St. Antonius Hospital Nieuwegein Holland Cees Casteleijn physiotherapist in the intensive care Tertiary medical and surgical 24 beds ICU 10 beds MCU
Content of the presentation • What is mobilization • Explain the PMF: Patient Mobilization Frame • Pilot study physical load phase ABC
Mobilization . . . ? What is meant by mobilization
DEFINITION mobilization PMF Mobilization is the passive or active (with or without help) change of posture of a patient, either in the bed or from the bed. The purpose of this change of posture is to promote healing of various organs 4
Who mobilizes? Impairment musculoskeletal function YES NO Physiotherapy Nursing staff mobilizes mobilizes and TREATMENT aim of mobilization aim of physiotherapy change of posture is Specific exercises focused on musculoskeletal posture to maintain or to promote healing improve muscle activity, range of of various organs motion and functionality.
Patient Mobilization Frame “An Easy Tool for Mobilization” A multidisciplinary operational communication method to improve the operationalization of early mobilization in the ICU 6
Principle of classification PMF Questions: 1. What is the exercise capacity of the patient in the ICU ? 2. Is the patient able and willing to participate in mobilization ? Subdivision in: 1. Physical load phase 2. Cooperation level Phase A: a phase of severe illness 0. not any REACTION to stimuli 1. reaction but, does not RESPOND to request Phase B: a phase of stabilization 2. carries out simple instructions and/or slight recovery 3. completely cooperative Phase C: a phase of stability and continuing recovery
CONSTRUCTION OF “ PATIENT MOBILIZATION FRAME ” 0 not any REACTION to stimuli COOPERATION 1 reaction but, does not respond to request 2 carries out simple instructions LEVEL 3 completely cooperative + Important organs: CARDIAC PHYSICAL MEDICATION LOAD PULMONAL RENAL CEREBRAL INFECTION = MOBILIZATION Laying, sitting, standing, walking , . . CHOICE
P H Y S I C A L L O A D P H A S E PMF C 0 O O P E 1 R A T I O 2 N L E V 3 E L BASIC FRAME C.Casteleijn
P H Y S I C A L L O A D P H A S E PMF A B C not any reaction to stimuli not any reaction to stimuli not any reaction to stimuli unlimited physical load limited physical load no physical load C 0 -clinical symptoms vital signs increase accepted and O -Bp and Hr 20% max increase desirable during exercise, to -RSB >30 agreed individual values. O - sPO2 < 90 P reaction but, does not reaction but, does not reaction but, does not E respond to request respond to request respond to request R limited physical load 1 no physical load unlimited physical load A - clinical symptoms vital signs increase accepted and - Bp and Hr 20% max increase desirable during exercise, to T - RSB >30 agreed individual values. - sPO2 < 90 I carries out simple carries out simple carries out simple O instructions instructions instructions N limited physical load unlimited physical load 2 no physical load - clinical symptoms vital signs increase accepted and - Bp and Hr 20% max increase desirable during exercise, to L - RSB >30 agreed individual values. - sPO2 < 90 E completely cooperative completely cooperative completely cooperative V limited physical load unlimited physical load E no physical load 3 vital signs increase accepted and - clinical symptoms L desirable during exercise, to - Bp and Hr 20% max increase agreed individual values. - RSB >30 - sPO2 < 90 BASIC FRAME C.Casteleijn
Activity frames Directly from the diagnostic basic frame 2 activity frames : • Nursing staff • Physiotherapy
P H Y S I C A L L O A D P H A S E PMF A B C - Positioning: - Positioning: - Positioning: preventing complications preventing complications preventing complications C - bed/mattress selection - bed/mattress selection - bed/mattress selection 0 - laying/sitting 0-30 ° - laying/sitting 0-30-45 ° - laying/sitting 0-30-45 ° O - splinting - splinting - splinting O P - Positioning: - Positioning: - Positioning: preventing complications preventing complications preventing complications E - bed/mattress selection - bed/mattress selection - bed/mattress selection 1 - laying/sitting 0-30-45 ° - laying/sitting 0-30 ° - laying/sitting 0-45 -80 ° R - splinting passive mobilization: lift in chair - lift in chair A - splinting T - Positioning: - Positioning: - Positioning: I preventing complications preventing complications preventing complications - bed/mattress selection - laying/sitting 0-45 -80 ° - active mobilization: O 2 - laying/sitting 0-30-45 ° - active / passive mobilization: bed edge, transfer chair, bed edge, attempt to stand, standing, possibly help N lift in chair - ADL stimulation - ADL stimulation L - Positioning: - Positioning: - Positioning: E preventing complications preventing complications preventing complications V - bed/mattress selection - sitting 45 -80 ° - active mobilization - laying/sitting 0-30-45 ° - active mobilization : transfer chair, walk in walker 3 E bed edge, transfer chair, - ADL training possibly help device - exercise independence L - ADL stimulation NURSING C.Casteleijn
