1. BWST Lecture KIN 436B Spring 2008

2. Transfer Place chair at angle to table Secure Chair Transfer Client Provide assistance as necessary

3. Stretching Hamstrings Glutes Adductors Calves Foot ROM Ankle

4. Locating Anterior Superior Iliac Spine Palpate ASIS Adjust harness location as necessary Strap/Secure harness across ASIS

5. Leg Straps Ask client to make any adjustments as necessary (esp. male clients) Give client privacy Start low then slide up Fasten and adjust

6. Chest Strap Secure chest straps Use towel or sweater if client is between sizes Tighten accordingly Allow about 1 inch of play between harness and client

7. Harness/ Transfer Ensure harness secure Sit client up Place client’s feet off table to allow for breathing Transfer Client back to chair (2 person)

8. Preparing for Treadmill Roll client up ramp and onto treadmill Have person in front to guide front wheels Secure chair Have leg trainers remove leg rests/prepare to lock knees Have front person assist with yolk/karibiners

9. Connecting BWS Device To Client Front Trainer brings down yolk Hip Trainer (Captain) connects karabiners with clip opening to the rear (front to back)

10. Standing/Sitting Procedure 4 trainers in contact while sitting/standing Hip trainer (captain), 2 leg trainers, front trainer Leg trainers position feet on ground Front trainer grabs waist loop and guides “Captain” confirms everyone is ready “Captain” signals computer operator to lift Team allows MACHINE to lift client, NOT hip/front trainers

11. “Safety FIRST Safety LAST” Once standing, front trainer confirms 3 other trainers have control prior to attaching/removing safety karabiner Safety is FIRST thing attached after client initially stands, LAST thing removed prior to sitting.

12. Safety Attachment Attach karabiner to closest loop ATTN: do NOT lock in the event of emergency drop

13. Bungee Cords Once chair removed, attach front bungee cords to anterior hip loop on opposing side (cross) Repeat process for rear bungee cords Wrap around post if necessary to correct posture

14. Alignment Leg trainers position client’s legs directly beneath to support weight 4 landmarks Shoulder Hip Knee Ankle

15. Leg Trainer Positioning Leg trainer sits partially on treadmill Seat/foot rest/back rest adjusted for comfort Keep limb close to body Use arms, not back (Don’t row a boat!)

16. One, Two, Step Captain calls weight shift to one side Trainer on same side holds stance Opposing leg trainer positions leg in terminal stance, pre-swing Captain chooses speed (usually 0.8mph) to start Treadmill controller starts treadmill and confirms by repeating command

17. Stance Hand closest to treadmill applies pressure on patellar tendon Other hand applies pressure on Achilles Tendon

18. Swing – Overview Closest (top) hand applies pressure on middle hamstring Bottom hand hooks foot to prevent foot drag

19. Swing – Top Hand Pulls on middle hamstring throughout swing NO pressure on patellar tendon

20. Swing – Bottom Hand Bottom hand uses thumb to lift foot Guides ankle placement at terminal swing

21. Successful Walking Tips Training team coaches/provides feedback Captain calls out adjustments to be made by leg trainers (i.e. L-side hold ext. longer) Leg trainers communicate/alternate stepping One trainer waits for opposing foot to perform prelim. stance prior to initiating swing Both trainers adjust to each other (i.e. stride length, swing speed, etc.)

22. Training Complete!!! Once training completed, turn off treadmill Have front trainer enter Reverse process with bungees, chair, safety, and ramp procedure

23. Additional Safety Precautions Any part of training team can call a pause at any time during session Commands by “captain” or leg trainers repeated by responding teammate for verification ex. Captain: Pause! Treadmill Controller: Pausing. Client always faces uphill on ramp whether entering or leaving treadmill

24. BWST THE END