A special issue on Physiotherapy in ICU

Physiotherapy is reported to be an integral part of patient management in the intensive care unit (ICU). Physiotherapists are vital members of the multidisciplinary team providing a spectrum of care from acute respiratory to rehabilitation. In an ICU set up, physiotherapists may be involved with specific patient positioning, suction, mobilization, exercise, passive movements, manual airway clearance techniques, manual (MH) and ventilator hyperinflation (VH), weaning etc. It is well documented that the general aims of any physiotherapy program in the critical areas is to apply advanced, cost effective therapeutic modalities to decrease the patient’s dependency on the ventilator, to improve residual function, to prevent the need for new hospitalizations and to improve the patient’s quality of life. In other words, the aim is to enhance the overall patient’s functional capacity and to restore his/her respiratory and physical independence, thus decreasing the risks of bed-rest associated complications. However, the education and training of physiotherapists and their role in the ICU in relation to other health professionals varies greatly. This leaves a young therapist with many unanswered questions in his/her mind with regard to the role they need to play. This special issue on Physiotherapy in ICU is an attempt to answer some of these questions and look at the current prospects and challenges for a therapist working in the ICU in the Indian context. 

As you are aware, in our special section “Physio Speaks’ we interview Physios of repute from across the globe. We are pleased to share that this issue features an exclusive interview with Brian Mulligan, the man behind Mulligan Concept, where he shares with us how it evolved from a one man’s approach to a worldwide phenomenon. The issue also features a photo gallery of the PHYSIOTIMES CME held on 18th July’10 at AMA, Ahmedabad to commemorate the completion of one year of its launch. Thank you again for being an important part of this journey. On behalf of all of you, I thank all the authors for contributing & sharing their thoughts with our readers in this issue and invite articles from all those, who would like to share their knowledge and experience with fellow therapists through this medium. I am sure this special issue on Physiotherapy in ICU would help the therapists working in the ICU set up in getting a comprehensive outlook on management of their patients suffering from critical illness.



COVER STORY: Physiotherapy in I.C.U Prospects And Challenges - DR G. ARUN MAIYA & DR.MOHAMMAD H. HADDADZADEH

The idea of intensive care stems back to the era when better understanding of the human physiology and the process of death occurred. Understanding the function of oxygenation and that life is an oxidation process led to put emphasis on the respiratory support and oxygen inhalation. Lavoisier (1743-1794) stated “Respiration is a process of combustion, in truth very slow, but otherwise exactly like that of charcoal.” The reason may be different but many cultures used insufflations ... Read More

EXPERT SPEAKS: Physiotherapy in Intensive Care: A Summary Of Research Evidence - KATHY STILLER

Introduction : In 2000 I wrote a paper entitled ‘Physiotherapy in Intensive Care: Towards an Evidence-Based Practice’ which reviewed research evidence regarding the effectiveness of physiotherapy for patients in the Intensive Care Unit (ICU), thus providing a frame-work for evidence-based practice (EBP).1 EBP has risen in popularity as the need and demand for healthcare outstrip resources. Physiotherapists need to be aware of research evidence that supports their decision-making a... Read More

PHYSIO SPEAKS: A Tete-A-Tete With The Man Behind Mulligan - BRIAN MULLIGAN

Brian Mulligan is a name that needs no introduction to physiotherapists across the globe. His concept of mobilisation with movement (MWMS) in the extremities and sustained natural apophyseal glides (SNAGS) in the spine have progressed physical therapist-applied passive physological movements and accessory techniques in the treatment of musculoskeletal injuries. No.we didn't travel to New zealand to do the interview but were able to connect with brian through email, where he shared some of... Read More

RESEARCH REPORT: The Effect Of Physiotherapy On Ventilatory Dependency & The Length Of Stay In ICU - MEHTAP MALKOC, DIDEM KARADIBAK & YUCEL YILDIRIM

