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    Nabilah
    Physical therapy is a healthcare profession that evaluates and treats musculoskeletal, neurological, and cardiopulmonary impairments through skilled interventions to improve functional mobility and independence. Physical therapists receive entry-level masters or doctoral education and work in various settings like hospitals, outpatient clinics, schools, and home health. They may specialize in areas like orthopedics, neurology, or cardiopulmonary physical therapy. In intensive care units, physical therapists play an important role in early mobilization of critically ill patients to prevent complications and improve outcomes through interventions like bed mobility exercises, transfers training, and gait activities.

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    ICU

    Uploaded by

    Nabilah
    179 views12 pages
    Physical therapy is a healthcare profession that evaluates and treats musculoskeletal, neurological, and cardiopulmonary impairments through skilled interventions to improve functional mobility and independence. Physical therapists receive entry-level masters or doctoral education and work in various settings like hospitals, outpatient clinics, schools, and home health. They may specialize in areas like orthopedics, neurology, or cardiopulmonary physical therapy. In intensive care units, physical therapists play an important role in early mobilization of critically ill patients to prevent complications and improve outcomes through interventions like bed mobility exercises, transfers training, and gait activities.

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    Physiotherapy

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    Physical therapy is a healthcare profession that evaluates and treats musculoskeletal, neurological, and cardiopulmonary impairments through skilled interventions to improve functional mobility and independence. Physical therapists receive entry-level masters or doctoral education and work in various settings like hospitals, outpatient clinics, schools, and home health. They may specialize in areas like orthopedics, neurology, or cardiopulmonary physical therapy. In intensive care units, physical therapists play an important role in early mobilization of critically ill patients to prevent complications and improve outcomes through interventions like bed mobility exercises, transfers training, and gait activities.

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    179 views12 pages

    ICU

    Uploaded by

    Nabilah
    Physical therapy is a healthcare profession that evaluates and treats musculoskeletal, neurological, and cardiopulmonary impairments through skilled interventions to improve functional mobility and independence. Physical therapists receive entry-level masters or doctoral education and work in various settings like hospitals, outpatient clinics, schools, and home health. They may specialize in areas like orthopedics, neurology, or cardiopulmonary physical therapy. In intensive care units, physical therapists play an important role in early mobilization of critically ill patients to prevent complications and improve outcomes through interventions like bed mobility exercises, transfers training, and gait activities.

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    of 12

    Louise Wall PT

    June 18th 2010


    What is Physical Therapy?
    Definition: a health care profession that performs
    evaluation and skilled intervention for individuals who
    demonstrate musculoskeletal, neurologic,
    cardiopulmonary impairments that directly affect normal
    functional mobility and independence
    Physical therapy education is evidence based, and entry
    level masters or doctoral programs.
    Physical Therapist work in a variety of settings such as
    Hospitals, Inpt Rehab, Outpt and sports clinics, Schools,
    Home health, Work hardening/Industrial, Women's
    Health, Research centers.

    www.apta.org
    Due to the large body of knowledge comprised by
    physical therapy, some PTs specialize in a specific
    clinical area. The APTA recognizes 8 areas of specialty
    :
    Cardiovascular and Pulmonary
    Clinical Electrophysiologic Application
    Geriatrics
    Neurologic
    Orthopedics
    Pediatrics
    Sports Medicine
    Womens Health
    There are also unofficial specialties dealing with
    integumentary systems

    www.apta.org
    PT practice has evolved over the years from So what is Skilled?
    prescriptive to PTs having direct access in
    47 of 50 states.
    Skilled interventions are defined
    However CMS (Medicare) continues to require as those that require the specific
    MD prescription for direct access services for
    knowledge, skills and judgment of a
    all Medicare patients. CMS has also
    therapist for patient education and
    implemented very strict guidelines as to what
    qualifies as a skilled intervention. Medicaid,
    skilled training. There should be an
    along with many private insurances have
    expectation for improvement in a
    adopted these reimbursement changes
    reasonable and measurable amount
    of time.
    Why is this important? PT is a billable service
    and must adhere to CMS guidelines. Non skilled interventions are
    those aimed at maintenance in
    conditions that are permanent or
    chronic in nature such as palliative
    ROM or exercise programs, ROM in
    the absence of complicating factors
    and repetitive gait for conditioning

    www.clinicalreimbursment.com
    Why PT in the ICU?
    PTs are specialists in the evaluation and treatment of
    musculoskeletal, neurologic, and cardiopulmonary impairments
    and their direct impact on the patients, strength, motor
    control, sensation, functional mobility, gait, and balance.

    What constitutes mobility?


