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Background & Purpose: Recovery after severe traumatic brain injury (TBI) often involves prolonged immobility, resulting in decreased balance, strength, and endurance, and increasing the risk of secondary complications such as wounds, contractures, and respiratory illnesses. The purpose of this case report is to describe the acute rehabilitation course of a patient with a severe TBI and emphasize the role of physical therapy in preparing the patient for the next level of care. Case Description: 31-year-old male found unresponsive after a rollover motor vehicle crash, which resulted in a severe traumatic brain injury, a subdural hematoma, and several orthopedic injuries to the spine and mandibular condyle. He had a prolonged hospitalization complicated by ventilator-associated pneumonia, respiratory failure, tracheobronchitis, dysautonomia, and hyponatremia. Physical therapy interventions during the acute hospitalization included positioning, bed mobility, range of motion, transfers, balance, and gait training. Outcomes: The patient was treated daily for 30 days during his acute hospital stay with an AM-PAC Inpatient Basic Mobility Short Form (“6-clicks”) score improvement from 6 to 9. Alternative measures include the GOSE, ACIF and AlphaFIM. Discussion: Physical therapists play an integral role in the acute recovery of severe TBIs to improve functional mobility and prevent secondary complications associated with prolonged immobility. This case demonstrates the importance of early mobilization despite having a poor prognosis for independent mobility and in the presence of impaired consciousness.