Define 50% weightbearing, please. (Full Version)

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chami -> Define 50% weightbearing, please. (February 9, 2007 9:40:00 PM)

A PT I am working with defines 50% weightbearing in a way I've never heard of. She says full weightbearing is the weight on the affected leg while the patient is standing with equal weight on each leg, and 50% weightbearing would be half of that. I think full weightbearing is the weight borne on one leg during single limb stance, and 50% weightbearing would be what the patient would have on the affected leg while standing with equal weight on each leg. Her definition of 50% WB is the same as my definition of 25% WB. (In other words, I think a 200-pound man with a 50% WB restriction would be able to bear as much as 100 pounds on the affected leg. She thinks the same man would only be allowed 50 pounds on the affected leg.) What do y'all think?




ehanso -> Re: Define 50% weightbearing, please. (February 9, 2007 11:09:00 PM)

I think you are right.




PTupdate.com -> Re: Define 50% weightbearing, please. (February 10, 2007 8:06:00 AM)

I would say you are right Michelle, as that is the manner everybody I know practices, and continuity is always needed.

Has anyone ever been amused and annoyed at the same time, when recieving a patient for cane instruction, PWB?!?!

John Duffy, PT OCS
[URL=http://www.PTUpdate.com]www.PTUpdate.com[/URL]




TC PT -> Re: Define 50% weightbearing, please. (February 10, 2007 9:36:00 AM)

I agree, you are correct Michelle.




FLAOrthoPT -> Re: Define 50% weightbearing, please. (February 10, 2007 10:52:00 AM)

50 wb is definitely a step to gait, can be bilateral load just no single leg stance




jlharris -> Re: Define 50% weightbearing, please. (February 10, 2007 2:43:00 PM)

[QUOTE]50 wb is definitely a step to gait, can be bilateral load just no single leg stance[/QUOTE]I disagree. 50% can easily be a step through gate with an AD. The pt just must be taught what 50% of their weight is during single leg stance on the affected side.




jma -> Re: Define 50% weightbearing, please. (February 10, 2007 2:43:00 PM)

Agree as well.




FLAOrthoPT -> Re: Define 50% weightbearing, please. (February 10, 2007 3:38:00 PM)

you're going to rely on a patient to know 50% of weight through arms and take risk of injuring shoulder rather than going to step to until wbat?




jlharris -> Re: Define 50% weightbearing, please. (February 10, 2007 4:54:00 PM)

yep. I trust that my patients are able to learn and have a fair understanding of their bodies and what they feel. How many shoulders have you seen injured?? None on my part, ever. I've seen hip and knees from falling but never a shoulder. If they know how to use their AD correctly that shouldn't be a worry.

*edit:
Clarification. I've never had anyone hurt their shoulder trying to use an AD, PWB, after proper gait training using that AD.




FLAOrthoPT -> Re: Define 50% weightbearing, please. (February 10, 2007 8:31:00 PM)

then again you patients aren't 85-95 year old with severe arthritis...welcome to AD training in south FL.




SJBird55 -> Re: Define 50% weightbearing, please. (February 11, 2007 7:13:00 AM)

The 85-95 year olds not only have severe arthritis, but sometimes dementia and/or peripheral neuropathy. The ability to determine the 50% isn't only limited to the upper extremities in being able to perform OR remember but a combined ability to remember what 50% feels like in the distal lower extremity too and to be able to have the upper extremity do it's job when the limits are occurring in the lower extremity combined with the timing of when the upper extremity comes into play to reduce the load.

Jason, a cane with 50% weightbearing is problematic because it isn't just the shoulder that takes the load, but also the wrist. Some of the elderly have issues at their wrist that do not allow for proper use of the cane to take that much of a force either.

HeHe, you're good Jason. I was ready to jump all over the "never a shoulder" comment. LMAO

Thankfully for me, the surgeons in this area always just use non-weightbearing or partial weight bearing. That has always made more sense to me than any other type of order if the surgeon is worried about too much loading occurring in the post op region. I honestly doubt if there is any reasonable research out there substantiating that the strict 50% weightbearing is consistently adhered by a patient.




jlharris -> Re: Define 50% weightbearing, please. (February 11, 2007 8:48:00 AM)

Point taken FLAOrthoPT.

