When assessing for seating, whether in a wheelchair or static postural seat, there are times when it is necessary to consider additional accessories of belts and harnesses. Sometimes, the use of belts and harnesses is misunderstood, so let’s explore what we mean by safe and appropriate use.

Improper fitting and adjustment of belts and harnesses can result in injuries of pressure damage, postural deviation, falls and strangulation. The Medicines and Healthcare products Regulatory Agency (MHRA) has reported 4 deaths and 17 serious injuries relating to the use of belts and harnesses in the UK[1]. As a result, BS 8625[2] was published in 2019 and ISO/TS 16840-15[3] is currently under development to provide clear guidance on the selection and placement of postural support belts and harnesses. Belts and harnesses selected should comply with ISO standard 16840-3:2022[4] and ISO standard 16840-10:2021[5] for safety.

A pelvic belt can be used to stabilise the pelvis in sitting by providing anterior support to reduce pelvic tilt and rotation. It should not be confused with a standard lap belt or a seatbelt in a vehicle, used to prevent injury in a crash. Sometimes, it is incorrectly advised that a pelvic belt should be fitted at a 45° angle, which is appropriate for a seatbelt but not a pelvic positioning belt[6]. Pelvic belts are padded and should be fitted firmly anterior to the greater trochanter as postural support. There are different types of pelvic belts, but they are generally categorized as 2-point (with 2 anchor points) or 4-point (with 4 anchor points).

There are also different types of harnesses that provide anterior postural support to the trunk in sitting. These are used when a person requires assistance to maintain an upright posture, possibly due to low tone or instability of the spine. A harness can encourage extension through the trunk when used in conjunction with lumbar or sacral support by assisting to elongate the natural curves of the spine and hold the trunk against the backrest. This can be achieved by using a shoulder harness to provide an anterior pull to the front of the shoulders, or by using a dynamic harness to provide sternum support. Other shapes of harness are available, which provide different anchor points depending on where the pull force is desired and the body shape requirements.

Belts and harnesses are sometimes used inappropriately due to misunderstanding their use or how they are fitted. Occasionally, care staff wrongly believe a pelvic belt is fitted as a restraint, to prevent the user from standing up from their seat or wheelchair. Indeed, there are instances where this is the case, but when fitted by an appropriate professional, this is not the reason they are used. Similarly, harnesses are sometimes mistakenly thought of as a requirement for transport, when they are not crash-tested accessories. When travelling, the 3-point vehicle occupant seat belt must always be used, regardless of whether a pelvic belt or harness is in use as a postural support.

When selecting an appropriate pelvic belt or harness, it is important to consider the location of the desired forces upon the body structure to achieve the correct postural support. It is also important to consider the buckles and whether the person using them has the manual dexterity and cognition required to secure and release the belt or harness. There are a variety of options available when selecting a pelvic belt or harness, ranging from side release clips that are squeezed to release, a latch buckle, a push button operated clip or more complex clips that require a thin object to penetrate through a small hole to release a push button.

Selection of the most appropriate type of belts and harnesses must consider:

  • Manual dexterity and cognitive ability of the user to secure and release.
  • Speed required to exit the person from the seating (e.g. in the event of a seizure).
  • The mental capacity of the user and whether the use of a belt or harness could be considered a restraint.
  • Other supports that are necessary to use in conjunction with the belt or harness (e.g. contouring of the seat).
  • Body shape and required location of pull force to achieve postural stability.
  • Mounting type and location.

When choosing and fitting postural support belts and harnesses, a risk assessment must always be completed to ensure the correct selection is made, fitted and used appropriately. The user and any family or support workers that are to assist with its use must also receive training to ensure it is used safely and correctly. Regular checks are required to ensure the belt or harness is in good working order and not frayed or damaged.

To find out more about the safe and appropriate use of belts and harnesses in seating and how to select the most appropriate option, you can read more here: Careflex positioning aids: belts and harnesses. If unsure, it is recommended to have an assessment by an appropriately trained professional. To book an assessment, click here: Book a seating assessment.

Written by our guest blogger, Lauren Osborne, an Independent Posture & Wheelchair Specialist Occupational Therapist.

Lauren Osborne

[1] BES Rehab Ltd. (2024) Newly published standard with requirements for belts and harnesses in seating [Online] URL: https://www.besrehab.net/news-articles/newly-published-standard,-with-requirements-for-belts-and-harnesses-in-seating/ (Accessed 25.03.24)
[2] British Standards Institution (2019). BS8625: Selection, placement and fixation of flexible postural support devices in seating. Specification. London: British Standards Institution.
[3] ISO/TS 16840-15 Wheelchair seating. Part 15: Selection, placement and fixation of flexible postural support devices in seating [Online] URL: https://www.iso.org/standard/80064.html (Accessed 25.03.24).
[4] International Organisation for Standardisation (2022) Wheelchair seating Part 3: Determination of static, impact, and repetitive load strengths for postural support devices [Online] URL:  https://www.iso.org/standard/79160.html (Accessed 25.03.24).
[5] International Organisation for Standardisation (2021) Wheelchair seating Part 10: Resistance to ignition of postural support devices. Requirements and test method. [Online] URL: https://www.iso.org/standard/79159.html (Accessed 25.03.24).
[6] Barend ter Haar (2022) Let’s get it clear: what makes a good positioning belt? Safety First [Online] URL: https://attoday.co.uk/lets-get-it-clear-what-makes-a-good-positioning-belt-safety-first/ (Accessed 25.03.24).