*U.S. Patent #6,945945 B2 September 20, 2005

Introduction & Background Slings are bad? Designed in collaboration between Victoria Givler OT and Paul Mohr PT Patent awarded in September, 2005 List all the reasons slings are bad.

Therapeutic Reasoning The job of the human brain is to learn After a stroke, the brain still learns Every modality applied should support this learning “Prescription” for a sling Refer to “Prescription” handout

Anatomy of the GivMohr Sling Handpiece OVAL - To maintain open web space. Can be modified easily to accommodate specific hand issues. CURVED - To support transverse arch of hand. Can be adjusted to control for ulnar or radial deviation. Provides primary support of arm in reducing shoulder subluxation. Elbow Strap Controls elbow position. Provides secondary arm support in reducing shoulder subluxation. Provides arm protection by keeping elbow close to body. Anterior and Posterior Arm Straps Provide dynamic compressive forces through wrist, elbow and shoulder. Reduce potential for accommodation of nervous system. Protect shoulder from over-tightening (impingement). Allow arm swing with ambulation. Provide arm protection by keeping arm close to body. Shoulder Harness Fashioned after "figure 8" harness. Facilitates thoracic extension, scapular retraction, and scapular depression. 1" webbing for strength and comfort. Anterior and Posterior Buckles Adjust both buckles to reduce shoulder subluxation. Adjust posterior buckle independently once subluxation has been reduced to bring shoulder into neutral rotation. Locking 4 Tab (back cross) Maintains proper positioning of shoulder harness. Position over spine and low between scapula for maximum comfort. Axillary Pad Position at anterior axillary wall of uninvolved arm for maximum comfort. Wrist Cross Maintains positioning of sling to properly support arm. Helps hold wrist in neutral position.

Attributes of the GivMohr Sling Reduces shoulder subluxation Reduces shoulder pain Facilitates erect posture Increases balance Improves gait Increases sensory input

Attributes of the GivMohr Sling Supports the arm in a functional position Protects the involved arm Allows controlled arm swing Improves activities of daily living Easy application by user

Common Diagnoses The GivMohr Sling is suitable for individuals with diagnoses including: Stroke Post Polio Syndrome ALS Transverse Myelitis Brain Injury Central Cord Syndrome Brachial Plexus Injury Rotator Cuff Injury

Proper Fit To insure proper fit, initial fitting is done by PT or OT. Once sling has been donned, check the following: Locking 4-Tab centered over spine, low on back Elbow strap 1” below elbow and horizontal Elbow less than 30 degrees of flexion

Proper Fit To insure proper fit, initial fitting is done by PT or OT. Once sling has been donned, check the following: Wrist cross centered over wrist joint Wrist in neutral (10 degrees or less) Shoulder approximates neutral rotation Paul check on 10 degrees or less

Sizing Size Height Range Weight Range Pediatric 45-70 lbs. Extra Small Less than 5’ 80-100 lbs. Small 5’ – 5’ 4” 100-140 lbs. Medium 5’ 3” – 5’ 10” 135-185 lbs. Large 5’ 10” – 6’ 4” 180-235 lbs. Extra Large Over 6’ 4” Over 235 lbs.

Donning Instructions Place uninvolved arm through shoulder loop. Lay sling across back and drape anterior strap over involved shoulder. Center 4-Tab buckle over spine and near inferior angle of scapulae (T6). Place hand piece in hand Pull elbow strap into place 1” below elbow. Paul check on T6

Donning Instructions Adjust both straps at buckles to reduce subluxation. Slide Axillary Pad to a comfortable position. Reposition 4-Tab buckle over spine and near inferior angle of scapulae (T6). Lock the 4-Tab to maintain adjusted position. Adjust posterior strap at buckle to bring shoulder into neutral rotation.

Donning Demonstrations Donning and Fitting Sling to Client Self-donning Questions and Discussion

Locking the 4-Tab for Optimal Fit Correctly position sling on user With 4-Tab UNLOCKED, slide down as low as possible over spine LOCK the 4-Tab in place by snapping the webbing under the locking tabs on ALL 4 SIDES Recheck the overall fit of the sling

Common Modifications Add splint(s) to facilitate proper wrist and hand positioning Use with compression glove for edema control. Modify handle to minimize CMC joint pain Decrease handle volume to accommodate distal motor return Mix sling sizes for different body types and arm lengths Finger abduction Wrist cockup splint, resting wrist splint

Research Comparative Effectiveness of the GivMohr Sling in Subjects With Flaccid Upper Limbs on Subluxation Through Radiologic Analysis Archives of Physical Medicine and Rehabilitation: Vol 86, December 2005 Kathy Dieruf, PT, PhD, NCS Janet L. Poole, PhD, OTR/L Cindy Gregory, PhD Erin Joerg Rodriguez, PT Carol Spizman, MOT

Research Uninvolved Subluxed Other GivMohr Refer to the “Research” handout and Research page on www.givmohrsling.com for link to full article. Uninvolved Subluxed Other GivMohr Conclusion: “These results show that a properly fitted GivMohr sling reduces subluxation without overcorrecting. This new sling provides an alternative treatment option for persons with flaccid ULs that may prevent secondary complications and improve outcomes.”

Research The Effect of the GivMohr Sling on Gait Parameters Post Stroke (March 2012) Kathy Dieruf, PR, PhD, NCS Jerimiah MacDonald, SPT Luke Myers, SPT Discussion : “The velocity of gait is one primary predictor of functional ambulation…In addition, velocity is related to discharge location, falling, and quality of life.” Clinical Relevance “The GivMohr Sling is a simple and inexpensive treatment that not only supports and protects the UE, but properly positions it during upright postures.” Refer to the “Poster Presentation” handout

Other GivMohr Slings GivMohr Pediatric Sling GivMohr Bilateral Sling

*U.S. Patent #6,945945 B2 September 20, 2005