BARIATRICS: Flashcards
Bariatrics =
the branch of medicine relating to the study and treatment of obesity
What raises the risk of overweight and obesity?
Lack of physical activity
Unhealthy eating behaviors
Not getting enough good-quality sleep
High amounts of stress
Genetics
Medicines
Your environment
Increased Risk:
DM II, heart disease, HTN, Stroke, apnea, osteoporosis
BMI > 30
Body Mass Index (BMI)
BMI is an inexpensive, quick, easy tool used to screen for a weight category
Based on height and weight
The most commonly used method today for classifying obesity is based on the BMI
The BMI Formula to calculate Body Mass Index:
take your weight (in kilograms)
and divide by your height (in meters) squared
Underweight:
<18.5
Normal weight:
18.5 – 24.9
Overweight:
25 – 29.9
Obese:
30.0 – 39.9
Extreme Obesity:
40.0 or greater
Bariatric Surgeries
Gastric Bypass
Laproscopic Gastric Banding
Gastric Sleeve
Intragastric Balloon
Duodenal Switch
Gastric Bypass Diet
Up to 6 weeks➔ liquid or soft diet; solids added gradually
Pts work with dietician to plan healthy meals balanced in macro & miconutrients
Life-time supplement of vitamins & minerals
Immediately after surgery ➔ Pts likely feel ‘full’ with a couple sips of water
Bowel movements not regular after surgery ➔ avoid constipation & straining
Patients advised: no liquid during meals, before and after meal (once on solids), eat slowly, 5-6 small meals
Dumping Syndrome ➔
stomach empties food into SI too quickly➔ faint, lightheaded, shaky
High Sugar foods
Panniculus Grading
Grade 1- Covers hairline of mons pubis but not the genitalia
Grade 2- Extends to cover the genitalia
Grade 3- Extends to cover the upper thighs
Grade 4- Extends to cover the mid thighs
Grade 5- Extends to cover the knees and beyond
Bariatric Movement challenges
Panniculus (pannus)
Movement patterns ➔ ADLs, bed mobility, transfers, ambulation
Locations of adipose tissue➔ Adipose Folds ➔ impacts movement
Location of feet ➔ LE mechanics➔ impacts movement
Bariatric comorbidities
type 2 diabetes
dyslipidemia
cancer risk
mood disorders
heart disease
reproductive disorders
liver disease
hypertension
***patient education
Dionne’s Bariatric Body Types
Apple Ascites
Apple Pannus
Pear Abduction
Pear Adduction
Gluteal Shelf
Apple Ascites
High waist to hip ratio with forward abdominal region
Cardiopulmonary intolerance to flat postures
Supine to sit ➔ roll supine to sidelying, progress to sit at edge of bed
Waist-to-hip ratio (WHR) norms - males
excellent: <0.85
good: 0.85-0.89
average: 0.90-0.95
at risk: >0.95
Waist-to-hip ratio (WHR) norms - females
excellent: <0.75
good: 0.75-0.79
average: 0.80-0.86
at risk: >0.86
Apple Pannus
High waist to hip ratio demonstrating an inferior abdominal drift
Intolerant to supine position
Supine to sit: flat spin to Perpendicular ➔ Then progress to full sitting ➔ caution edge of bed
Logroll to side lying careful➔ a little Risker due to potential to roll off edge of bed
Pear Abduction
Low Waist to hip ratio
Hip abduction movement pattern
Supine to sit: Avoidance of rolling, tend to go from supine to long sitting then short sitting
Sit to stand: knee extension, Followed by trunk extension
Pear Adduction
Low waist to hip ratio but able to achieve full femoral condyle contact
Hip adduction movement pattern
Supine to sit: May use log rolling or long sitting techniques for supine to sit
W/C foot pedals challenging to fit ➔ wide WC seat and narrow foot rest needs
Gluteal Shelf
Person who demonstrate excessive asymmetrical posteriorly directed tissue at the level of the gluteal region. May have either high or low waist to hip ratio
Supine may be uncomfortable
W/C seating may need to be adapted for back support
Waist to hip vs bmi
High waist to hip & high BMI
High BMI
Low waist to hip & high BMI
High waist to hip & high BMI
high WHR (above 0.9 for men and 0.85 for women) suggests more abdominal (visceral) fat, which is associated with a higher risk of metabolic conditions like heart disease and diabetes
high BMI (above 25 is considered overweight, above 30 is obese) measures overall body weight in relation to height, but it does not distinguish between muscle and fat or fat distribution
Someone with both a high WHR and a high BMI likely has significant fat accumulation around the abdomen, posing a high risk for cardiovascular diseases, type 2 diabetes, and other metabolic issues.
