PT  - JOURNAL ARTICLE
AU  - Trees, Darin W.
AU  - Smith, James M.
AU  - Hockert, Steven
TI  - Innovative Mobility Strategies for the Patient With Intensive Care Unit–Acquired Weakness: A Case Report
AID  - 10.demo/ptj.20110401
DP  - 2013 Feb 01
TA  - Demo Journal of Physical Therapy
PG  - 237--247
VI  - 93
IP  - 2
4099  - http://demo.highwire.org/content/93/2/237.short
4100  - http://demo.highwire.org/content/93/2/237.full
AB  - 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.