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Toni Talks about PT Today

People Watching and Stroke Risk

Published April 5, 2011 1:33 PM by Toni Patt

I am a people watcher. Last weekend at the zoo was no exception. I don't look for extreme fashion or hairstyles. Couldn't care less who is with who. I watch how people walk. I do gait analyses. I look for deviations on people who walk past me. Isn't that what PTs do? Assess gait? Every new person who comes by is another opportunity to practice.

My friends aren't so excited about this habit. They don't care who has a limp or is using their quad cane incorrectly. I get really excited if someone on crutches comes by. I've yet to see someone use them correctly. Stroke survivors who walk by don't interest them either. No one cares how I would correct the problems. In fact, as long as I don't go over and offer to adjust a RW they pretty much ignore me. They tune me out as much as I tune out their discussions on who has the cutest outfit.

I also play a mental game with myself while I watch people. I try to predict who I'll being seeing as a stroke patient based on appearances. Once I decide I'm watching a stroke in the making, I decide if I'd allow them on my unit. Very few of them make the cut. Excluded is anyone who weighs more than twice what I do, is eating junk food, is short of breath from walking and is shaped like a pear. I work with those people every day. They rarely make it back home.

Obviously there are more potential strokes walking around then I'll ever identify. Medical history and genetics can strike a marathon runner just as easily as a couch potato. I'd rather have the marathon runner though. At least the runner is used to working and understands the benefit for physical activity. For most of the people I peg as future strokes, walking across the room looks like a chore.

There's a reason weight scores high on my checklist. It's much harder to mobilize an overweight person. Their limbs weigh more. Stomach fat acts like an anchor during bed mobility. Pear-shaped bottoms anchor them to the edge of the bed. If someone is too heavy I'll need help, which can be a rare commodity. Heavy people aren't going to do as well in therapy and it'll fall on me to make a try. I'd much rather have a skinny person with dense hemiplegia than an overweight person with minimal to moderate weakness. I'll get father with the skinny one.

I wish there was a way to make these walking time bombs see what I see. If only it were as easy as walking up to one and explaining how losing weight will help that person walk again after the future stroke. Running public service announcements about the relationship between weight and stroke outcomes probably wouldn't help either. Doctors avoid the weight issue. So does most everyone else until it is too late.

At least my friends are aware. They've heard me comment enough times to know.


One of the most surprising patients I ever treated weighed in at over 400 pounds.  At the time, I tipped the scales at about 130.  She was a home health patient and I was intimidated.  A 400 pound double knee replacements - the doctor performed both knee replacements during the same surgery.  I was dumbfounded at his apparent lack of wisdom.  But this patient was amazing.  Despite her weight, she advanced more quickly with her double knee replacements than many of my single knee replacements.  Her attitude carried her through.  

You make valid points about the unhealthy affect of additional weight.  But, based on the patients I've treated, I rank attitude far above weight for an ideal patient.

Janey Goude April 5, 2011 10:59 PM

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