st. antonius hospital nieuwegein holland · 4 mobilization is the passive or active (with or...

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 of 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 of 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

0

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

0

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

0

- 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

0

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

0

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

bas

ic

physiotherapy

nu

rsin

g

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