Early Progressive Mobilization of Patients with External Ventricular Drains: Safety and Feasibility.

BACKGROUND/OBJECTIVE: Early mobilization of critically ill patients has been shown to improve functional outcomes. Neurosurgery patients with an external ventricular drain (EVD) due to increased intracranial pressure often remain on bed rest while EVD remains in place. The prevalence of mobilizing patients with EVD has not been described, and the literature regarding the safety and feasibility of mobilizing patients with EVDs is limited. The aim of our study was to describe the outcomes and adverse events of the first mobilization attempt in neurosurgery patients with EVD who participated in early functional mobilization with physical therapy or occupational therapy. METHODS: We performed a single-site, retrospective chart review of 153 patients who underwent placement of an EVD. Hemodynamically stable patients deemed appropriate for mobilization by physical or occupational therapy were included. Mobilization and activity details were recorded. RESULTS: The most common principal diagnoses were subarachnoid hemorrhage (61.4%) and intracerebral hemorrhage (17.0%) requiring EVD for symptomatic hydrocephalus. A total of 117 patients were mobilized (76.5%), and the median time to first mobilization after EVD placement in this group of 117 patients was 38 h. Decreased level of consciousness was the most common reason for lack of mobilization. The highest level of mobility on the patient's first attempt was ambulation (43.6%), followed by sitting on the side of the bed (30.8%), transferring to a bedside chair (17.1%), and standing up from the side of the bed (8.5%). No major safety events, such as EVD dislodgment, occurred in any patient. Transient adverse events with mobilization were infrequent at 6.9% and had no permanent neurological sequelae and were mostly headache, nausea, and transient diastolic blood pressure elevation. CONCLUSION: Early progressive mobilization of neurosurgical intensive care unit patients with external ventricular drains appears safe and feasible.

Comparison of muscle-activation patterns during the conventional push-up and perfect· pushup™ exercises.

Manufacturers of Perfect·Pushup™ handgrips claim enhanced muscular recruitment when compared with the conventional hand-on-floor push-up exercise. Electromyographic (EMG) data were recorded using surface electrodes from the right-sided triceps brachii, pectoralis major, serratus anterior (SA), and posterior deltoid muscles during push-ups performed from 3 different hand positions: (a) shoulder width, (b) wide base, and (c) narrow base (NB). Push-ups were performed under 2 conditions: (a) standard push-up and (b) Perfect·Pushup™ handgrips. We recruited 20 healthy subjects, 11 men (24.9 ± 2.6 years) and 9 women (23.8 ± 1 years). Subjects completed 3 consecutive push-ups for each hand position under both conditions. Push-up speed was controlled using a metronome, and testing order was randomized. We recorded peak EMG activity for each muscle during each of the push-ups and normalized EMG values by maximum muscle contractions (% maximum voluntary isometric contraction [MVIC]). Electromyographic data were analyzed with 3 (hand position) × 2 (condition) repeated-measures analysis of variance with a post hoc Bonferroni-adjusted simple effects test to detect significant position effects for position by condition interactions (α = 0.05). A push-up required considerable muscle activation of the triceps brachii (73-109% MVIC), pectoralis major (95-105% MVIC), SA (67-87% MVIC), and posterior deltoid (11-21% MVIC) whether performed using the conventional hand-on-floor position or the Perfect·Pushup™ handgrips. The NB hand position was most effective for preferentially activating the triceps brachii and posterior deltoid muscles. Based upon EMG activation from 4 muscles, the Perfect·Pushup™ handgrips do not appear to preferentially enhance muscular recruitment when compared with the conventional push-up method.