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Toni Talks about PT Today

Size Matters

Published August 23, 2011 11:25 AM by Toni Patt

Last week, I had two patients who were polar opposites in size. One was 4-foot-1. The other was 6-foot-5. One was a man, the other a woman. Even so, they still had something in common. Nothing was the right size - not the hospital gown, not the wheelchair nor the hospital bed. Those discrepancies demonstrate how difficult being an odd-size person in the hospital can be.

Proper fit is paramount when working with patients and equipment. I think most of us realize the importance of a correctly sized wheelchair. Beside pressure sore prevention, it can make the difference between independence and dependence for mobility. The same is true for walkers and canes. But I don't think we realize how important the correct bed can be. Continually pulling someone up isn't the solution for a bed that is too short.

With his head as high as it would go in bed, the heels of my taller patient still rested on the footboard. We had to remove it for proper positioning. My shorter patient couldn't eat while in bed. When sitting in bed with the head elevated, the tray was too tall for her. We had to get a low-boy bed because it went lower to the ground.

Almost everything is available for bariatric patients. It costs a little more but with a phone call it can be rented or purchased. The percentage of patients requiring wider chairs and beds continues to grow. Where I work, when a request is made no one questions it. The same is true for big-boy beds. One can be delivered within a few hours of the call.

Something tells me those same companies can provide extra-long beds and extra-tall wheelchairs. At least shorter people have the advantage here. Pediatric equipment can often be substituted. We have a professional basketball team in Houston. I wonder what happens when one of them needs to be hospitalized. I doubt their feet hang over the footboard.

High-low mats can also be a problem. Most of the time they get low enough, but sometimes not high enough. I've had tall patients I couldn't put on one because it was too low for them to transfer on and off. Sure, the mat can be elevated by placing it on blocks or a platform but not for one patient. By the time maintenance got around to it, the patient would probably have already discharged. Just today, I had a man who was too tall to safely walk in the parallel bars. I had to go from non-ambulatory to a cane so he had some support.

Purchasing one or two long beds or tall wheelchairs wouldn't work either. The beds would be used regardless of patient size. If a tall person transferred on the unit, it would mean moving someone out of a bed and cleaning it before the tall patient could use it. It would be even worse for wheelchairs. The tall chairs would be used for taller patients. If an exceptionally tall patient came, there would be a debate over who got the wheelchair.

Obviously there is no answer for this. Patients come in all sizes. We have to accommodate them to the best of our abilities. In a perfect world, I would have immediate access to equipment of a wide variety of sizes and widths. Instead, I make do with what I have.


I was released from hospital in an over-sized wheelchair. Too bad it couldn't make it through my house's door frames or even into my bathroom.

I am glad to say I don't need a wheel chair now, but if I did I would fit a regular size one.

Linda Cooper August 29, 2011 11:07 PM

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