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

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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

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CrankVelocityTargetSpeedPowerStimulationLevelResistance