St. Antonius Hospital Nieuwegein Holland Cees Casteleijn - - PowerPoint PPT Presentation

• St. Antonius Hospital

Nieuwegein Holland

Cees Casteleijn physiotherapist in the intensive care

Tertiary medical and surgical 24 beds ICU 10 beds MCU

Content of the presentation

• What is mobilization
• Explain the PMF:

Patient Mobilization Frame

• Pilot study physical load phase ABC

What is meant by mobilization

Mobilization . . . ?

4

Mobilization is the passive or active (with or without help) change of posture of a patient, either in the bed or from the bed. The purpose of this change

• f posture is to promote healing of

various organs DEFINITION mobilization PMF

aim of physiotherapy

Specific exercises focused on

musculoskeletal posture to maintain or improve muscle activity, range of motion and functionality.

aim of mobilization change of posture is to promote healing

• f various organs

Who mobilizes?

Nursing staff mobilizes

Impairment musculoskeletal function

YES NO Physiotherapy mobilizes

and

TREATMENT

6

Patient Mobilization Frame

A multidisciplinary operational communication method to improve the operationalization of early mobilization in the ICU

“An Easy Tool for Mobilization”

Principle of classification PMF

• 2. Cooperation level

Questions:

• 1. What is the exercise capacity of the patient in the ICU ?
• 2. Is the patient able and willing to participate in mobilization ?

Subdivision in:

Phase C: a phase of stability and continuing recovery

• 1. Physical load phase
• 3. completely cooperative
• 0. not any REACTION to stimuli
• 1. reaction but, does not RESPOND to request
• 2. carries out simple instructions

Phase A: a phase of severe illness Phase B: a phase of stabilization and/or slight recovery

PHYSICAL LOAD

Important organs: CARDIAC MEDICATION PULMONAL RENAL CEREBRAL INFECTION

+

0 not any REACTION to stimuli 1 reaction but, does not respond to request 2 carries out simple instructions 3 completely cooperative

=

MOBILIZATION CHOICE

Laying, sitting, standing, walking , . .

COOPERATION LEVEL

CONSTRUCTION OF “PATIENT MOBILIZATION FRAME”

PMF

P H Y S I C A L L O A D P H A S E C O O P E R A T I O N L E V E L

1 2 3

BASIC FRAME

C.Casteleijn

PMF

P H Y S I C A L L O A D P H A S E

A B C

C O O P E R A T I O N L E V E L

not any reaction to stimuli

no physical load

not any reaction to stimuli

limited physical load

• clinical symptoms
• Bp and Hr 20% max increase
• RSB >30
• sPO2 < 90

not any reaction to stimuli unlimited physical load vital signs increase accepted and desirable during exercise, to agreed individual values.

1

reaction but, does not

respond to request

no physical load reaction but, does not

respond to request

limited physical load

• clinical symptoms
• Bp and Hr 20% max increase
• RSB >30
• sPO2 < 90

reaction but, does not respond to request unlimited physical load

vital signs increase accepted and desirable during exercise, to agreed individual values.

2

carries out simple instructions no physical load

carries out simple

instructions

limited physical load

• clinical symptoms
• Bp and Hr 20% max increase
• RSB >30
• sPO2 < 90

carries out simple

instructions

unlimited physical load vital signs increase accepted and desirable during exercise, to agreed individual values.

3

completely cooperative

no physical load completely cooperative

limited physical load

• clinical symptoms
• Bp and Hr 20% max increase
• RSB >30
• sPO2 < 90

completely cooperative unlimited physical load vital signs increase accepted and desirable during exercise, to agreed individual values.

BASIC FRAME

C.Casteleijn

Activity frames

• Nursing staff
• Physiotherapy

Directly from the diagnostic basic frame 2 activity frames :

PMF

P H Y S I C A L L O A D P H A S E

A B C

C O O P E R A T I O N L E V E L

• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-30°
• splinting
• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-30-45°
• splinting
• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-30-45°
• splinting

1

• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-30°
• splinting
• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-30-45°

passive mobilization: lift in chair

• splinting
• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-45 -80°
• lift in chair

2

• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-30-45°
• Positioning:

preventing complications

• laying/sitting 0-45 -80°
• active / passive mobilization:

bed edge, attempt to stand, lift in chair

• ADL stimulation
• Positioning:

preventing complications

• active mobilization:

bed edge, transfer chair, standing, possibly help

• ADL stimulation

3

• Positioning:

preventing complications

• bed/mattress selection
• laying/sitting 0-30-45°
• Positioning:

preventing complications

• sitting 45 -80°
• active mobilization :

bed edge, transfer chair, possibly help device

• ADL stimulation
• Positioning:

preventing complications

• active mobilization

transfer chair, walk in walker

• ADL training
• exercise independence

NURSING

C.Casteleijn

PMF

P H Y S I C A L L O A D P H A S E

A B C

C O O P E R A T I O N L E V E L

Passive Motion Examination

• ROM, tonus reaction patient
• prevention joint contractures

Passive Motion Examination

• ROM, tonus, reaction patient
• prevention joint contractures
• Passive Motion Examination
• ROM, tonus, reaction patient
• prevention joint

contractures

• activating passive movement

1

Passive Motion Examination

• ROM, tonus reaction patient
• prevention joint contractures

Passive Motion Examination

• ROM, tonus, reaction patient
• passive mobilization
• mobilization advice nursing
• encourage active movements
• cycle exercises: passive
• NMES
• Passive Motion Examination

