Dropping Gait Belts
Gait belts are often a requirement during gait training, transfers and balance activity. However, there are some therapists who do not use gait belts. As long as the patients are safe during the activity, it becomes an individual choice. Several years ago I worked with a PT who instructed me to place a gait belt closer to the patient's center of gravity - approximately around the hips - rather than around the waist, "So you have greater control of the patient."
When a gait belt is placed around the waist of a patient and he is assisted to stand by pulling the gait belt from behind, the patient flexes the trunk and often the belt slips up out of position. This can also cause skin abrasions. Placing the belt lower will certainly give me more control of the patient's weight shifting ability; however, it does little if he has poor trunk control. So I am careful about which patients I drop the belt on.
Then there are patients I place a belt on but never use it. I end up facilitating standing by gently pulling forward and upward on their shoulder blades or assisting them to stand from behind by gently lifting their hips to initiate the motion to get up. Over the years I have gotten a sense of which patients respond better to the different types of transfers.
Policies of a facility usually dictate gait belt usage as well as the patient's safety and circumstances of injury. There are always patients who are unsafe and unaware of their own limitations. As far as which position is better for gait belt usage, it really depends on the patient, as well as the therapist's knowledge of how to effectively and safely transfer and facilitate mobility with the patient.