PT in the Acute Care Setting/PT for Extremely Weak Pt Flashcards
describe the continuum of care in PT
ER, ICU, step down unit, discharge, acute rehabilitation, skills nursing facility, home PT, outpatient
the process of obtaining a history, performing a systems review, and selecting/administering tests and measures to gather data about the pt
examination
list 5 things to consider to examine when performing examination
- aerobic capacity/endurance
- CN and peripheral N integrity
- Assistive devices
- muscle performance (strength, power, endurance)
- posture
(pain, posture, prosthetics, sensory integration, ventilation, self-care, ROM, integumentary system integrity)
allow PT, nurses, other healthcare providers to monitor the progress of the pt over time and assess any functional changes
outcome measures
list some examples of outcome measures
- Borg RPE
- AM-PAC 6 clicks
- FIM (functional independence measure)
- TUG
- 6 MWT
- 5x STS
- 10 MWT
uses 6 questions to assess the function of patients; can be used with a variety of pt populations
AM-PAC 6 Clicks
what are the 3 domains assessed in AM-PAC 6 Clicks
mobility
daily activities
cognation
used specifically for pts in the ICU; can be used to guide prescription in the ICU as well as measure function
FSS-ICU (functional status score of the ICU)
what does the FSS-ICU (functional status score of the ICU) examine
pt ability to:
- roll
- transfer from supine to sit
- sit edge of bed
- transfer from sit to stand and walk
(bed mobility, transfers, ambulation)
what do higher scores indicate on FSS-ICU (functional status score of the ICU)
better physical function
what are the 3 main types of intervention strategies
restorative
compensatory
preventative
directed towards remediating/improving the pt’s status in terms of impairments, activity limitations, participation restrictions, and recovery of function
restorative
directed toward promoting optimal function using residual abilities; the activity is adapted in order to achieve function
compensatory
directed towards minimizing potential problems and maintaining health
preventative
what are the 4 components of exercise training sessions
- warm up
- conditioning
- cool down
- stretching
how long should warm up take
5-10 minutes
light to moderate intensity cardiorespiratory and muscular endurance activities
how long should conditioning be
20-60 minutes
of aerobic, resistance, neuro-motor, and/or sports activities
how long should cool down be
5-10 minutes
light to moderate intensity cardiorespiratory and muscular endurance activities
how long should stretching be
10 minutes
stretching exercises should be performed after warm up and cool down phases (dynamic or static)
transitional phase; allows the body to adjust to the changing physiologic, biomechanical, and bioenergetics demands placed on it during the conditioning or sports phase of the exercise session; improves ROM; may reduce the risk of injury
warmup
allows for gradual recovery of HR and BP; removal of metabolic end products from the muscles used during the more intense exercise conditioning phase
cool down
describe light intensity strength training
- 40-50% 1 RM
- 8-10 exercises involving the major muscle groups
- > 1 set of 10-15 reps
- progressive weight training or WB, stair climbing, etc.
describe moderate intensity strength training
- > or equal to 2days/week
- 60-70% of 1 RM
- 5-6/10
- 8-10 exercises involving the major muscle groups
- > 1 set of 10-15 reps
- progressive weight training or WB, stair climbing, etc.
describe vigorous intensity strength training
- 7-8/10
- 8-10 exercises involving the major muscle groups
- > 1 set of 10-15 reps
- progressive weight training or WB, stair climbing, etc.
what decreases with age, making it important to do resistance training in older adults
strength
what may need to be precede areobic training in frail adults
muscle strength training
individuals with _____ need to increase muscular strength before they are physiologically capable of engaging in aerobic training
sarcopenia
describe moderate intensity aerobic training
- > or equal to 5 days/week
- 40-60% HRR
- 30-60 minutes, at least 10 minute bouts, 150-300 minutes per week
- any modality that does not impose excessive orthopedic stress (walking, aquatics, stationary bike)
describe vigorous intensity aerobic training
- > or equal to 3 days/week
- 60-90% HRR
- 20-30 minutes/day, at least 10 minute bouts, 75-100 minutes/week
- any modality that does not impose excessive orthopedic stress (walking, aquatics, stationary bike)
describe FIIT for balance training
- > or equal to 2-3 days/week
- to the point of feeling tightness or slight discomfort
- hold stretch for 30-60 seconds
- progressively difficult postures that gradually reduce BOS, dynamic movements that perturb the COG, stressing postural muscles, reducing sensory input, tai chi
describe neuromotor exercise training and what is it effective in doing
- combines balance, agility, and proprioceptive training
- effective in reducing and preventing falls
pts who have been on prolonged bed rest and pts in the ICU are especially prone to what
neuromuscular dysfunction and ICU acquired weakness
describe the weakness pattern with best rest induced weakness
symmetry
LE > UE weakness
antigravity muscles most affected
describe severity of bed rest induced weakness
weakness is proportional to duration of bed rest
are DTR present or absent in bed rest induced weakness
present
describe weakness pattern of ICU acquired weakness
symmetric
extremity weakness
respiratory muscle involvement
describe the severity of ICU acquired weakness
weakness is disproportionate to duration of bed rest
are DTRs present or diminished in ICU acquired weakness
diminished
what do you have to assess with ICU acquired weakness
tone, motor control, strength and sensation
what outcome measure can be used to assess ICU acquired weakness
functional status score for ICU (FSS ICU)
interventions used on severely weak pt
- progressive mobilization
- strengthening
- aerobic endurance
- balance
- flexibility
initiated based on pt’s tolerance and response to activity, vitals and neurological status must be monitored continuously, consider orthostatic hypotension
progressive mobilization for severely weak pt
list some pros and cons for NMES
Strengths: can be used in sedated pts, can be done in supine, single person implementation, provides “something”
Limitations: completely non-volitional, current can be impaired by things such as obesity or edema, limited therapist time (takes time to set up), no outcomes beyond ICU awakening
what type of training will pts respond better to
interval training better than long periods of activity
used to prevent contractures/pressure ulcers, does not prevent muscle atrophy, positioning pts in muscle shortening positions should be avoided especially in pts that cannot move themselves
passive ROM
what position helps to correct orthostatic intolerance
exercises in upright positions
what is ICU acquired weakness associated with
increased mortality
what are the 3 subcategories of ICU acquired weakness
- critical illness myopathy
- critical illness polyneurophy
- critical illness neuromyopathy
what is the best form of management for ICU acquired weakness and what helps to improve prognosis
- prevention is the best form of management
- early mobilization improves prognosis
what are complications of ICU acquired weakness
- increased time on ventilator
- increased time in ICU
- increased hospital length of stay
general indications for stopping exercise
- onset of angina/angina-like sx
- drop in SBP >10 mmHg with increase in work rate
- SBP decreases below the value obtained in same position prior to testing
- excessive rise in BP (systolic > 250 and/or diastolic > 115)
- SOB, wheezing, leg cramps, claudication
- signs of poor perfusion (light headed, confusion, ataxia, pallor, cyanosis, nausea, cold or clammy skin)
failure of HR to increase with increased exercise intensity - noticeable change in heart rhythm by palpation or auscultation
- subject requests to stop
- physical or verbal manifestations of severe fatigue
- failure of testing equipment
