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Progressive Upright Mobility Protocol (PUMP) Plus
Availability
For more information about this instrument: Progressive Upright Mobility Protocol Plus.
Classification
Exploratory: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage (SAH)
Short Description of Instrument
The PUMP is a series of steps designed to improve ambulation and withstand the stresses of inactivity for patients who have spent time in intensive care. The purpose is not only to prevent musculoskeletal deconditioning but also to prevent cardiovascular deconditioning.
Comments
It is a sequence of specific movements starting at the patient’s current mobility status and returning to his or her baseline level of mobility. The “Plus” part of the protocol is six additional levels for rehabilitation, for a toal of 11 steps:
1: Elevate head of the bed (HOB) 45°
2: Elevated (HOB) and legs are in a dependent position (partial chair mode or cardiac chair)
3: Elevated HOB and legs are in a dependent position (full bed chair mode/cardiac chair)  
4: HOB elevated 65°, legs in dependent position and feet are on the floow and standing in place
5: Initiate stand position/pivot and into chair
6: Transfer standing from bed to chair for 2–3 meals with sitting time not to exceed 45 min
7: Ambulate within room using assistive devices and extra personnel as needed (goal = 20 feet)
8: Ambulate within hallway using assistive devices and extra personnel as needed (goal = 50 feet)
9: Ambulate within hallway using assistive devices and extra personnel as needed (goal  = 100 feet)
10: Ambulate 150 feet with contact guard (hands on only for balance) or personnel supervision/assistance (coaching only)
11: Ambulates without coaching or supervision, may use device as necessary  
(Titsworth et al., 2012)
References
Titsworth WL, Hester J, Correia T, Reed R, Guin P, Archibald L, Layon AJ, Mocco J. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg. 2012 Jun;116(6):1379–1388.
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