Implementation of a Structured Balance Training Protocol During Early Mobilization in the ICU: A Case Report

ABSTRACT Background and Purpose: Balance impairments are common in critically ill patients and may limit progression within early mobilization programs. Although international guidelines support early rehabilitation in the intensive care unit (ICU), structured balance training approaches tailored to this setting remain poorly described. This case report describes the implementation of the U-Balance protocol within early mobilization in the ICU. Case Description: An 85-year-old man was admitted to the ICU after emergency abdominal surgery and required reoperation and invasive mechanical ventilation. The patient was cooperative, able to follow commands, and screened negative for delirium using the CAM-ICU. At the initiation of physiotherapy, he presented with intensive care unit–acquired weakness, marked balance deficits, and functional limitations restricting mobility. Intervention: The U-Balance protocol was incorporated into the patient's early mobilization program and delivered daily by physiotherapists. Balance performance and progression were monitored using selected items of the Berg Balance Scale (sit-to-stand, standing unsupported, and sitting without trunk support). Muscle strength, mobility, and overall physical function were assessed using the Medical Research Council sum score, ICU Mobility Scale, and Chelsea Critical Care Physical Assessment Tool, respectively. Outcomes: Clinically meaningful improvements were observed in muscle strength, mobility, physical function, and balance, enabling progression to upright postures, transfers, and assisted ambulation. No adverse events occurred, and implementation required no additional equipment or staffing. Discussion and Conclusion: This case report demonstrates that structured balance training can be safely and feasibly integrated within early mobilization in the ICU and may contribute to functional recovery in critically ill patients.