Occupational therapy in ICU

An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive treatment medicine.

ICU patients may have experienced a sudden decline in their medical and functional status due to a traumatic event, a worsening of a progressive disease, or the onset of a new condition.

The primary goal of acute care is to stabilise the patient's medical status and address life-threatening issues. An essential second goal is to improve functional status and safety to prevent physical and cognitive complications — which are also key components of occupational therapy interventions.

The occupational therapist assesses the patient in the beginning to find out what problems do the patient has. It may include the following:

♦ Difficulty in activities of daily living (ADL) like feeding, dressing, writing by using their hand due to poor fine motor skills, poor range of motion in shoulder ,elbow, wrist and finger joints, poor muscle strength and lack of confidence

♦ Difficulty in bilateral hand use

♦ Poor trunk control

♦ Abnormal hand position

♦ Poor oral motor control

♦ Poor knowledge about pressure care and rehabilitation after discharge

♦ After assessing the condition of the patient, the occupational therapist may suggest multiple interventions for the patient's well-being, which may include:

♦ Educate the patient about proper positioning and transitional movement

♦ Train the caregivers to assist with range-of-motion exercises, safe transfers and mobility, and skin checks

♦ Evaluate the need for splints and positioning devices to preserve joint integrity and protect skin from breakdown due to prolonged pressure

♦ Use neuromuscular re-education, trunk stabilisation, and balance activities to improve clients' ability to move in and out of bed and maintain an upright posture necessary to perform self-care and, eventually, home management activities

♦ Practice writing by using writing splint

♦ Functional joint range of motion exercises in both upper limbs

♦ ADL practice (drinking water, wash and wipe faces) in simulated environment

♦ Discuss with the patient about their present condition and how it can be improved by proper therapeutic treatment for increasing confidence

♦ Engaging the patient in leisure activities like reading the newspaper

♦ Practice oral motor controlling exercises for increasing feeding skills (chewing, sucking, swallowing and drinking)

♦ Discuss with patient about their further rehabilitation after discharging the hospital

♦ Educate patient about pressure sore prevention

Occupational therapists closely work with other health care professionals such as doctors, nurses, physiotherapists and speech therapists to create an interdisciplinary plan of care and a coordinated and appropriate discharge plan. They have a good understanding of the match between the patient's needs, abilities and the environments in which they need to function, which assists with the successful transition to the home, community, or next level of care.

In spite of the short length of hospitalisation in the acute care setting, occupational therapy practitioners play an integral role in starting a successful rehabilitation process.

The writer is an occupational therapist at the department of Physical Medicine and Rehabilitation, National Institute of Neurosciences and Hospital (NINS&H).

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