Background: The CentriMag Extracorporeal Blood Pumping System is an effective means of temporary ventricular support for patients acutely decompensating from cardiac shock. Out-of-bed activities are not currently recommended by the manufacturer, leaving patients functionally limited and restricted to the intensive care unit (ICU). Purpose: This report aims to describe progression of functional mobility and ambulation with CentriMag ventricular assist device (VAD) equipment using appropriate clinical reasoning and multidisciplinary collaboration. Methods: Functional mobility activities were initiated on the first physical therapy (PT) session and progressed throughout the length of stay and included sit–stand transfers, bed–chair transfers, standing activities, and ambulation. Outcomes: The patient remained in the cardiovascular surgical ICU for 30 days and received PT for 13 total treatment sessions with 4 different physical therapists without adverse events. Out-of-bed activities were performed during all 13 PT sessions and the average session duration was 49.8 minutes. Ambulation was documented on 9/13 sessions and on the days the patient ambulated, and the average distance was approximately 183 feet. The patient was seen on 7 occasions with biventricular assist device CentriMag devices and 6 occasions with the concurrent CentriMag right VAD–HeartMate II left VAD. Discussion: As the technology and scope of application for VADs continues to progress, it is imperative that the acute care PT understands the complexities, risks, and benefits of functional mobility in critically ill patients. Conclusion: This report suggests that mobilization with CentriMag devices is feasible, without adverse events, using appropriate clinical decision-making, and suggests that patients who ambulate under multiple conditions of CentriMag VADs may demonstrate functional improvements.

Purpose: Despite the prevalence of dizziness and vertigo, evidence examining the impact of acute vestibular physical therapy evaluation and intervention for patients reporting these symptoms in the acute care setting is limited. Recent evidence indicates that patients may present with vestibular impairments without obvious symptoms; however, physical therapists are not routinely evaluating for vestibular dysfunction in hospitalized adults. The primary purpose of this study was to determine the influence and feasibility of vestibular physical therapy evaluation and treatment on recommended discharge environment for hospitalized inpatients. Methods: A retrospective chart review was conducted of patients who were referred for vestibular physical therapy evaluation and treatment after not responding to conventional balance intervention during hospitalization. Primary outcome measures included change in recommended discharge environment and time in minutes for the vestibular encounter. Secondary outcomes included the Activity Measure for Post-Acute Care (AM-PAC) Basic Mobility Score and the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale from prior to vestibular encounter and upon discharge. Results: Twenty-two patients who met inclusion criteria were included for analysis. Of the patients evaluated for vestibular impairment, less than 5% had been admitted for symptoms of dizziness. A statistically significant change in recommended discharge environment after the vestibular physical therapy encounter was found (χ2 = 64.86, P < .001), with an associated 54.5% reduction in the number of patients requiring inpatient rehabilitation. Average session duration for all vestibular encounters was—mean (SD) [range]—57.59 (21.19) [30-120] minutes. Significant differences in functional mobility from prior to the vestibular encounter to discharge were found for both the JH-HLM (P = .003) and the AM-PAC (P = .050). Discussion: This study demonstrates that identifying and treating hospitalized patients with vestibular impairments regardless of having a primary admitting diagnosis of vestibular impairment may influence the recommended discharge environment resulting in higher levels of mobility during and after hospitalization. While a higher overall treatment time was required to address vestibular impairments during hospitalization, the significant reduction in patients recommended for inpatient rehabilitation suggests potential for significant health care dollar savings for both the patient and the institution. Further exploration is needed to investigate vestibular intervention and overall reduction in length of stay. Conclusion: By providing a more comprehensive approach to evaluation and assessment, acute care physical therapists can have a profound impact in early identification of vestibular impairments in hospitalized inpatients, thus providing more focused therapy interventions, promoting more rapid improvements in functional mobility, and facilitating discharge to the most appropriate destination.

This clinical perspectives article provides a comprehensive and evidence-based overview of diagnosing and treating dizziness in complex patients. These patients typically present with overlapping comorbidities and symptoms that can create difficulty in discovering an accurate diagnosis and treatment plan. Vestibular dysfunction affects over 35% of adults older than 40 years, and that prevalence significantly increases with age. Eighty-five percent of adults older than 80 years had evidence of balance/vestibular dysfunction. We believe this differential diagnosis between cardiopulmonary and vestibular dizziness transcends all rehab environments across the continuum of care. We will provide evidence for vestibular background knowledge and clinical skills that intersects with evidence regarding pharmacology and competing cardiopulmonary diagnoses to provide clinicians with the framework, skills, and knowledge to differentially diagnose dizziness across multiple care settings. In addition, we will provide examples of appropriate interdisciplinary communication to assist the clinician in decision making and best practice management.