Physical Therapy for the Client Pre/Post-Bariatric Surgery

1 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPhysical Therapy for the Client Pre/Post-Bariatric SurgeryTamara , PT, DPT, CCSW ashington University Program in Physical TherapyApril 6, 2010 Overall GoallPhysical Therapists to become agents of change helping to prevent and remedy the obesity epidemiclThe development of overweight in normal weight individualslThe progression of obesity in those who are already overweightlWeight regain in those who have lost weightlFurther worsening of an obesity-related condition2 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerObjectiveslUnderstand the prevalence & implications for health & function.

2 LDiscuss bariatric Surgery and potential complications effecting the musculoskeletal system;lDesign appropriate screening, examination, and exercise interventions pre and post bariatric Surgery ;lIdentify mobility impairments, functional limitations and disabilities and methods to address interventions; lCreate strategies an educational materials to supplement a group exercise intervention and promote long term adherence to physically active is Obesity?lExcessive accumulation of adipose tissue to an extent that health is impaired; BMI > 30 kg/m2lImbalance between caloric input & energy outputOutput4 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerContributing FactorslContributing Factors behavioral environmental physiological social cultural lExamples sedentary lifestyle consumption of energy dense food family/social gatherings surround food women more obese & less active than men5 HealthComorbidities.

3 AdultslCardiovascular disease HTN DyslipidemialDiabetes mellituslObstructive sleep apnealOsteoarthritislAsthmalInfertilityl Gallbladder diseaselLiver diseaselMetabolic syndromelCerebrovascularaccidentslVenous StasislGERDlIncontinencelDepression6 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerFunctional Impairments/ ConsequenceslPainlDyspnealStrength deficitslROM deficitslBalance deficitslCoordination deficitslPostural AberrationslVital sign abnormalitieslDecreased Aerobic capacitylRisk of fallinglLimited endurancelCompromised hygienelDependence in bed mobility transfers gait stairs ADL s7 Patient Examination: Health HistorylHealth History surgeries orthopedic problems Prior treatment for obesity diet, exercise, Surgery , behavioral counseling, etc.

4 Current adaptive equipment Currentcomorbidities Current treatment regimens Medications Diet Activity level8 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPatient Examination: Home EnvironmentlSelf-Care Ability/Functional Limitationsltoileting, grooming, housework, bed mobility, transfers, gait, work limitations, set-uplshower/tub, toilet/commode, bed, current equipmentlstairs (in & outside)ldistances in homelHelp available/support systemlOccupation9 Patient Examination: System s ReviewlOrgan System Checklist General health Cardiovascular Pulmonary EndocrinelVital Signs HR, BP, SpO2, RR10 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPatient Examination: Exercise Intentions & ExpectationslPhysical activity & attitude questionnairelActivity History activity regularity?

5 RPE of activity? perceived fitness level? willingness to routinely exercise? support? expectations?11 Patient Examination: Objective AssessmentlBMI, Waist circumferencelFlexibility and ROM Note ROM limitations due to excessive tissuelMuscle strength and endurancelPosturelPain Individual joint assessments as neededlExercise capacity assessment Maximal or sub-maximal**12 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerTypes of Exercise Tests: ModelTreadmill/6 MWlAdvantages: treadmill uses a familiar mode of exercise (walking) and uses large muscle mass resulting in less localized fatiguelDisadvantages.

6 Space, expensive equipmentlBicyclelAdvantages: less LE joint stresslDisadvantages: local muscle fatiguelStepslAdvantages: shorter testslDisadvantages: subject must maintain a steady pace (metronome) and local muscle fatigue13 Patient Examination: Visual InspectionlBody Type Androidvs Gynoid ApplevsPearlSkin discoloration presence oflymphaedema symmetry of extremities atrophy induration wounds/ulcers presence of infection14 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPostural Alignment Examples15 Patient Examination: Functional Tests & MeasureslTransferslSit to StandlFloor to StandlGaitlStair Climbing lBalancelPenny RetrievallTimed UP & GO lFunctional Reach16 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPatient Examination: General TransferslIn and out of bedlUp and down from the chair, toilet and/or floorlIn and out of the car view or have patient verbally describe17 Patient Examination.

7 Sit to StandlTimed test Repeat sit to stand 5 times use 18 , 16 , 14 chair Document use ofUE s, pain, time, RPE & vital signs18 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPatient Examination: Stair Climbltimed one flightlability to complete 4 flights document use of railings, assistive device, method ( foot over foot), rests, BalancenNarrow Baseqeyes open 10 closed 10 open 10 closed 10 Limb Stanceq30 seconds20 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPatient Examination: SensationlPresence of Neuropathy Light touch/pressure loss?

8 Pain? Hypersensitivity? Does loss affect function?21 Egress Test*lTest 1: 3 reps of sit to standlTest 2: 3 steps of marching in placelTest 3: Advance step and return each footlIf during any part of the Egress test, the patient demonstrates difficulty or need for Physical assistance beyond cues and/or guarding techniques, that patient is indicated for mechanical conveyance* Michael Dionne, Choice Physical Therapy ,Gainsville, GA22 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerPatient EvaluationlWhat are your clinical judgments(s) based on the data gathered during the patient/ Client examination?

9 Impairments functional limitations disabilities movement diagnosis health/safety concerns for activity equipment needed to increase function or limit disability23 PrognosislTo achieve goals regarding: Fitness level impairments function weight loss adherence to Physical Therapy HEPlWill be affected by intention and readiness to change24 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerWhy Physical Therapy in Managing ObesitylCarefully Prescribed Exercise Counseling Encourage sufficient Physical activity to increase energy expenditure, reduce fat storage and adjust energy balance to create a caloric deficit Monitor safety during performance of Physical activity ( cardiovascular and musculoskeletal)

10 Reduce functional impairments and disablementEnergy ExpenditureEnergy intake25 The Acute Care EnvironmentlMobilize the patient to preventbedrestcomplications & promote independencelPrevention of injuries to patient & healthcare workerslAddress equipment Needs26 Physical Therapy for the Client Pre/Post-Bariatric SurgeryApril 6, 2010 Tamara , PT, DPT, CCSNot to be copied without permission of the speakerTransfer TechniqueslContinue with what the patient currently is doinglSupine to long sitting to edge of bedlRollsidelying, push up withUE s (log or non-log rolling techniques)lRoll prone, turn and push up onceLE sreach floor27 Transfer AssistlPatient placementlHand placementlGait belt placement underpannusin abdominal fold underaxilla(especially if surgical incision)