Occupational therapy rehabilitation while you are in intensive care

This leaflet explains how we can help you relearn your daily activities during your time in intensive care. If you have further questions, please speak to the therapist or nurse caring for you.

How can occupational therapists help me?

Occupational therapists can help you relearn life skills, such as activities of daily living (for example grooming, feeding, dressing, banking and spending) and using your memory.

The main goals are to enable you to participate in activities of daily life to aid your recovery.

My personal goals

Things that are important for me

Things I want to do

Priority	Date	Goal	Outcome

Functional exercises to do while you are in hospital

These activities can be done with your nurse or occupational therapist. They will help give a structure to your day whilst you are in intensive care, and will help to re-enable familiar routines. 

	Dressing: ask your nurse or loved one to set up loose clothing within easy reach.
	Toileting: turn on your side whilst the nurse is helping you, or ask to use the commode if you are able to.
	Bathing: request a shower cap and bath gloves to freshen up.
	Eating and drinking: ask to speak to your occupational therapist if you are having difficulty (for example using both hands to cut up food or drinking). They can recommend some adaptive aids to help you eat and drink.
	Personal care and hygiene: ask your nurse or loved one to set up the items you need if you are able.
	Getting out of bed: ask your nurse to help you sit out in the morning.

Exercises to do while you are in hospital

These exercises are a gentle way to get your arms moving again while you are in intensive care.

Active assisted hand on head

1. With your arms hanging down, clasp your hands in front of you.
2. Move your clasped hands behind your head without loosening your grip.
3. Hold your hands behind your head for 5 seconds.
4. Lower your arms and rest them loosely at your sides for 20 seconds.
5. Repeat the exercise at least 5 times.

Active assisted hand on head to flexion (moving arms above head)

1. With your arms hanging down, clasp your hands in front of you.
2. Move your clasped hands behind your head and point your elbows out to the side of your head, without loosening your grip.
3. Raise your clasped hands above your head, hold them there for at least 5 seconds. Rest your hands back on your lap for 20 seconds.
4. Repeat the exercise at least 5 times.

Active hand behind back and head

1. Touch the back of your neck with one hand and with the other hand, touch the small of your back (or even further up your spine if you are able). Hold your hands in place for 5 seconds.
2. Drop your hands by your side and rest for 20 seconds.
3. Switch hands and do the same behind-your-back movements.
4. Repeat each movement at least 5 times.

Active shoulder abduction (moving arm away from body)

1. Drop one arm down so your palm is facing your hip. Raise your arm out to the side until it is level with your ear. Hold it for 5 seconds.
2. Raise your arm so the hand is pointing up at the ceiling and hold it there for 5 seconds.
3. Bring your hand back down to your side and rest for 20 seconds.
4. Repeat this set of movements at least 5 times.
5. Repeat the whole series of movements with your other arm.

Active shoulder flexion (moving arms above head)

1. Drop your arm so your palm is facing your hip. Raise your arm forwards, so your fingers are pointing ahead and hold this for 5 seconds.
2. Raise the arm so your hand is pointing to the ceiling and hold for 5 seconds.
3. Drop your hand back to your side and rest for 20 seconds.
4. Repeat this set of movements at least 5 times.
5. Repeat the whole series of movements with your other arm.

How to become familiar again with daily life while you are in hospital

Remembering everyday thoughts and activities will help to aid your recovery.

• It is important to have conversations with medical staff and friends and family about the reasons for your stay in intensive care.
• Your medical team will talk with you and explain what your life has been like during your time in hospital.
• A patient diary will help you to remember life during your critical care journey. It can be filled out by your nurse or any member of the intensive care team.
• Hospital staff and friends and family can help you regain your memory for things like the day of the week, date and time of day.

Managing fatigue during your recovery

How can I conserve my energy?

When you are ill or recovering from an illness, you are likely to have less energy and feel tired. A simple task, such as putting on your shoes, can feel like hard work. The following advice can help you find ways to conserve your energy as you go about your daily tasks. By making these small changes you’ll have more energy throughout the day.

Top tips for conserving energy while doing tasks

The 3 Ps principle (pace, plan and prioritise)

You will save energy if you learn to pace, plan and prioritise your daily activities.

Managing low mood and anxiety

If you feel in a low mood or anxious, these tips can help you maintain your spirits.

Controlled breathing exercise to manage your mood

This controlled breathing exercise can help to stop your mind focusing on stressful thoughts.

1. Sit or lie comfortably in a calm, quiet place. (Once you get the hang of controlled breathing, you will be able to do it anywhere and in any position).
2. Slowly inhale through your nose.
3. Hold your breath for a few seconds.
4. Exhale through your mouth.
5. Inhale again, this time counting to four.
6. Hold your breath for a few seconds.
7. Exhale, counting to six.
8. Repeat steps 5 to 7, focusing on breathing and counting while letting your body relax away from the things that are making you stressed.

Visualisation exercise to manage your mood

Some people have difficulty calming their mind long enough to focus solely on breathing and counting. If you are one of them (or even if you are not) you can try visualisation.

To do this exercise, picture yourself in a relaxing environment. Visualise the place and try to also sense the place. This is an example using a mountaintop:

• Sit comfortably in a calm, quiet place. You can choose a different location once you have become used to doing this exercise.
• Imagine you are sitting on the side of a mountain. Take in the scenery around you. The trees, wildlife, greenery, skyline and world below.
• Imagine the sounds around you. The rustling leaves as the breeze blows against them, the tweeting of birds in the sky, the bubbling of water as a stream flows in the background, the scent of mountain flowers.
• Feel the sun beaming onto your face and the breeze cooling the sun’s heat.

You can repeat the process using any setting. Remember to incorporate the sights, sounds, feelings, and smells of your chosen location so you can visualise it fully.

More information

Society of Critical Care Medicine on Post-Intensive Care Syndrome (PICS) www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome
Royal College of Occupational Therapists on conserving your energy www.rcot.co.uk/conserving-energy

_{Images on Freepick (including by storyset, studio4art)
Exercise content reproduced by kind permission of TrackActive Pro: Exercise Prescription Software with Outcome Measures} 

Contacts

Maria Paula Alvarez, Intensive Care Unit Lead Occupational Therapist, Monday to Friday 8 am to 4 pm

020 8546 7711 bleep 765