st. antonius hospital nieuwegein holland · 4 mobilization is the passive or active (with or...
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St. Antonius Hospital Nieuwegein Holland
Cees Casteleijn
physiotherapist
in the intensive care
Tertiary medical and surgical 24 beds ICU 10 beds MCU
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Content of the presentation
• What is mobilization
• Explain the PMF:
Patient Mobilization Frame
• Pilot study physical load phase ABC
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What is meant by mobilization
Mobilization . . . ?
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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
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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
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6
Patient Mobilization Frame
A multidisciplinary operational communication method to
improve the operationalization of early mobilization in the ICU
“An Easy Tool for Mobilization”
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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
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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”
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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
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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
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Activity frames
• Nursing staff
• Physiotherapy
Directly from the diagnostic basic frame
2 activity frames :
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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
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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
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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
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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
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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.
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CARDIAC
PULMONAL
BLOOD
RENAL
INFECTION
CEREBRAL
CONTRA
INDICATIONS
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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.
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PMF is a CONSENSUS MODEL or TOOL
to reach
all together the same goal, . . . .
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. . sooner home with the patient mobilization frame . . .
Thank you for your attention
Happy End of this story
Information PMF: