The Role of Rehabilitation in Neurological Critical Care: Innovations in Early Mobilization

Abstract

Purpose of review

This review appraises the existing literature to highlight the benefits, barriers, and role of rehabilitation in the early mobilization of patients in neurological critical care.

Recent findings

While the benefits of early mobilization in patients with critical illness have become more widely acknowledged, there are benefits and challenges to the successful implementation of early mobilization rehabilitation programming in the neurological critical care setting. The imperative role of rehabilitation providers is underscored in successful implementation. Furthermore, the discrete needs of patients and caregivers in neurocritical care necessitate interdisciplinary collaboration among medical and rehabilitation teams for the successful deployment of early mobilization programs.

Summary

This work discusses the expanding role of rehabilitation providers in neurocritical care and the importance of early mobilization for patients with neurological injuries. Experience-dependent neuroplasticity is a primary mechanism in facilitating recovery following neurological injury, and physical rehabilitation plays a critical role in this process. There is, however, a discrepancy in nomenclature regarding the definition of “early mobilization,” which makes it challenging to synthesize and translate evidence into practice. Despite the benefits of early mobilization, applying this evidence to the neurocritically ill patient is controversial given the innate medical complexity associated with these diagnoses. Nonetheless, early mobilization has been shown to decrease ICU and hospital length of stay, increase discharge to home, and reduce medical costs. Furthermore, consideration for those with severe acute brain injury and necessary medical interventions should be accounted for. While extensive literature has demonstrated the feasibility of adopting early mobilization to minimize secondary complications of ICU episodes of care, adoption of this paradigm has progressively expanded in the neurological population. Factors including the timing and frequency of mobilization are unclear and vary among studies, suggesting that more research is needed to better understand the role and benefits of early mobilization in neurocritical care.