Barriers and Trends to Early Mobilization in Children With a Traumatic Brain Injury

Area of Science:

• Pediatric critical care medicine
• Neuroscience
• Rehabilitation therapy

Background:

• Traumatic brain injury (TBI) is a significant cause of morbidity and mortality in children.
• Early mobility (EM) is increasingly recognized as crucial for improving outcomes in critically ill patients.
• Limited data exist on EM metrics and participation barriers in pediatric intensive care unit (PICU) populations with TBI.

Purpose of the Study:

• To characterize early mobility (EM) metrics in children with TBI admitted to a PICU.
• To identify common barriers to EM participation in this population.
• To explore associations between injury severity and EM participation.

Main Methods:

• Retrospective cohort study of children (0-18 years) with TBI admitted to a PICU between January 2022 and July 2023.
• Collected data on demographics, injury characteristics, severity metrics (GCS, AIS), and occupational therapy (OT)/physical therapy (PT) for the first 14 ICU days.
• Categorized OT/PT session activity as high or low mobility and recorded participation barriers.

Main Results:

• Eighty children underwent 189 therapy sessions; 53-56% initially involved high mobility, increasing to 68-70% by discharge or day 14.
• Mechanical ventilation, lower Glasgow Coma Scale (GCS) scores, higher Abbreviated Injury Scale (AIS) scores, and longer ICU stays were associated with lower odds of high mobility.
• Barriers were reported in 51.4% of sessions, primarily medical instability (26.5%), procedures (21.9%), and bedrest orders (14.8%).

Conclusions:

• Early mobility interventions are feasible in pediatric TBI patients within the PICU setting.
• Participation barriers are prevalent and significantly impact therapy engagement.
• Targeting modifiable barriers could enhance OT/PT participation and potentially improve clinical outcomes for children with TBI.