more than doubled, and her lateral reach has increased by 500%. With the additional pelvic support provided by the Hip Grip, Michaela no longer suffers leg cramping after a day at school. Most importantly, Michaela feels considerably less anxious in her wheelchair with the support of the Hip Grip. She says, I can bend down without feeling that I am going to fall, which is a big improvement! Michaela s teacher also reports that she shows more confidence and initiative in moving around the classroom. ADITYA Aditya is a 25-year-old university student. He was involved in a motorcycle accident in 2002 resulting in a C4-5 spinal cord injury. In 2006, he developed a lower lumbar pressure wound. Aditya s doctor recommended surgery to correct the problem; however, his therapist suggested that he try the Hip Grip as a noninvasive alternative first. Aditya sat up straighter in the Hip Grip, lessening his kyphosis. His improved posture relieved pressure on his spine, allowing the wound to heal and preventing surgery. Aditya s initial gains with the Hip Grip were mostly postural, but over time he also developed significant improvements in his functional reach. With the Hip Grip, Aditya can lean significantly further forward and then return to an upright position without assistance. ADITYA See film on 20 BES Rehab Ltd

DO NOT SIT WITHOUT PROPER FIT. Objectives. Recommendations 4/23/2014 CSMC Participants will be able to:

DO NOT SIT WITHOUT PROPER FIT. Objectives. Recommendations 4/23/2014 CSMC Participants will be able to: DO NOT SIT WITHOUT PROPER FIT CSMC 2014 Presented by: Elizabeth Cole, MSPT, ATP Director of Clinical Rehab Services Objectives Participants will be able to: Match each anatomical measurement to the corresponding