P H Y S I C A L L O A D P H A S E PMF A B C Passive Motion Examination Passive Motion Examination - Passive Motion Examination - ROM, tonus reaction patient - ROM, tonus , reaction patient - ROM, tonus, reaction patient C - prevention joint contractures - prevention joint contractures - prevention joint 0 O contractures - activating passive movement O P Passive Motion Examination Passive Motion Examination - Passive Motion Examination - ROM, tonus reaction patient - ROM, tonus, reaction patient ROM, tonus, reaction patient E - prevention joint contractures - passive mobilization - passive mobilization 1 R - mobilization advice nursing - mobilization advice nursing - encourage active movements - encourage active movements A - cycle exercises: passive - cycle exercises:passive - NMES - NMES T - active / passive motion AME: muscle power AME: muscle power I examination - active mobilization - active mobilization O - prevention by passive / - mobilization advice nursing - mobilization advice nursing 2 active movements - functional exercises - functional exercises N - NMES - cycle exercises: passive/ active - cycle exercises: active - NMES - condition training L E - aktive / passive motion AME: MRC sumscore AME: MRC sumscore examination - active mobilization - active mobilization V - prevention by passive / - mobilization advice nursing - mobilization advice nursing 3 active movements - functional exercises - functional exercises E - cycle exercises: passive - cycle exercises: active - cycle exercises: active - NMES - resistance exercises - resistance exercises L - condition training PHYSIOTHERAPY C.Casteleijn
P H Y S I C A L L O A D P H A S E PMF A B C Passive Motion Examination Passive Motion Examination - Passive Motion Examination - ROM, tonus reaction patient - ROM, tonus , reaction patient - ROM, tonus, reaction patient C - prevention joint contractures - prevention joint contractures - prevention joint 0 O contractures - activating passive movement O P Passive Motion Examination Passive Motion Examination - Passive Motion Examination - ROM, tonus reaction patient - ROM, tonus, reaction patient ROM, tonus, reaction patient E - prevention joint contractures - passive mobilization - passive mobilization 1 R - mobilization advice nursing - mobilization advice nursing - encourage active movements - encourage active movements A - cycle exercises: passive - cycle exercises:passive - NMES - NMES T - active / passive motion AME: muscle power AME: muscle power I examination - active mobilization - active mobilization O - prevention by passive / - mobilization advice nursing - mobilization advice nursing 2 active movements - functional exercises - functional exercises N - NMES - cycle exercises: passive/ active - cycle exercises: active - NMES - condition training L E - aktive / passive motion AME: MRC sumscore AME: MRC sumscore examination - active mobilization - active mobilization V - prevention by passive / - mobilization advice nursing - mobilization advice nursing 3 active movements - functional exercises - functional exercises E - cycle exercises: passive - cycle exercises: active - cycle exercises: active - NMES - resistance exercises - resistance exercises L - condition training PHYSIOTHERAPY C.Casteleijn
PRACTICE Patient: PMF 2B Positioning: nursing preventing complications carries out simple instructions laying/sitting 0-45 -80 ° basic limited physical load active / passive clinical symptoms mobilization: bed edge, Bp and Hr 20% max increase attempt to stand , lift in chair RSB >30 ADL stimulation sPO2 < 90 AME: muscle power active mobilization mobilization advice nursing functional exercises cycle exercises:passive/ active physiotherapy NMES Minimal 2 activities a day Mobilization: edge of the bed Physiotherapy: with functional training and bedcycle Nursing: lift in chair , ADL stimulation
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