Mobilization patterns and physical activity in hospitalized individuals with moderate to severe acquired brain injury: a prospective observational study - 11/10/26

Doi : 10.1016/j.rehab.2026.102190

Vibeke Wagner ^a,^b,^c, Berivan Kyed Bayram ^a,^d,^#, Markus Harboe Olsen ^e,^f, Christina Kruuse ^a,^b,^c, Christian Gunge Riberholt ^a,^b,^c,^⁎

^a Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

^b Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

^c Copenhagen NeuroInjury and Rehabilitation Research Center (CNIRC), The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

^d Department of Geriatrics, Amager & Hvidovre Hospital, The Capital Region, Hvidovre, Denmark

^e Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

^f Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

^# BKB conducted the work while affiliated with Department of Geriatrics, Amager & Hvidovre Hospital, The Capital Region, Hvidovre, Denmark

^⁎ Corresponding Author. Christian Gunge Riberholt, Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 23, 2600 Glostrup, Denmark Department of Brain and Spinal Cord Injury, The Neuroscience Centre, Copenhagen University Hospital Valdemar Hansens Vej 23, 2600 Glostrup Rigshospitalet Denmark

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Sunday 11 October 2026

Highlights

•	Upright time after severe acquired brain injury (ABI) is recommended.
•	Upright time during early admission after ABI was as low as 8 minutes per day.
•	Medical devices were associated with shorter upright time early after ABI.
•	Longer early upright time after ABI was linked to better ambulation at discharge.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Upright time is an important component in early rehabilitation following moderate to severe acquired brain injury (ABI); however, objective in-hospital data are scarce. This study quantified upright time during inpatient rehabilitation using triaxial accelerometry.

Objective

To characterize mobilization and physical activity during early and late rehabilitation phases in individuals with moderate to severe ABI.

Methods

Prospective cohort study in a tertiary neurorehabilitation facility. Participants : Adults (≥18 years) with moderate to severe ABI (Glasgow Coma Scale score < 13 or amnesia duration > 1 hour), admitted between Nov 2022 and Jan 2024. Data collection and outcomes : Accelerometer data were collected for 7 days (7 AM to 10 PM) at 2 time points: early (T1) and late admission (T2). The primary outcome was upright time. Other outcomes included associations between clinical characteristics and upright time, and between early upright time and functional outcomes at discharge.

Results

Ninety-nine participants were enrolled; 58 provided sufficient activity data at both time points. Median upright time was 8 minutes/day (IQR, 3; 30) at T1, increasing to 43 minutes/day (IQR 22; 131) at T2 (+6.6 percentage points, 95% CI 4.3 to 8.9). Shorter upright time at T1 was associated with the confusional state and medical device attachment, and at T2, with spasmolytic and sedative treatments. Longer upright time at T1 was associated with improved Functional Ambulation Category (β = 0.17 per % increase, 95% CI 0.08 to 0.27), and Functional Independence Measure, motor subscale (β = 3.01, 95% CI 0.77 to 5.25). Missing activity data were substantial (41% excluded).

Conclusions

: Upright time increased during rehabilitation but remained low overall. Medical devices were associated with reduced upright time, and more early upright time showed potential links to higher walking ability and greater independence in mobility at discharge. These findings underscore the need for tailored interventions, real-time feedback, and clinical guidelines to optimize mobilization during rehabilitation.

Clinical Trial Registration

NCT05571462.

Le texte complet de cet article est disponible en PDF.

Keywords : Brain injuries, rehabilitation, exercise, accelerometry, inpatients, sedentary behavior

Abbreviations : 6-MWT , 10-mWT , 30-sSTS , ABI , CI , DoC , FAC , FIM , FIM-C , FIM-M , ICU , IQR , T1 , T2