Occupational Therapy in Neurocritical Care: Use of Cycle Ergometry for Early Upper-Extremity Rehabilitation in a Critically Ill Stroke Patient

PURPOSE: Early rehabilitation of patients with neurocritical illness can be challenging due to varying levels of arousal and acute complex motor, cognitive, and sensory deficits common to the disease. Additionally, concerns about fluctuations in blood pressure during the early stroke period can contribute to delays in initiation of restorative therapies. To date, early mobility and activity programs in critical care settings emphasize transfer and ambulation, while focused upper-extremity (UE) rehabilitation has not been prioritized. Implementation of evidence-based interventions focused on recovery of paretic arms, such as robotic therapy, constraint-induced movement therap, and bilateral arm training with rhythmic auditory cuing, are difficult in the critical care setting due to time constraints, cost, and the patient’s medical acuity. UE cycle ergometry may provide one alternative as it is inexpensive and simple and is proven to improve force production and function of the shoulder, elbow, and hand in chronic stroke patients. While active and passive lower-extremity supine cycling is widely described for critically ill patients, benefits of UE cycling still need to be explored.

METHOD: This is a descriptive case report of a man age 82 yr admitted to the neurocritical care unit (NCCU) with right cerebellar hemorrhage and prolonged NCCU course secondary to difficulty weaning from the ventilator. A bedside cycle ergometer (MOTOmed Letto 2, RECK-Technik, Betzenweiler, Germany) with passive and active mobility settings was used for UE cycling. The patient’s ability to follow commands, participate in activities of daily living, level of arousal, and hemodynamic parameters were measured pre, post, and during this intervention. Cycling parameters were recorded.

RESULTS: The patient underwent three trials of UE cycling during his NCCU stay. The patient performed bilateral UE cycling actively for 25 min, 20 min, and 12 min. There was no change in hemodynamic status pre, post, and during this intervention. Arousal level and command following pre- and postintervention were unchanged during all trials.

CONCLUSION: UE cycle ergometery is a feasible intervention for early UE rehabilitation in a critically ill patient with stroke. UE cycling did not affect the patient’s hemodynamic status, a critical consideration in the early stroke recovery period. This technology may provide an alternative treatment modality as clinicians attempt to initiate restorative therapies earlier in the stroke recovery period. Future studies should focus on a larger sample size and use of performance-oriented outcome measures to study the impact of this intervention on longer-term functional outcomes in critically ill stroke patients.

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