Early Interventions, Lasting Impact: A Case Report on the Role of Physiatrists in Guiding Recovery from Critical Illness Myopathy

Case Diagnosis: Critical illness myopathy following cardiogenic shock from pre-eclampsia

Case Description or Program Description: A 30-year-old Spanish-speaking woman at 36 weeks gestation presented to an acute care hospital in cardiogenic shock suspected from pre-eclampsia. She underwent an emergent cesarean section and was placed on veno-arterial extracorporeal membrane oxygenation. Subsequently, she lost lower extremity movement and reflexes, suspected from an ischemic spinal cord injury despite early negative imaging. Physiatry was consulted in the intensive care unit and followed the patient throughout her acute care stay, providing recommendations for bowel and bladder, spasticity, and assisting in identifying a diagnosis of critical illness myopathy (CIM). The patient was later transferred to inpatient rehabilitation (IPR), where repeat electromyography confirmed a diagnosis of CIM.

Setting: Acute care, IPR, outpatient

Assessment/Results: The patient made remarkable functional progress during her IPR stay. Her functional status at time of admission IPR was maximum assist and at time of discharge she was functioning at a level of modified independent with a wheelchair for mobility and independent with self care and activities of daily living (ADLs). She continued to follow with physiatry throughout her outpatient therapy course, progressing to household ambulation with the use of assistive devices and full independence with ADLs.

Discussion (relevance): While the benefit of IPR for patients with a late diagnosis of CIM has been previously described, there is limited literature describing the benefits and long term functional outcomes of patients for whom early and continued involvement of PM&R was sought. This case highlights the crucial role physiatrists play within the interdisciplinary team in identifying diagnoses and guiding early interventions to optimize functional status at all stages of recovery.

Conclusions: Early involvement of physiatrists in the care of critically ill patients can contribute to patient success throughout the recovery process, potentially accelerating functional recovery by targeted interventions and early identification of debilitating diagnoses.