ICU-acquired weakness can set in quickly and have lasting impacts. And once the condition has developed, there is no known medical therapy available to treat it.1 Muscles need to move.
Dr. Wischmeyer of Duke University gives an overview of the challenges associated with early mobility, and the importance of implementing protocols.
With their vital skill sets, mobility therapists are an integral part of getting patients moving. Support from other members of the RISE team is vital. Intensivists can streamline physical therapist and occupational therapist orders and reduce sedation, respiratory therapists can protect patients’ airways, and nurses can help assess patient stability and readiness for therapy. Working together, the whole team can help your patients RISE.
No matter how sick the patient, physical therapists can offer an early mobility therapy that may help. Passive patients can benefit from electro-mechanical stimulation and passive motion exercises. Depending on their condition, responsive patients can sit up, transfer to chairs, walk — even cycle.([FOOTNOTE=Sommers J, Engelbert RHH, Dettling-Ihnenfeldt D, et al. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil. 2015;29(11):1051–1063. doi: 10.1177/0269215514567156],[ANCHOR=],[LINK=])
Comprehensive criteria can help determine when and what type of mobility exercises are safe for a particular patient.([FOOTNOTE=Hodgson CL, Stiller K, Needham DM, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658. doi: 10.1186/s13054-014-0658-y],[ANCHOR=],[LINK=])
Occupational therapists bring a unique and vital viewpoint to early mobility. They focus on the patient’s ability to function outside the hospital. And they help patients maximize the benefits of early mobility and prepare for life beyond the ICU — whether they need training with assistive devices or coping strategies for performing daily activities.4,([FOOTNOTE=Bondoc S, Lashgari D, Hermann V, Finnen L, Frost L, Alexander H, and the American Occupational Therapy Association. AOTA Fact Sheet: Occupational Therapy’s Role in Acute Care. AOTA. 2017. Accessed July 22, 2017.],[ANCHOR=View Fact Sheet],[LINK=https://www.aota.org/-/media/corporate/files/aboutot/professionals/whatisot/rdp/facts/acute-care.pdf])
Occupational therapists also counsel patients’ families on how to assist their loved ones with continued recovery.5
A survey of acute care physical therapists shows that barriers to providing early mobility in the ICU persist. They include inadequate staffing and education, lack of resources, and oversedation of patients.([FOOTNOTE=Malone D, Ridgeway K, Nordon-Craft A, Moss P, Schenkman M, Moss M. Physical therapist practice in the intensive care unit: results of a national survey. Phys Ther. 2015;95(10):1335–1344. doi: 10.2522/ptj.20140417],[ANCHOR=],[LINK=]) But strategies for overcoming some of these barriers already exist. Making early mobility a higher priority, better communication with ICU nurses, and clarifying physical therapist consultation criteria can be tackled now.