This document discusses occupational therapy treatments for patients in the intensive care unit (ICU) to address problems caused by prolonged bedrest, sensory deprivation, and cognitive impairment. OT treatments include upper extremity exercises, positioning, splinting, early participation in functional activities and ADLs, and cognitive stimulation. The document also discusses using ICU diaries to fill memory gaps and communicate experiences, as well as communication technologies like iPads to aid in communication, motor coordination, and cognition. Program goals include designating OTs in the ICU, prioritizing patients, advocating a team approach, and documenting functional performance. Additional resources discussed are family involvement menus, mobility guidelines, and engagement tools.

1. Occupational
Therapy in the ICU
3 Problems to target:
prolonged bedrest and ventilation, sensory deprivation and stress,
and cognitive impairment

2. OT TreatmentsOT Treatments
Upper Extremity Exercise, positioning, splinting
Early participation in functional activities and
ADLs
Cognitive stimulation
Use of technology for alternative treatment
interventions
Participation in ICU diaries

3. ICU DiariesICU Diaries
Purpose: to fill memory gaps and provide an
understanding of what happened in a
chronological narrative account.
Connects facts with autobiographical memory (or
lack of) to make sense of a time that may have
been dominated by delirium or confusion.
A way to communicate the experience with
others.

4. Communication technologyCommunication technology
Encouraged use of and iPad and/or Eye Gaze
System for communication while on vent or trach
Use of iPads for fine motor coordination tasks
and UB strengthening
Use of iPad and/or Eye Gaze System for
cognition activity

6. Program GoalsProgram Goals
Designated OT’s in the ICU
Prioritizing ICU patients
Advocate Team Approach to patient care
Participate in Research Log Book by
documenting highest level of ADL performance
(sitting or higher)

7. Additional ResourcesAdditional Resources
Family involvement menu, Mobility
guidelines, Engagement tool

8. Family Involvement MenuFamily Involvement Menu
Welcome: Welcome to Mayo Clinic hospital ICU
Purpose: We believe that you know the person we are serving
better than we do. We would like to invite you to participate in
your loved ones care.
Contract: We would like to participate in the care of this person
with the following tasks. We are receptive to instruction.
tasks: incentive spyrometry, bath care, eating care, exercise,
etc

9. Mobility toolsMobility tools
Mobility Board / Quality BoardBoard / Quality Board
Guidelines/fact sheets
levels of consciousness (assessment, activity, therapy)
Is my patient ready to start mobility activity today? (neuro,
respiratory, cardiovascular screens)
Progressive Mobility tolerence screen
Progressive Mobility decision tree for PT /OT consults

10. Function toolsFunction tools
standardize as much as possible
grip test
6 minute walk test
Quality of Life measure

11. EngagementEngagement
Operant Conditioning: learning that occurs through
rewards and punishments of behavior (ie: positive and
negative reinforcement)
Motivational Interviewing: using patient goals or values
to shape care
Resist righting, understand patient motivation,
reflective listening, empowerment
as apposed to using goals centered on external
factors

12. Engagement toolsEngagement tools
Done in collaboration with whole team
Starter: Hand-off communication tools for
therapist to therapist and for therapist to / from
nurse
Advanced model: Bundle system-wide an
interdisciplinary approach to communicating
function so there is seamless progress when
patients move unit to unit

13. SafetySafety
Study concluded out of 5300 PT sessions with 50%
sitting or higher activity level, there were only 34
potential safety occurrences (89% of them were
changes in vital signs). There were no major events
such as catheters or trachs removed or MI’s. There
were 2 assisted falls and 1 unassisted fall. Only 8
events that needed minimal intervention.
Potential area of study as we proceed with our
culture of mobility.

14. Thank You
Carmen Cononie, Kristien Daron, Rebekah Davis,
Hali Cole