title: After critical care: Challenges in the transition to inpatient rehabilitation.
abstract: The aftermath of treatment for critical illness and/or critical injury in the intensive care unit (ICU) often includes persisting cognitive and emotional morbidities as well as severe physical deconditioning (a constellation termed post-intensive care syndrome, or PICS), but most patients do not receive psychological services before they enter the inpatient rehabilitation facility (IRF). Although a burgeoning literature guides the efforts of critical care providers to reduce risk factors for PICS - for example, reducing the use of sedatives and enacting early mobilization, there is need for a corresponding awareness among IRF psychologists and other providers that the post-ICU patient often arrives in a state of significantly reduced capacity, with persisting cognitive impairments and acute psychological distress. Many are at risk for long-term complications of posttraumatic stress disorder, general anxiety and/or clinical depression, and assuredly all have experienced a profound life disruption. This paper offers a multilevel perspective on the adaptation of post-ICU patients during inpatient rehabilitation, with discussion of the psychologist's role in education and intervention.
  
  
  
  Clinical review paper.
  
  
  
  NA.
  
  
  
  To optimize response to rehabilitation, it is important to understand the behavior of post-ICU patients within a full biopsychosocial context including debility, cognitive and emotional impairment, disruption of role identities, and environmental factors. The psychologist can provide education about predictable barriers to participation for the post-ICU patient, and guide individual, family and team interventions to ameliorate those barriers. (PsycINFO Database Record
authors.affiliation: Department of Physical Medicine and Rehabilitaiton, University of Michigan.
authors.forename: Nancy Hansen
authors.initials: NH
authors.lastname: Merbitz
authors.affiliation: Private Practice.
authors.forename: Katharine
authors.initials: K
authors.lastname: Westie
authors.affiliation: University of Michigan Health System.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Dammeyer
authors.affiliation: Craig Hospital.
authors.forename: Lester
authors.initials: L
authors.lastname: Butt
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan.
authors.forename: Jessica
authors.initials: J
authors.lastname: Schneider
mesh_terms: D000223:Adaptation, Psychological; D000275:Adjustment Disorders / Q000523:psychology / Q000534:rehabilitation; D003072:Cognition Disorders / Q000523:psychology / Q000534:rehabilitation; D003422:Critical Care / Q000523:psychology*; D016638:Critical Illness / Q000523:psychology* / Q000534:rehabilitation*; D019983:Guideline Adherence; D010359:Patient Readmission; D010360:Patient Transfer; D012047:Rehabilitation Centers; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology* / Q000534:rehabilitation*; D017741:Survivors / Q000523:psychology*