title: Innovative mobility strategies for the patient with intensive care unit-acquired weakness: a case report.
abstract: OBJECTIVE
  Although the benefits of early mobilization in the intensive care unit (ICU) have been well documented in recent years, the decision-making process and customization of treatment strategies for patients with ICU-acquired weakness have not been well defined in the literature. This case report will describe a patient with ICU-acquired weakness in the long-term acute care hospital (LTACH) setting and mobilization strategies that include novel devices for therapeutic exercise and gait training.
  
  
  METHODS
  A 73-year-old, active woman underwent a routine cardioversion for atrial fibrillation but developed multiple complications, including sepsis and respiratory failure. The patient spent 3 weeks of limited activity in the ICU and was transferred to our LTACH for continued medical intervention and rehabilitation. A 4-phase graded mobilization program was initiated in the LTACH ICU. Within that program, the physical therapy interventions included partial weight-bearing antigravity strength training with a mobile leg press and gait training with a hydraulic-assist platform walker.
  
  
  RESULTS
  Before interventions, the patient had severe weakness (Medical Research Council [MRC] sum score of 18/60) and displayed complete dependence for all functioning. She progressed to being able to ambulate 150 ft (1 ft=0.3048 m) using a rolling walker with accompanying strength increases to an MRC sum score of 52/60.
  
  
  CONCLUSIONS
  This case report describes novel mobility strategies for managing a patient with ICU-acquired weakness. The application of a graded mobilization program using a mobile leg press and a hydraulic-assist platform walker was safe and feasible, and appeared to expedite the patient's recovery process while decreasing the amount of manual lifting for the therapists.
authors.affiliation: Rehabilitation and Wound Care, Solara Hospital Conroe, 1500 Grand Lake Dr, Conroe, TX 77304, USA. darintrees@yahoo.com
authors.forename: Darin W
authors.initials: DW
authors.lastname: Trees
authors.forename: James M
authors.initials: JM
authors.lastname: Smith
authors.forename: Steven
authors.initials: S
authors.lastname: Hockert
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D018908:Muscle Weakness / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D055070:Resistance Training; D012131:Respiratory Insufficiency / Q000150:complications; D018805:Sepsis / Q000150:complications