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Special Considerations for Mobilizing Patients in the Neurointensive Care Unit

Kocan, Mary Jo MSN, RN, CNRN; Lietz, Hendrika PT, DPT, NCS

doi: 10.1097/CNQ.0b013e3182750b12
Original Articles

Patients with neurologic illness or injury benefit from early interventions to increase physical activity and mobility, but they also have special needs related to hemodynamic stability and intracranial pressure dynamics. After brain injury, moving paralyzed limbs—even passively—helps promote neural plasticity, “rerouting” signals around the injured area and forming new connections, resulting in improved functional recovery. Neurologic deficits may impede a patient's functional and language abilities, so a mobility program must take into account the need for assistive devices, communication strategies, and additional personnel. Because cerebral autoregulation may be impaired, stability of blood pressure and intracranial pressure must be considered when planning mobility activities. The clinical team must consider the full spectrum of mobility for the neuroscience patient, from having the bed in the chair position for a comatose patient to ambulation of the patient with ventriculostomy whose intracranial pressure will tolerate having drainage clamped for a short period of time. Those involved with mobility need to understand the patient's disease process, the implications of increasing activity levels, and the monitoring required during activity.

Departments of Nursing—Neuro Intensive Care Unit and Stroke Unit and Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor.

Correspondence: Mary Jo Kocan, MSN, RN, CNRN, Department of Nursing, Neuro Intensive Care Unit and Stroke Unit, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48103 (

The authors disclose no conflicts of interest and no source of funding.

© 2013 Lippincott Williams & Wilkins, Inc.