The Critical Role of Physical Therapists in the ICU
Christiane Perme, PT CCS is currently a Senior Physical Therapist at the Methodist Hospital in Houston,
[caption id="attachment_370" align="alignright" width="140" caption="Chris Perme"]
[/caption]where she has practiced for the past 25 years with a variety of complex acute care patients. Mrs. Perme has extensive experience in treating adult patients in Intensive Care Unit with special interest in patients requiring mechanical ventilation. For many of these patients, Perme says, the focus of physical therapy is on early mobility and walking. Perme was instrumental in the development of a program at Methodist by which physical therapists and occupational therapists train nursing assistants to help their patients walk. Perme explains that regaining mobility early on benefits individual patients, the hospital, the ICU team, and the physical therapy profession. For example, patients who can regain mobility while in the ICU, even with limitations, may be able to transfer into a less-expensive setting, even at home with family care, rather than into a inpatient rehabilitation unit. Positive outcomes for these patients, she adds, has translated into increased resources for therapists in the ICU, and increased recognition for the profession.
APTA highlights this approach to therapy in the ICU as a model to consider for an Accountable Care Organization. Please click here to view the APTA article and video (you will need to log in to APTA)
Please click here to link to Chris Permes up-coming course in July
Therapists working with patients in ICU face a complex challenge. These patients have limited mobility due to life support, monitoring equipment, multiple medical problems and muscle weakness. For selected patients in ICU, early mobility and walking enhances functional outcomes by optimizing cardiopulmonary and neuromuscular status. Early mobility can lead to an increase in the patient’s quality of life and higher functional capability. It can also potentially reduce length of hospital stay with overall reduced costs. The content of this course will guide clinicians through the process of managing adult ICU patients. Case reports will be presented to demonstrate how the early mobility and walking program in ICU can positively impact the recovery of selected patients.
DEAR ERI COMMUNITY: I am a pediatric physical therapist, and I have a 33 mo old male patient who has been exhibiting signs of autism since he was about 18-19 mos; his mother has been told by a developmental specialist and a neurologist that it is likely that he does have autism, but he still has no official diagnosis. He has low tone, poor attention and eye contact, babbles but does not speak, is obsessed with spinning wheels and opening and closing doors, does not demonstrate appropriate play skills for his age, and has feeding difficulties, frequently gagging or vomiting with attempts at feeding. He has a long history of respiratory trouble, including asthma and bronchitis. He also has a long history of digestive issues, including gastroenteritis, vomiting, diarrhea, etc. He has been making fairly consistent progress throughout the time I have been treating him, but about 3 mos ago, he fractured his radius, and he made a substantial improvement in function and showed a dramatic decrease in signs of autism very quickly while he was wearing the cast. In brainstorming with his mother, it was determined that there had been no other life changes (change in diet, outside therapies, people living in the home, etc) during that time; however, she was giving him ibuprofen for his pain. After he had the cast removed, he returned to his former behaviors. When I noticed his behaviors returning, I asked his mother if she was still giving him the ibuprofen, and she told me she quit giving it to him a couple of days earlier when the doctor told her his bone was healed. One time since then, he started running a fever during my therapy session, and the next day during therapy, he had an incredible session. I asked his mother after the session if she had given him ibuprofen that day, and she said his fever had gotten worse during the night, so she had given him some ibuprofen to reduce his fever and help him sleep. I have discussed many possibilities with his physician, but we have not been able to identify any inflammatory processes that may be affecting his behavior. Does anyone have any experience with any children whose signs of autism decreased dramatically when given NSAIDs or know of any inflammatory conditions that can cause or mimic signs of autism? I’d love to hear any ideas!
For all of you fans of Stacey Szklut, we wanted to let you know that she is back on our faculty! She took a hiatus from teaching for several years to build her highly respected private practice. She’ll be teaching a much needed continuing education course on autism intervention which will integrate evidence based treatments with practical techniques for behavior, communication, and function.
Stacey is well known for her dynamic engaging teaching style, and her ability to take current research and make it clinically relevant and exciting. She will teach you to view familiar problems with new eyes. She is a master clinician in occupational therapy, and also a published author who lectures throughout the country with a specialty in sensory processing disorders.
Look for her dates and locations here.
Stacey Szklut is also presenting at our annual Therapies in the School conference
DEAR ERI COMMUNITY:
Client with Feeding Difficulties:
I am seeing a child who is now 15 months of age. She was born at 36 weeks gestation, with very low birth weight and a very weak suck – was never able to breast feed successfully. After transitioning from hospital to home, mom found that only one orthodontic nuk nipple would work for feeding her 50/50 mix of breast milk and formula. The child was very sensitive to different bottle nipples, many of which would make her gag and vomit. Since 1 month of age, the child has been vomiting almost daily (previously was after every feed). She was diagnosed with reflux (GERD) and put on medication (Prevacid), which was recently discontinued due to doctor’s belief that the reflux has improved now. The child was able to take in enough with the frequent liquid feeds, and she is still currently an age-appropriate weight. Mom has been trying several strategies and for over a few months to transition her to accepting anything solid (started with trying pablum, which child could not accept without having a gag and/or vomit response). Mom has applied all recommended sensory strategies (z-vibe introduction and exercises, tactile exploration, sensory play, introducing new smells/tastes in graded steps, and use of wilbarger oral protocol, etc.). The problem now is that the child’s transitioning to solid foods and thickened liquids is ongoing, but slow. As well, the child has been vomiting daily since 1 month of age. Now, when the child coughs too much, gets too upset, or has something stuck in her mouth that she can’t get out with her tongue, she uses vomiting as a default strategy for getting anything uncomfortable out of her system. The mom would like to know if there are any strategies/tools or approaches that can be used to 1) stop the vomiting from occurring once she can see early signs of that response in the child (i.e. if the reflux is just starting, the mom can sometimes stop it if she distracts child by putting her feet in water — she would like more strategies like this); and 2) prevent the child from developing a voluntary behavioural issue with vomiting, as she matures.
Any advice, recommendations, feedback from other health professionals familiar with these issues would be greatly appreciated!!!!! Thanks
Carol Loria, President ERI:
You want to share your learning and enthusiasm with your colleagues but you only have 1 ½ hours to present 2 days worth of material.
How do you pair down the material? How do you decide which information will have the greatest impact on your colleagues?
Questions to Consider:
- Who is the audience for this in-service?
- How well do they know the topic and what is their general level of expertise? This will determine how much background/theoretical information to cover versus how much time you can spend focusing on clinical applications.
- What is the predominant patient population that they work with? What are their greatest challenges and priorities? This can help tailor the focus of your presentation to their needs
- How does the audience feel about the topic?
- If their attitude is supportive or better yet, excited about learning this new information, you needn’t spend much time presenting material to win them over and you can get down to clinical applications fairly quickly.
- If the group is not generally open to this new or alternative information, you may want to spend the majority of the time providing an evidence-based cogent argument and leave the clinical applications and treatment strategies for a follow-up with those that are apt to be open to them.
- How best to divide the time?
- For a one and one-half hour talk, plan on 5 minutes for an introduction to explain your goals and plan for the session
- Offer one comment to let them know how “charged and excited you are about the material….do this in the first few minutes
- Plan 75 minutes of content after your intro, and 10 minutes for questions at the end.
Share your thoughts and stay tuned; next time we’ll be talking about hints for deciding on content for your in-service.