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When it comes to wheelchair “seat belts,” some people think of safety, while others think of positioning. However, a wheelchair “positioning belt” truly serves both purposes, resulting in a third consequential result: Increased overall mobility functionality.

When a Seat Belt Was a Seat Belt
It used to be that wheelchair “seat belts” were basic, downsized versions of a traditional lap belt found in older automobiles – that is, wheelchair seat belts were thin pieces of nylon webbing, with a buckle, where a tug on the excess webbing cinched them tight around one's waist. For those requiring “positioning,” early wheelchair seat belts had two inherent flaws: First, the bare webbing could cut into one's pelvis, and secondly, such primitive seat belts could loosen, allowing one to slide out of position. For those needing an extra security measure, traditional seat belts worked reasonably well, but they weren't of much aid to those needing functional positioning.

Body Point, a leading manufacturer of positioning components, revolutionized the market in the 1990s by introducing true “positioning belts,” designed specifically to keep a wheelchair user positioned correctly and securely. Rather than bare webbing, Body Point added padding to distribute the lap belt's pressure, and then they added high-strength buckles, secure adjustment methods, and strategic mounting points, all creating a wheelchair positioning belt with no rivals, offering comfort, positioning, convienance, and security all in one.

Today, a host companies manufacture “positioning belts,” with a number of styles to choose from – and understanding the options, and how they relate to your disability and positioning needs, is the key to selecting the right belt for you.

Buckle Styles
The foremost daily interface of a positioning belt is the buckle – after all, this is the component that's used every time that you transfer. Starting with the most basic, a plastic “side-release” buckle is one like those used on backpacks, where you squeeze in two plastic prongs to release the buckle. On the plus side, side-release buckles are lightweight, low-profile, and can't be accidentally released. However, they are the most difficult to use, requiring considerable dexterity and strength.

“Push button” buckles, much like those in cars, are very easy to use for many, where pressing the center button releases the buckle. They are the most common type of buckle, where the only real drawbacks are that they require some finger dexterity, and the recessed button can collect debris from food and everyday use.

For those with very limited dexterity, an “aircraft buckle” (or, the modified version called a “rehab latch”), allows one to hook and lift the buckle, releasing it with very little strength. It is important to note that aircraft buckles can catch on clothing, though newer “rehab latch” versions are a lower-profile, less-obtrusive evolution that lessens snagging.

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Adjustment Method
Because positioning belts are designed for positioning, they offer several adjustment variations based on how much control over the pelvis is required. A “center pull” belt adjusts the tension by pulling webbing through one side of the buckle like a traditional lap belt. A “dual pull” allows adjustment of the belt's tension by pulling webbing on each side of the buckle. And, a “rear pull” adjusts the belt's tension on both sides where the webbing meets the belt's mounting points, behind the occupant.

The variation of “pull” style that one selects is based on the user's anatomy and positioning. A traditional side pull is fine for someone with aligned posture, seated perfectly straight. For those with pelvic obliquities, where one's hips rotate toward one side, a dual pull helps adjust each side of the belt for better fit and comfort. And, for those needing the securest positioning and “realignment,” a rear pull best retains one in a more symmetrical position, drawing one's pelvis and hips into a desired position.

Mounting Angle
Among the least understood aspects regarding positioning belts is the angle at which they should be mounted. Logically, many install a “seat belt” at a 45-degree angle, mounting it near where the back canes meet the seat pan, in the rear-most corner of the seat. However, while this angle works well for those with self-supporting posture, it typically doesn't serve those with pelvic tilt or movement, where they may slide underneath the belt. Instead, mounting the belt slightly ahead of the back canes, at a 60-degree angle (and, in some cases, 90-degrees), retains the user's positioning to a greater extent, pulling both downward and rearward on the pelvis, keeping one well in place, preventing the belt from riding up on the abdomen.

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Mounting Location
For those needing a simple 45-degree mounting angle, most power and manual wheelchairs have stout backrest mounting bolts that securely hold a positioning belt, making installation quite simple. However, since 60- and 90-degree locations are ahead of the back canes, mounting can be trickier. On manual wheelchairs, if the seat upholstery is through-bolted (a bolt passing through the tube, with a nut on the back side), it's a suitable belt mounting location. But, if the manual wheelchair features threaded screws or embedded riv nuts, one should not mount a positioning belt to the location because it may pull out the screws. Instead, most positioning belt manufacturers offer “clamps” that mount on frame tubing, and secure the belt in any number of locations.

On rehab power wheelchair seats, many feature some sort of “track” to which a positioning belt can attach, offering tremendous mounting possibilities. Additionally, stout hardware used throughout power wheelchair seating, providing a wealth of mounting points.

Getting the Length Right the First Time
One of the toughest aspects of mounting a positioning belt is in getting it initially adjusted to the correct length. Traditional positioning belts use a “figure 8” clip, which holds the webbing in the desired length by weaving it through – but this method is very difficult to adjust on the wheelchair. When possible, determine the overall required length of the belt by measuring across the user from mounting point to mounting point, or measure the existing lap belt's length (if there is one), then adjust the new positioning belt to the approximate length, end-to-end, before mounting it. Even easier, Body Point offers its Cinch Mount, where you mount cam buckles to the wheelchair, feed the webbing through, and cinch it tight, effortlessly adjusting it even with the user in the wheelchair.

Toward the final mounted length, the belt should position the user securely in place with half of the buckle pull adjustment used – this typically allows for 2” of adjustment by the end user, both looser and tighter, to compensate for clothing and weight changes day to day.

Not Just for Positioning
While positioning belts serve a dramatic role toward positioning, they also enhance functionality and safety in many cases. Naturally, when one's lower body is stabilized, the upper body's balance is enhanced, where a positioning belt can increase one's overall functionality. Additionally, wheelchairs can come to sudden stops – from power wheelchairs shutting down in motion, to manual wheelchairs hitting obstacles, to any wheelchair braking quickly – so always wearing a positioning belt is an absolute way to stay in place during even the most abrupt, jarring situations.

The Overall Right Fit
Surely, there's still a place for traditional “seat belts.” If you're semi-ambulatory, with the ability to maintain proper positioning, a simple lap belt of webbing is a wise choice toward overall wheelchair operation – it will keep you in place when needed.

However, if you're a rehab user looking for comfort, positioning, convenience, and security, all in one, a positioning belt is the way to go. And, with most positioning belts covered by insurance – or, $50 to $100 out of pocket – it's by far among the least-costly investments made toward optimizing your long-term mobility.

Published 5/09, Copyright 2009, WheelchairJunkie.com