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EXERCISE - The EXercise and Early Rehabilitation in Critically Ill Children: a Systematic Evaluation

Lay Abstract

When children suffer from a critical illness, we focus on resuscitating and saving lives. Typical intensive care practices of liberal sedation and maintaining these children in bed for prolonged periods of time, applied with the intent of enhancing their safety and recovery from critical illness, have paradoxically contributed to the development “side effects” of a Pediatric Intensive Care Unit (PICU) stay. Such side effects include muscle weakness, difficulty weaning from a ventilator, prolonged PICU and hospital stays, and delayed recovery. Furthermore, once these children leave the PICU, very little is known about what happens to them - how long it takes for them to recover, how families cope, and what factors that impede their recovery. The specific objectives of this research project are to 1) understand how children recovery after a critical illness; 2) evaluate the risk factors for poor recovery; 3) evaluate rehabilitation interventions that might enhance recovery after a critical illness. This research will help us develop best practice recommendations for the care and follow-up of critically-ill children that currently do not exist, and develop sustainable programs to support the rehabilitation of our patients.

Phases of the EXERCISE research program:

Phase 1) To evaluate knowledge, perceptions, stated and actual rehabilitation practices within Canadian PCCUs

Phase 2) To evaluate functional recovery, and predictors of impaired recovery in critically ill children

Phase 3) To evaluate the effectiveness of acute rehabilitation on patient important PCCU outcomes and functional recovery in critically ill children

Phase 4) To develop evidence based rehabilitation guidelines to optimize both PCCU and post-discharge based recovery in critically ill children.


1. Early mobilization in critically ill children: A Survey of Canadian Practice. Choong K, Koo KY, Clark H, Chu R, Thabane L, Burns KE, Cook DJ, Herridge MS, Meade MO. Crit Care Med 2013;41:1745-53.

2. Acute Rehabilitation in Critically ill Children. Choong K, Corsi D, Tran N, Clark H, Cupido, C. J Pediatr Intensive Care 2012;1(4):183-92

3. Acute Rehabilitation in Critically Ill Children: a multi-center study. K Choong, D Fraser, K Menon, J Hutchison, A Joffe, P Jouvet, E Pullenayegam, R Ward, on behalf of the Canadian Critical Care Trials Group). Manuscript under review, Critical Care Medicine, Sept 2013. Abstract accepted for presentation at Critical Care Forum Canada 2013 (Submission ID# 0309-000090)

4. Wii-Hab in Critically ill Children: a Pilot Trial. F Abdulsatar, R Walker, H Clark, B Timmons, K Choong. Accepted for publication Sept 2013, Journal of Pediatric Rehabilitation Medicine.

5. Early Rehabilitation in the Pediatric Critical Care Unit: a Pilot Study. K Choong, M Chacon, R Walker, G Al-Mahr, H Clark, B Timmons. Accepted for presentation at Critical Care Forum Canada 2013 (Submission ID# 0309-000146)

6. The Wee-cover Pilot Study: an evaluation of Functional Recovery in Critically Ill children. S Al-Harbi, K Siu, H Clark, B Timmons, B Baird, JW Gorter, L Thabane, K Menon, M Khetani, K Choong. (Clinical Trials.gov # NCT00896220). Accepted for presentation at Critical Care Forum Canada 2013 (Submission ID# 0309-000018)