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Rehabilitation Practices in Patients With Moderate and Severe Traumatic Brain Injury

Kreitzer, Natalie MD; Rath, Kelly ACNP; Kurowski, Brad G. MD, MS; Bakas, Tamilyn PhD, RN; Hart, Kim MS; Lindsell, Christopher J. PhD; Adeoye, Opeolu MD, MS

The Journal of Head Trauma Rehabilitation: February 27, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/HTR.0000000000000477
Original Article: PDF Only

Objective: To characterize the indications, timing, barriers, and perceived value of rehabilitation currently provided for individuals with moderate or severe traumatic brain injury (TBI) admitted to the intensive care unit (ICU) based on the perspectives of providers who work in the ICU setting.

Participants: Members (n = 66) of the Neurocritical Care Society and the American Congress of Rehabilitation Medicine.

Design: An anonymous electronic survey of the timing of rehabilitation for patients with TBI in the ICU.

Main Measures: Questions asked about type and timing of rehabilitation in the ICU, extent of family involvement, participation of physiatrists in patient care, and barriers to early rehabilitation.

Results: Sixty-six respondents who reported caring for patients with TBI in the ICU completed the survey; 98% recommended rehabilitative care while patients were in the ICU. Common reasons to wait for the initiation of physical therapy and occupational therapy were normalization of intracranial pressure (86% and 89%) and hemodynamic stability (66% and 69%).

Conclusions: The majority of providers caring for patients with TBI in the ICU support rehabilitation efforts, typically after a patient is extubated, intracranial pressure has normalized, and the patient is hemodynamically stable. Our findings describe current practice; future studies can be designed to determine optimal timing, intensity, and patient selection for early rehabilitation.

Departments of Emergency Medicine (Drs Kreitzer and Adeoye and Ms Hart), Neurology and Rehabilitation Medicine (Drs Kreitzer and Adeoye and Ms Rath), Pediatrics (Dr Kurowski), and Neurosurgery (Dr Adeoye), University of Cincinnati, Ohio; University of Cincinnati College of Nursing, Ohio (Ms Rath and Dr Bakas); and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Lindsell).

Corresponding Author: Natalie Kreitzer, MD, Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267 (

Previous presentation: October 2017 Neurocritical Care Society Conference, Waikoloa, Hawaii.

Dr Adeoye reports that he is founder and has equity with Sense Diagnostics, Inc, although this device is unrelated to the current study.

The authors declare no conflicts of interest.

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