Over the past 20 years or more, the number of obese people in this country has grown exponentially. In fact, more than one-third of US adults—more than 72 million people—were obese in 2005-2006.¹ In retrospect, physical therapy and rehabilitation centers have had to manage patients of significant size with very few bariatric equipment options that often resulted in work-related back injuries and injuries to their patients. Rehabilitation staff in general have received specialized training in terms of being more sensitive to patients who have experienced weight discrimination. In addition, they have incorporated nutritional guidelines and obesity with new mobilization techniques, instructions for self care and hygiene, and how to manage cardiorespiratory safety and deal with pressure relief.

First and foremost to successful therapy is appropriate goal setting. It depends on the degree of obesity, of course, an individual's particular situation, and other issues. "We have a partnership with the Southern Oregon Bariatric Center (SOBC) that puts the patients more into a direct fitness routine that's realistic for the long haul," explains Dee Gillen, MS, exercise physiologist and certified personal trainer at Superior Athletic Club. "There are different goals and considerations. Mobility is a big factor in the way people fit in equipment," she says.

Equipment sizing is a big deal. SOBC is a partnership of Oregon Surgical Specialists and Rogue Valley Medical Center in Medford, Ore. It specializes in treating the unique problems and challenges of bariatric surgery patients, offering medical expertise and a comprehensive staff of well-trained weight-management professionals. It has a specialized team of surgeons, clinicians, dietitians, fitness specialists, and counselors who understand the unique problems and challenges of morbidly obese patients. The result is a program that not only treats patients' conditions but provides the support and education needed for them to succeed.

FINDING AND USING THE RIGHT EQUIPMENT EFFECTIVELY

Gillen's bariatric patients are all under 60 years of age and have to be ambulatory to undergo surgery there. Some of the extraneous issues that are not apparent but occur in the patients with whom Gillen works are chronic back, knee, and hip problems and all kinds of other ailments that are common with obesity. "It's going through the challenge of what works for each individual person and tailoring a fitness routine that will work for them," she adds.

When transferring or working with obese patients, specialized equipment ensures fewer injuries among the rehabilitation staff and patients. This includes, but is not limited to, specialized beds, lifts, parallel bars, treatment and tilt tables, wheelchairs, commodes, and scales. Michael Dionne, PT, who is considered a bariatric specialist in the rehabilitation industry, visits facilities to help them pinpoint their needs. He provides on-site training to medical facilities seeking to specialize in bariatric rehabilitation, offers patient consultations to institutions that are "challenged in how to mobilize patients of significant size," he notes, and renders advice on the types of equipment facilities should purchase or rent. (For more information, visit his Web site at www.bariatricrehab.com.)

MUST-HAVES OR THE ESSENTIALS

According to Dionne, your list is going to be different depending on your type of facility. "Obviously, standing frames aren't something you're going to use a lot in hospitals or acute care, but you're going to use them a lot in rehab," he says. "You have to look at where you are and get a sense of what your patient population coming in is. If you are only getting people who weigh 500 pounds as your peak patient population, you don't need 1,000-pound-capacity equipment."

Generally speaking, Dionne adds, most facilities are going to beds that have between 800- and 1,000-pound capacity. "The trend has been to buy some of the beds rather than rent them. The problem is that they break, they're high-tech, and they have lots of moving parts. The advantage of renting the bed is that the vendor has to pick it up, take it back, blast it clean and refurbish it, and get it ready for the next job," he says. Another advantage of renting is that the billing can actually follow the patient among facilities. The patient remains with the bed or the equipment follows the patient (even to home care).

An interesting genre of equipment is out there, Dionne says. "More equipment to roll patients, which is important, and the webbing you put under patients to roll them. Boosting patients is [critical], as are pneumatic risers. However, you can do the same thing with a bedside lift," he notes. Dionne believes walking harnesses for the bariatric patient are underutilized in rehab. "But you run into problems with so many different body types that a lot of those things end up cutting into soft tissue, so they don't work well. Getting these folks walking is still quite a challenge," he stresses.

"Using a new step machine, which is similar to a recumbent bicycle, doesn't restrict your motion as much, so, for example, your stomach doesn't get in the way of your knees doing circles," Gillen says. A hand ergometer is helpful because a lot of people going through these surgeries have knee and hip problems, so using the upper body to do these exercises versus the lower body is always the general idea." Gillen states that a lot of these things have been in the field for a while, and you just have to be creative and find what works. "Pool exercises are excellent. Restrictions that come with that are, number one, comfort, just getting into a bathing suit or shorts," she says. "But also having the ability to get in and out of the pool and having a strong enough bar in your pool that they can hold on to."

Nina Silberstein is a contributing writer for Physical Therapy Products. For more information, contact .

REFERENCE

1. Overweight and Obesity. Atlanta, Ga: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2008.