2 5
2 0
1 5
1 0
5
022-W
ard
21-Ward
19-Ward
15-Ward
13-CTICU/BOLT
8-MICU/ECMO
5-MICU/ECMO
Resistance (NM)Power (Watts)MET MinutesEnergy Expenditure (Cal)Distance (km)
Day
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OutcomesBackground
Purpose
CaseDescription
Functionalelectricalstimulationcyclingpre- andpost- orthotopiclungtransplantation:ACaseReport
MelaniGravesSPT1,KathleenDecinaSPT1,LaurenAlexanderSPT1,TamaraKirkPT2,SelinaMParryPTPhD3,AmyMPastvaPTPhD1
1DoctorofPhysicalTherapyDivision,DukeSchoolofMedicine,Durham,NC,USA;2DepartmentofPhysical&OccupationalTherapy,DukeUniversityHospital,Durham,NC,USA;3DepartmentofPhysiotherapy,TheUniversityofMelbourne,Australia
Discussion/Relevance
Acknowledgements /References
• ICU-acquiredmuscleweakness(ICU-AW)leadstoimpairedphysicalfunctioninginindividualswhosurvivetheinitialinsultofcriticalillness
• Musclewastingoccursearlyandrapidly(upto30%infirst10days)
• Patientsonlife-supportinginterventionlikeextracorporealmembraneoxygenation(ECMO)and/orundergoingorgantransplantmaybeatincreasedriskforICU-AW
• ICUrehabilitationissafeandisassociatedwithimprovedoutcomes,butinitiationisoftendelayedbypatient’sinabilitytoactivelyparticipate
• AssistivetechnologiesmayenabletherapytocommenceearlyinICUadmissionandhelppreservemusclemass
1 Examinethesafetyandefficacyoffunctionalelectricalstimulation(FES)-cycling(FES-C)inapatientpreandpostbilateralorthotopiclungtransplantation(BOLT)
2 Monitorlegmusclemassandechointensity(quality)withultrasound(US),ambulationdistances,andFES-Cmetrics
• Completed7/7(100%)ofsessionsattemptedwithnoadverseevents• Exercise:IntervaltrainingwithprogressivelyincreasingpowerandMETlevel,
especiallypost-ICUd/c• MeanTreatmentDuration:34.95min;MeanStimulation:8.96μC• DistanceRange:1.56- 11.09km
Quadriceps US ICU baseline Quadriceps US hospital discharge
RF
VI
Femur
RF
VI
Femur
Ultrasound
FES-SupineCycleMetrics Ambulation
• Swedishwalkerduringinpatient,nodeviceduringoutpatient
• Rectusfemoris(RF)andvastusintermedius(VI)massremainedstableduringthehospitalstay(1.5-1.6and0.95-1.15cm,respectively)andincreasedbycompletionofoutpatientrehab(>2.0cm)
• Echointensityincreasedday-1today-11by15-30%forRFand50%forVI,andsubcutaneousthicknessincreasedby30%butreducedbacktobaselinebyday-30,suggestingedemaratherthanmusclenecrosis
• FES-Cwassafeandfeasiblewithnoadverseevents• Contrarytowhathasbeenreportedinliteraturewithconventionalrehabilitation,
musclewastingwasnotevident• QuantitativeUSholdsgreatpotentialinclinicalandresearchevaluationofICU-AW• FutureresearchisneededtoconfirmtheeffectivenessandoptimaldosageofFES-C
inthispopulation
Puthuchearyetal.2013,Rahimietal.2013,Hogdsonetal.2015,Langer2015,Parryetal.2014
• Subject:30y/ofemale,independentinADLsandworkedfull-time
• Diagnosis:Cysticfibrosiswithsevereobstructivepathophysiology(FEV1<15%),pneumonia,respiratoryfailure
• Equipment:MechanicalVentilation(MV)andveno-venous(V-V)ECMOviainternaljugular asbridgetoBOLT
• Timeline:Day1:AdmissionDay10:BOLTDay26:HospitalD/CDays30-63:Outpatientpulmonaryrehabilitation
• InpatientIntervention: FES-Cwithestimtobothlowerextremities(RT300,RestorativeTherapies)plusconventionalacutecarerehabilitation
• OutpatientIntervention:Incrementalaerobicandresistiveexercise
Outcomes
RTI DataLink - Therapy Session Report
1342462Patient ID
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RTI DataLink - Therapy Session Report
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Passive-AssistedCycling,AerobicTraining
Active-AssistedCycling,IntervalTraining
Dis
tanc
e (m
) &
Res
t Bre
aks
(#)
6 0 0
4 0 0
2 0 0
0
00
3
3
3
1
2
2
1
63-Outpt
30-Outpt
15-Ward
14-CTICU
13-CTICU
12-CTICU/BOLT
9-MICU/ECMO
3-MICU/ECMO
2-MICU/ECMO
Day
Page 1
RTI DataLink - Therapy Session Report1342462
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RTI DataLink - Therapy Session Report1342462
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RTI DataLink - Therapy Session Report1342462
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CrankVelocityTargetSpeedPowerStimulationLevelResistance
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