Got a patient who suffered an embolic stroke due to valve defects from RHD. Just would like to find out if it would be safe for me to put him on arm and leg ergo without the risk of dislodging an embolus and causing another stroke. Patient also is on warfarin due to thrombus formation. If you had a similar experience with a patient like this I would just like to find out how did you deal with the situation. Much thanks! Alex
Joined: October 21, 2005
Seems to me the risk is reduced by his anticoagulation and as long as his "INR" (International Normative Ratio - an indicator of clotting with 1 being normal, 2 being that clotting takes twice as long as normal) is therapuetic and the MD says go for it is as safe as anything else the patient needs to do to live life. Asking the patient to do the ergometer is not more difficult than daily tasks the patient does regularly. In fact, often times, since we are aiming for aerobic training which needs to be at an intensity that can last 6-20 minutes the ergometer is easier. If it is harder, and they are working harder than in daily life, than the role of the ergometer should be assessed, and the use of structured intervals should be incorporated since you are doing near, maximal, or perhaps supramaximal VO2 max training. Hope this helps - Sean
Sean M. Collins, PT, ScD, CCS Associate Professor Research Coordinator Department of Physical Therapy Coordinator, Graduate Program in Disability Outcomes Adjunct Professor, Department of Work Environment School of Health &
That helped a lot Sean. I will look into his INR. Its my first time to hear about it. As for the MD orders I think I can get the MD to agree with me on putting him on ergo. We are currently doing 10 minutes with very little resistance as I am a little bit apprehensive. Thanks once again Alex
Joined: January 25, 2003
You will be perfectly safe, particularly with anticoagulation. Therapuetic INR is between 2-3, but even without this, being on the cycle ergometer would pose no more risk than the typical ADL just as Sean mentioned.
Dr. Wagner DO Moderator of Medical Complexity Forum