Technology to enhance physical rehabilitation of critically ill patients.
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Needham
Dale M
DM
Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA. dale.needham@jhmi.edu
Truong
Alex D
AD
Fan
Eddy
E
D018849:Controlled Clinical Trials as Topic; D016638:Critical Illness / Q000534:rehabilitation; D004434:Early Ambulation / Q000379:methods*; D004599:Electric Stimulation Therapy / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D053580:Muscle Strength; D018908:Muscle Weakness / Q000534:rehabilitation*; D009142:Musculoskeletal Physiological Phenomena; D017063:Outcome Assessment, Health Care; D010810:Physical and Rehabilitation Medicine / Q000379:methods; D020127:Recovery of Function; D055070:Resistance Training / Q000379:methods*