Personalized Rehab Helps People Overcome Post-Intensive Care Syndrome

People with serious illnesses are living longer, but after more than four days in an intensive care unit (ICU), on prolonged bedrest, or on a ventilator for breathing support, they may experience extreme muscle weakness, shortness of breath, anxiety, and depression, memory problems, and other concerns. Collectively these issues are called post-intensive care syndrome. These effects can last a long time after leaving the hospital.

“A lot of patients really struggle to get back to normal activity levels,” said Sara Dorn, PT, DPT, a physical therapist at Duke Health.

Moser, of Fleetwood, NC, suffered from liver failure for years before going to Duke in June 2022 to be evaluated for a liver transplant. “I had researched enough to know Duke was the top of the line,” said the retired ER nurse. During her transplant evaluation, Moser became so sick that she was immediately hospitalized. Over the next month, doctors tried to get her well enough for a transplant; however, her kidneys started to fail, and she was put on dialysis. She underwent a kidney and liver transplant at Duke in early August.

After the organ transplants, Moser was in bad shape. “My legs weighed a ton because I had so much fluid in me,” she said. “I could not pick my feet up. My sister and my son had to pick up my feet to get me in the bed.” The surgeries, she said, “had messed with the muscles and nerves in my abdomen. I had to use tools to do everything.”

Moser spent three months in the hospital before being released to a nearby hotel for another month so she could be near her doctors as she continued to recover. That’s when she started occupational therapy and physical therapy at the Duke Critical Care Recovery Center in Durham.

The critical care recovery center is staffed by physical therapists and occupational therapists who help people like Moser rehabilitate after a serious illness and hospital stay. “We assess patients’ functional and cognitive status and screen for other needs,” said Dorn. Examples include mobility challenges that require specialized wheelchairs, shortness of breath, swallowing problems, or post-traumatic stress syndrome. When needed, Dorn and her colleagues refer patients to the appropriate Duke specialists.

“Whether you have pelvic floor issues or need to see a neurologist, we can coordinate care to reduce the burden on the patient and their family,” said Samantha Green, MSOT, OTR/L, BCPR, Moser’s occupational therapist. “We have a lot of resources in one building that most clinics don’t have.”

Moser remembers “working with Sara on simple tasks, relearning how to do things like getting up and down from a chair. Sam helped me with hand dexterity and my memory,” which had been impacted by the many medications Moser was given in the hospital. “They gave me tools like a stretch band to strengthen my muscles and my hand.” She was taught exercises she could practice on her own. In one week, Moser began to see improvements in her ability to care for herself.

Now at home, Moser says she continues to make progress every day. “I am increasing my walking and can walk on uneven ground. It’s tremendous. The people at Duke know what they are talking about. You have to work to get better. No one would let me slack. That was a good thing.”

Many times, symptoms of post-intensive care syndrome do not emerge until after people leave the hospital. “We address issues that are not evident initially but that can impact patients’ and caregivers’ lives for a long time,” Green said. She encourages people who struggle with physical or cognitive changes after a lengthy hospitalization to contact their provider for a referral to their center. “We can assess your needs and help you make a full recovery,” she said.