Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized...

Area of Science:

• Pediatric critical care medicine
• Neurocritical care
• Rehabilitation therapy

Background:

• Limited data exist on the feasibility, safety, and efficacy of intensive care unit (ICU)-based rehabilitative services for pediatric patients.
• Pediatric neurocritical care patients often have prolonged ICU stays, necessitating specialized interventions.

Purpose of the Study:

• To evaluate the feasibility and safety of an early, protocolized approach to rehabilitation services for children in the neurocritical care unit.
• To compare early protocolized rehabilitation with usual care in terms of consultation timing, treatment type, and patient outcomes.

Main Methods:

• A randomized controlled trial was conducted in three tertiary care pediatric intensive care units (PICUs) in the United States.
• Fifty-eight children (3-17 years) with new brain insults and expected ICU stays >48 hours were randomized to either early protocolized rehabilitation (physical therapy, occupational therapy, speech and language therapy within 72 hours) or usual care.
• Outcomes included consultation timing, treatment delivery (ICU vs. ward), safety events, and functional/quality of life outcomes at 6 months.

Main Results:

• Early protocolized rehabilitation significantly accelerated the timing of consultations for physical therapy, occupational therapy, and speech and language therapy compared to usual care.
• A greater proportion of children in the early group received all three therapy consults and treatments within the ICU.
• No significant differences were found in the total dose of rehabilitation or in functional and quality of life outcomes at 6 months between the groups. Safety events were minimal and did not impact patient outcomes.

Conclusions:

• Implementing a protocol for early, personalized rehabilitation involving physical therapy, occupational therapy, and speech and language therapy is feasible and safe in pediatric neurocritical care.
• This protocol leads to more ICU-based treatment sessions, advancing the timing and modifying the nature of interventions without changing the overall rehabilitation dose.
• Early protocolized rehabilitation can optimize the delivery of essential therapies to critically ill children with neurological injuries.