Physiotherapeutic Management in Neurocritical Care

Physiotherapeutic management of neurological patients within the critical care unit is crucial especially with the steadily improving survival rates in the advent of technological advancements. At the same time, critically ill neurological patients present with unique challenges to physiotherapists such as altered state of consciousness, cognitive impairments, respiratory impairments, ICU-acquired weakness, hemiplegia, and altered cerebral autoregulation. Early and comprehensive care including the cardiopulmonary, musculoskeletal, and neurological physiotherapeutic interventions reduce disability and iatrogenic morbidity. It, therefore, requires expertise to individualize each physiotherapeutic session and hence encash the critical window period of recovery with utmost precision and care. The physiotherapeutic techniques and modalities are directed to prepone weaning from mechanical ventilation, improve sensorium, improve respiratory and peripheral muscle strength and endurance, manage muscle tone, and prevent tightness, contractures, deformities, venous thromboembolism, pressure sores, and other deleterious effects of bed rest and critical illness. The increasing presence of “secondary” problems, often preventable pathologies and dysfunctions take a back seat, considering the primacy of life saving interventions within the critical care set up, there is an urgent and significant need to prevent and reduce the incidence and the cost of care. The economic burden of health related complications in low and middle income countries is huge. Effective and adequate physiotherapy services in critical care units has the potential in impacting the individual, the caregivers and the healthcare systems.