At the Abilities Expo last week, we saw numerous larger wheelchair users with their backs slumped down against the chair -- an important reminder that users of size need positioning just as much as every other user. Sometimes it is said, "the center of gravity keeps a heavier user in the wheelchair." This says nothing about the pain, stiffness and lack of reach that a "C shape" or other poor position entails.
Some wheelers wore regular leather-type belts on their legs, so stiff and tight that pressure ulcers, chafing and worsening edema (swelling) are very likely. When users were unable to consider purchasing a postural support and wore hard, stiff substitutes, we discussed that even a wide fabric strip made of old clothes, a scarf or a robe sash, worn loosely, would be safer than what they had. If you know anyone wearing a leather or plastic belt, please share this.
Others wore old Velcro® or webbing that provided no support at all. There were children literally falling out of their setups, even with a hip belt and support in front of their ankles, as these supports were often too thin, overstretched or just not structured enough to provide comfortable support.
As a rough idea, a typical BP hip belt that is mounted to the chair, and available in sizes as large as 36" (three feet) across the front of the body or as small as one foot, would be about $100 retail. Or, our more portable hook-and-loop elastic strap, which was a hit at the show, would be about $70 depending on the seller.
These products carry limited lifetime warranties against defects. So it comes down to, you might spend a nickel a day for a $100 belt that lasted five years and made you more comfortable and productive each of those 1825 days. Not too shabby.
In some areas of life, it's better to have something than nothing (like food, water and indoor plumbing). In postural supports, it would honestly be better to have nothing than some of the belts we saw, across any size. But it may be larger people, who work harder to shift their weight, who suffer the most, or children, for whom not having the best support can result in lifelong deformity.
So we say again: regardless of size, everyone deserves the best postural support s/he can get.