Does the Use of an Upper Extremity Exercise Program Improve Activity Tolerance and Increase Independence With ADL's

Study Design This is an evidence-based project based on current research from a literature search. It is a case series design. Patients will be selected from the medical intensive care unit and will be provided with a daily upper extremity exercise program that will be completed in addition to standard interventions such as completion of activities of daily living. Currently therapist within the intensive care unit have the ability to provide upper extremity exercise programs but there is no set standard of care in place for this exercises to be done on a daily basis with patients.

Subject Selection Patients for this project will be selected from the medical intensive care unit at Upstate University Hospital. The physical therapist working in the medical intensive care unit will provide patients with a handout highlighting the project. Patients will be instructed to have their nurse contact the co-investigator through Vocera. Patients will be required to sign a consent form to voluntarily participate in this project. Patients will be expected to engage in an initial evaluation that can take up to an hour. Participation in daily treatment session will also be expected during a patients stay in the hospital. Treatment session can last from 30-60 minutes each day and will continue throughout a patients stay in the medical intensive care unit or a maximum of six weeks, which is the duration of the implementation phase of this project.

Statistical Methods, Data Analysis and Interpretation Quantitative data will be collected through the use of the Activity Measures Post Acute Care, manual muscle testing and the activity-tracking sheet. Information collected from the Activity Measures Post Acute Care will be used to determine if there were improvements in the level of assist for activities of daily living (dressing, bathing, toileting). The scores from the manual muscle testing will be used to determine improvements in upper extremity strength, while the data collected from the activity-tracking chart will be used to see the improvements in activity tolerance. Comparison of data for the manual muscle testing will use information from the initial evaluation and at the time of discharge from the medical intensive care unit. The Activity Measures Post Acute Care and the activity-tracking chart will be performed at each session and data will be compared over the span of the patients stay in the medical intensive care unit.

Study Procedures Pre-Intervention Procedures

• Request and obtain permission from the Director of therapy at Upstate Hospital. Received on 5/31/2016
• Request and obtained permission for the use of the Activity Measure Post Acute Care assessment.
• Completed the CITI training that is a requirement for IRB approval at Upstate Hospital.
• Discuss purpose of the project and review the recruitment handout with Physical therapist in the medical intensive care unit.
• Develop and photocopy recruitment handout for Physical therapist.
• Develop a set of 5 upper extremity exercises that patients will participate in daily developed in Physio-Tools. These exercises will be specialized to clients' needs.