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Table of Contents
COMMENTARY
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 145-146

Wheel-chair mobilization: Its phenomenal power in the intensive care unit setting


Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication02-Nov-2021

Correspondence Address:
Dr. Sanjay Behari
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJNO.IJNO_420_21

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How to cite this article:
Behari S. Wheel-chair mobilization: Its phenomenal power in the intensive care unit setting. Int J Neurooncol 2021;4, Suppl S1:145-6

How to cite this URL:
Behari S. Wheel-chair mobilization: Its phenomenal power in the intensive care unit setting. Int J Neurooncol [serial online] 2021 [cited 2021 Nov 27];4, Suppl S1:145-6. Available from: https://www.Internationaljneurooncology.com/text.asp?2021/4/3/145/329815



A wheel-chair usually lies in one small area of an intensive care unit (ICU), thoroughly neglected, never being accorded the respect given to its more dominating brethren like the ICU beds, monitors, ventilators and treatment carts. Has anyone ever focused on meticulously cleaning and oiling its parts or on checking its components for their proper functionality on a daily basis…or even sparing a thought to negotiating a “comprehensive maintenance contract” for its upkeep? After all, what is the role of a “lowly” wheel-chair except to transport patients a few times a day? One could not be more wrong!

A kind offer to donate money for the economically weaker patients in our ICU by the grateful parents of a child, following her recovery from a serious ailment, was the initiating point for the genesis of this article. I realized that a few wheel-chairs in the ICU would make us less dependent on the central transportation facility. It made more sense to accept wheel-chairs (that would serve many more patients for a longer time) as donation than to accept a one-time monetary help for a few patients. I requested the family to donate four wheel-chairs, which they immediately did. For nearly 6 months, the wheel-chairs kept lying in one corner of the ICU, seldom being utilized except for the occasional transportation of patients to the radiology department for an imaging study. One day, on the morning round, I noticed the neglected wheel-chairs huddled in one corner. Just to increase their utilization, I requested the sister-in-charge to involve relatives in mobilizing their patients on a wheel-chair a few times in a day…and that is when the magical transformation serendipitously started in the ICU!

The simple acts of alighting from the bed onto a wheel-chair and then climbing back, as well as sustaining oneself in it, require enormous cognitive and physical efforts by these often very sick patients. These efforts represent an activity equivalent to several rounds of physiotherapy in bed. Moreover, it is a pleasurable effort that every conscious patient cherishes. This simple act often breaks the monotony of staying in bed and helps to restore, and maximize physical strength and overall well-being of patients much more than any vigorous rounds of physical exercises in bed would. What if a patient is unable to support his/her head and trunk? Stabilizing the head using a soft neck collar and the torso by wheel-chair straps, easily enables him/her to be wheeled around.

One would think that this practice would be less acceptable to the ICU staff since it represents a lot more effort on their part. Contrary to this, our ICU staff found this act of handing over patients to their relatives each day very reassuring. It ensured that the relatives had a first-hand assessment of their patient's health status; it also helped the staff concentrate on other activities during this time and occasionally to take a physical and emotional break from the patients they were assigned to.

The unconscious mercifully remain oblivious…the conscious remain communicative, have a will, make choices on their own and are mobile…it is the semiconscious and completely dependent patients who really face the brunt of a prolonged stay in the ICU. It is an inescapable fact that the latter stratum of patients represents the cadre most likely to benefit from ICU care. Fortunately, this group immediately shows a beneficial response to wheel-chair mobilization.

One-third of former ICU patients have depression. This phenomenon does not end at discharge. Survivors of intensive care have a propensity to develop long-term psychosocial issues. Every fifth ICU patient suffers from a full-or subsyndromal manifestation of a major depressive disorder up to 6 months after transfer to postacute ICU. The perceived helplessness in ICU and a diagnosis of posttraumatic stress disorder up to 6 months following the ICU stay are significant predictors of major depressive disorders.[1]

Every individual sustains oneself with the love of one's family and friends. The act of helping out the patient on to the wheel-chair a few times in a day represents an immeasurable act of bonding and often helps to obviate the occurrence of these psychological disorders. The healing powers of exposure of the patient to sunlight and fresh air (while he/she is being wheeled around by loved ones) have been enunciated too often to be repeated. Pushpa Rana in “Just the Way I Feel” stated, “Even if you lose your memory, your imagination haunts you, as deep down your subconscious mind, you know who you are.”[2] Being helped even by medical personnel in an activity which one looks forward to has a positive effect on the subconscious mind. Even the quadriplegic, dementic as well as tracheostomised and ventilated patients, when made to sit on a wheel-chair close to their bed and ventilator a few times a day, undergo an amazing and positive transformation that aids in their recovery [Figure 1].
Figure 1: Wheel-chair of critical patients in the neurosurgery intensive care unit. The mobilization, bonding with relatives, sunlight and a change of environment often helps patients recover well

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Every ICU is plagued by the silent demons, namely, bedsore, basal pneumonitis, aspiration during feeding and deep vein thrombosis.[3] These problems may be obviated to a significant extent by focusing on the task of mobilizing the patient on a wheel-chair. Postural hypotension is the bane for early mobilisation in the ICU. We also noticed that with each passing day, the incidence and duration of postural hypotension associated with recumbency progressively lessened and improved the acceptance of the practice of wheel-chair mobilization.

A subtle assessment of truncal power is possible by evaluating the patient's ability to hold the head or trunk steady while on a wheel-chair, or even the ability to elevate and steady one's arms and legs on its supports. Patients often suffer from reversible causes of neurological deterioration in an ICU setting. An impending hyponatremia, hypoxemia or hypercarbia, and a lack of adequate response following the occurrence of subclinical seizures or septicaemia have been picked-up early just by comparing the patient's day-to-day effort in perching on the wheel-chair from the ICU bed. A resident's remark, “Yesterday, he was able to sustain his head and trunk holding on a wheel-chair but is unable to do so today” represents an enormous source of information that mandates an immediate battery of investigations to determine the cause. These subtle changes would often not be evident in a dependent patient who is solely being evaluated on his ICU bed.

Nelson Mandela remarked, “May your choices reflect your hopes, not your fears.” The morbidity within an ICU, the dispassionate efficiency of the ICU staff, and the constant thought in the patient's mind of things going wrong at any given moment, create a claustrophobic atmosphere that has to be experienced to be really understood. The approach of the wheel-chair to wheel-out the patient a few times a day in this all-pervading, stifling atmosphere represents the action of reaching out to the person…of imparting the feeling that “we still care for you,” and more importantly, that “all is not lost, there is still hope for you.”

The plenitude of sophisticated equipment in the ICU has resulted in relegation of the role of the “simple” wheel-chair. It is time for us to consciously appreciate its multifarious uses and not take it for granted. Simple things in life do matter.



 
  References Top

1.
Wintermann GB, Rosendahl J, Weidner K, Strauß B, Petrowski K. Predictors of major depressive disorder following intensive care of chronically critically ill patients. Crit Care Res Pract 2018 Aug 1;2018:1586736. doi: 10.1155/2018/1586736.  Back to cited text no. 1
    
2.
Rana P. In: 'Just the Way I Feel. https://www.goodreads.com/author/show/8420526.Pushpa_Rana. [Last accessed on 2021 Feb 08].  Back to cited text no. 2
    
3.
Wollschlager CM, Conrad AR, Khan FA. Common complications in critically ill patients. Dis Mon 1988;34:221-93.  Back to cited text no. 3
    


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