Feasibility of early, motor assisted upper extremity cycle ergometry in critically ill neurological patients with upper extremity weakness and variable cognitive status: a case series.

Upper extremity paresis, common in many neurological conditions, is a major contributor of long-term disability and decreased quality of life. Evidence shows that repetitive, bilateral arm movement improves upper extremity coordination after neurological injury. However, it is difficult to integrate upper extremity interventions into very early rehabilitation of critically ill neurological patients due to patient arousal and medical acuity. This report describes the safety and feasibility of bilateral upper extremity cycling in critically ill neurological patients with bilateral or unilateral paresis. Patients were included in this pilot observational series if they used upper extremity cycle ergometry with occupational therapy while in the neurocritical care unit between May and August 2016. Patient demographics, neurological function, and hemodynamic status were recorded pre and post cycling. Cycling parameters including duration and active and/or passive cycling were collected. No significant changes in hemodynamic or respiratory status were noted post intervention. No adverse effects or safety events were noted. In this series, upper extremity cycle ergometry was a safe and feasible intervention for early rehabilitation in critically ill patients in the neurocritical care unit. Future studies will prospectively measure the impact of early upper extremity cycle ergometry on neurological recovery and functional outcome in this population. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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