Early mobilization of patients with severe deconditioning can be a daunting task for therapists. In the past, physical manpower has been used to begin standing these patients when they lacked the lower extremity strength to support full body weight. The manual lifting approach has proven to be physically taxing for therapists and psychologically degrading for patients because the activity is too difficult for the patient. This article describes the use of a dynamic tilt table that allows severely deconditioned patients to perform closed-chain exercise in a gravity-reduced environment from 2% to 75% body weight depending on the incline. Use of the dynamic tilt table offered a safe and controlled transition from bedrest to standing with full body weight and appeared to expedite the recovery process compared to the manual lifting approach. Additionally, it appeared to provide psychological benefits by empowering the patients with an activity they could perform without physical assistance.

With survival rates increasing due to continuing advancements in medical technology, the impact of prolonged immobility of the medically complex patient becomes an even more profound and costly issue for healthcare providers. A decrease in physical activity is often linked to losses in the functional capacity of the musculoskeletal and cardiovascular systems. These two systems are critical to achieving and maintaining functional independence, which is a prerequisite for discharge from a healthcare facility.  The return to functional mobility, and the minimization or prevention of complications encountered by the bedridden patient, are increasingly important issues for healthcare providers to address.

History - 45 year-old female admitted with a small bowel obstruction. She underwent an exploratory laparotomy the following day and developed multiple post-operative complications including acute respiratory failure, renal failure, pneumonia, and ventilator dependency requiring a tracheostomy. Patient deemed medically stable for physical therapy four weeks after admission. Patient was hypertensive and morbidly obese (Height: 4’11”, Weight: 260 lbs). Prior to admission, patient was active and independent in all ADLs.

History - 57 year-old male admitted to the emergency room with difficulty walking and numbness to the feet, diagnosed with Guillain-Barré Syndrome. The patient was moved to the ICU and placed on mechanical ventilation due to respiratory failure. He underwent five treatments of plasmaphoresis and required a tracheostomy for long-term mechanical ventilation. Physical therapy was consulted to begin rehabilitation. Patient was independent with all ADLs prior to admission.

History -  52 year-old male admitted to the ICU with right-sided weakness and diagnosed with a left hemorrhagic stroke. Patient was extubated and deemed medically stable on day two. Physical and Occupational Therapy were consulted on day three. Patient was independent with all ADLs prior to admission, working as a truck driver.