INTRODUCTION : Physical therapy may be applied for patients in the intensive care setting when they have retained secretions and radiological evidence of atelectasis or infiltration, or as prophylaxis in conditions such as acute head injury and smoke inhalation (Stiller ,2000;Buhop,1996). The short-term physical therapy goals was to reduce the gas exchange impairment by optimizing the ventilation perfusion ratio, decreasing patient’s work in breathing, instructing them in effective coug... Read More

REVIEW ARTICLE: Early Mobilization In ICU: Current Perspective & Future Directions


Early ambulation of hospitalized patients being first introduced late during World War II in an effort to expedite the recovery of soldiers for return to the battlefield.1 Years later, intensive care units (ICUs) were created. Intensive care physician, Thomas Petty, provides a vivid comparison of medical care in ICU sat present v sat the inception of critical care:

When I make rounds in critical care units...what I see... Read More


Critical illness is a medical condition that impairs one or more vital organ system, jeopardizing the patient’s survival. Patients with chronic critical illness experience profound deterioration of function and quality of life, and their families are faced with major emotional and financial burdens.[1]

The role of a physical therapist in the intensive care unit (ICU) has been established with regard to airway clearance.[2] A survey in India found that more than 94% of therapis... Read More

EXPERT OPINION: Elderly and Critical Care Management-Implication To Physical Therapy Practice - RAVINDRA SAVITA

BACKGROUND: Aging is a wonderful and unique experience. It starts in the uterus at the time of conception. It represents the passage of time, not pathology. By the age of 5, the personality of an individual is well formed and by the age of 60, the hallmark of aging becomes clear i.e. individual uniqueness. No two person age identically. Chronological age based on date of birth is not always similar to physiological age. Aging has its effect on various systems which includes cardiovascular, mu... Read More

GUEST COLUMN: Physiotherapy In Metabolic Dysfunctions In Icu: An Upraising Need - N.VENKATESH, T.SENTHIL KUMAR, S.SRIDEVI

INTRODUCTION: The role of physiotherapy in the management of patients in the intensive care unit (ICU) has been growing with changing trends. Initially, physiotherapy was applied for bronchial hygiene alone, for selective patients requiring prolonged stay in ICU. Every treatment technique has been tested over time for their utility (Stiller K,2000). Along with advancements in life saving methods and life prolonging medications, many patients do survive in the ICU for a longer period but with ... Read More


Ethics in critical care is based on four fundamental principles1:

a.) Health care professionals’ obligations to provide treatment for the patients (Beneficence) b.)The duty  to avoid harm (Nonmaleficience) c.) Respect for patient’s rights to self-determination (Autonomy) d.) Justifiable allocation of health care resources (Justice)

As like other professions physiotherapy has an ethical code. It fosters and guarantees the ethos. It assures the members of th... Read More


Time and again I talk with physical therapy practice owners who try one or more marketing strategies, don’t get the results they want, and then give up. I believe some of you are confused about what marketing really is. Today, I have a unique and useful scorecard to help you assess your marketing knowledge.

This Marketing Scorecard is designed to help you understand exactly where you are with your marketing. What's working, what's not working and where do you need to p... Read More

PHYSIO YOGA: Ashtang Yoga:Healer of The Heart - DR.NILIMA PATEL

The 21st century is described as the age of anxiety and stress. Amongst many psychosomatic illnesses, the cardiovascular diseases are quite significant. The modern man is constantly facing symbolic stress. This stress and strain of day-to-day life affects ones’ bodily organs through several psychophysical mechanisms. More than forty million people are suffering from CVS and its related disorders in our country.

The report of an expert committee convened by WHO indicate lifesty... Read More

BOOK REVIEW: Intern a doctor's initiation - Sandeep Jauhar

Jauhar, a thriving cardiologist and the director of the Heart Failure Program at Long Island Jewish Medical Center, completed his internship a decade ago, but still remembers his confusing, tumultuous medical apprenticeship at the prestigious New York Hospital the way soldiers remember war.

Intern is Dr. Sandeep Jauhar's story of his days and nights in residency at a prominent teaching hospital in New York City, a trial that led him to question every conventional assumption abou... Read More




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