Even though each case of rehab is different. Mostly you are dealing with medical, surgical, neurological, or orthopedic. Each has its challenges as well as a usual pathway of recovery. Of course not all cases are the same and there is usually some kind of bump in the road to complicate things.
Orthopedic weight bearing restrictions
Orthopedic weight bearing restrictions can certainly cause complications in a rehab stay. This is true for any restriction, being either upper extremity or lower extremity.
The amount of complications are dependent on if a surgery was performed or even if there are multiple sites that are restricted.
Non-weightbearing LE
With some time and Therapy intervention non-weightbeaing to a lower extremity can be overcome. As the resident gets stronger on the other lower extremity as well both upper extremities you can regain functional movement.
Non weight bearing to the upper extremity
When dealing with non-weighr bearing to the upper extremity there are some other factors involved. The prior level of function might have required the need for an assistive device and the need to use both upper extremities to functionally move around.
This is also complicated by the need of most residents to use both upper extremities to perform a simple transfer. Many times the resident is unable to perform a sit to stand without the use of an upper extremity.
Partial weight bearing to the lower extremity
This can be a complicated situation depending on the cognitive ability of the resident. If the resident can understand the concept and adequately practice in the parallel bars you can steadily progress to more functional ambulation with a walker.
For those that do not have the cognitive ability to understand it primarily comes down to needing to stay non-weightbearing in order to maintain the restriction. Unfortunately the more complicated aspect is when the resident starts to progress and does not have you to remind and control the restriction. They then can attempt to move on their own without assistance. This can lead to falls and possible further injury.
Regardless of the limitations hopefully healing is occurring
As you progress along with training for functional mobility while limiting the weight bearing, you have the hope that quickly you will be able to progress to more weight bearing.
As you progress to more weight bearing, or the best words ever of “weight bearing as tolerated”, we can push along to a return to prior functional mobility.
What happens when the bone is not healing
The hardest complication for a rehab stay is when a bone is not healing. When this happens usually thr orthopedic doctor will continue the restriction longer. This can really complicate things. Often we will hit a plataue of functional mobility and be stuck not being able to progress until weight bearing is allowed.
This situation makes it very hard for the resident and the family. Often we need to discharge from therapy until weight bearing is changed. Unfortunately this can mean the resident will have to stay in the nursing home or possibly go to assisted living until enough bone healing has occurred. Often times this is a very big financial burden. Some just wind up going home due to financial restraints. Unfortunately this is where even with the best skills and the maximum about of effort, nature can out do us.
