Interestingly, although an admission
GCS of 8 or less was associated with
starting physical therapy later in the
hospital course, the admission GCS
and the GCS at each physical therapy
session were lower in patients needing
mechanical ventilation or ICP
monitoring, suggesting that GCS
alone was not a barrier to performing
physical therapy. However, the
admission GCS was independently
associated with less frequent physical
therapy in the NICU. Together,
these data potentially indicate that
although the GCS is not a barrier to
initiating an individual physical therapy
session, it does influence the timing
of physical therapy and the frequency
at which physical therapy
can be performed. A low GCS,
together with requirements for
mechanical ventilation and ICP monitoring,
is a marker of disease severity
and suggests that a patient may
not be stable enough for early physical
therapy. Additionally, although
physical therapy can be performed
on a patient with a low GCS, we can
hypothesize that it is performed less
frequently because of the increased
nurse and physical therapist time
needed to perform physical therapy
with such a patient and insufficient
staff to spend that time.