    PTs evaluate individuals deficits. They will synthesis this
    information with considerations of baseline function, current
    activity tolerance / response to treatment. Each therapy
    intervention is individualized and incorporates pts goals.

    Mobilization is a progressive process.


    Mobility includes: bed mobility, edge of bed activities, transfers
    out of bed to chair, gait training, wheelchair mobility.

    Gosselink R. Bott J, Johnson M. (2008)


    Physiotherapy for adult patients with critical
    illness: Recommendations of European
    Respiratory Society and European Society of
    Intensive Care Medicine Task Force on
    Physiotherapy for Critically Ill Patients:
    History of PT in ICU

    Mid Eighties/ Early 90s


    East coast cardiopulmonary PTs
    - Chest Physical Therapy
    Massachusetts General Hospital
    Maryland Shock Trauma
    Changes in reimbursement in late 90s
    Reduction of staffing
    Prioritization of workload
    Specialization of Services.

    Stiller K (200) Physiotherapy in Intensive Care


    Units Chest 2000;118;1801-1813
    Challenges of ICU for PT
    Skills:
    Early mobilization of the critically ill
    patient receiving mechanical
    ventilation is an advanced physical
    therapy practice and requires
    education and specialized skills in
    specific areas that affect clinical
    decision making as well as
    treatment prescription

    Environment:
    Numerous lines, tubes, monitoring
    & ventilator=labor intensive

    Sedation, level of alertness,


    cognition, patients active
    participation, ability to learn.

    Medical stability, activity tolerance,


    adequate proximal muscle strength
    to participate in active mobility
    training

    Perme C PT CCS, Chandrashekar R PT,(2009)


    Early Mobility and Walking program for Patients
    in ICU: creating a standard of Care. AJCC 36:8
    2230-2243
    Assessment for mobility

    PT eval:
    Asses level of alertness , ability to follow commands.
    Active ROM/ Motor Control or Strength, Sensation,
    Proprioception, Coordination
    Vitals Signs, medical stability for mobilization.

    Asses bed mobility-> rolling, scooting , bridging


    How much can the patient assist? Is the patient able to
    follow simple motor commands.
    Supine to Sit transfers-> Is patient able to perform
    activity/ How much assist required?
    Sitting edge of bed ( EOB) Asses trunk control, static and
    dynamic sitting balance
    If pt unable to sit EOB unsupported likely not ready for
    transfers//amb.
    Establish Goals must be measurable and achievable

    Establish Treatment Program : Intervention should


    address functional impairments identified during
    assessment with focus of building on available skills to
    progress I mobility
    www.hopkinsmedicine.org/dome
    PT interventions:
    EOB activities: ongoing assessments of I static and
    dynamic sitting balance, seated activities, reaching outside base of
    support. These activities establish proximal stability which is
    fundamental for distal mobility (transfers/ gait)

    Transfer training: This may begin as simple as sit to


    stand activities at the edge of bed, weight shifting with assistive
    devices, pre gait activities. If pt does not have adequate LE strength
    to stand but does have I dynamic sitting balance transfers could be
    performed with transfer board, building up to stand pivot transfers.

    Gait activities: may also begin with weight shifting,


    marching, or short distances repeated frequently to build up to
    longer more functional distances.

    .
    Each of the therapy interventions include ongoing
    assessments of patient tolerance, ability to participate,
    measurement of improvement and reevaluation of goals.

    PTs must be able to document measurable gain in


    function and achievement of established goals in order for
    the intervention to continue as skilled.

    There should be periodic reevaluation of patients who may


    have been placed on a RN program for ROM/ out of bed to
    chair to establish appropriateness for skilled intervention
    (i.e. due to poor activity tolerance/ inability to achieve
    goals with therapy).

    Establish guidelines for transition to Nursing mobilization.

    www.hopkinsmedicine.org/dome
    References:

    Rochester, C MD Rehabilitation in the Intensive Care Unit Seminars in respiratory and Critical Car med/ Volume 30, 6

    Hopkins RO, Spuhler VJ, Thompsen GE. Transforming ICU culture to facilitate early mobility. Crit Care Clin 2007;23:81-96

    Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA
    2008; 300:1685-1690

    Morris PE Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Med 2008 Vol36
    No. 8

    Perme C Early mobility and Walking Program for Patients in ICU: Creating a standard of care. AJCC 2009 Vol 8 No 3 212-220

    Gosselink R Physiotherapy for adult patients with critical illness recommendations of European Resp Society and European
    Society of Intensive Care Medicine task force on physiotherapy for critically ill patient. Intensive Care med 2008 34:1188-
    1199.

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