Table 3.

Summary of Physical Therapy Episode of Care

HD	Key examination findings	Physical Therapy Interventions
6	Medically sedated and non responsive	PROM to all major upper extremity (UE) and lower extremity (LE) joints, stretching of plantar flexors, and application of pressure relieving ankle foot orthoses (PRAFO®) for positioning and pressure relief.
ECMO initiated
7	Medically sedated, now on ECMO, SIMV, and s/p tracheostomy	PROM continued, mother instructed in PROM and donning/doffing the PRAFOs. Right glenohumeral joint mobilization.
8	Awake, mouthing words	Active assistive range of motion (AAROM) of all major UE and LE muscle groups. Recommendation for speech therapy and occupational therapy consults.
9	Awake and following commands, but lethargic. Bleeding from trach site. Bilateral UE and LE muscle strength −2/5	AM: Patient “sat up” with the bed in the “chair position” (∼60°) for ∼10 min. AAROM in “sitting.” PM: Sitting with bed in “chair position” for ∼15 min. Bilateral planar flexor stretches, active assisted ankle, knee, and hip flexion and extension while in sitting.
10	Alert, ready to sit up. Brief complaint of dizziness, in sitting, but MAP 87–93 mm Hg, HR 80–90 bpm, and SpO2 92–95% on FiO2 0.35. Knee extensor strength 3-/5.	Transfer from supine to sitting edge-of-bed (EOB) with maximal assistance (2 persons to assist the patient and 3 more to guide her ventilator tubes, ECMO cannulae, and other arterial and venous lines). Minimal/moderate assistance required to maintain upright sitting (more as patient fatigued). Sat edge of bed for ∼40 min, intermittently performing UE and LE AAROM.
11	Eager to sit and stand. No adverse signs or symptoms related to intervention except pain at trach site and fatigue at end of session (MAP 90–108 mm Hg, HR 68–95 bpm, SpO2 mid-90s).	UE and LE AAROM in supine. Transferred to EOB with maximal assistance. Sat EOB for 15 min with contact guard-to-minimal assistance (see Fig 1). Worked on weight shifting, reaching and scooting while in sitting. She stood twice with maximal assistance (15 to 20 sec each). Knees did not buckle in standing, but she required assistance to stand erect, presumably due to hip extensor weakness.
12	AM: Anxious and medically sedated PM: Drowsy but motivated.	Transferred to EOB with maximal assistance. Stood twice with maximal assistance, but was able to remain standing for almost 2 min each time. Required assistance to block her knees and help facilitate hip extension.
13		Stood twice for 60–90 sec. Required only moderate assistance for sit-to-stand, then only minimal assistance to maintain standing. Sat EOB ∼45 min with contact guard/minimal assistance. Performed active (gravity resisted) UE and LE exercises in sitting.
14	Off ventilator, on trach collar trial for first time (FiO2 0.40). No complaints of trach site pain, dizziness, or dyspnea. Patient excited to be out of bed. Vital signs stable throughout.	Sit-to-stand with moderate assistance. Practiced weight shifting in standing. Took 5 steps from bed and pivoted to sit in chair for the first time. Repeated 2 more sit-to-stand trials, with standing durations of ∼45 sec. Sat upright in chair for ∼30 min and then with feet elevated for another 90 min. Transferred back to bed, again taking 5–6 steps.
Bilateral lung transplant