Rehabilitation conceptual model

This chapter addresses the importance of integrating the process of rehabilitation within the milieu of critical care. A conceptual model will be presented to show how rehabilitation can be organized within the ICU, incorporating the whole of the patient s journey irrespective of their length of stay (LOS) within the ICU. The chapter will focus on those patients who require prolonged mechanical ventilation (PMV), i.e., >21 days and will be presented from a U.K. perspective. Case examples from my own critical care practice will be used to demonstrate how a rehabilitation framework of care impacts upon patient mortality, quahty of care, and ICU costs. Finally, recommendations will be made for future practice. 

Figure 4 shows a conceptual model that encompasses the phases of the patient s potential journey through ICU. Inevitably, these phases overlap. As the LOS increases there are greater risks of secondary infections and acute events that require management. Therefore, the intermediate or long-term phases pause, although rehabilitation should never be stopped, but... 

Figure 4 Conceptual model of rehabilitation for each phase of a patient s potential journey through ICU. Abbreviation. ICU, intensive care unit.

Schizophrenia was conceptualized as a behavior taught to a child by a schizophrenogenic parent. Patients were then isolated from their families for long-term hospital care. In recent years, the approach has been to effect social rehabilitation with active involvement of the family. We will first review evidence pertinent to earlier approaches and then discuss the more recent assertive case management model. 

Note that resource availability in GSPT and thus in the ERM is potentially a function of time, allowing quantitative modeling of dynamic processes such as child development, aging, disuse atrophy, and rehabilitation. The notation further implies that availability of a given resource must be evaluated at a specific operating point, denoted as Q. At least conceptually, many parameters can be used to characterize... 

This classification is a useful distinction that can be applied to the conceptual rehabilitation model and framework (Figs. 4 and 5). The core ICU team undertakes the acute and intermediate phase of nonspecialized rehabilitation. The long-term phase is specialized rehabilitation and again undertaken by the core ICU team but in collaboration with other relevant specialist practitioners, such as speech and language and occupational therapy, to optimize the patients rehabilitation potential. 

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