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Raising the Bar in Rehab

A Big Problem

Published August 27, 2009 2:51 PM by
I had a patient on my schedule today who weighed, no exaggeration, 450 pounds.  This woman had been bed-ridden for some time and was admitted to acute care for treatment of cellulitis. 

During a co-treatment with OT, we were able to mobilize this patient to the edge of the bed and place a bariatric recliner in front of her.  The back of the recliner had two metal bars to act as a transfer bar, and the chair itself was a wonderful method of providing anterior knee block support.  In two trials, the patient attempted to stand and demonstrated significant trunk elongation and good use of upper extremity support, but did not actually clear her buttock from the bed.

Since the chair was blocking her knees, we were unable to move the chair or the patient would have fallen off the bed.  Instead, we asked a nurse and nursing assistant to help us mobilize the patient back to supine.  Count them: 4 people in total.

The point here is: This woman needs skilled therapy to increase mobility, and she requires a minimum of two people, and in this example, four people to safely attempt any transfer.  How realistic is it to assume we will be staffed well enough to meet these needs?  What are the other options?

In all reality, this patient should have taken whatever additional time was needed to find a hospital specifically for bariatric patients.  

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Check out  Michael Dionne is an excellent resource and very creative when it comes to ideas for working with the bariatric patient. Also, learning more about what happens physiologically when an individual becomes morbidly obese can give you valuable insight in working with this patient population

Irene, PT - PT Supervisor, CIH VA September 9, 2009 12:38 PM
Des Moines IA

Was this patient previously offered or educated about the option of a bariatric hospital? And was her medical issue minor enough that it could have waited to be treated until a spot was opened?  Especially withthe obesity epidemic it is important to be able to accomodate overweight patients at our hospitals, and it is wonderful you recognized and receieved support for the tranfers. There is a lot of weight disscrimination in our health field, its important to be privoy to that.

Maxine, PT - Student September 8, 2009 7:00 PM
Philly PA

Check out Toni's blog from August 5, "PT and Obesity".

For two PTs to be writing such a similar blog post in the same month speaks volumes about the prevalence of this issue.

janey goude August 28, 2009 1:56 AM

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