• What Is Post-Intensive Care Syndrome? A Physical Therapist’s Perspective

    Physical Therapy for Post-Intensive Care Syndrome

    What Is PICS?

    If you have spent time in a hospital intensive care unit, or ICU, you may experience problems with your physical abilities, your mental health, or your cognition — your ability to think. This is called post-intensive care syndrome, or PICS.

    Physical problems can include:

    • Muscle weakness.
    • Breathing problems.
    • Trouble walking.
    • Struggling to care for yourself, drive, or work.

    Mental health problems can include:

    • Posttraumatic stress disorder, or PTSD.
    • Anxiety.
    • Depression.
    • Trouble sleeping.

    Cognitive problems can include:

    • Difficulty remembering things.
    • Trouble concentrating or thinking clearly.
    • Difficulty completing tasks.

    Your family also may experience anxiety, depression, or stress while caring for you. This is known as PICS-Family.

    How Long Does PICS Last?

    Most people who have been in an ICU will have problems with movement, thinking, and/or mental health. These problems can be serious and may last from a few months to even years. This can be frustrating for people with PICS and their families. Writing about your problems in a diary can help you and your health care team understand and treat your symptoms. A diary also can help you notice when these symptoms get better.

    Physical Problems Linked to PICS

    After your ICU stay, the muscles that move your arms, legs, and body may feel weak. This weakness even can make it hard to breathe, stand, or sit. You may have trouble doing simple things, such as standing up from a chair or a toilet, going up and down stairs, or even just walking.

    You may get tired easily or have trouble doing things that used to be easy, like dressing, bathing, or preparing a meal. Some people with PICS are not able to safely drive a car or go back to work. Others may be able to do those things, but may have a hard time with physical activity, exercise, or sports.

    How Can a Physical Therapist Help?

    If you have physical problems related to PICS, a physical therapist can help. You may have had physical therapy in the hospital already. Physical therapists also care for patients in inpatient rehabilitation centers, through home health care, and in outpatient clinics. A physical therapist assistant can provide many of the services prescribed by a physical therapist.

    Your physical therapist first may suggest that you use equipment to help you do your daily tasks. Some examples are:

    • Using a walker or a cane to help you walk safely.
    • Using a raised toilet seat or raising the height of chairs to help you stand up easily.
    • Using a reaching tool to get something from a shelf.

    Your physical therapist also may suggest exercises to help you get stronger, walk better, and address other troubles that you may be having. The most common types of exercises are:

    • Stretching, to improve flexibility.
    • Resistance training, to improve strength. Some examples are lifting weights or pulling elastic bands.
    • Exercises such as walking, bicycling, swimming, or long-distance running, to improve endurance.
    • Balance exercises.

    These exercises may be harder than you are used to. This will help your body get used to doing greater amounts of work.

    Physical therapists design specific exercises for each person to meet their personal needs and goals. The exercises prescribed for one person may not be helpful for another person.

    The Health Care Team

    If you are having trouble thinking, or if you are having symptoms of depression or anxiety, it can be hard to do simple tasks or practice your exercises. These problems are common with PICS, and it is important to also get treatment for them!

    A PT can screen for these and other problems and refer you to the right health care providers.

    Your PT will work with you, your physician, and other providers involved in your recovery. The health care team can help you take control of the problems related to PICS and speed your recovery.

    Remember …

    • Being in an ICU may affect your physical activity, mental health, and ability to think clearly. This is known as PICS.
    • Your family members and caregivers also may be anxious or depressed because they are concerned about you and your recovery. This is known as PICS-Family.
    • Physical therapists provide treatments that will improve the physical problems related to PICS. These treatments include exercises to improve muscle strength, walking endurance, and balance. Your physical therapist will prescribe an exercise plan specific to your needs.
    • Recovery from PICS is slow and may take months or years. It is important to be persistent and continue to do the home exercise program your physical therapist designed for you to improve your quality of life.
    • Other health care professionals can help improve problems with thinking or mental health for those with PICS or PICS-Family.

    This information is a public service from the American Physical Therapy Association and the APTA Academy of Acute Care Physical Therapy. This content is for educational purposes only and should not be used as a substitute for advice from your physical therapist and your health care providers.

    Contributing authors: J.P. Coffey Scott, MLS; A.C. Lee, PT, PhD; P.J. Ohtake, PT, PhD; J.M. Smith, PT, DPT; A. Thiele, PT, DPT; H. Zeleznik, PT, DPT

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