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Textbook of Neuroanesthesia and Neurocritical Care pp 261–275Cite as

Physiotherapeutic Management of Critically Ill Neurological Patients

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Abstract

The improvement in survival rate of critically ill neurological patients with advancement in critical care medicine is congruent with neuromuscular, cardiopulmonary, cognitive, psychological and functional deterioration. Therefore, an early discharge from the intensive care unit (ICU) by promptly addressing the primary problem and preventing secondary complications is the ultimate goal for health-care professionals. Physiotherapy in ICU is directed towards maintaining bronchial hygiene, preventing/treating respiratory complications, preventing ICU acquired weakness, promoting early mobility, managing abnormal muscle tone, preventing/treating loss of range of motion, improving arousal and cognition levels, preventing decubitus ulcers and venous thromboembolism and eventually promoting functional recovery. It is essential to evaluate the haemodynamic, respiratory, circulatory and neurologic status before planning a tailor-made protocol of physiotherapy care of neurological patients. Therapeutic positioning, incentive spirometry, manual hyperinflation and positive-pressure ventilation augment alveolar expansion to manage atelectasis. Bronchial hygiene therapy is achieved by facilitating mucociliary clearance; manual airway clearance techniques like percussion, vibration and postural drainage; and self-assisted airway clearance techniques like active cycle of breathing technique and autogenic drainage. It is imperative to mobilize critically ill patients at the earliest possible to combat deleterious effects of bed rest. Decubitus ulcer prophylaxis, venous thromboembolism prophylaxis and management of abnormal muscle tone help in reducing secondary complications. Coma arousal techniques using multimodality sensory stimulation and right median nerve stimulation are effective strategies to improve arousal level in comatose patients.

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Authors and Affiliations

  1. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

    Rajeev Aggarwal & Vandana Dua

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  1. Rajeev Aggarwal
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  2. Vandana Dua
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Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Division of Neuroanesthesiology, Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India

    Zulfiqar Ali

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Aggarwal, R., Dua, V. (2019). Physiotherapeutic Management of Critically Ill Neurological Patients. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3390-3_19

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  • DOI: https://doi.org/10.1007/978-981-13-3390-3_19

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