AT A GLANCE
Very Early Mobilization – clinical benefits*
Manual early mobilization is part of the ABCDEF-bundle and is seen as one of the most important measure in the prevention of negative effects of immobility.
Early mobilization accelerates the recovery process and reduces secondary complications associated with immobility.
Early mobilization was shown be an effective treatment:
- Stimulation of neuromuscular function
- Improvement of respiratory function & diaphragmatic function
- Improvement of vigilance through positional change
- Stimulation of the cardiovascular system
- Triggering of metabolic activity
- Thrombosis prophylaxis
- Decubitus prophylaxis
- Preservation of muscle strength and bone density
- Stimulation of the digestive system
- Reduction of the risk of delirium
→ Prevention of secondary complication and higher vigilance can reduce the care requirements.
For ventilated patients up to three therapists are required to perform early mobilization. Given the strained staff situation of intensive care professionals, severely affected patients might not receive optimal therapy.
Our approach to address this challenge: Robot-assisted early mobilization with VEMOTION.
Manual mobilization – helpful but challenging
© Schön Kliniken Bad Aibling, used with permission
Manually mobilizing patients that are severely affected or have limited ability to interact is challenging. Besides the physical strain on therapists, several nurses are required to perform therapy, and patients’ safety may be compromised. If the patient is mobilized to the bedside, tubes, catheters and cables might come under tension.
Why are existing technologic systems for mobilization insufficient?
Conventional tilting tables offer therapy without movement of the legs and the cardiovascular, musculoskeletal system is almost not addressed. Without leg movement, the duration of verticalization is limited because leg movement provides cardiovascular stability.
- Robotic mobilization with separate „stand-alone“ devices requires the patient to be transferred onto a separate device.
- More than one person is needed for the transfer, it takes time and is physically demanding.
Relief through robot assisted mobilization
70% of the ICU patients in Germany receive manual early mobilization. 30% of the ICU patients are so critically ill that manual therapy is suboptimal or too dangerous due to the severity of their symptoms such that manual therapy cannot be sufficiently performed.
Reasons for the not-mobilization are amongst others paralysis, sedation, unconsciousness, lack of staff or weekends.
Robot assisted early mobilization by VEMOTION would enable the clinical staff to treat even the most critically ill patients:
- Because the patient can stay in bed – the critical transfer is avoided
- Because the mobilization is feasible with one instead of two or more therapists
Needham, D. M., R. Korupolu, et al. (2010). "Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project." Arch Phys Med Rehabil 91(4): 536-542.
M. Morreale, P. Marchione,, A. Pili, A. Lauta, S. Castiglia, A. Spalleone, F. Pierelli, P. Giacomini, “Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach?”, in Eur. J. Phys. Rehabil. Med., 2015 July 28
Schweickert, W.D., et al., Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 2009. 373(9678): p. 1874-82.
Morris, P.E., et al., Early critical care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med, 2008. 36(8): p. 2238-43.
Chiang, L.L., et al., Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther, 2006. 86(9): p. 1271-81.
Goemaere, S., et al., Bone mineral status in paraplegic patients who do or do not perform standing. Osteoporos Int, 1994. 4(3): p. 138-43.
Hoenig, H., et al., Case study to evaluate a standing table for managing constipation. SCI Nurs, 2001. 18(2): p. 74-7.
Walter, J.S., et al., Indications for a home standing program for individuals with spinal cord injury. J Spinal Cord Med, 1999. 22(3): p. 152-8.
Chang, A.T., et al., Standing with assistance of a tilt table in critical care: a survey of Australian physiotherapy practice. Aust J Physiother, 2004. 50(1): p. 51-4.
*According to studies on manual early mobilization, not mobilization related to VEMOTION
Our experience has proven that Very Early Mobilization is instrumental for faster recovery of patients. With VEMOTION coming up, we will be able to treat our ventilated patients more often, in a very secure environment, with lower physical strain on our nurses and therapists. The idea of transforming the patient bed into a therapy device will allow us to implement early mobilization even more efficiently in our ICU.
Neurologist, Head of the Acute Neurorééducation Unit Neurology Department of Clinical Neuroscience, Lausanne University Hospital – Lausanne, Switzerland
The VEMOTION is a varied addition to circulation training and verticalisation in therapy for our patients in the Paraplegic Centre. The movement sequence of the legs, which is based on a gait cycle, activates the sensorimotor function of the muscles that are still reinnervated.
Physiotherapist, BGU Murnau - Querschnittzentrum – Germany