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Patient Information

Rehabilitation after your stay in intensive care

https://kingstonhospital.nhs.uk/information/occupational-therapy-rehabilitation-after-your-stay-in-intensive-care

This leaflet explains how we can help you recover and return to your everyday activities following time in intensive care (ICU). If you have further questions, please speak to the therapist or nurse caring for you.

Graphic showing possible post-ICU problems

Recovery after time spent in ICU

Everyone reacts to a stay in ICU in different ways, but most people undergo some reaction, both during and afterwards.

It is common for people to have health problems that remain after they have experienced critical illness. These problems can involve your body or mind (thoughts, feelings) and they may affect your family.

There can be problems with thinking and judgment, known as cognitive (brain) dysfunction, or other mental health problems. There can also be ICU-associated muscle weakness.

You may need help with activities after leaving the hospital. Up to 50% of patients may return to work within the first year, but some might not be able to return to the jobs they had before their illness.

ICU-associated muscle weakness

Muscle weakness often develops during an ICU stay. It is a common problem associated with being critically ill and it affects

  • 33% of all patients on ventilators
  • 50% of all patients admitted with severe infection (known as sepsis)
  • up to 50% of patients who stay in the ICU for at least a week.

Patients with muscle weakness may take more than a year to recover fully. It makes daily living activities difficult, for example grooming, dressing, feeding, bathing and walking. It may greatly delay you from resuming activities the way you used to before you were ill.

How to manage fatigue and muscle weakness

Man shaving

Washing and grooming

PaceSit to wash your face, brush your teeth and dry your hair
Have a rest after each
Pat yourself dry rather than rubbing dry
PlanKeep all the things you need in the same place
Put a mirror at face level when sitting
Liquid soap lathers more quickly than bar soap
Use long-handled equipment, such as a long-handled sponge
PrioritiseTry using dry shampo
Use electric items, such as a toothbrush and razor
Image of bathing and showering

Bathing and showering

PaceAllow plenty of time and take a rest as you go
Sit in the shower if possible
PlanOpen an inside door to allow good ventilation
Use long-handled equipment
Equipment such as a rail or chair can help you get in and out of the bath or shower
PrioritiseIs bathing an activity you enjoy and are willing to spend a lot of energy on?
Is a daily bath or shower necessary?
Can you have a strip wash at the sink instead during your early recovery?
Dressing image

Dressing

PaceSit to dress
Break up tiring tasks with easy ones and take a rest several times
Dress your lower half first, when you have the most energy
PlanKeep all the things you need in the same place
Collect all your clothes before you start
Wear clothes that fasten at the front and are loose
Put pants and trousers on at the same time and then pull them up together
Put skirts on over your head
Sit down to put on shoes and socks. Lift and cross one leg onto your knee to bring your foot closer
PrioritiseCan you rearrange your wardrobe and drawers so that all your clothes are close together?Can a member of your household get your clothes out and help you get dressed?
Image of people making a bed

Making the bed

PacePut on the sheet, stop for a rest, then do the pillowcases, then rest again
Sit for some of the task, such as doing the pillows
Get help with the duvet cover
PlanHave your bed positioned so you can walk all the way around it
Start and finish one side, then move to the other so you only circle the bed once
PrioritiseCan you take turns with someone you live with, or can they make the bed for you?

Image of cooking pot

Cooking

PaceSpread the preparation throughout the day
Peel vegetables in the morning, cook in the afternoon and reheat in the evening
Sit to prepare food or when waiting to stir
Take rests during and after cooking
PlanCook large amounts and refrigerate or freeze extra portions
Get everything you need ready before you start
Find recipes with a short preparation time
Use a trolley to move cooking equipment or cutlery for the table
PrioritiseBuy frozen ready meals for days when you are very tired
Can a member of your household cook for you?
Image of food shopping basket

Shopping

PaceHave a rest when you get to the shop
Take your time collecting your items
Put heavy items in different bags
Use a trolley to push your shopping home rather than carrying a bag
PlanMake a list that follows the aisles and means you only need to visit one or two shops
Shop at quieter times of the day
Avoid large/deep trolleys to reduce bending when putting in and removing items
Pack items together that go in the fridge/freezer or same cupboard, so it is easier to unpack
PrioritiseCan a member of your family help?
Can you do online shopping?
Laundry image

Laundry

PaceSpread the tasks throughout the day
Load the machine in the morning and empty it in the afternoon
Sit down to iron
Use a low clothes horse and sit to hang out washing
Take rests during and afterwards
PlanWear clothes that wash, dry and iron easily
Do several smaller loads each week, rather than one large wash
Store everything you need in one place, such as powder and pegs
Use a laundry basket on wheels
If possible, have your dryer at chest height
PrioritiseIs it necessary to iron all of your clothes?
Can someone help you fold large or heavy items, such as sheets and towels?
Can someone else do the laundry?
House cleaning image

Housework

PaceSpread heavy activities throughout the week
For example, Hoover a different room each day
Do a mix of heavy and light activities in a day
Have a rest during and between activities
Sit down for tasks like polishing or washing up
PlanCollect all the items you need before you start
Use long-handled equipment where possible
Use a mop to clean floor spills rather than bending over
Allow washing-up to air dry
Use small rubbish bags so you don’t have to lift one heavy bag
PrioritiseCan someone else do the heavy activities for you?

Hand-strengthening exercises

You can do these gentle exercises with putty to get your hands moving again after your stay in hospital.

For each of the following exercises, follow the instructions 5 times (this equals one set of exercises). Do each set three times. (This means you will squeeze the putty 15 times for each exercise).

