The goals of individuals recovering from serious chronic illnesses and conditions with long stays in the ICU are simple, yet powerful. The ability to walk 100 yards to see your son graduate, the delight of pushing your grandchild in a stroller, or the fulfillment of taking one last cherished trip are the everyday actions that can motivate even the most medically complex cases to accomplish rehabilitation goals.
UT Southwestern’s Kim Barker, M.D., Associate Professor of Physical Medicine and Rehabilitation, found great inspiration in helping a patient who simply wanted to get close enough to see his son receive his diploma. “He had polio, post-polio, and then also a heart and kidney transplant on top of it, and I thought how simple and tangible his goals were. It’s not like he wanted to climb Mount Everest. It was just, ‘I want to be able to walk that one time.’ That's part of why I really like the medically complex patients, because they've gone through so much, and a lot of them have literally faced death. They have a new chance at life, but it doesn't always mean they’re able to function physically or cognitively the way they were hoping to. That’s where I hope to come in.”
This growing subspecialty in the field of Physical Medicine and Rehabilitation at UT Southwestern finds great success by knowing a patient’s history, completing a physical exam, and also getting to know each patient to get a better understanding of what is preventing them from doing what they want to do. It takes a collaborative effort from doctors, physical, occupational, and speech therapists, and nurses to help patients reach their milestones. The pride and joy on a patient’s face when they succeed – even in the smallest way – speaks volumes about the impact of this multidisciplinary approach.
Defining the recovery path
The treatment might start while waiting for a transplant or after a prolonged ICU stay and continue on in an outpatient setting.
Every patient and their challenges are different, but the physicians in the ICU at UT Southwestern know how important it is to get people up and moving and to be vigilant in screening for changes in cognition as early as possible. Getting patients started with physical therapy to maintain muscle mass and endurance, and speech therapy to focus on communication, swallowing, and cognition is incredibly beneficial to make up for anything that’s been lost.
Dr. Barker adds, “We do a fabulous job of getting what other hospitals would think of as super sick people up and moving – even in the ICU. Many have been so sick for so long and multiple complications will have happened to them that are unexpected and unavoidable. It’s figuring out how does that complication impact their functioning and what they’re able to do, and how do we improve that or work around it so that they can get better functionally.”
Tuning in to patient goals
Of utmost importance to Dr. Barker’s work is figuring out a patient’s goal. Everyone wants their patient to get stronger and improve, but what might be “better” to the patient is different than what the physician thinks and she works to bridge those goals. Patients don’t say, “I wish my heart pumped more effectively.” They say, “I want to go fishing again.” The physician might have one outcome metric in mind, but what might be more important to the patient is not having to have their loved ones help them in the restroom. “If they can be with their family or go out with their friends and be able to live what we would call a ‘normal life’ – socialize and be a member of their community – then that’s what our goal is,” says Dr. Barker.
One patient of Dr. Barker’s had metastasis in his spine causing paraplegia. Eventually his goals changed and he said, “I have grandkids, and I can’t push the stroller and push myself in the wheelchair.” Dr. Barker saw the utility in a power wheelchair and prescribed one so that he could push his grandkids during walks in the neighborhood.
These somewhat ordinary activities lead to extraordinary recoveries in the patient’s Dr. Barker sees. She recalls helping one patient, who developed critical illness myopathy resulting in quadriplegia and was unable to feed himself, recover to the point that he could get around not only in his apartment, but also in the community and ultimately drive himself to the clinic and walk in using only a cane.
At UT Southwestern, a dedicated team comprising physician specialists, therapists, nursing staff, and care management all work together to care for patients. Dr. Barker emphasizes, “It takes a village. As an exceptional institution and one that is especially unique in North Texas for this discipline, we receive referrals for these critically ill patients that other hospitals have given up on, and it’s a privilege to leverage our talent and abilities to help them achieve their goals.”