Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage.
BACKGROUND
Survivors of aneurysmal subarachnoid hemorrhage (SAH) are faced with a complicated recovery, which typically includes surgery, prolonged monitoring in the intensive care unit, and treatment focusing on the prevention of complications.


OBJECTIVE
The purpose of this study was to determine the safety and feasibility of an early mobilization program for patients with aneurysmal SAH.


METHODS
This study was a retrospective analysis.


METHODS
Twenty-five patients received early mobilization by a physical therapist or an occupational therapist, or both, which focused on functional training and therapeutic exercise in more progressively upright positions. Participation criteria focused on neurologic and physiologic stability prior to the initiation of early mobilization program sessions.


RESULTS
Patients met the criteria for participation in 86.1% of the early mobilization program sessions attempted. Patients did not meet criteria for the following reasons: Lindegaard ratio >3.0 or middle cerebral artery (MCA) mean flow velocity (MFV) >120 cm/s (8.1%), mean arterial pressure (MAP) <80 mm Hg (1.8%), intracranial pressure (ICP) >15 mm Hg (1.8%), unable to open eyes in response to voice (0.9%), respiratory rate >40 breaths/min (0.6%), MAP >110 mm Hg (0.3%), and heart rate <40 bpm (0.3%). Adverse events occurred in 5.9% of early mobilization program sessions for the following reasons: MAP <70 mm Hg (3.1%) or >120 mm Hg (2.4%) and heart rate >130 bpm (0.3%). The 30-day mortality rate for all patients was 0%. Participation in the early mobilization program began a mean of 3.2 days (SD=1.3) after aneurysmal SAH, and patients received an average of 11.4 sessions (SD=4.3). Patients required a mean of 5.4 days (SD=4.2) to participate in out-of-bed activity and a mean of 10.7 days (SD=6.2) to walk ≥15.24 m (50 ft).


CONCLUSIONS
The results of this study suggest that an early mobilization program for patients with aneurysmal SAH is safe and feasible.
Department of Rehabilitation, Capital Health, 750 Brunswick Ave, Trenton, NJ 08638, USA. bolkowski@capitalhealth.org
Brian F
BF
Olkowski
Mary Ann
MA
Devine
Laurie E
LE
Slotnick
Erol
E
Veznedaroglu
Kenneth M
KM
Liebman
Melissa L
ML
Arcaro
Mandy Jo
MJ
Binning
D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D004434:Early Ambulation; D004569:Electroencephalography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy; D018579:Patient Selection; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000534:rehabilitation*; D016896:Treatment Outcome