Safety and efficacy of add-on robotic therapy for early mobilization in intermediate neurocritical care: a pilot study

BACKGROUND: Early mobilization has become a cornerstone of critical care due to its benefits in mitigating adverse effects associated with prolonged immobility. Individuals with critical neurosurgical conditions face unique challenges for mobilization, including paresis, cognitive dysfunction, and reliance on cerebral monitoring devices. Staffing limitations, high workloads, and person-specific factors further hinder early mobilization. In recent decades, robots have been developed to overcome these barriers. This pilot study aims to evaluate the safety and efficacy of using the VEMOTION® robotic system as an add-on intervention for early mobilization in individuals with critical neurosurgical conditions. METHODS: A randomized controlled pilot study was conducted at a tertiary hospital involving 18 individuals who required intermediate care due to severe neurosurgical conditions. Participants in the control group received standard physiotherapy, while those in the study group received VEMOTION® robot therapy in addition to conventional physiotherapy. The primary outcome was the occurrence of (serious) adverse events (SAEs/AEs), while secondary outcomes included improvements in physical and respiratory function as measured by the Chelsea Critical Care Physical Assessment Tool (CPAx). RESULTS: No AEs or SAEs were observed in either group related to the therapy. The study group showed greater improvements in the CPAx, with a median increase of 15 (IQR 11-19) points, compared to a median increase of 4 (IQR: 0-5) points in the control group (p = 0.0002). In the control group, the median score of the individual items of the CPAx did not change significantly over the course of the therapy, whereas in the study group, the median of each individual item significantly improved over time. CONCLUSIONS: The results of this pilot study indicate that VEMOTION® robotic therapy is a safe and effective adjunct to conventional physiotherapy for the early mobilization of critically ill neurosurgical patients, leading to clinically significant improvements in physical and respiratory function. Further large-scale studies are needed to confirm these findings and establish the robot's role in daily clinical practice.