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

Abstract

To describe early mobility (EM) metrics, including participation barriers, among children admitted to a pediatric ICU with TBI. This retrospective cohort study included children aged 0-18 years with a TBI admitted to a single pediatric ICU from January 2022- July 2023. Demographics, injury characteristics, injury severity metrics, and occupational therapy (OT) and physical therapy (PT) data were collected for the first 14 ICU days. OT/PT session activity was categorized as high or low mobility based on level of active participation, and barriers were recorded. Eighty children received 189 therapy sessions. Median admission GCS was 11, and 67.5% required mechanical ventilation. High mobility occurred in 53% of OT and 56.3% of PT evaluations, increasing to 69.7% and 68.3% respectively by ICU discharge date or day 14. Mechanical ventilation (P<.001), lower GCS (P<.001), higher AIS (P=.023), and longer ICU stay (P<.001) were associated with lower odds of high mobility at evaluation. Barriers occurred in 51.4% of attempted sessions, most commonly medical instability (26.5%), procedures (21.9%), and bedrest orders (14.8%). In children with TBI, participation in EM is feasible, but barriers are common. Addressing modifiable barriers may improve OT and PT engagement and could positively affect clinical outcomes.