177 VR-THERAPY FOR UPPER EXTREMITIES MOBILISATION 8 8.1 INTRODUCTION In the Netherlands, an average of 80.000 patients are admitted to the intensive care unit (ICU) annually.1 Reasons for an ICU-admission are diverse, including major operations, trauma and infection.2 Advances in the management of critically ill patients have led to an increase in survival, but not necessarily to an improvement in quality of life.3,4 Many ICU-survivors suffer from newly developedorworsened long-termmental (e.g. cognitive dysfunction, emotional distress) and physical impairments (e.g. muscle weakness, reduced endurance) as a result of ICU-treatment,4 termed Post Intensive Care Syndrome (PICS).5 It is estimated that 50-70% of the ICU-survivors suffer from PICS one year after ICU-admission.6,7 The growing number of ICU-survivors with PICS shows the need to address long-term consequences more fully. Muscle weakness, referred to as ICU-acquired weakness (ICU-AW), is one of the consequences of critical illness and immobilisation. ICU-AW occurs within 24h and continues to progress during admission.6-8 In the ICU, mobilisation is therefore started as early as possible to diminish long-term muscle weakness. Early mobilisation could include any combination of bed mobility practice, active exercises in bed, transfers from sitting to standing and walking, or lifting to a chair.6 Early mobilisation is feasible, safe, and can improve muscle strength and function at ICU-discharge.9-13 However, in clinical practice, there are barriers to implement early mobilisation, such as lack of staff, equipment, and knowledge.14 Moreover, patient anxiety and lack of motivation, confidence, and knowledge about ICU-AW are identified as barriers impeding adherence to early mobilisation.15 The ideal early mobilisation program should deliver therapy that is feasible for staff as well as safe and motivating for patients. Virtual Reality (VR) therapy may provide a solution to address barriers of delivering early ICU-mobilisation in a fun, relaxed way. VR can influence patient behaviour by presenting strong immersive stimuli and its ability to provide a feeling of presence and emotional engagement in a virtual three-dimensional world.16-18 Exercises embedded in VR are more engaging than in a sterile medical setting, which may increase patient motivation and subsequent adherence to therapy.17-19 VR is a helpful tool to recover cognitive and motor functioning of populations with neurodegenerative diseases, traumatic brain injury, and stroke.17,18,20-23 Prior to using VR-therapy as an adjunct to standard daily early mobilisation and physical therapy in ICU-patients, its feasibility must be assessed. The primary
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