Is Your Patient Truly Independent?

Is Your Patient Truly Independent?

 

As a Physical Therapist, I have noticed that most Assisted Living Facilities, Nursing Homes, Hospital, Rehab Centers, Outpatient Clinics as well as Home Care Agencies make gait belt use on patients mandatory.  Gait belts are used around a patient's waist to provide the therapist with a sturdy grip just in case the patient loses their balance. 

Even if your patient is highly functioning with minimal loss of balance while walking, most of these settings require use of the gait belt for liability reasons.  This is understandable.  However, when the goal of therapy is to discharge your patient to living independently in their home, using the gait belt every visit may not be most beneficial for your patient.  I totally agree with using the gait belt on a patient who is just beginning therapy and is extremely weak or has balance deficits.  This is for your safety as well as their safety.  However, I also feel that frequent use gives your patient a sense of security and comfort and gives you the therapist a sense of control.  This "security blanket" may help boost your patient's confidence, because in the back of their mind they know you will be there to grab the belt if they stumble.  Once they are discharged, they will no longer be walking around the community or their home with this "security blanket."  If they never practiced functional activities in therapy without the gait belt, how can we expect them to feel comfortable performing these activities without the gait belt after being discharged.  As therapists, we are not only working on improving strength, balance, gait and transfers.  We are also trying to improve confidence by reducing the fear of falling before we discharge.  If we intend to discharge to independent status, I feel there should be a transition during our sessions and prior to discharge to eliminate gait belt use.  I am not for or against using a gait belt.  I feel that there are times it is overutilized and can actually be detrimental to a patient's progress.

 

I have also noticed that during many sessions of gait training with patients, some therapists have the habit of walking with their patient while lightly placing their hand on the patient's shoulder, hip or lower back.  With gait training, this is considered Contact Guard Assist.  If you are providing this, your patient is not independent and you can not document that they are independent.  This is another "security blanket" that we provide to our patients and ourselves for comfort and security.  However, it is counterproductive if the goal is independence.  Once they are at home alone, how confident, safe and secure will they feel walking without that manual support?  It is establishing a false confidence.  If the intention is to discharge our patient to independent status, we need to stand back a bit to allow them to accomplish their goal.  But common sense should never be ignored.  If it is obvious that your patient can not walk yet without your manual assist, then provide only what is necessary to prevent injury.  Do not overutilize or underutilize these protective measures, because either extreme may cause problems for your patient in the future.