Early mobility in the Neuro ICU presents unique challenges. Patients with impaired consciousness, mechanical ventilation, and invasive devices may be unable to participate in conventional rehabilitation activities.
But should the inability to follow commands automatically mean mobility has to wait?
A study published in Critical Care Explorations examined motorized verticalization in 33 critically ill patients with a mean Glasgow Coma Scale (GCS) score of approximately 8, reflecting significant neurological impairment.
Across 153 verticalization sessions and 409 angle exposures, researchers reported no observed dislodgements of endotracheal tubes, central venous catheters, or external ventricular drains (EVDs).
These findings raise an important question: Could supported upright positioning offer a mobility opportunity for selected patients who cannot yet participate in traditional rehabilitation?
Why Consider Upright Positioning Earlier?
Prolonged immobility in critically ill patients can contribute to:
- Rapid skeletal muscle loss and weakness
- Cardiovascular deconditioning
- Orthostatic intolerance
- Respiratory complications
- Delayed progression toward functional rehabilitation
For neurocritical care patients, these challenges may be compounded by neurological impairment that limits participation in conventional therapy.
While Verticalization Therapy® is not a substitute for active rehabilitation, progressive upright positioning may offer an opportunity to introduce graded weight-bearing and physiologic activity when traditional out-of-bed mobility is not yet feasible.
If early rehabilitation matters, should we wait until patients can participate fully before introducing supported upright activity?
What Does the Research Tell Us About Safety?
Safety remains a primary concern when mobilizing patients with impaired consciousness and invasive devices.
In the retrospective study by Dakakni and Roebuck, researchers evaluated protocolized motorized verticalization in a clinically complex patient population.
The study reported:
- No observed dislodgements of endotracheal tubes, central venous catheters, or EVDs
- No sessions terminated because of intracranial pressure crises or hemodynamic instability
These findings provide preliminary evidence that carefully monitored motorized verticalization may be feasible in selected critically ill patients, even with significant neurological impairment and invasive devices.
However, the study was small and retrospective. It did not establish that verticalization improves neurological or functional recovery, nor does it eliminate the risks associated with mobilizing complex patients.
The key takeaway: Impaired consciousness and invasive devices may not automatically rule out supported mobility.
Explore the Research
Learn more about the safety findings and protocolized approach to motorized verticalization in patients with impaired consciousness and invasive devices.
Beyond Mobility: Rethinking When Rehabilitation Can Begin
For Neuro ICU patients, recovery involves more than physical movement. Consciousness, arousal, and the potential for future rehabilitation are important considerations.
The study authors described informal observations of increased arousal and interaction during some verticalization sessions. Although these observations were not systematically measured and do not establish neurological benefits, they raise questions for future research about the potential role of upright positioning in neurorehabilitation.
The findings also challenge the assumption that patients must be able to actively participate before every form of progressive mobility can be considered.
For selected Neuro ICU patients, the question may no longer be simply whether mobility is possible, but whether supported mobility can begin earlier than traditionally considered.
Bringing Verticalization Into Daily Practice
Traditional out-of-bed mobilization often requires multiple caregivers and active patient participation, which may not be feasible for patients with significant neurological impairment.
Motorized verticalization offers another approach, allowing care teams to introduce progressive upright positioning and supported weight-bearing while patients remain in bed.
Appropriate patient selection, clinical monitoring, invasive-device management, and institutional protocols remain essential.
Explore Verticalization Therapy® With The Catalyst®
Discover how The Catalyst® Critical Recovery Bed incorporates Verticalization Therapy® to support progressive mobility for patients with complex clinical needs.
LEARN MORE ABOUT THE CATALYST® →
Reference
Dakakni T, Roebuck LD. Safety of Protocolized Motorized Verticalization in Critically Ill Patients With Impaired Consciousness and Invasive Devices, Including External Ventricular Drains. Critical Care Explorations. 2026;8(10). doi:10.1097/CCE.0000000000001491.
Research note: The published study evaluated a motorized verticalization system other than The Catalyst®. Its findings should not be interpreted as product-specific clinical evidence for The Catalyst®.