Physical Therapist Treatment of Patients in the Neurological Intensive Care Unit

While studies have established the safety and feasibility of physical therapy (PT) in the critical care setting, minimal information about physical therapy practices in the neurological intensive care unit (NICU) exists. This study describes physical therapists’ management of patients admitted to a NICU. Data collected were patient demographics, use of mechanical ventilation, and intracranial pressure (ICP) monitoring. For each PT session, length of the session, the individuals location (ICU or post-ICU setting), and presence of mechanical ventilation or ICP monitoring were recorded. Safety parameters including vital sign response, falls, and dislodgement of lines were collected. Over one year, 180 individuals were admitted to the NICU; 86 were evaluated by a physical therapist resulting in 293 PT sessions located in the ICU (n=132) or post-ICU setting (n=161). Only one (0.3%) session was stopped, and this was secondary to an increase in ICP. The first PT session occurred on ICU day 3[2-6]. Individuals had a median of 3.4[1.8-5.9] sessions/week. Individuals with mechanical ventilation had less frequent PT sessions compared to those without mechanical ventilation (p=0.01). Individuals with ICP monitoring had less frequent sessions compared to those without ICP monitoring (p=0.01). However, after multivariate analysis, only admission GCS han an independent association with PT frequency in the ICU. Individuals were more likely to stand, transfer, and walk in the post-ICU setting than in the NICU (all p<= 0.001).

The study concluded that physical therapy can be performed safely in the NICU. Patients who require invasive support receive less frequent PT.

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