Date of Paper/Work

4-2015

Type of Paper/Work

Research Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Lisa L. Dutton

Abstract

BACKGROUND AND PURPOSE: Recent literature has shown that early mobility in the intensive care unit (ICU) is safe and effective. Early mobilization reduces a patient's risk for experiencing sequelae such as muscular weakness, bone demineralization, contracture, skin breakdown, pneumonia, insulin resistance, thromboembolic disease and psychological issues, such as anxiety and depression. Some patients are unable to participate in early mobilization due to the complexity of their medical stay, putting them at risk for functional limitations that may last long past discharge from the hospital and limit their quality of life. The aim of this case report was to depict the manifestations of probable intensive care unit acquired weakness in a patient who experienced prolonged bed rest and ventilator dependence and describe the interventions used to improve her functional mobility.

CASE DESCRIPTION: The patient was a 58 year old woman admitted to the ICU with acute respiratory failure secondary to a ST elevated myocardial infarction. Physical therapy was initiated on the 13th day of her hospital stay and she was found to have general limitations in strength and ROM in both lower extremities and was dependent for all mobility and transfers. At the time of evaluation the patient still required mechanical ventilation and was restrained at the wrist due to agitation and anxiety leading the patient to pull at her lines and tubes.

INTERVENTION: Physical therapy interventions, including transfer training, therapeutic exercise and gait training with tactile and verbal cues were provided to address identified impairments and restore functional mobility.

OUTCOMES: Prior to physical therapy intervention the patient was dependent for all functional mobility and unable to lift her lower extremities through full range of motion without assist. After 6 sessions of physical therapy intervention the patient was discharged to a transitional care unit requiring minimal assist for supine to sit transfers, contact guard to stand by assist for sit to stand transfers and contact guard assist to ambulate 50 feet with a front wheeled walker.

DISCUSSION: This case report describes the manifestations of prolonged bed rest in a patient with probable ICU acquired weakness and outlines the physical therapy interventions that were utilized during the patient’s recovery of functional mobility. Further research is needed to investigate physical therapy interventions to reduce the risk of developing ICUAW in patients who are unable to participate in an early mobilization program.

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