Research ArticleOriginal Article
Open Access

Effectiveness of an early mobility protocol for stroke patients in Intensive Care Unit

Majed S. Alamri, Intsar S. Waked, Fatma M. Amin, Khalid W. Al-quliti and Mohammad D. Manzar
Neurosciences Journal April 2019, 24 (2) 81-88; DOI: https://doi.org/10.17712/nsj.2019.2.20180004

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Tables

  • Table 1

    Categories of stroke patients.

    CategoryAimCriteria of patientsIndications for categoryModalities
    1Start mobilization as soon as patient’s medical condition is stableAcutely ill
    Unstable
    Requires life-support equipment such as mechanical ventilator    		Comatose patients
    Patients tolerate bed activities but have marked weakness.
    Limited activity tolerance
    Inability to ambulate
    Patients are alert, but have altered mental status    		Positioning
    Passive proprioceptive neuromuscular facilitation
    Splinting
    Transcutaneous electrical muscle stimulation
    Rolling (side to side, side to sitting) Sitting balance
    2Stimulate standing and walking activities while maintaining patient safety measuresStable
    Cooperative patient
    Still on mechanical ventilation    		Patient able to follow simple commands
    Patient’s medical condition allows participation in therapy    		Standing with a walker and assistance
    Standing balance
    Weight shift
    Steps in place
    Side steps along the bed
    Transfer to chair
    3To master transfer abilities and start a progressive walking program to increase enduranceCooperative patient
    Patient weans from mechanical ventilation    		Patients able to tolerate limited walking with a walker and assistance
    Some patients may be able to walk but still have difficulties    		Walking with support
    Walking without support
    Resistive muscle training
    Techniques to increase inspiratory rate
    Techniques to increase expiratory flow rate
  • Table 2

    Descriptive Statistics of the study participating stroke patients. N=60

    CharacteristicsMean±SD
    Age (yr)49.02±6.36
    Stroke duration (hrs)20.08±11.81
    BMI (kg/m2)32.95±5.67
    Intensive care unit stay (days)7.08±2.70
    Type of stroke
     Large infarction30 (50.0)
     Lacunar infarction12 (20.0)
     Massive hemorrhage8 (13.3)
     Subarachnoid hemorrhage10 (16.7)
    Gender n (%)
     Male38 (63.3)
     Female22 (36.7)
    Risk factors n (%)
     Hypertension16 (26.7)
     Diabetes14 (23.3)
     Hypertension and diabetes10 (16.7)
     Ischemic heart disease4 (6.7)
     Hyperlipidemia5 (8.3)
     Atrial fibrillation4 (6.7)
     Smoking7 (11.7)
    Handedness n (%)
     Right46 (76.6)
     Left14 (23.3)
  • Table 3

    Pre-post clinical measurements: muscle strength, pulmonary functions, and quality of life. N=60

    MeasurementsPre-treatment Mean±SD/(median)Post-treatment Mean±SD/(median)P-value
    Muscle strength#
     Biceps
      Right14.91±3.4415.97±1.58.029
      Left15.06±3.4116.10±1.53.032
     Triceps
      Right13.54±3.3215.05±1.65.001
      Left13.64±3.2915.21±1.63.001
     Deltoid
      Right10.68±2.3212.10±2.48.001
      Left10.80±2.3312.23±2.48.001
     Quadriceps
      Right17.62±2.1618.91±2.60.006
      Left17.75±2.1718.77±3.38.001
     Dorsiflexors
      Right15.48±2.9518.77±3.19.001
      Left15.61±2.9318.74±3.17.001
     Planter flexors
      Right16.79±2.8520.90±2.99.001
      Left16.91±2.8421.05±2.98.001
     Pulmonary function#
      Forced Vital Capacity (l)2.09±0.352.27±0.37.001
      Forced Expiratory Volume(l)1.77±0.332.02±0.32.001
     Quality of Life Measures¥
      Barthel Index (Median)15.00 (30)42.00 (60).001
      Modified Rankin ScaleScore 4: 26 (43.3)*Score 3: 36 (60.0)**.001
      Score 5:34 (56.7)*Score 4: 24 (40.0)**

    • ↵# Paired t-test,

    • ↵¥ Wilcoxon signed-rank test,

    • ↵* Patients” scores before treatment were ranged between score 4 and score 5 (maximum to sever disability),

    • ↵** Patients” scores after treatment were progressed into score 3 and score 4 (moderately to maximum disability)

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