Another of my essential pieces of equipment when I see adult patients is my Gait Belt. Mine has yellow and blue stripes on it. It's quite fashionable.
The gait belt is used to help patients "transfer;" yes, "transfer" is a verb in the rehabilitation world. It means to move successsfully from one surface to another. With a gait belt around a patient's middle, combined with a little physics and excellent body mechanics, a smallish therapist can help a patient of almost any size transfer. Such things as getting from the bed to a bedside chair (or a toilet, or a wheelchair) can be accomplished by bringing the patient's weight forward on his feet, pivoting toward the desired surface, then gently letting the patient's weight shift back down to his hips to sit. If the patient has use of his arms, I usually ask him to push from the surface behind them when getting up, and reach back for the surface behind them as he's lowering down.
Patient safety with a gait belt is also addressed during ambulation, or "gait." Hence, the term gait belt. In school, we practice "guarding" people using a gait belt during all kinds of activities, including ambulation on flat surfaces, up and down stairs, with crutches, with less than full use of 2 healthy legs, you-name-it. We also learn how to lower people slowly, safely, and gently to the ground if they so happen to fall while we're guarding them.
Anyway--back to my favorite use of gait belts: transfers.
I believe in the utility of the belt. Some nurses look at me a little funny when I give it so much credit, but when you know how to use it, it can make some "two person" transfers possible with just one person. Many times I will qualify my report to a patient's nurse: "He was a max-assist transfer of one to the chair, but I also had a gait belt. If you don't have a belt, you'll probably want two people to get him back to bed."
Many of my patients come to believe in the gait belt, too. Sometimes it's an unhealthy belief. Kind of like Dumbo's feather: they associate their ability to move from here to there with the belt. And if you don't have a belt, then it's NOT going to work.
True Story:
I knock on the hospital room door of a patient for whom the physicians have ordered a Physical Therapy consult. Apparently, this woman has been very sick for a few weeks, to the point where she has not been out of bed for a few weeks, either. Therefore, she is profoundly deconditioned.
She answers my knock, "Come in?"
"Hello!" I smile as I walk in the door, rubbing my hands with the sanitizing foam positioned directly outside the door. "How are you today Mrs. Deconditioned? My name is Sephora and I am a physical therapist. I'm here because your physicians have ordered a physical therapy evaluation."
I explain to her the role of physical therapists in the hospital setting (which is not, by the way, to give out deep tissue massages--nor is it to "walk" people, as if they are pets that need to do their business 3 times a day).
The role of physical therapists in the hospital setting is to assess patients' mobility. We help the medical team determine whether patients are safe to discharge home, based on their ability to perform daily mobility activities--one of which activities, is, YES, walking. One must almost always demonstrate safety with ambulation in order for a physical therapist to recommend discharge home. However, there are frequent exceptions to this rule: equipment, family members who can be of assistance, home modifications, and other outstanding factors must be taken into account. Every patient is different.
If I conclude from an assessment that a patient is not able to perform mobility activities, I help him as much as possible while he is in the hospital, and make recommendations for follow-up if he has not met the physical therapy goals by the time he is medically ready to leave. Some patients are finished with physical therapy by the time they are discharged to home.
I explain to Mrs. Deconditioned that I understand she has not been moving very much recently, and that I am here to see how strong she is, and to help her get stronger so that she is ready to leave the hospital when the medical team is ready to send her.
"YOU're going to help me get up?" she asks, incredulous. "But you're a such a tiny little thing. I don't want to fall."
Next comes my memorized--but sincere--mini monologue, where I explain to her that I am a physical therapist and that means that I am a professional who is specially trained to help her move, even if she is not strong. I explain to her that this is an assessment, and that we are not going to do anything that she is not ready for, or that might be unsafe.
"Besides," I add to every such encounter where I determine it appropriate, "I have a magic belt here. With this belt, I have helped many patients who are much larger than you."
That gets them, one way or another, almost every time. Sometimes the patients are so confused, they don't remember that I just introduced myself as the physical therapist, and so they give some non-sequitor response such as, "Libby, you look so much like your mother in that outfit" or "I wonder why the bubbles are moving up and down the wall again." But most of the time, they're willing to try out the magic belt. Even if it's to challenge the truth of my claim.
In the case of this particular lady, she was super-weak. She had been through it all, and had seen much more across the span of healthcare than I ever wish to discover, even as a healthcare provider. But throughout my examination I continually explained everything we were going to do, along every step of the way, which is always appreciated by people who are apprehensive.
Incidentally, I have found apprehension to be a common denominator among patients in the hospital who are moving for the first time after a long sickness, with the assistance of someone they barely know...)
The end result was that this lady stood for a few seconds next to her bed before having to sit down again. There were plenty "tricks of the trade" that were utilized, but the most visible one was the use of the gait belt.
This patient was now a believer in the gait belt.
I knew for sure that she was convinced, because the next day when I went to see her again, and this time, one of her daughters was in the room. I greeted my patient and introduced myself to her daughter. Before I could proceed, my patient turned to her daughter with these words:
"Sephora might look like just a sprite of a thing, but she can do wonders with that belt!"
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