I spent 2 weeks straight, twice a day, with a 75 year old man in an IP Rehab setting trying to get him to use a FWW with a 10lb WB restriction on his fx hip. To make it more complicated the fx was on the left and he had a history of a right CVA. And he was a classic right CVA as he was very impulsive in his decisions. He was never able to consistently perform a sit to stand abiding by his WB restriction let alone ambulate. MD didn't "believe" in skilled nursing so just sent him home "hoping" he'd follow his restrictions. LOL, I hate MD's sometimes.




FLAOrthoPT -> Re: Define 50% weightbearing, please. (February 11, 2007 7:54:00 PM)

ditto




Shill -> Re: Define 50% weightbearing, please. (February 12, 2007 7:51:00 AM)

I love it when people "dont believe" in things that exist. You can choose to not believe in the easter bunny, santa, and even the boogey man, but one cant not believe in nursing homes. I apologize for the double negative, but it is necessary.




Jeffre -> Re: Define 50% weightbearing, please. (February 12, 2007 8:44:00 PM)

Sorry Michelle I have you beat. Try getting an order from an ORTHO for: gait training, PWB (B) LE. The sad thing is I was just out of school and spent about 30 min with a RW trying to figure out if it was possible. After calling him back he eventually changed it to WBAT.
I personally feel that WB should be either WBAT or NWB. Specific poundages, partials and TTWB are way to hard for anyone to be able to do correctly. So if a MD orders 10 lbs WB, what happens if the pt puts 15,20 or 25?




chami -> Re: Define 50% weightbearing, please. (February 21, 2007 8:32:00 PM)

Thank you all for convincing me I haven't been doing it wrong for 2 decades! Now, does anybody have references to back up "our" position, so I could broach the subject with my boss (she's a speech therapist.) This is a new job for me in a new city. I need something in black and white to back me up, so I don't come across as an opinionated troublemaker.

Interestingly, both the PT and her student, who is from the same school the PT attended, are quite adamant about their definition, so I think the source of the problem is the PT school.

I did a little research and found that studies show people are pretty lousy at judging how much weight they are putting on the limb. One study showed that using a bathroom scale to teach this doesn't work. I agree with "Junction 13" that the pressure sensor sounds like the way to go. I've heard of those but never seen one. Does anyone have any brand names, or recommendations?

An anecdote:

How about an orthopedist who loved to order "50 lb wbing" on just about everybody;he does surgery on a little boy who broke his leg. (I guess it was his femur, I can't remember.) Anyway, sure enough, he orders "50 lb. wb'ing." What if the kid didn't weigh 50 pounds? Were we supposed to weigh him down or something?




chami -> Re: Define 50% weightbearing, please. (February 21, 2007 9:05:00 PM)

You'll all like this one, too:

A top-knotch surgeon orders "PWB ass amb" for a pt who's going home. The pt previously had been WBAT. The PT and I laughed until we cried imagining this poor patient scooting around the floor on his bottom, with more weight on one cheek than the other. We had to call down to the surgeon in the OR to get the order clarified, and the nurse who answered the phone had to shout to the doctor "WHAT DOES PARTIAL WEIGHT BEARING ASS AMBULATION MEAN???" And, she had to shout it repeatedly because he didn't understand. (Of course he didn't understand, because what he'd written made no sense.)




Shill -> Re: Define 50% weightbearing, please. (February 22, 2007 7:44:00 AM)

Michelle,
The number of opinions you have on this is evidence enough that the therapist in question has this one wrong. He or she needs to pony up and just accept it, and move on. We all make mistakes. Some things are just "generally accepted", and your therapists view on this is not the generally accepted definition.




orthotherapist -> Re: Define 50% weightbearing, please. (February 22, 2007 8:10:00 AM)

Michelle,

You are right on this one. Like steve said this is "generally acccepted". You are doing what other prudent therpaists would do.

Just because you have the A after PT does not mean you are wrong and he/she is right.




chami -> Re: Define 50% weightbearing, please. (February 22, 2007 6:29:00 PM)

Yes, I'm confident that I'm right, but just to say I asked around and everybody says that I'm right would be using the "appeal to the people" propaganda technique my daughter and I learned about while studying logic and fallacies in logic, so that's why I was hoping to find more.

I do have more than one option, however, as a supervisor at the sister facility is a PT, so if I don't get anywhere with my boss, I'll go to him.

Thanks again, all, for voicing in.




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