A patient came to the nursing facility with a weight-bearing restriction of TTWB. Hospital notes indicate he walked between 25 and 50 feet while there. The day I saw the patient we were only able to gait about 10 feet before I noted the increase in weight to the involved LE.
We worked on upper-extremity exercises as well as lower-extremity strengthening in lieu of increasing gait distance. This posed a problem with everyone involved with his care. When questioned, I related what I perceived as too much weight bearing on the involved lower extremity. Stairs were impossible due to this, safety became an issue when nursing walked him to the bathroom and lack of strength and stability during activity deemed him a fall risk as well as impaired healing to the surgery site.
The push for increasing gait distance was felt throughout the therapy department. We pushed back, stating the patient is not consistent enough with the surgeon's order of TTWB. That calmed the storm for a while, but it was still brewing just outside of the parallel bars, waiting to come back at us stronger than before.
Because of the surgeon's order and our assessments of the patient and his lack of strength, he was saved from being discharged to home. Once the surgeon's order is changed to full weight bearing, the patient will most likely be sent home with inadequate follow-up care for balance, strengthening and safety. He will amble along in his home, drive his car, go shopping etc. without the benefit of continued therapy. He is a fall waiting to happen (again) because he chose the wrong insurance company.