Rehabilitation and Wound Care, Solara Hospital Conroe, 1500 Grand Lake Dr, Conroe, TX 77304, USA.
Phys Ther. 2013 Feb;93(2):237-47. doi: 10.2522/ptj.20110401. Epub 2012 May 10.
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.
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.
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.
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.
尽管近年来大量文献已经证实了重症加强护理病房（ICU）中早期活动的益处，但 ICU 获得性肌无力患者的决策过程和治疗策略的定制尚未在文献中得到很好的定义。本病例报告将描述 1 例在长期急性护理医院（LTACH）环境中发生 ICU 获得性肌无力的患者，以及包括用于治疗性运动和步态训练的新型设备的活动策略。
1 名 73 岁的活跃女性因心房颤动接受了常规电复律治疗，但出现了多种并发症，包括败血症和呼吸衰竭。患者在 ICU 中活动受限 3 周，并转入我院 LTACH 接受进一步的医疗干预和康复治疗。在 LTACH ICU 中启动了 4 阶段分级活动计划。在该计划中，物理治疗干预包括使用移动式腿部按压器进行部分负重抗重力力量训练，以及使用液压辅助平台助行器进行步态训练。
干预前，患者肌力严重减弱（医学研究委员会[MRC]总分 18/60），所有功能均完全依赖。她进展到能够使用带轮助行器行走 150 英尺（1 英尺=0.3048 米），同时力量增加到 MRC 总分 52/60。
本病例报告描述了管理 ICU 获得性肌无力患者的新型活动策略。使用移动式腿部按压器和液压辅助平台助行器进行分级活动计划的应用是安全可行的，并且似乎可以加快患者的康复过程，同时减少治疗师的手动提升量。
