title: Physiological Effects of Early Incremental Mobilization of a Patient with Acute Intracerebral and Intraventricular Hemorrhage Requiring Dual External Ventricular Drainage.
abstract: BACKGROUND
  Recent trials have challenged the notion that very early mobility benefits patients with acute stroke. It is unclear how cerebral autoregulatory impairments, prevalent in this population, could be affected by mobilization. The safety of mobilizing patients who have external ventricular drainage (EVD) devices for cerebrospinal fluid diversion and intracranial pressure (ICP) monitoring is another concern due to risk of device dislodgment and potential elevation in ICP. We report hemodynamic and ICP responses during progressive, device-assisted mobility interventions performed in a critically ill patient with intracerebral hemorrhage (ICH) requiring two EVDs.
  
  
  METHODS
  A 55-year-old man was admitted to the Neuroscience Critical Care Unit with an acute thalamic ICH and complex intraventricular hemorrhage requiring placement of two EVDs. Progressive mobilization was achieved using mobility technology devices. Range of motion exercises were performed initially, progressing to supine cycle ergometry followed by incremental verticalization using a tilt table. Physiological parameters were recorded before and after the interventions.
  
  
  RESULTS
  All mobility interventions were completed without any adverse event or clinically detectable change in the patient's neurological state. Physiological parameters including hemodynamic variables and ICP remained within prescribed goals throughout.
  
  
  CONCLUSIONS
  Progressive, device-assisted early mobilization was feasible and safe in this critically ill patient with hemorrhagic stroke when titrated by an interdisciplinary team of skilled healthcare professionals. Studies are needed to gain insight into the hemodynamic and neurophysiological responses associated with early mobility in acute stroke to identify subsets of patients who are most likely to benefit from this intervention.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Sowmya
authors.initials: S
authors.lastname: Kumble
authors.affiliation: Department of Neurosciences Nursing, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Zink
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Burch
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Deluzio
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Department of Neurology, Neurosurgery, and Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.|Cerebrovascular Division, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stevens
authors.affiliation: Cerebrovascular Division, Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA. mbahout1@jhmi.edu.
authors.forename: Mona N
authors.initials: MN
authors.lastname: Bahouth
mesh_terms: D002543:Cerebral Hemorrhage / Q000534:rehabilitation* / Q000601:surgery*; D000074042:Cerebral Intraventricular Hemorrhage / Q000534:rehabilitation / Q000601:surgery; D004434:Early Ambulation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014696:Ventriculostomy / Q000379:methods*
keywords: Early mobility; Intracerebral hemorrhage; Intracranial hypertension; Stroke; Supine cycle ergometry; Tilt table