ROM, tonus, reaction patient

• passive mobilization
• mobilization advice nursing
• encourage active movements
• cycle exercises:passive
• NMES

2

• active / passive motion

examination

• prevention by passive /

active movements

• NMES

AME: muscle power

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: passive/ active
• NMES

AME: muscle power

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: active
• condition training

3

• aktive / passive motion

examination

• prevention by passive /

active movements

• cycle exercises: passive
• NMES

AME: MRC sumscore

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: active
• resistance exercises

AME: MRC sumscore

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: active
• resistance exercises
• condition training

PHYSIOTHERAPY

C.Casteleijn

PMF

P H Y S I C A L L O A D P H A S E

A B C

C O O P E R A T I O N L E V E L

Passive Motion Examination

• ROM, tonus reaction patient
• prevention joint contractures

Passive Motion Examination

• ROM, tonus, reaction patient
• prevention joint contractures
• Passive Motion Examination
• ROM, tonus, reaction patient
• prevention joint

contractures

• activating passive movement

1

Passive Motion Examination

• ROM, tonus reaction patient
• prevention joint contractures

Passive Motion Examination

• ROM, tonus, reaction patient
• passive mobilization
• mobilization advice nursing
• encourage active movements
• cycle exercises: passive
• NMES
• Passive Motion Examination

ROM, tonus, reaction patient

• passive mobilization
• mobilization advice nursing
• encourage active movements
• cycle exercises:passive
• NMES

2

• active / passive motion

examination

• prevention by passive /

active movements

• NMES

AME: muscle power

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: passive/ active
• NMES

AME: muscle power

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: active
• condition training

3

• aktive / passive motion

examination

• prevention by passive /

active movements

• cycle exercises: passive
• NMES

AME: MRC sumscore

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: active
• resistance exercises

AME: MRC sumscore

• active mobilization
• mobilization advice nursing
• functional exercises
• cycle exercises: active
• resistance exercises
• condition training

PHYSIOTHERAPY

C.Casteleijn

PRACTICE

carries out simple instructions limited physical load clinical symptoms Bp and Hr 20% max increase RSB >30 sPO2 < 90 AME: muscle power active mobilization mobilization advice nursing

functional exercises cycle exercises:passive/ active

NMES

Patient: PMF 2B

Positioning: preventing complications

laying/sitting 0-45 -80°

active / passive mobilization: bed edge, attempt to stand, lift in chair

ADL stimulation

Minimal 2 activities a day Mobilization: edge of the bed Physiotherapy: with functional training and bedcycle Nursing: lift in chair , ADL stimulation basic

physiotherapy

nursing

Classification in physical load capacity

Points Phase Allowed load by Mobilization > 6 points

phase A

No physical load at all

1 – 5 points

phase B

Limited physical load

• clinical symptoms
• Bp and Hr 20% increase max
• RSB >30
• sPO2 < 90

0 points

phase C

‘Unlimited’ physical load

Vital signs increase accepted and desirable during exercise, to agreed individual values.

CARDIAC PULMONAL BLOOD RENAL INFECTION CEREBRAL CONTRA INDICATIONS

MATERIAL AND METHODS

A prospective observational pilot study in 82 ICU patients Two staff members and one resident All observations were at the same date and time The scoring system is based on 15 items RESULTS Kappa observer 1 and 2 is 0,93. Kappa observer 1 and 3 is 0,71. Kappa observer 2 and 3 is 0,73. Physical Load Capacity Stage A (critically ill) > 6 pts Stage B (stable) 1-5 pts Stage C (nearly recovered) 0 pts

WHAT IS THE DEGREE OF SIMILARITY IN SCORES OF THE PHYSICAL LOAD CAPACITY A B C?

• M. VOGEL, C.W. CASTELEIJN, A.J.M. MEINDERS, P. BRUINS

CONCLUSION

• Classification ABC seems to be a reliable scoring system
• Further research needed
• The cost effectiveness of the algorithm deserves further investigation.

PMF is a CONSENSUS MODEL or TOOL to reach all together the same goal, . . . .

. . sooner home with the patient mobilization frame . . .

Thank you for your attention

Happy End of this story

Information PMF: c.casteleijn@antoniusziekenhuis.nl