Category: Complementary Integrative Rehabilitation Medicine; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To determine if patients with a Left Ventricular Assist Device placed in the post partum period can benefit from acute inpatient rehabilitation, and to identify the special considerations the rehabilitation team use in developing a rehabilitation plan.
Design : A report of one case.
Setting : A free standing acute academic inpatient rehabilitation hospital.
Participants (or Animals, Specimens, Cadavers) :
A 21 year old female underwent a spontaneous vaginal delivery with a complicated post partum course including endometritis, septic shock, and acute decompensated heart failure (EF 28%). She underwent multiple surgical procedures including left ventricular assist device (LVAD) placement. After LVAD placement, she had distal weakness, neuropathic pain, and sternal precautions leading to deficits in mobility and self care; she was admitted to acute inpatient rehabilitation to upgrade her functional status.
She underwent an intensive inpatient rehabilitation program. Physical therapy focused on her cardiopulmonary status, endurance, transfers, ambulation, bed mobility, sternal precautions and safely carrying her LVAD unit. Occupational therapy focused on her self care while keeping the LVAD safe, including dressing, bathing, toileting, LVAD power changes, and infant care. From a medical standpoint, she required management of her neuropathic pain, fluid status, edema management, and depression.
Main Outcome Measure(s) :
1 - Change in patient functional status as measured by the Functional Independence Measure specific tasks.
2 – Discharge destination.
On admission she required contact guard assistance for bed mobility, minimum assistance for transfers, moderate assistance for ambulation 94 feet, maximum assistance for climbing four stairs, moderate assistance for lower body dressing, toileting and toilet transfers. The therapists also addressed bottle preparation, infant clothing changes, and diaper changes. On discharge she was modified independent for bed mobility; and supervision for transfers, ambulation 420 feet, 16 stairs, lower body dressing, toileting and toilet transfers.
Discharge destination: home with family.
A coordinated effort between therapy and medical teams can allow for a unique post-partum rehabilitation plan in a population facing LVAD care, sternal precautions, and depression. Understanding specific home needs and goals to care for infant allowed the rehabilitation team to set particular goals and standards needed for safe discharge home with infant.
George Malik– Resident Physicain, Shirley Ryan Ability Lab, Chicago, Illinois
Allison Armstrong– Physical Therapist, Shirley Ryan Ability Lab, Chicago, Illinois
Erin Walaszek– Physical Therapist, Shirley Ryan Ability Lab, Chicago, Illinois
Leslie Rydberg– Assistant Professor, Shirley Ryan Ability Lab, Chicago, Illinois