Neurocritical Care

, Volume 27, Issue 1, pp 115–119 | Cite as

Physiological Effects of Early Incremental Mobilization of a Patient with Acute Intracerebral and Intraventricular Hemorrhage Requiring Dual External Ventricular Drainage

  • Sowmya Kumble
  • Elizabeth K. Zink
  • Mackenzie Burch
  • Sandra Deluzio
  • Robert D. Stevens
  • Mona N. BahouthEmail author
Practical Pearl



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.


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.


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.


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.


Early mobility Stroke Intracerebral hemorrhage Tilt table Supine cycle ergometry Intracranial hypertension 



The authors would like to acknowledge the enthusiastic work of the Johns Hopkins Hospital NCCU staff and the rehabilitation therapists for their participation in the early mobility project. We also acknowledge Sara Combilizer®Arjo Huntleigh Group for providing the Sara Combilizer tilt table for trial for few months.

Compliance with ethical standards

Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Sowmya Kumble
    • 1
  • Elizabeth K. Zink
    • 2
  • Mackenzie Burch
    • 1
  • Sandra Deluzio
    • 1
  • Robert D. Stevens
    • 3
    • 4
    • 5
  • Mona N. Bahouth
    • 5
    Email author
  1. 1.Department of Physical Medicine and RehabilitationJohns Hopkins HospitalBaltimoreUSA
  2. 2.Department of Neurosciences NursingJohns Hopkins HospitalBaltimoreUSA
  3. 3.Department of Anesthesiology and Critical Care MedicineJohns Hopkins School of MedicineBaltimoreUSA
  4. 4.Department of Neurology, Neurosurgery, and RadiologyJohns Hopkins School of MedicineBaltimoreUSA
  5. 5.Cerebrovascular Division, Department of NeurologyJohns Hopkins School of MedicineBaltimoreUSA

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