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COTA Thoughts

Bariatric Patients (and my aching back)

Published December 4, 2008 11:44 AM by Tim Banish
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Do you have one or more patients in the bariatric weight range? And, despite following all the precautions with transfers do you still find you come up with a sore back?

Transfers with bariatric patients must be one of the hardest parts of our job. Right now, I have a couple of very heavy patients who are a max assist of 2 for a sit to stand transfer. Even with two of us doing the lift, it still takes quite an effort to get these people to a standing position at the parallel bars.

With all the equipment in place, gait belt strapped on tight, dycem on the floor to hold the feet, and even grasping the back of the person's pants, there seems to be no good way to reach over the wheelchair and boost them up.  Your back just has to take the brunt of the lift. Several of these transfers and your back will be letting you know.

The gait belt always seems to loosen and ride up. Their feet tend to lift and extend out, making it seem like you're trying to stand a tree up off the ground. And despite the nice handle a pair of pants makes, I've grasped a handful of pants a few times and found more than the pants.  Along with all the obstacles that you have to avoid, like the wide wheelchair, the parallel bars, the person's feet, etc, there seems to be only one way to get our bariatric patients standing, and that's using every muscle given to us.

In a few places I've worked we have been fortunate enough to have a standing table or a tilt table. These are nice pieces of equipment to have at your disposal, but in my experience using them with a bariatric patient it still does not solve the sit to stand issue. Just transferring the patient onto the table can be a major task. Once on the table there is a knee strap so the person does not have to expend much energy other than support their weight on both feet. 

I've had bariatric patients in the past that can walk 50+ feet with a rolling walker once they're standing. They were still a Max assist to stand though, and as one PT I know used to say "Even if you can walk 10 miles, if you can't get out of your seat then that ability is useless."

I think the biggest goal to keep in mind is the patient's participation. If you have a motivated person who really gives it their all in therapy, then all the lifting is worth it. On the other hand, if the person gives little or no energy into these types of transfers then we have to work harder lifting.

So if you treat bariatric patients try to remember to follow the rules for protecting your back. Being down with a back strain is no fun, trust me.

 

Until next time, hope all your thoughts are good,

Tim

posted by Tim Banish
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4 comments
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I'm a 51 year old newly practicing COTA, and am enjoying working with a good team in a rehab setting, but doing sit to stand with our current (325#) bariatric patient really takes the stuffing out of me - it's a 2 person mod assist to get her up in the parallel bars for 30 seconds 3-4 times on a good day with the P.T. pulling from the front, and me lifting (with good body mechanics) from the back-we use a double gait belt, and I place my hands as far under her buttocks as I can to lift-with my legs-until she's standing, then rotate my hands so I'm pushing against her buttocks to assist her standing/to prolong her stand. On a bad day, it's Max A times 2 to get her 2" off her seat; her chair doesn't fit inside the bars past the downposts, so we have to place her chair about 6" short of the downposts so that if she doesn't sit back enough, the chair can be moved forward to catch her.  She has chronic low back pain, a recently injured wrist, and becomes nauseated with minimal exercise.  There's got to be a better way.
Debbie B., Rehab - COTA, Rehab/SNF June 19, 2009 10:14 PM
Fairfield CA

Re Bariatric patient mobility: Dionne of the bariatric seminars shows and has you practice bobath-like transfers where you do an almost squat pivot/low profile transfer and only bear about 20% of their weight. Also with all my bairiatric patients and my more "curvaceous" female patients I tighten my gait belt A LOT! There is a lot less sliding and riding up.              Sunshine, COTA/L , Oregon
sunshine adams, geriatrics - cota/l February 3, 2009 11:40 PM

Thanks Tim!

So glad I came upon your blog!...My back is ALWAYS hurting ...and at my facility ...there is just no way around it ...our patients are VERY large (up to 600+ pounds thus far)...and very deconditioned...we have minimal bariatric therapy tools to use...not to mention no space .. ...and it seems difficult to find the right bariatric gait belt...I appreciate your input ...as I continue on my search for ways of working with the bariatric patients......
Tammy, geriatrics/adults - MSOTR/L, hospital January 23, 2009 9:46 PM
Wilkes Barre PA

I have never had a day of back pain.  I kind of a shrimp, too.  When working with bariatric patients for sit-to-stand xfers, I may use two gait belts (or three) hooked together for one long belt and make a figure eight to go around both the person's waist and also under their bottom.  If they have the ability to lift themselves with that little bit more help.  Otherwise I use a dependent mechanical lift to xfer to their WC and work on sit-to-stand action in the parallel bars, or from a high/low table (when I have one).  I'm over 50 and one of my goals is to never hurt my back.  Good luck.
Mary, geriatrics - OT, SNF January 1, 2009 10:25 PM
Lincoln NE

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