Bariatric Mobility
Practical considerations for
maximizing mobility for
patients of size.
Mount Auburn Hospital
Bed mobility considerations
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Use appropriately sized beds.
Patients likely have preferred bed mobility
techniques based on body size and shape.
Elevated risk of friction injuries.
Use of friction reducing sheets,
Trendelenburg position, airflow mattress,
bed rails, additional assistants.
Body shape and bed mobility
“Apple” shape body type
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Dominate abdominal girth.
Abdominal wall may be rigid and non moving, or may
have low, mobile pannus.
Usually cannot tolerate supine or prone positions.
Respiratory function may be compromised by size.
Difficulty rolling.
Typically don’t roll to sit up. Will spin to bring legs
over edge and then sit up.
May require wider bed.
Body Shape and Bed Mobility
“Pear” Shape Body Type
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May have excessive posterior tissue bulk.
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May have excessive tissue on outer aspects of
thighs and hips.
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May have increased low back pain due to excessive
posterior tissue.
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Patients with tissue bulk on outside of thighs can
usually roll more easily.
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Supine to long sit or side lying to sitting with rail.
Tips for safe mobility
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It is very difficult to prevent
or stop a slide from edge of
bed if patient is dependent.
Be careful while helping
someone move from sidelying
to sitting at edge of bed.
Tips for safe mobility
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Have bed as low as possible so when sitting up the
patient’s knees don’t drop below the height of
their hips.
While moving to edge of bed, prepare surfaces to
allow patient’s knees to align with hip joint.
Tips for safe mobility
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Use foot stool to
pre-position
patients thigh
before trunk
elevation.
ALWAYS avoid a
down slopping thigh
while at edge of
bed.
First attempt:
Debut Transfer Safety
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The Egress Test should be used if mobility
status is unclear and it is the first time
the person is getting up out of bed.
The Egress Test is a simple and practical
way to assess patient’s ability to complete
bed to chair transfer before leaving safe
zone at edge of bed.
Egress Test:
3 Phase Progression
1. Three repetitions of sit to stand, the 1st
attempt the patient lifts buttocks off
surface. The 2nd and 3rd attempts are full
sit to stand.
2. Three steps of marching in place (with
baseline assistive device)
3. Advance step and return to each foot.
Egress Test: Phase 1
Three Reps of Sit to Stand..\image004[2].jpg
Rep 1- Can patient elevate from and clear support
surface by only 1-2 inches? This clearing rep
verifies the patient’s weight-bearing ability to
perform the task without physical assistance.
The clearing test also allows the care provider to
assess that the set up is safe.
The patient then completes 2 full sit to stand reps.
A mechanical transfer assist should be used if the
patient requires assistance beyond cues and
guarding to complete any part of this phase.
Egress Test: Phase 2
Three Steps of Marching in Place
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This assesses patients’ ability to lift and weight
bear on each leg for 3 steps in place. This is a
strength and endurance test.
Be prepared to redirect patient back and down to
starting surface. Maintain close contact with
patient throughout and use appropriate body
mechanics.
If the patient requires any assistance beyond cues
and guarding techniques then a mechanical
transfer assist should be used.
Egress Test Phase 3
Advance Step and
Return Each Foot
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This test assesses
patient’s ability to step
forward and backward
before stepping fully away
from beside surface.
While you are in a guarding
position ask the patient to
advance one leg forward
and then return it back to
the starting position.
The task is repeated for
the other leg.
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If the patient can’t bring a
leg back to the starting
position, cue the patient to
shift weight back onto
trailing leg and sit on the
support surface.
Back of the trailing leg
should always be touching
the starting surface for
possible retreat during this
test.
Use a mechanical transfer
assist if patient needs any
assistance beyond guarding
and cues.
Equipment Considerations
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Most of the rolling walkers
on the floors support up to
300 pounds. You can
confirm weight capacity by
looking for sticker on
walker. Confirm that the
width is adequate.
We have wider bariatric
rolling walkers that can
support up to 500 pounds
as needed. Call PT if you
need to find one.
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Most of the standard
recliners and tall back
chairs support up to 300
pounds. Consider chair
width before using.
Support patient’s feet with
step stools while sitting at
edge of bed.
Bariatric recliners on N3
support up to 580 pounds.
Transport can help you find
a wheelchair to
accommodate your patient
if over 250 pounds.
Transfer Assist Devices:
Sara 3000 standing and
raising aid
Supports up to 440
pounds
Used with patients who
can weight bear on
legs.
Need adequate trunk
support.
Use with patients who
need more than just
guarding to safely
perform any part of
Egress Test.
Transfer assist devices
Maxi Move Dependent
Transfer
Total passive lift for
patient who cannot
weight bear minimally on
legs.
Used for patients who
cannot sit at edge of
bed without significant
physical assistance.
Supports up to 500 pounds
and can lift someone
from the floor.
Transfer assist devices
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Do not attempt to use either the
Sara 3000 or the Maxi Move until you
have completed training and the
competency.
If you need further training on either
device, let your nurse manager know.
Bariatric Mobility Test
1. Which Body Shape can roll easier?
A. Apple shaped
B. Pear shaped
C. Squash shaped
D. All can roll equally as easy
2. The Egress test has
A. 1 Phase: Get up and go
B. 2 Phases: Sit to stand, and advanced step
C. 3 Phases: Sit to stand, marching in place
and step forward/back with single leg
D. 4 Phases: Sit to stand, marching in place, step
forward/back with single leg , and take a stroll
3.
Your 450lb bariatric patient has fallen to the
floor and cannot get up. Which device will be
needed to lift him?
A. Stedy
B. Sara 200
C. Sara 3000
D. Maxi Move
4. When assisting a patient to a sitting position
on the edge of the bed it is important to:
A. Have the bed as low as possible
B. Avoid positioning in the knees below the hips
C. Use a foot stool to position thighs before
elevating patient trunk
D. All of the above
5. You have a 400lb patient who has good trunk control
up in the chair. He can usually bear weight fine
but is too tired to get up on his own.
Which device should be used to assist getting him
back to bed
A.
B.
C.
D.
Stedy
Sara 200
Sara 3000
Maxi Move