ATP Series
Bariatrics in Plain Sight
Seating & Mobility with Higher Weight Capacities, Plus Special Considerations for These Clients
The statistics are sobering: The Centers for Disease Control (CDC), citing the Journal of American Medicine, says more than a third of adults living in the United States are obese and at risk for a number of related conditions, including heart disease, stroke, type 2 diabetes and some forms of cancer — which are some of the most common causes of preventable deaths.
Obesity is also costly financially: The CDC reports that in 2008, the annual cost of obesity-related medical care was $147 billion.
Of course, most people who are overweight, even by significant amounts, do not end up as your seating & wheeled mobility clients. The bariatric clients you see likely have multiple clinical conditions that need to be taken into account as you assess which seating, positioning and mobility products are the best answers.
In other words, like all the clients you serve, bariatric consumers have complex needs that might require customization and creative thinking on your part.
Many Different Challenges
When working with bariatric patients, it’s easy for healthcare professionals to focus on their patients’ weights. But the successful seating & mobility assessment requires a far more in-depth evaluation.
Jay Doherty, OTR, ATP/SMS, senior clinical education manger of the eastern United States for Quantum Rehab, says a patient’s weight is only one part of the overall seating & mobility equation.
“This population that we work with has many different challenges that must be overcome well beyond their higher weight capacity that must be accommodated for,” Doherty says. “They have significant redundant tissue that must be accommodated for. This often requires customization of the seating system.”
With bariatric patients, collecting accurate measurements can be difficult — but very necessary for a successful end result.
“These custom modifications require very exact measurements on how the seating must be set up,” Doherty says. “For example, a large gap or pocket may be needed between the seat and the backrest in order to make allowances for redundant tissue. In addition, [bariatric clients] often have other medical complications, such as circulatory issues. Diabetes can contribute to pressure sores developing and not healing. Function in the seated position can be its own challenge when dealing with a very large individual. So as you can see, there are many different complications that can arise during a seating evaluation beyond just the seating system.”
How Weight Impacts Decisions
In more mainstream healthcare segments, obesity can be dealt with in a straightforward manner, such as by choosing a heavy-duty standard manual wheelchair that has a higher weight capacity.
But with some bariatric clients, the situation is more complex and requires a more complex answer.
For instance, in a standard mobility client with a higher body weight, we think of a person whose weight is distributed evenly throughout his/her body. A complex rehab client might have a comparable body weight, but that weight might be distributed very differently. Think of a patient with lymphedema whose extra weight is almost entirely in his legs. What will that mean when it’s time to choose a wheelchair?
“The location of the person’s weight and where it is mainly distributed impact the setup of a wheelchair significantly,” Doherty says. “If the weight is distributed forward, it can impact the wear and tear on the wheelchair and the performance of the wheelchair, whether manual or power. Weight that is distributed forward or is carried in the legs or lower abdomen can wear down the front end of a seat cushion and front load a wheelchair. A front-loaded wheelchair will perform poorly because the caster wheels will be carrying more weight than they are supposed to. This will wear the caster wheels out quicker, make it harder for the wheelchair to turn, and affect even a power wheelchair’s performance.”
The location of the client’s weight also affects the type of power chair an ATP or clinician ultimately chooses.
“Clinically, I have a preference towards front-wheel drive for this population,” Doherty says. “There are a multitude of reasons that front-wheel drive is a better choice. A good majority of people who require a bariatric power base carry their weight forward in the seating system; for this reason, having a drive wheel in the front leads to better overall performance.”
Facilitating Other Activities
In addition, the complex rehab team needs to consider other mobility-related activities that can be a real challenge for bariatric clients.
“Many of these individuals cannot ambulate functionally, but still perform a stand-pivot transfer,” Doherty points out. “And for that reason, having the large drive wheel up front prevents caster wheels from interfering with a stand-pivot transfer.”
Being able to safely and efficiently lift and move their own body weight can be a considerable challenge for this patient population.
“The individual who is larger often has a difficult time with transfers because of the weight they must lift to get into a standing position for a stand-pivot transfer to occur,” Doherty says. “An elevated seat is often a benefit because it helps to reduce the levers they must overcome by placing them in a partially standing position already to start. Unfortunately, there are not many power adjustable elevating seats that can handle weight capacities above 300 lbs.”
Doherty also explains that moving within the wheelchair can be very difficult.
“When getting up out of the wheelchair or getting properly positioned or repositioned in the wheelchair seating, they must shift their weight, and this often can be a big challenge for these individuals,” he says. “A slick, low-shear seat cover material can assist with this weight shifting that may be required. However, that slick material may also impact their ability to remain seated back in the seating system, so the overall effects should be considered.”
This article originally appeared in the July 2015 issue of Mobility Management.