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Thread: Weight Shift ?

  1. #1

    Weight Shift ?

    I was wondering about weight shifts. How often do you do them? Do you lean forward or lean back?

    My brother, Dennis is 5 months post, C5/6. while in rehab all weight shifts were done leaning back. He was in a manual chair most of the time, but when he was testing power chairs he shifted his entire body back, feet came up. Now that he is home, in a loner manual chair, he leans forward for all shifts.

    About 4 days ago both of his feet started to swell - they are now quite fat. He spoke to a nurse and his therapist about it and they said to keep an eye on it. Prior to his injury he was on 10mg of Coumdin per day due to a genetic blood disorder, Lieden Factor 5 - he clots too much. He was hospitalized twice over the past 10 years for clots. He was given a screen in his abdomen the day after his injury to catch any large clots, but we know the smaller ones can get through it.

    Should he be doing the weight shifts leaning back? Could all of the sitting cause edema in his feet?

  2. #2
    Senior Member Jesse's Mom's Avatar
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    Originally posted by book-sis:

    I was wondering about weight shifts. How often do you do them? Do you lean forward or lean back?

    My brother, Dennis is 5 months post, C5/6. while in rehab all weight shifts were done leaning back. He was in a manual chair most of the time, but when he was testing power chairs he shifted his entire body back, feet came up. Now that he is home, in a loner manual chair, he leans forward for all shifts.

    About 4 days ago both of his feet started to swell - they are now quite fat. He spoke to a nurse and his therapist about it and they said to keep an eye on it. Prior to his injury he was on 10mg of Coumdin per day due to a genetic blood disorder, Lieden Factor 5 - he clots too much. He was hospitalized twice over the past 10 years for clots. He was given a screen in his abdomen the day after his injury to catch any large clots, but we know the smaller ones can get through it.

    Should he be doing the weight shifts leaning back? Could all of the sitting cause edema in his feet?
    I am sure you are going to get expert advice from nurses or other SCI people but here is what I have just found out. We made a long trip from CA to MN for Christmas with our son, who is a C7. He assumed that since he was injured one year , he didnt need to do the weight shifts as much. WRONG. He ended up with two sores on his tailbone and one huge blister on the bottom of his foot because of the edema, I am sure from sitting without moving for 30 hours. He kept telling us "I am ok" and we believed him. His legs and feet swelled about half way through the trip and I imagine and have been told the pressure sore on the bottom of his foot could have been from that. Someone else will have to advise you about the ways to do the shifts since Jess just lifts his body straight up out of his chair, but some ppl cant do that, I know. Just be watching the heel of the feet. He almost had one on the other foot too but we must have caught it soon enough.

  3. #3
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    When I was in rehab in '82, we were instructed to do weight shifts every 20 minutes. Fortunately I am a fidigeter and can't sit still, which leads to constant weight shifts.

    As time goes by your skin will develop a tolerance and you will be able to vary the timinig. This means your skin is more likely to breakdown early in your SCI experience than later.

    I still wake up 3 or 4 times a night to turn myself when sleeping, even though now I can push it to once or twice a night.

  4. #4
    Hi book-sis,
    Dan was still very sick at 5 mos. post, (C5 now), and swelling that he got was from not elevating his feet, or not wearing his "teds". Does your brother have "Teds stockings"? They may help as well.
    God Bless,
    Cathy

  5. #5
    book-sis: It certainly sounds like dependent edema and periodically raising both legs up during the day as well as wearing support hose will help. I imagine the loaner chair he is in does not have elevating leg rests. If it does, I would certainly use these throughout the day to raise his legs up. Otherwise, someone can help him put his legs on a pillow on another surface.

    The fact that he has a history of clotting is something that he should continue to monitor. We have posted several threads in the past about this topic and you can hit the "find" button to locate these.

    KLD once wrote: "Although a Greenfield filter can prevent major emboli, it cannot prevent microemboli, and clots in the legs can cause long term phlebotic syndrome with chronic edema and skin problems".

    If elevation of his legs and support hose show no improvement, please let Dennis' doctor know.

    As far as weight shifts, does your brother have someone with him most of the day at home. To achieve a tilt back someone can sit behind him and support Dennis in his wheelchair as they tilt him back. Make sure to lock the wheelchair first so it doesn't slide forward during the tilt.

    Will Dennis be getting a tilt-in-space wheelchair for home use?

    PLG

  6. #6
    I would just like to add a little about weight shifts.

    They are recommended every 15-20 minutes, with the weight being off the ischiums for at least 15-30 seconds each time. There are 4 basic ways to do them (list below from most effective to least effective):

    Push up: requires the ability to lock the elbows, either by using triceps or rotating shoulders. Difficult with painful shoulders or any shoulder or sternum injury. Used most by those with low tetraplegia or paraplegia.

    Forward leans: A good method if you can get your chest all the way to your thighs, and can then reposition either using triceps or loops on chair (McCormick loops) which allow someone without good shoulder muscles to pull up without triceps. Requires excellent hip range of motion. Casters on chair must be turned forward to avoid tipping chair forward, esp. if done with a halo brace on.

    Side-to-side leans: easiest to do for those with limited shoulder strength or with previous shoulder injuries. You need to unweight either side separately for the same period of time. You can do this by pushing over or by pulling using wrist or shoulder muscles.

    Tip-backs (includes tilt in space on a power chiar or power or manual recliner): Not effective unless the back of the chair is closer than 45 degrees to the angle of the floor. Shifts weight from the ischiums to the sacrum, which has very little tolerance for pressure. Should only be used by those who cannot do any other type of weight shift independently.

    I hope this helps.

    (KLD)

  7. #7
    Thanks so much for all of the advice.

    Dennis does not have teds yet,we are wondering if he should. He did wear them after his surgery but had to take them off when AD set in and his temp hit 105.6 - they have not been on since.

    the power chair he has ordered will have the ability to tilt-in-space, also raising his legs. He usually does weight shifts every 30 minutes, leaning forward all the time now. He needs help leaning forward and coming back up but can 'hold' himself down for the shift. He had two sores while at Kessler - so had to stay in bed at all times while not at therapy.

    I am not sure he can do a side shift due to the spasms he has. Someone is home with him at all times still so if shifting back would be a better idea it can be done.

    Would lifting his legs in his manual chair be a bad thing? Meaning would it put too much pressure on his rear?
    Interesting that you mention shoulder pain, he has a tremendous amount of it - is there a reason why there is so much shoulder pain? He did not have it prior to his injury.

  8. #8
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    McCormack Loops

    I never heard of these, is there a picture that could be shown? I have sewn on scrap blue jean material to long blue jean shorts, so maybe if I saw a picture or detailed description, I could improvise. Please. Debra

  9. #9
    A McCormick loop is just a loop of 1" webbing that is screwed onto the frame of the chair at the push handles. The length must be individually adjusted. Prior to leaning forward, you slip your arm through the loop(s) past the elbow, lean down onto your knees, then use your shoulder muscles to pull yourself back up again by pulling on the loops with your shoulders. They can be on one or both sides of the chair back, and need to be long enough to allow you to go to chest-to-thigh, but not so long that you cannot pull yourself all the way back up to upright using only the loops.

    At our center the OT and PT work together to devise the loops and apply them to the chair so they are just right for the individual, but with some experimentation they are something you could easily do yourself. Sorry I don't have a photo.

    (KLD)

  10. #10
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    loopy

    I grt it now, thank you!

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