Role of Physical Therapy in Critical Care and Rehabilitation

Introduction

Advancements in medical care has increased the survival rate of seriously ill patients after critical care. However, most patients with critical illness, particularly mechanical ventilation, are associated with long-term impairments such as fatigue, weakness, poor functional status, and intensive care unit-acquired muscle weakness due to prolonged bed rest and inactivity. They also have short or long-term morbidity and physical impairments. Early physiotherapy interventions may prevent or improve physical impairments.

What Is Physical Therapy?

Physical therapy or physiotherapy helps people restore, maintain, and improve their physical functions, mobility, and strength. It involves using exercises, education, manual therapy, and other techniques to help people recover from injuries or illnesses, manage chronic conditions, and prevent future problems. It can be safely performed on patients with mechanical ventilation.

Physical therapy is often used with other medical treatments. It is helpful in various conditions, such as recovering from surgery, managing pain, improving mobility, and treating neurological disorders, arthritis, and balance issues in critical care and rehabilitation after critical illness.

Who Provides Physical Therapy?

Physical therapists or physiotherapists provide physical therapy for patients. They coordinate mobility sessions for patients daily. They also perform daily mobility screening and assessment of each patient under physical therapy.

What Is the Role of Physical Therapy in ICU Stay?

Physical therapy plays an important role in intensive care units for taking care of patients who are critically ill. Some key roles of physical therapy in critical care include the following.

• Maintaining Mobility: Patients in the intensive care unit who are critically ill are bedridden, leading to mobility loss and muscle weakness. Physical therapists can help maintain and improve mobility through exercise, positioning, and range of motion activities.

• Improving Respiratory Function: Patients in critical care have breathing difficulties, leading to respiratory failure. Physical therapists improve respiratory function through breathing exercises, airway clearance techniques, and other interventions.

• Preventing Complications: Patients in critical care are at an increased risk of having complications such as pressure ulcers, blood clots, and muscle contractures. Physical therapy in critical care units prevents these complications with a range of motion of activities, positioning, and other techniques.

• Reducing Delirium: Critically ill patients develop delirium, prolonging hospitalization and leading to poor outcomes. Physical therapies in critical care reduce the risk of delirium through activities such as early mobility and orientation exercises.

• Improving Functional Outcomes: Patients who are critically ill may require a prolonged period of rehabilitation after discharge from the hospital. Physical therapists can help improve functional outcomes through exercise programs and other interventions during their hospital stay.

What Is the Role of Physical Therapy During Rehabilitation?

Physical therapy is an essential component of rehabilitation. The role of physical therapy in rehabilitation is to help patients regain mobility, function, and independence after an illness, injury, or surgery. Some of the key roles of physical therapy in rehabilitation include the following.

• Improving Mobility: Physical therapy can improve mobility and range of motion after surgery or injury. Physical therapists use stretches, exercises, and other techniques to help patients regain flexibility and strength.

• Developing Personalized Treatment Plans: Physical therapists work with patients to assess their needs and develop individualized treatment plans to address their unique goals and challenges.

• Improving Balance: Physical therapy helps to improve coordination and balance, which is particularly important for older adults or patients with neurological conditions.

• Managing Pain: Physical therapists help manage pain through manual therapy, electrical stimulation, and heat or cold therapy.

• Preventing Future Injuries: Physical therapists provide education on body mechanics, proper posture, and other strategies to prevent future injuries and promote long-term health and well-being.

• Improving Overall Function: The goal of physical therapy in rehabilitation is to improve the patient’s overall function and independence, such as resuming normal daily activities and returning to work.

What Are the Effects of Physiotherapeutic Interventions on Critical Care Patients?

The effects of physiotherapeutic interventions on critical care patients include the following.

1. Early Mobilization in Chair:

• Improves respiratory frequency, oxygen saturation, and respiratory reserve.

• Improved inspiratory and expiratory muscle strength.

• Improves heart rate and blood pressure.

2. Exercise Therapy (Active and Passive):

• Training for daily activities of life.

• Improves blood values.

• Improves daily activities of life at discharge.

• Reduces the length of ICU and hospital stay.

3. Continuous Passive Motion (CPM):

• Improves joint flexibility.

• Decreased loss of proteins.

• Reduces inflammatory cytokines.

4. Electro Muscular Stimulations:

• Improves muscle thickness and increases muscle strength.

• Improves oxygen consumption, microcirculation, and reperfusion.

• Reduces muscle atrophy.

• Reduces weaning time and the length of hospital and ICU stay.

5. Breathing Exercises: Maintain lung function and prevent complications such as pneumonia.

6. Sitting and Standing Exercises:

• Help patients to maintain their balance.

• Improve patient strength.

• Prevent muscle atrophy.

7. Gait Training:

• Help patients in regaining their independence and mobility.

• These exercises include walking with assistance or using a walker or crutches.

8. Strength and Endurance Exercises:

• They include resistance training, aerobic exercise, or circuit training.

• Endurance exercises improve the declined cardiovascular fitness of the patients.

What Are the Limitations of Physical Therapy in Critical Care and Rehabilitation?

Some potential limitations of physical therapy in critical care and rehabilitation include the following.

• Patient Condition - It is difficult for patients to tolerate physical therapy who are critically ill or have undergone major surgeries.

• The Severity of the Injury - Physical therapy may not fully restore the function of people who have undergone spinal cord injuries or traumatic brain injuries.

• Underlying Health Conditions - Patients with heart disease or respiratory diseases may have limitations in the types of physical therapy.

• Access to Physical Therapy- It is sometimes limited due to factors such as hospital discharge or insurance coverage.

What Are the Strategies to Overcome the Limitations of Physical Therapy?

The strategies to overcome the limitations of physical therapy include the following:

• Collaborative care with other healthcare teams, including physicians, nurses, and occupational therapists.

• Educating the patients and their families about the benefits of physical therapy.

• Individualized treatment plans according to the patient’s unique needs.

• Use of technology such as virtual reality and gamification.

• Home-based therapy.

Conclusion

Physical therapy is just one component of the overall patient care plan who are critically ill or undergoing rehabilitation after critical illness. The health care team works closely with patients and their families to develop a personalized care plan to address the patient’s unique needs and challenges. Despite its limitations, physical therapy is a valuable tool to promote recovery and improve patient outcomes in critical care and rehabilitation.