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Company stamp<br />

Date: Orthotist‘s name:<br />

Patient information:<br />

Diagnosis: Application:<br />

IMPORTANT!<br />

Patient must lie supine, if possible with dorsolumbar support.<br />

A = length of trunk from superior edge of sternum to center of pubic bone minus 6 cm<br />

B = M-L measurement of the chest from axilla to axilla<br />

C = M-L measurement of the pelvis from iliac crest to iliac crest at the level of the anterior iliac spines<br />

Size of the orthosis<br />

small<br />

medium<br />

large<br />

Thoracolumbar Pad<br />

standard<br />

extra-wide<br />

cm<br />

cm<br />

Fax no. +49(0)36628663377<br />

Measurement Sheet for BECKER<br />

Hyperextension Orthosis<br />

Name: Sex: M F Age: Size: Weight:<br />

A<br />

cm<br />

B<br />

C<br />

Measurement Guide for Dist. A:<br />

35 40 45 50 55 60 65 cm<br />

small<br />

39 cm–46 cm<br />

medium<br />

large<br />

44 cm–56 cm<br />

48 cm–58 cm<br />

(The anterior pads may be adjusted resulting in an additional<br />

height A of 5 cm.)<br />

Measurement Guide for Dist. B and C<br />

25 30 35 40 cm<br />

small<br />

medium<br />

large<br />

27 cm–33 cm<br />

28 cm–36 cm<br />

30 cm–39 cm

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