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Innovative Mobility Strategies for the Patient With Intensive Care Unit–Acquired Weakness: A Case Report

Darin W. Trees, James M. Smith, Steven Hockert
DOI: 10.2522/ptj.20110401 Published 1 February 2013
Darin W. Trees
D.W. Trees, PT, DPT, CWS, Rehabilitation and Wound Care, Solara Hospital Conroe, 1500 Grand Lake Dr, Conroe, TX 77304.
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James M. Smith
J.M. Smith, PT, DPT, MA, Department of Physical Therapy, Utica College, Utica, New York.
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Steven Hockert
S. Hockert, PT, BS, MHA, FACHE, Rehabilitation, Solara Hospital Conroe.
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Abstract

Background and Purpose 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 have 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.

Case Description A 73-year-old, active woman underwent a routine cardioversion for atrial fibrillation but developed multiple complications, including sepsis and respiratory failure. The patient spent 3 weeks of limited activity in the ICU and was transferred to our LTACH for continued medical intervention and rehabilitation. A 4-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.

Outcome Before 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 ft (1 ft=0.3048 m) using a rolling walker with accompanying strength increases to an MRC sum score of 52/60.

Discussion This case 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 and feasible, and appeared to expedite the patient's recovery process while decreasing the amount of manual lifting for the therapists.

Footnotes

  • Dr Trees provided concept/idea/project design and data collection. All authors provided writing and consultation (including review of manuscript before submission). Mr Hockett provided data analysis, facilities/equipment, and clerical support. The authors thank “Phyllis” for her willingness to participate in this case report and to share her ICU recovery so that other ICU survivors may benefit.

  • Received November 14, 2011.
  • Accepted May 2, 2012.
  • © 2013 American Physical Therapy Association
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Vol 93 Issue 2 Table of Contents
Physical Therapy: 93 (2)

Issue highlights

  • Physical Therapists' Management of Patients With Post–Intensive Care Syndrome
  • An Early Mobilization Protocol in a Trauma and Burns Intensive Care Unit
  • An Early Mobility Protocol to Increase Ambulation in Intensive and Intermediate Care Settings
  • An Early Mobilization Program for Patients With Aneurysmal Subarachnoid Hemorrhage
  • Physical Therapist Student Confidence and Simulation-Based Management of Patients in Critical Care
  • Inspiratory Muscle Training in Infants
  • Mobility Strategies for the Patient With Intensive Care Unit–Acquired Weakness
  • Rehabilitation in Patients Receiving ECMO
  • Delivery of Physical Therapy Services for Individuals With Critical Illness
  • Physical Therapist Management of Patients With Ventricular Assist Devices
  • Exercise, Weight Loss, and Hip Osteoarthritis
  • A Novel, Intensive, Task-Specific Intervention for Individuals With Chronic Stroke
  • Psychometric Properties of the Mini-BESTest and BBS in Patients With Balance Disorders
  • Biofeedback System for Sensory Evaluation and Re-education
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Innovative Mobility Strategies for the Patient With Intensive Care Unit–Acquired Weakness: A Case Report
Darin W. Trees, James M. Smith, Steven Hockert
Physical Therapy Feb 2013, 93 (2) 237-247; DOI: 10.2522/ptj.20110401

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Innovative Mobility Strategies for the Patient With Intensive Care Unit–Acquired Weakness: A Case Report
Darin W. Trees, James M. Smith, Steven Hockert
Physical Therapy Feb 2013, 93 (2) 237-247; DOI: 10.2522/ptj.20110401
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    • Abstract
    • Patient History and Review of Systems
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Subjects

  • Case Reports
  • Acute Care

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