5. Use heat and cold therapies
Both can be used effectively in the care of critically ill patients. Thermotherapy (heat) causes vasodilation, thus increasing
blood flow and oxygen delivery. It can help heal skin and surface tissues and relax muscles and connective tissues to provide
temporary relief from muscle spasms. Heat should be used before massage, stretching or range-of-motion exercises. Never use
it during the acute inflammatory stage. Pay extra attention to obtunded or paralyzed patients who cannot react to burns.
Cryotherapy (cold) is useful during the acute inflammatory stage. Cold packs on the affected areas cause vasoconstriction,
helping to decrease hemorrhage, cellular metabolite production, histamine production, edema accumulation, cartilage-degrading
enzymes and pain. Avoid cryotherapy on areas with decreased circulation or loss of sensation.
6. Try massage
Massage can promote relaxation; increase circulation, lymphatic drainage and flexibility; decrease edema and pain; and enhance
proper collagen formation. There are two main types of massage:
- Effleurage is a very light stroking technique that helps loosen the connective tissue and stimulate the lymphatic system and
- Petrissage is a deeper massage technique performed with a kneading motion to increase blood flow and oxygen delivery to tissues,
and decrease stiffness, spasms and pain.
Massage is contraindicated in patients with fever, cardiovascular or hemodynamic shock or thromboembolic disease as well as
over tumors, wounds or fractures.
7. Exercise the patient
Passive range-of-motion (PROM) exercise is a rehabilitation technique in which an external force is used to put a patient's
joints through the full movement range and, in turn, stretch the muscles. PROM encourages healing by stimulating the nervous
system, reversing the effects of chronic immobility, promoting the health of joint fluid and lining, preventing adhesions
and improving soft tissue and muscle flexibility. Don't use force during these exercises; rather, apply pressure only within
the patient's comfort zone. PROM must be performed properly to avoid additional damage to the joint and surrounding tissues.
Patients that are immobilized because of their critical status also are at higher risk for life-threatening thromboembolisms.
These can develop when blood pools in dependent regions and creates erratic sedentary flow, circulation is compromised due
to injury and clotting factors are activated by inflammation. Use rehabilitation techniques to reduce the likelihood of thrombus
formation during disseminated intravascular coagulation and to limit the need for heparin therapy. Standing or assisted-standing,
massage and PROM can be beneficial in resolving edema and re-establishing normal blood flow.
Rehabilitation techniques can improve outcomes for your critically ill patients and should be incorporated routinely into
their treatment plans. Chest physiotherapy techniques, movement, percussion or coupage, vibration, proper body positioning,
heat and cold therapies, massage and exercise can be used to manage pain, minimize complications and speed healing. Keep in
mind, however, that using these techniques correctly and safely—particularly in critical care patients—requires the training
and experience of a certified rehabilitation therapist.
Dr. Van Dyke is the founder and CEO of the Canine Rehabilitation Institute in Wellington, Fla., with locations in Fort Collins, Colo.,
and Annapolis Junction, Md. Pronko is with the Critical Care Unit at Colorado State University's College of Veterinary Medicine
and Biomedical Sciences.