So your patient has one upper extremity, or even worse, bilateral non-weightbearing precautions, likely due to distal radius fracture(s).
Does this mean OT cannot do any activities with them? Is everything not attempted for safety in your initial evaluation? In fact, OT can play an important role in the recovery of patients with non-weight bearing precautions in their wrists.
Clarify with the MD if there any concerns.
Biomechanically, these patients are allowed to weight bear proximally such as through the elbow. Therefore, platform walkers are OK. Let’s get to some functional activities:
Feeding/Eating – Yes
- OK – including the use of utensils and holding cups
- Patients should be careful if they are pushing on meal tables as they can be very heavy.
Grooming – Yes
- Brushing teeth – OK
- Washing hands – OK
- Washing face – OK
- Brushing hair – OK
- Putting on makeup – OK
- Patients should be careful if they are weight-bearing with their hand on the sink in standing or while seated edge of the bed.
Dressing – Yes
- Upper body – OK
- Lower body – OK
- Footwear (light, easy to don/doff) – OK
- Patients should be careful if weight-bearing for balance during sitting or standing.
- Patients should be careful when opening/closing heavy drawers.
Bathing – Yes
- Rinsing – OK
- Light scrubbing – OK
- Light drying – OK
- No weight bearing on tub bench if seated or pulling/pushing on grab bars while standing.
- As usual, ensure open wounds or staples are covered.
Toileting – Depends
- Clothing management – OK
- Hygiene – OK
- Patients should be careful during toileting transfers not to weight bear on toilet seats, grab bars, commode handles, etc.
Bed Mobility – Depends
- OK – rolling supine to either side without pulling or pushing on rails
- OK – use of elbows to scoot or come into fowler’s position
- OK – sit to stand using legs, elbows with platform walker
- Not recommended – overhead trapeze, slide/beasy boards (due to pushing laterally while sliding), transfer poles, sara stedy
Functional Mobility – Depends
- Not recommended – FWW, 4WW, canes, hemi-walkers, crutches
- Not recommended – wheelchair propulsion
- Platform FWW for involved joints – OK
- Or no device =) – OK
- No use of grab bars, arm rests, bed rails, edges of beds, transfer poles, overhead trapezes, sara stedy (during pull to stand)
- Elevate surface to facilitate the transfer or use raised DME (commodes, bath benches)
- Strengthening of involved joint – not recommended, until cleared by MD
- Opening/closing doors – not recommended
- Carrying heavy objects (bags, backpacks, etc.) – not recommended
- Sexual activities – depends on position
- Patient may consider being on bottom and their partner on top