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针对重症监护病房获得性肌无力的职业治疗干预:一例报告

Occupational Therapy Intervention for Intensive Care Unit-Acquired Weakness: A Case Report.

作者信息

Aoyama Yusuke, Yoshida Akihito

机构信息

Department of Rehabilitation, Graduate School of Medicine, Nagoya University, Nagoya, JPN.

Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya City, JPN.

出版信息

Cureus. 2025 Jun 30;17(6):e87014. doi: 10.7759/cureus.87014. eCollection 2025 Jun.

Abstract

Intensive care unit-acquired weakness (ICU-AW) poses a challenge to physicians and paramedical staff. ICU-AW causes long-term limitations in patients' daily lives; therefore, we aimed to devise an effective treatment strategy. We present a novel occupational therapy strategy for patients with ICU-AW. We present the case of a 52-year-old male with ICU-AW developed by cardiogenic shock. The patient was bedridden all day at the start of occupational therapy. To improve upper extremity activity time, enhance muscle strength, and promote activities of daily living (ADL), we used a portable spring balancer (PSB) to support arm movements, modified the nurse call to be thicker, adjusted the bed's head-up angle, and collaborated with nursing staff to facilitate daily practice. Training was structured around repetitive, goal-directed upper extremity exercises both on a bed or on a wheelchair. Following the intervention, the patient demonstrated marked improvements in upper extremity strength and ADL, and regained independence in feeding and grooming. This case report suggests that PSB-assisted, goal-directed OT combined with environmental modifications may be a safe and effective rehabilitation strategy even for patients with severe ICU-AW.

摘要

重症监护病房获得性肌无力(ICU-AW)给医生和医护人员带来了挑战。ICU-AW会导致患者日常生活出现长期限制;因此,我们旨在制定一种有效的治疗策略。我们为患有ICU-AW的患者提出了一种新颖的职业治疗策略。我们介绍了一名52岁男性因心源性休克而发生ICU-AW的病例。在职业治疗开始时,患者整日卧床。为了增加上肢活动时间、增强肌肉力量并促进日常生活活动(ADL),我们使用便携式弹簧平衡器(PSB)来辅助手臂运动,将护士呼叫器改得更粗,调整床头抬高角度,并与护理人员合作以方便日常练习。训练围绕在床上或轮椅上进行的重复性、目标导向性上肢运动展开。干预后,患者的上肢力量和ADL有了显著改善,并在进食和洗漱方面恢复了自理能力。本病例报告表明,即使对于患有严重ICU-AW的患者,PSB辅助的、目标导向性的职业治疗结合环境改造可能是一种安全有效的康复策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc0d/12308451/b378680d7d21/cureus-0017-00000087014-i01.jpg

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