title: Early rehabilitation for severe acquired brain injury in intensive care unit: multicenter observational study.
abstract: BACKGROUND
  The increased survival after a severe acquired brain injury (sABI) raise the problem of making most effective the treatments in Intensive Care Unit (ICU)/Neurointensive Care Unit (NICU), also integrating rehabilitation care. Despite previous studies reported that early mobilization in ICU was effective in preventing complications and reducing hospital stay, few studies addressed the rehabilitative management of sABI patients in ICU/NICU.
  
  
  OBJECTIVE
  To collect clinical and functional data about the early rehabilitative management of sABI patients during ICU/NICU stay.
  
  
  METHODS
  Prospective, observational, multicenter study.
  
  
  METHODS
  Fourteen facilities supplied by intensive neurorehabilitation units and ICU/NICUs.
  
  
  METHODS
  Consecutive sABI patients admitted to ICU/NICU.
  
  
  METHODS
  Patients were evaluated at admission and then every 3-5 days. Clinical, functional and rehabilitative data, including Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), The Rancho Los Amigos Levels of Cognitive Functioning Scale (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome scale (GOS) and Functional Independence Measure (FIM) were collected.
  
  
  RESULTS
  One hundred and two patients (F/M 44/58) were enrolled. The mean duration of ICU stay was 24.7±13.9 days and the first rehabilitative evaluation occurred after 8.7±8.8 days. Regular postural changes and multijoint mobilization were prescribed in 63.7% and 64.7% cases, respectively. The mean session duration was 38±11.5 minutes. Swallowing evaluation was performed in 14.7% patients, psychological support was provided to 12.7% of patients' caregivers, while 17.6% received a psycho-educational intervention, and 28.4% were involved in interdisciplinary team meetings. The main discharge destinations were Severe Acquired Brain Injury rehabilitation units for 43.7%, intensive neurorehabilitation units for 20.7%.
  
  
  CONCLUSIONS
  Data showed that early rehabilitation was not diffusely performed in sABI subjects in ICU/NICU and rehabilitative interventions were variable; one-third of subjects were not referred to dedicated rehabilitation unit at discharge.
  
  
  CONCLUSIONS
  The study stresses the need to spread and implement a rehabilitative culture also for critical ill patients due to neurological diseases.
authors.affiliation: Neurorehabilitation Unit IRCCS INM Neuromed, Pozzilli (IS), Italy - bartolomichelangelo@gmail.com.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Bartolo
authors.forename: Stefano
authors.initials: S
authors.lastname: Bargellesi
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Castioni
authors.forename: Donatella
authors.initials: D
authors.lastname: Bonaiuti
authors.forename: Roberto
authors.initials: R
authors.lastname: Antenucci
authors.forename: Angelo
authors.initials: A
authors.lastname: Benedetti
authors.forename: Valeria
authors.initials: V
authors.lastname: Capuzzo
authors.forename: Federica
authors.initials: F
authors.lastname: Gamna
authors.forename: Giulio
authors.initials: G
authors.lastname: Radeschi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Citerio
authors.forename: Carolina
authors.initials: C
authors.lastname: Colombo
authors.forename: Laura
authors.initials: L
authors.lastname: Del Casale
authors.forename: Elena
authors.initials: E
authors.lastname: Recubini
authors.forename: Saimir
authors.initials: S
authors.lastname: Toska
authors.forename: Marco
authors.initials: M
authors.lastname: Zanello
authors.forename: Carlo
authors.initials: C
authors.lastname: D'Aurizio
authors.forename: Tullio
authors.initials: T
authors.lastname: Spina
authors.forename: Alredo
authors.initials: A
authors.lastname: Del Gaudio
authors.forename: Filomena
authors.initials: F
authors.lastname: Di Rienzo
authors.forename: Domenico
authors.initials: D
authors.lastname: Intiso
authors.forename: Giulia
authors.initials: G
authors.lastname: Dallocchio
authors.forename: Giovanna
authors.initials: G
authors.lastname: Felisatti
authors.forename: Susanna
authors.initials: S
authors.lastname: Lavezzi
authors.forename: Roberto
authors.initials: R
authors.lastname: Zoppellari
authors.forename: Valentina
authors.initials: V
authors.lastname: Gariboldi
authors.forename: Luca
authors.initials: L
authors.lastname: Lorini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melizza
authors.forename: Guido
authors.initials: G
authors.lastname: Molinero
authors.forename: Giorgio
authors.initials: G
authors.lastname: Mandalà
authors.forename: Amedeo
authors.initials: A
authors.lastname: Pignataro
authors.forename: Andrea
authors.initials: A
authors.lastname: Montis
authors.forename: Alessandro
authors.initials: A
authors.lastname: Napoleone
authors.forename: Felicita
authors.initials: F
authors.lastname: Pilia
authors.forename: Marina
authors.initials: M
authors.lastname: Pisu
authors.forename: Monica
authors.initials: M
authors.lastname: Semerjian
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Pagliaro
authors.forename: Lorella
authors.initials: L
authors.lastname: Nardin
authors.forename: Federico
authors.initials: F
authors.lastname: Scarponi
authors.forename: Mauro
authors.initials: M
authors.lastname: Zampolini
authors.forename: Raffaele
authors.initials: R
authors.lastname: Zava
authors.forename: Maria A
authors.initials: MA
authors.lastname: Massetti
authors.forename: Carlo
authors.initials: C
authors.lastname: Piccolini
authors.forename: Fulvio
authors.initials: F
authors.lastname: Aloj
authors.forename: Sergio
authors.initials: S
authors.lastname: Antonelli
authors.forename: Chiara
authors.initials: C
authors.lastname: Zucchella
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome