Effect of early physiotherapy on intracranial pressure and cerebral perfusion pressure.

Background: Physiotherapy plays an important role in the therapy of patients with acute cerebral diseases. Studies concerning the effects of physiotherapy on intracerebral pressure (ICP) and cerebral perfusion pressure (CPP) are, however, rare.

Methods: An observational study was performed on critically ill patients who were receiving ICP measurements and who were treated with passive range of motion (PROM) on our neuro-intensive care unit. ICP, CPP, mean arterial pressure (MAP) and heart rate were recorded continuously every minute, beginning 15 min before, during (26 min) and 15 min after treatment with PROM. Patients with mean ICP <15 mmHg (Group 1) and patients with mean ICP ≥15 mmHg (Group 2) before physiotherapy were analyzed separately.

Results: Overall there were 84 patients (f:m = 1:1) with 298 treatments units, 224 in Group 1 and 74 in Group 2, respectively. Mean ICP before treatment was 11.5 ± 5.1 mmHg, with a significant decrease of 1 mmHg during therapy (p = 2.0e-10). This was also true for Group 1 (baseline ICP 9.4 ± 3.7 mmHg, decrease of 0.7 mmHg, p = 3.8e-6) and Group 2 (baseline ICP 18.1 ± 2.7 mmHg, decrease of 2 mmHg, p = 3.7e-6). However, a persistent ICP reduction after therapy was seen only in Group 2. There were no significant differences between mean CPP and MAP comparing ICP before and after PROM in all groups. No adverse side effects of PROM were observed.

Conclusions: Physiotherapy with PROM can be used safely in patients with acute neurological diseases, even if ICP is elevated before therapy.