Transforming Neurocritical Care: A Multidisciplinary Approach to Stroke and Brain Injury Rehabilitation

Emergency teams are simultaneously shaving minutes off reperfusion in stroke and planning day‑one rehabilitation for brain‑injured patients—pairing speed with coordinated follow‑through across neurocritical care.

The rapid response mechanism that mobilizes a multidisciplinary team speeds time‑critical steps in stroke care and is associated with better outcomes largely through faster reperfusion and coordinated pathways, though actual recovery varies with baseline severity and system resources. A multidisciplinary approach in emergency stroke care is associated with improved outcomes largely through faster reperfusion and coordinated pathways, as exhibited by the NYU Langone stroke team; actual outcomes vary by patient factors and system resources, and align with systems‑of‑care benchmarks emphasized by major guideline bodies.

Effective blood pressure management in intracerebral hemorrhage is a shared goal that reduces hematoma risk and supports neurological recovery. Guidelines (for example, the 2022 AHA/ASA ICH guidance) recommend prompt lowering of systolic blood pressure to a practical target range of about 140–160 mm Hg within the first hours for eligible patients, with evidence from INTERACT2 and ATACH‑2 suggesting benefits in limiting hematoma expansion while highlighting safety considerations. Guidelines advocate for acutely lowering systolic blood pressure to a practical target of about 140–160 mm Hg within the first hours in eligible patients to limit hematoma expansion, while recognizing that overly aggressive lowering may increase risks such as renal adverse events. Early and intensive blood pressure management in such cases is crucial.

Innovative neuromodulatory approaches such as vagus nerve stimulation may influence cognitive recovery after traumatic brain injury by engaging anti‑inflammatory pathways.

Such strategies inform current practices in pediatric neurorehabilitation, where consensus statements from pediatric societies emphasize early mobilization in the PICU and timely initiation of therapy; implementing early rehabilitation protocols can enhance recovery trajectories.

For children recovering from neurocritical events, consistent and early access to rehabilitation is linked to better function and everyday participation, often reflected in improved functional measures (for example, WeeFIM or PEDI scores), underscoring its essential role in pediatric care.

If immediate rehabilitation is not prioritized, pediatric patients may face longer recovery times; emphasizing early, effective intervention aligns with the evidence summarized above and helps mitigate longer‑term challenges.

Managing post‑traumatic seizures remains a challenge, necessitating optimized pharmacotherapy. Optimizing levetiracetam for seizure prophylaxis remains an area of active study; retrospective evaluations suggest that higher doses may be associated with lower rates of early post‑traumatic seizures in select populations, but optimal dosing is uncertain and requires careful monitoring for neuropsychiatric adverse events.

Extending the focus on targeted pathways in neurorecovery, emerging research on periostin suppression in pediatric subarachnoid hemorrhage remains preclinical and early translational, with preliminary findings suggesting potential but emphasizing the need for rigorous clinical evaluation.

Key Takeaways:

• A multidisciplinary systems‑of‑care approach is associated with faster reperfusion and better functional outcomes in stroke care.
• Early blood pressure management in hemorrhage cases targets SBP about 140–160 mm Hg in eligible patients to limit hematoma expansion, balancing potential risks.
• Innovative therapies, like vagus nerve stimulation, show early‑stage promise for cognitive recovery in TBI via anti‑inflammatory pathways.
• Early rehabilitation and PICU mobilization are linked to improved pediatric neurocritical outcomes.