Although the benefits of early mobilization in the Intensive Care Unit (ICU) have been well-documented in recent years, the decision making process and customization of treatment strategies for patients with ICU-acquired weakness has not been well defined in the literature. This case report will describe a patient with ICU-acquired weakness in the long term acute care hospital (LTACH) setting and mobilization strategies that include novel devices for therapeutic exercise and gait training.
A 73-year-old active female underwent a routine cardioversion for atrial fibrillation but developed multiple complications, including sepsis and respiratory failure. The patient spent three weeks of limited activity in ICU and was transferred to our LTACH for continued medical intervention and rehabilitation. A four-phase graded mobilization program was initiated in the LTACH ICU. Within that program, the physical therapy interventions included partial weight-bearing antigravity strength training with a mobile leg press and gait training with a hydraulic-assist platform walker.
Prior to interventions, the patient had severe weakness (Medical Research Council [MRC] sum score of 18/60) and displayed complete dependence for all functioning. She progressed to being able to ambulate 150 feet using a rolling walker with accompanying strength increases to an MRC sum score of 52/60.
This report describes novel mobility strategies for managing a patient with ICU-acquired weakness. The application of a graded mobilization program using a mobile leg press and a hydraulic-assist platform walker was safe, feasible, and appeared to expedite the patient's recovery process while decreasing the amount of manual lifting for the therapists.
Source: http://ptjournal.apta.org/cgi/content/short/ptj.20110401v1?rss=1
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