bed mobility and exercises in ICU

[ahah1313]

hello,

i have a patient in ICU who has come on in leaps and bounds since his extubation yesterday, i wnat to start some bed mobility and exercises to improve his strength, function and to prepare him fo sitting out of bed, sit to stand and eventually mobilising at his baseline (independant)

i am a brand new physio student on placement so i would really appreciate some guidance on this. i am familiar with the basice static quads and gluts etc, SLR, ankle pumps, so any more comprehensive exercises would be brilliant

thanks v much

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[pudding_bowl]

Hi ahah1313,

Think about what is required of each of the tasks. getting out of bed. and break it down. The patient will need to roll onto their side and then bring the legs off the side of the bed then push through the hand and elbow to become upright.
So exercises for that would be controlled lumbar rotations to work the abdominal and oblique muscles. Using small arm weights and punching the air etc to work the arms.
inner range quads (with pillow under the knee) to work the locking in mechanism of the knee for standing. Bridges (progressed to 1 leg bridges or bridges with arms in the air) are really important as help the patient get around the bed. Otherwise in terms of bed exercises the ones you'v talked about are good.
You'll need to ensure that you strengthen the major muscle groups needed in standing and wakling (calf, quad, glutes)
hmm, i'll summarise in a list for ease of viewing:
Static quads
Inner range quads
Heel slides
Straight leg raise
Bridge (with and without arm support)
ankle ROM (can be combined with a theraband for plantar flexion strengthening)
Lumbar rotations (knees going one side then the next - gently and slowly)
Use theraband or small hand weights (1-2kg) and get them punching the air and doing bicep curls.

Beware that exercises like the bridge, lumbar rotation, and SLR can put strain through the belly and if your patient has had abdo surgery they may not enjoy it.

Have fun - remember that every patient is different, and as long as you work with your patients symptoms and be aware of what they cant do (contraindications) then you can continue to progress and add resistance as required.

Pudding