Critical Care Physiotherapist
Toronto General Hospital
University Health Network
Tell us a little about your background and how you came to be providing physiotherapy to people in the ICU.
I have been a physical therapist for 18 years. During my student internship I was impressed by how sick and de-conditioned patients were in the ICU and hospital in general. I felt that there was a great role to play for improving functional outcomes on these patients and I wanted to be a part of that. I also loved the complexity of ICU and practicing there required all of the knowledge and training I received in school like knowing normative values, vital signs, ventilators, invasive lines and tubes, medical conditions, etc. I have and still find it incredibly challenging and exciting. The best thing is seeing patients come back to visit and thanking me for helping them through a hard time and achieving optimum strength and mobility.
What are the issues that you are seeking to address for people who have to spend a long time in the ICU?
Minimizing the impact of prolonged bed rest which includes, bed sores, blood clots, deconditioning, weakness, muscle atrophy and contractures. These impairments may also impact ultimately on long term functional prognosis. A patient may survive a complicated ICU course but will they ever walk again? Will they enjoy a good quality of life? We have had many stories in the past and many successes.
How is RT300 Supine ergometer able to assist people who are confined to their beds?
The issue with many patients in the hospital is that they spend every day doing practically no activity and spend 22 to 24 hours in bed. No wonder they are getting bedsores and deconditioning. Some patients just can’t move unless you do it with them and partially for them. They are too weak to move their limbs without assistance. In such patients, any movement, any muscle recruitment is better than nothing. The RT300 can allow patients to receive physical activity even if they are very weak and they can do it even if they cannot get out of bed. Some patients who may be able to get out of bed can’t use the RT300 because their feet fall out of the pedals and their legs fall to the side because they are too weak to maintain the position. The RT300 Supine provides support for their legs in a specially designed petal with backrest. Their legs cannot fall out. A gentle motor gets them started and keeps up the momentum so that they can take over the effort when they are ready to use the RT300 Supine actively.
You have been using the RT300 Supine with patients for some time, what benefits do you see from this use and how does this compare with previous physiotherapy approaches?
There are patients who are too weak to use the RT300 the traditional way and too weak to exercise in general. The RT300 offers these types of patients an opportunity to build strength in whatever capacity they are able.
We understand you are going to join as one of Dr Michelle Kho's CYCLE research study RCT sites. What does this mean for patients in the ICU and how would you expect them to benefit?
In bed therapy is just another tool that we can use to get patients active. The beauty of the device is that once you set it up, you can just let it run and the patient can engage as they feel ready.
What do you say to patients to encourage them to participate in supine ergometer therapy?
In bed therapy is very gentle and after they get used to it, I just tell them to go for it! Like any physical activity, more effort they put into it, the more benefit. But for those who cannot participate very much I think even a little muscle recruitment may be important.
What would you say to other clinicians who are contemplating working with patients confined to their beds?
We try very hard to get all out stable patients out of bed and actively participating. For those who are confined to bed for medical reasons, the RT300 provides another option.
Do you have any other comments about RT300 Supine ergometer and/or Restorative Therapies?
The other benefit of RT300 is that it records session information and stores it in a database for objective analysis which can then be used to promote patient compliance, provide encouragement, quantifying objective performance, or be used research.