Effect of Neurophysiological Facilitation Techniques in Intensive Care Patients

The aim of this study was to investigate the effect of neurophysiological facilitation techniques on respiratory and functional levels in intensive care patients. Participants were divided into two groups as experimental (n=20) and control (n=20). Conventional physiotherapy, which includes chest physiotherapy, mobilization exercises and range of motion exercises were applied in control group. Neurophysiological facilitation techniques in addition to the conventional physiotherapy program ere applied in experimental group. The functional status, lower and upper extremity muscle strength, grip strength measurements of the patients and the rates of weaning from mechanical ventilation were evaluated before and after treatment. Vital signs, dyspnea and fatigue perception were assessed each day of treatment. Evaluations were analyzed statistically using Statistical Package for the Social Sciences-22 program.

The intensive care unit is a multidisciplinary unit in which patients with acute, life-threatening organ dysfunction or under risk are monitored and treated comprehensively. Advanced technology is used for follow-up and treatment in intensive care. These supports decrease the mortality rate. However, the increase length of stay in the ICU leads to higher hospital costs in addition to serious secondary pathologies. Prolonged immobilisation in the intensive care unit(ICU); causes the loss of muscle mass and strength of the patients. When the course of illness, the medical devices used, various medications, malnutrition and other reasons such as sepsis are accompanied by this immobilization, the disorder called Intensive Care Acquired Muscle Weakness (ICU-AW) occurs. This neuromuscular disorder, also causes functional impairments after ICU discharge.

Early physiotherapy intervention in ICU, has a positive effect on the symptoms frequently occur in patients. In addition to improve the functional status of the patient such as exercise capacity, muscle strength and mobilization, its increase weaning from mechanical ventilation, and decrease the length of stay in the ICU and hospital. It also provides airway clearance, reduction the work of breathing and improvement of respiratory function.

Neurophysiological facilitation of respiration is the use of proprioceptive and tactile stimulation that produce reflexive movement responses. These responses provide to increase the depth of breathing, decrease respiratory rate in patients with decreased level of consciousness. It also increase inspiratory expansion of the ribs, epigastric excursion and abdominal muscles tone. In the study conducted Kumar et al. has indicated that neurophysiological facilitation (NPF) techniques improves levels of dyspnea and oxygen saturation (spO2) in Coronavirus patients. It is very important to increase the level of oxygen saturation to rate the mortality. In NPF techniques, respectively the proprioceptors and tactile receptors in the abdominal, intercostals and spinal muscles are affected, phrenic motor neurons are stimulated, thoracic and abdominal excursions are increased and thus provide improves vital parameters.

Eligibility Criteria:
Inclusion Criteria:

* Clinically Unstable
* Participants Over the Age of 18
* Individuals who volunteered to participate in the study or were allowed by their first-degree relatives if they were unconscious.
* Patients who are suitable for physiotherapy by the intensive care specialist.

Exclusion Criteria:

* Having coagulation disorder (INR \> 1,5 platelet\<50.000 mm3)
* Having neuromuscular diseases
* Having psychiatric disease or overly agitated (Richmond Agitation Sedation Scale score ≥ +2)
* Having acute stroke
* Having Raised Intracranial Pressure Syndrome symptoms
* Having cardiac and respiratory instability (Respiratory frequency \> 30 breaths/min,Partial pressure of oxygen(PaO₂)\< 65 mmHg , fraction of inspired oxygen(FiO₂)\>%55, Diastolic blood pressure \< 50 mmHg or \> 200 mmHg , Systolic blood pressure \< 80 mmHg or \> 200 mmHg)
* Having hemodynamic instability (intropin dose \> 5 mcg/kg/min)
* Fever
* Malignity
* Shock
* Patients admitted to ICU after cardiac, trauma and surgery