Effect of Early Cognitive Rehabilitation Therapy on Mechanical Ventilation Weaning Time in Moderate Traumatic Brain Injury: A Randomized Controlled Trial

Abstract

Background: Prolonged mechanical ventilation is common in traumatic brain injury (TBI) and is associated with higher morbidity and delayed recovery. While early physical rehabilitation is widely implemented in neuro–intensive care unit (ICU) settings, the potential role of early cognitive rehabilitation in facilitating clinical recovery and accelerating ventilator weaning has not been adequately explored. Objective: To examine the effect of early cognitive rehabilitation therapy, delivered alongside standard physiotherapy, on mechanical ventilation weaning time in patients with moderate TBI. Methods: In this randomized controlled trial, 34 adults with isolated moderate TBI (Glasgow coma scale (GCS) 9– 12; age 18–45 years) were randomly assigned into two groups: a study group (Group A) receiving early cognitive rehabilitation plus a standardized physiotherapy program, and a control group (Group B) receiving physiotherapy alone. Interventions were provided six sessions per week for two weeks. Outcome assessors were blinded to group allocation. Consciousness and cognitive recovery were measured using the GCS and Rancho Los Amigos Scale (RLAS) at baseline, after one week (post I), and after two weeks (post II). Mechanical ventilation weaning time was recorded for all patients. Results: Both groups demonstrated significant improvements in GCS and RLAS over time (p < 0.001). However, the study group showed significantly greater gains in cognitive recovery, with higher GCS at post-intervention (mean difference 1.23; 95% CI 0.56–1.91; p = 0.001) and higher RLAS scores at both follow-up points (p = 0.001). The median ventilation weaning time was substantially shorter in the study group (6 days [IQR 0–9.5]) compared with the control group (14 days [IQR 3.5–20.5]; p = 0.02). Conclusions: Early cognitive rehabilitation therapy meaningfully enhances consciousness and cognitive recovery in moderate TBI and is associated with earlier readiness for ventilator weaning. Incorporating structured cognitive stimulation into routine neuro–ICU care may support safer and faster liberation from mechanical ventilation.