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Janine Keswick, a 45 year old woman, is admitted to your ward after a 3-week stay in ICU. As a result of a motor vehicle accident,

Janine sustained unstable open-book pelvic fracture and spiral fracture of the right mid-femur. Following surgery, she was ventilated in ICU for two weeks and required inotropic support due to sepsis. She was fed enterally while intubated.

Research evidence shows that survivors of severe critical illness, like Janine, experience prolonged neuromuscular complications after discharge from ICU.

Research also shows that rehabilitation for patients who sustain pelvic and lower extremity trauma is complex. Janine�s weight-bearing status is restricted; she will not be fully weight-bearing until 12 weeks after her injury and surgery.

In this essay, you are required to:

� Analyse the pathogenesis of neuromuscular weakness in critically ill patients, with particular reference to Janine;

� Identify a muscle strengthening and reconditioning rehabilitative approach for Janine.

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