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Technology to enhance physical rehabilitation of critically ill patients

Needham, Dale M. MD, PhD; Truong, Alex D. MD, MPH; Fan, Eddy MD

doi: 10.1097/CCM.0b013e3181b6fa29
Scientific Reviews
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Background: Neuromuscular complications after critical illness are common and can be severe and persistent. To ameliorate complications, there is growing interest in starting physical medicine and rehabilitation therapy immediately after physiologic stabilization. The introduction of physical medicine and rehabilitation-related technology into the intensive care unit may help facilitate delivery of this therapy.

Discussion: Neuromuscular electrical stimulation therapy creates passive contraction of muscles through low-voltage electrical impulses delivered through skin electrodes placed over target muscles. Although neuromuscular electrical stimulation has not been studied in patients with acute critical illness, published guidelines based on available evidence suggest that neuromuscular electrical stimulation may be considered in intensive care unit patients who are at high risk of developing muscle weakness. Bedside cycle ergometry can provide range of motion and muscle strength training for intensive care unit patients who are either sedated or awake, and may help preserve muscle architecture and improve strength and function. Finally, custom-designed technological aids to assist with ambulating mechanically ventilated patients may reduce the human resource requirements and improve the safety and effectiveness of early mobilization in the intensive care unit.

Conclusion: Physical medicine and rehabilitation-related technologies may play an important role in preventing and treating intensive care unit-acquired neuromuscular complications. Future studies are needed to evaluate their efficacy in intensive care unit patients.

From the Division of Pulmonary and Critical Care Medicine (DMN, ADT, EF) and Department of Physical Medicine and Rehabilitation (DMN), Johns Hopkins University, Baltimore, MD; and Critical Care Physical Medicine and Rehabilitation Program (DMN), Johns Hopkins Hospital, Baltimore, MD.

Dr. Needham is named in a provisional patent application for a mobility aid device discussed in this paper. Dr. Needham holds a Clinician-Scientist Award and Dr. Fan holds a Fellowship Award, both from the Canadian Institutes of Health Research.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: dale.needham@jhmi.edu

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins