A Physical Therapist's Perspective on Daily Unknowns and Gait Belts

Believe it or not, some of you receiving physical therapy services immediately put me on mental alert. I worry that I might not be able to provide services safely. I worry about "what ifs." In my heart, I know it is crazy to worry and it is better to have a game plan for those "what ifs."

Many of you are prescribed multiple medications for various conditions - like diabetes or high blood pressure or heartburn or high cholesterol. Every once in a while, someone has a history of seizures. Seizures are serious events... and scary too, especially for someone who has never seen one happen.

I'd like to tell a story about "Josh." I had the pleasure of meeting Josh a few years ago. He was a Vietnam veteran who sacrificed a lot for all of our freedom. The things he did and the things he saw changed him for life. Upon his return to the States, he had post traumatic stress disorder. Shortly after his return to the States, he was seriously injured in a car accident. The multiple fractures and head trauma continued to affect his life many years later. One serious condition he had as a result was grand mal seizures. Neither the medications nor the implanted stimulator really stopped him from having seizures. Josh immediately put me on mental alert and sounded off my "worry alarms."

As many of you know, I ask 20 million questions. Sometimes I ask questions due to my innate curiosity... sometimes I ask to help better understand your situation. Well, I got the low down from Josh. Generally speaking, what you see above is what happens after a seizure:  911. Josh made his wishes very, very clear. I was not to have Liz even think of doing a 911 unless he was injured from having a seizure.

One of the activities Josh performed in the clinic focused on standing balance. He lived most of his life in an electric wheelchair, but he did need to walk short distances and needed to be able to stand for short periods of time. He wasn't safe with these out of the wheelchair activities due to a recent injury while having a seizure. While outside his home, he somehow broke his leg when he fell during a previous seizure. So, yes, I worried - I knew he had a high probability of having a seizure in the clinic while I was treating him and I worried if I could keep him safe.

Of course, I was right in my mental prediction. He actually had 3 seizures one of the days while I was treating him. Maybe the worrying was a good thing, because the other steps I took in my worrying was planning how I would react. More often than not, when working with someone to improve balance, I use something called a gait belt. I know, it doesn't look like much, but that one tool has saved quite a few patients I have worked with from hitting the floor at full gravity acceleration!

Seriously, we all know that I'm not a large person and I need to do what a smaller person has to do to 1) keep patients safe and 2) reduce the likelihood of injuring myself in the process. Many of you are in situations where you care for others. I'd like to think you have the exact same 2 goals: keep your loved one safe and don't injure yourself in the process. More often than not, the person you care for hates the gait belt and "poo-poos" it. Let me continue the story, so you and your loved one can have a better appreciation for the gait belt.

While I was working with Josh doing some balance activities, I was behind him (using a gait belt). What I vividly recall was, all of a sudden, Josh stopped moving and kind of froze in the standing position. He didn't respond to my questions and then lost consciousness and had a seizure. Unlucky for me, I couldn't see his face and when he didn't respond I began having little alarms going off in my head warning me that something wasn't right. Lucky for me, the gait belt was on snugly and I could feel his legs buckling. At first, I thought he was dinking around and trying to do a short squat, but very quickly, I realized this was no joke. I had to react... I held the belt, brought him into me, slowly lowered him to the floor and then protected his head. He had two more seizures that very same day with me. The second one he had while walking to the bathroom. Again, the gait belt came in handy. I knew very quickly that something felt wrong. Again, I did the exact same procedure. He was safely lowered to the ground and he didn't have an injury. The third time (by now I'm a pro at knowing what it would feel like just before he had a seizure) happened on the sidewalk outside the clinic as he was headed to the van. I will admit, this time I was mentally begging for the seizure not to happen. That short, brick wall... the pointy, decorative outside light... the concrete... the curb. I most definitely was frazzled. It was summer time. I felt horrible that as I lowered him to the ground his skin ripped on the concrete. He had a nice scrape on his calf. So, then I worried about infection... An ambulance wasn't called - it wasn't one of his wishes.

Hopefully, this story will help you realize how helpful a gait belt can be. If you don't use a gait belt for your loved one, you really won't be as aware that your loved one is becoming unsteady and beginning to fall. All you have to help your loved one keep upright are your loved one's arms. Things happen so fast... there is a high chance you will injury your loved one as you yank on that arm. There is a high chance you may injury yourself too because by the time you react, your loved one is already headed to the floor - you'll bend and you'll pull. Predictably, you'll hurt one of your muscles, hurt your back or even lose your balance and fall in the process.

For some reason, lately I've been treating quite a few of you who are caregivers for your loved ones. You've inspired me to write this because no one seems to like the darn gait belts. In all seriousness, for those of you in the community who read this and want to learn how to use the gait belt, just give me a call and I'll take time to meet with you to show you. You and your loved one's safety are important to me. If you aren't in the area (or prefer self-learning), this video nicely demonstrates the use of a gait belt moving a person from a bed to a wheelchair. This video is more lengthy and does a nice job describing additional details that will interest you.

photo by colbolt123 via Flickr