From the Guidelines
Gentle range of motion and mobilization can typically be started within 24-48 hours after a moderate spontaneous intracranial hemorrhage in a neuro-ICU patient, provided the patient is hemodynamically stable and there is no evidence of ongoing bleeding or increasing intracranial pressure. This approach is supported by the 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage from the American Heart Association/American Stroke Association 1.
Key Considerations
- The patient's individual clinical condition, hemorrhage size, location, and overall stability should guide the specific timing of mobilization.
- Early mobilization should begin with passive range of motion exercises while the patient is in bed, gradually progressing to sitting at the edge of the bed, standing, and eventually walking as tolerated.
- The intensity and duration of mobilization should be individualized based on the patient's neurological status, vital signs, and response to activity.
- Close monitoring of intracranial pressure (if being measured), blood pressure, heart rate, and neurological status is essential during mobilization.
Monitoring and Safety
- If the patient shows signs of increased intracranial pressure, such as severe headache, vomiting, decreased level of consciousness, or new neurological deficits, mobilization should be immediately stopped.
- Early mobilization helps prevent complications like deep vein thrombosis, pressure ulcers, pneumonia, and muscle atrophy, while potentially improving functional outcomes.
- The decision to start mobilization should be made by the treating physician, taking into account the latest evidence and guidelines, such as those from the American Heart Association/American Stroke Association 1 and expert panels on positioning and early mobilisation in the critically ill 1.
Latest Evidence
- A recent guideline on positioning and early mobilisation in the critically ill by an expert panel 1 supports the use of mobilisation protocols that combine passive and active mobilisation, which can benefit patients with impaired consciousness and stroke patients.
- However, the specific protocol and timing of mobilization should be tailored to the individual patient's needs and clinical condition, as emphasized in the 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage 1.
From the Research
Timing of Gentle Range of Motion and Mobilization
The timing of gentle range of motion and mobilization in neuro-ICU patients after moderate spontaneous intracranial hemorrhage is a critical aspect of their care. According to the study by 2, the implementation of a progressive mobility algorithm was safe and associated with a higher likelihood of mobilization in the first week after spontaneous ICH.
Key Considerations
Some key considerations for gentle range of motion and mobilization in these patients include:
- The patient's level of consciousness and motor function, as outlined in the NCCU Mobility Algorithm 2
- The potential for neurologic deterioration and hemodynamic lability in the acute phase of injury 2, 3
- The use of mobility technology devices to achieve progressive mobilization, as demonstrated in the case report by 3
- The importance of titrating mobilization by an interdisciplinary team of skilled healthcare professionals 3
Study Findings
The study by 4 found that early mobilization of mild-moderate ICH patients within 24 to 72 hours of stroke onset may improve early functional independence compared with standard early rehabilitation. Additionally, the study by 2 found that patients in the post-intervention group were significantly more likely to undergo mobilization within the first 7 days after admission.
Mobilization Protocols
Mobilization protocols for neuro-ICU patients after moderate spontaneous intracranial hemorrhage may include: