Physiotherapeutic Management of Critically Ill Neurological Patients

  • Rajeev Aggarwal
  • Vandana Dua


The improvement in survival rate of critically ill neurological patients with advancement in critical care medicine is congruent with neuromuscular, cardiopulmonary, cognitive, psychological and functional deterioration. Therefore, an early discharge from the intensive care unit (ICU) by promptly addressing the primary problem and preventing secondary complications is the ultimate goal for health-care professionals. Physiotherapy in ICU is directed towards maintaining bronchial hygiene, preventing/treating respiratory complications, preventing ICU acquired weakness, promoting early mobility, managing abnormal muscle tone, preventing/treating loss of range of motion, improving arousal and cognition levels, preventing decubitus ulcers and venous thromboembolism and eventually promoting functional recovery. It is essential to evaluate the haemodynamic, respiratory, circulatory and neurologic status before planning a tailor-made protocol of physiotherapy care of neurological patients. Therapeutic positioning, incentive spirometry, manual hyperinflation and positive-pressure ventilation augment alveolar expansion to manage atelectasis. Bronchial hygiene therapy is achieved by facilitating mucociliary clearance; manual airway clearance techniques like percussion, vibration and postural drainage; and self-assisted airway clearance techniques like active cycle of breathing technique and autogenic drainage. It is imperative to mobilize critically ill patients at the earliest possible to combat deleterious effects of bed rest. Decubitus ulcer prophylaxis, venous thromboembolism prophylaxis and management of abnormal muscle tone help in reducing secondary complications. Coma arousal techniques using multimodality sensory stimulation and right median nerve stimulation are effective strategies to improve arousal level in comatose patients.


Respiratory physiotherapy Lung expansion Airway clearance Bronchial hygiene therapy Early mobility Coma arousal Therapeutic positioning Inspiratory muscle training 


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Rajeev Aggarwal
    • 1
  • Vandana Dua
    • 1
  1. 1.Department of NeurologyAll India Institute of Medical SciencesNew DelhiIndia

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