High BMI (with normal or low WHR):
high BMI indicates that the person is overweight or obese
normal or low WHR suggests that fat is not primarily located in the abdominal region but may be more distributed in areas like the hips or thighs
fat distribution (e.g., more around the hips and thighs) is considered less harmful metabolically
Low waist to hip & high BMI
ow WHR suggests that body fat is stored in a healthier distribution, primarily around the hips and thighs rather than the abdomen
high BMI still indicates an overall excess of body weight
person has a higher BMI, the risk for metabolic diseases may be somewhat lower due to the healthier fat distribution
Physical Therapy Examination
Social History: Home set up & Family Support
PMH
Strength
ROM, Flexibility
Sensation
Skin integrity, folds, infection
Balance
Pain
Mobility ➔ bed mobility, transfers, gait
Movement Patterns
Mental Health
Home Set Up, Family Support & Medical History
Where do they live?
Do they have help at home?
Stairs
Prior level of function/techniques of mobility
Assistive devices➔ walkers, wheelchair, cane
Activity habits➔ do they exercise/leave home?
Co-morbidities
ROM and Flexibility
Are there acute or chronic impairments?
ROM may be limited by excess tissue
Is ROM functional for ADL’s?
Can they reach areas necessary for ADL’s or skin inspection?
Are there restrictions from surgeries?
Strength
Are they strong enough to move their body?
Are they strong enough to move their limbs?
Are their strength issues acute or chronic?
May need to adjust hand placement for any MMTs
Patient may not be able to lie flat
Patient may try to use muscle substitution due to difficulty achieving test positions
Sensation
Do they have dermatomal deficits?
Do they have neuropathy due to co-morbid conditions of diabetes or peripheral vascular disease?
May have poor blood supply or peripheral nerve injury as a result of impingement by fatty tissues
Skin integrity & integumentary system
Do they have DM?
Do they have ulcers?
Can they examine their own skin?
Can they reach all areas necessary for hygiene?
Skin fold inspection
Edema
Attention to reducing shear and friction with bed mobility
Is their skin being pinched by lifts, bedrails, or wheelchairs?
Balance
Test in sitting and standing
Posture may be affected by excess tissues, affecting center of mass
Pear abducted body types may have abducted femurs
Pear adducted body type may have adducted femurs
Apple pannus body types may have increased lumbar lordosis
Apple ascites body types may have a flexed trunk
Pain
Will this affect treatment or examination?
How does the excess weight affect long-term stress on weight-bearing joints?
Pain score & location
Behavior
What are their personal goals?
Consider psych history
Be aware of your biases
Mental Health
Are they motivated to participate?
Mobility
When was the last time they mobilized?
How did this mobility occur?
Do they use physical assist, or assistive device at baseline?
Independent or level of assist
Egress Test by Michael Dionne, PT
Hospital No Lift Policy: use mechanical lift
Egress Test by Michael Dionne, PT
Patient clears hip 1-2 inches from bed and returns to seated position.
If successful then,
Two reps of sit to stand are then performed.
If successful then,
Patient stand and marches in place 3 rep
If successful then,
Patient steps forward and back with one leg then the other
Lifts:
EZlift -1,000lb limit
ARJO- 350lb limit. Sling-420lbs
Hoyer -600lbs
Trans Aid-600lbs
Sarah lifter-350lbs
Ultralift-600lbs
Weight Capacities:
Check both the lift and the sling as they may be different
Beds / Bed features:
Bari Kare ®
Bari Maxx beds ®
Equipment options
Hover Matt®
HoverMatt® Single-Patient Use (SPU) Air
Transfer System - YouTube
Tilt table
Chairs
Wheelchairs
Walkers
Commodes
Body-weight support slings for transfers, standing, walking
Repositioning strap
Turning/Limb Support Straps
Body-weight support harnesses attached to ceiling lifts
Mobility Options/Techniques
Guarding techniques
Hand holds
Gait Belt
Utilization of aides and/or assistants
Methods for transferring
Pre-gait/gait
Stairs
Assessment Considerations
PT and Patient goals
Intervention & plan
D/C planning➔ barriers
Environmental barriers
Available assistance at home
Patient anxiety & fear
Need for other rehab services ➔ OT, nutrition, medical psychology