Resisted lateral pinch exercise
Place the putty in between your thumb and the side of your index (first) finger.
Press down with your thumb to squeeze the putty.
Unflatten the putty, reposition it and start again.
resisted lateral pinch crop
Resisted single finger extension exercise
Put the flattened putty and the heel of your hand on the table.
Begin with your index (first) finger bent into your palm while keeping the finger tip on the putty.
Straighten your finger against the resistance of the putty.
Do not let your wrist or forearm help with the motion of your finger.
Lift your finger out of the putty.
Reflatten the putty, reposition your hand and start again.
Resisted single finger extension
Resisted three point pinch exercise
Hold the putty inbetween the pad of your thumb, index (first) and middle fingers.
Pinch the putty as firmly as you can, by squeezing your fingers and thumb together.
Unflatten the putty, reposition your hand and start again.
Resisted three point pinch
Resisted thumb extension exercise
Use your unaffected hand to wrap the putty around your thumb.
Hold the end of the putty in your unaffected hand.
Move your thumb out from the palm of the hand.
Re-roll the putty, reposition it and start again.
Resisted thumb extension
Resisted thumb flexion (bending around joint) exercise
Place the putty in your palm.
Bend your thumb towards the base of your little finger, pushing it into the putty.
Unflatten the putty, reposition it and start again.
Resisted thumb flexion
Resisted thumb palmar abduction (moving thumb) exercise
Wrap the putty around your thumb and index (first) finger. Move your thumb away from the index finger so it is in front of your palm. Unflatten the putty, reposition it and start again.
Resisted thumb palmar abduction
Resisted two point pinch exercise
Place the putty between the pad of your thumb and the pad of your index (first) finger.
Squeeze the putty.
Unflatten the putty, reposition it and start again.
For variation, you can change the thickness of the putty between your thumb and finger.
Resisted two point pinch

Hand-movement exercises around the house

When your hands are feeling strong enough, you can start doing some common daily-living movements. These include:

  • picking up coins and small items such as paper clips, pasta pieces
  • buttoning and unbuttoning clothes
  • tying shoelaces
  • handwriting exercises from a section of a newspaper, book or magazine
  • shuffling and passing during card games
  • opening household items such as jars, bottles, cans
  • engaging in hobbies such as painting, playing a musical instrument, jigsaw puzzles, arts and crafts.

Cognitive or brain dysfunction

This refers to problems connected with remembering, paying attention, solving problems, and organizing or working on complex tasks.

After leaving the ICU, 30% to 80% of patients can experience these kinds of problems. Some people improve during the first year after discharge from the hospital, but other people may never fully recover.

Cognitive dysfunction might affect whether you can return to work or perform daily tasks that involve organization and concentration.

How to manage memory and concentration difficulties

Create a food shopping list or a to-do list.To do list plain
Save medical appointments and other important dates in a calendar.Plain calendar
Do regular crossword, sudoku or word search puzzles.Sudoku

Other mental health problems

Critically ill patients may develop problems with falling or staying asleep. They may have nightmares and unwanted memories. Reminders of their illness may produce intense feelings or strong, clear images in their mind. Their reactions to these feelings may be physical or emotional.

Patients may also feel depressed and anxious and have symptoms of post-traumatic stress disorder (PTSD). These include having bad dreams and unsettling memories, feeling ‘keyed up’ and wanting to avoid thinking or talking about their stay in the ICU.

How to manage anxiety

Go for a walkwalking imageMeditatemeditation image
Eat healthilyhealthy eating imagePrioritise sleepsleep image

Progressive muscle relaxation

The idea behind progressive muscle relaxation is that your body may not know the difference between being tense and relaxed. This makes it hard for you to relax properly.

It will help if you can learn how to tense up and then release.

The following exercise can teach your body how to tense and release:

  • lie comfortably on the floor, your bed, or any other available surface
  • tense your toes and hold for 5 seconds
  • relax your toes and hold for 30 seconds
  • moving up your body, tense your foot and hold for 5 seconds
  • relax your foot and hold for 30 seconds
  • tense your calves and hold for 5 seconds
  • relax your calves and hold for 30 seconds
  • repeat tensing and relaxing with each part of your body, moving upward and finishing with your head and neck. If you prefer, you can reverse this and begin with your head, working your way down to your toes.

More information

SCCM logo
Society of Critical Care Medicine on PICS
www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome
QR code for Society of Critical Care Medicine on PICS

Royal College of Occupational Therapists on how to conserve your energy
www.rcot.co.uk/conserving-energy
QR code for Royal College Occupational Therapists on conserving your energy
CIBS Center logo
Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center on PICS
www.icudelirium.org/patients-and-families/pics
QR code for CIBS Center info on PICS
CIBS Center logo
Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center on cognitive impairment
www.icudelirium.org/patients-and-families/cognitive-impairment
QR code for CIBS Center info on cognitive impairment

Images by Freepik (incl rwapixel, studio4art, upkiyak, macrovector, pikusperstar and brgfx)
Exercise content reproduced by kind permission of TrackActive Pro: Exercise Prescription Software with Outcome Measures 

Occupational therapy rehabilitation after your stay in intensive care - Kingston Hospital Download PDF


Contacts

Maria Paula Alvarez, Intensive Care Unit Lead Occupational Therapist, Monday to Friday 8 am to 4 pm 020 8546 7711 bleep 765

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For detailed information on accessibility at Kingston Hospital visit Kingston Hospital AccessAble (https://www.accessable.co.uk/kingston-hospital-nhs-foundation-trust).


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