Background: Therapeutic activity after stroke is a component of early recovery strategies. Interactive video games have been shown to be safe as an adjunct rehabilitation therapy in the medical intensive care setting, but patients with neurologic disease were often excluded from those protocols., Objectives: To evaluate the feasibility and safety of individualized interactive video game therapy in critically ill neurologic patients., Methods: Adults admitted to the neurosciences critical care unit during the observation period were eligible for inclusion. Wii sports games with the potential to target common neurologic deficits were categorized by our interprofessional team. We collected information regarding the number of sessions attempted, time for setup, indications of use, patient/staff experience, and predefined safety events., Results: Twelve sessions were completed in 9 patients, mean (SD) age 48.6 (18.1) years, and sessions were led by nursing and therapy teams. Prescribed video game therapy sessions targeted the following recovery domains: coordination (70%), balance (50%), endurance (30%), cognition (30%), fine motor control (30%), neglect (20%), engagement in activity (10%), and vision (30%). On average, 4.7 minutes were spent for setup and 18.8 minutes were spent playing video games. No safety issues were identified. All patients indicated that they enjoyed participating in video game therapy., Conclusions: In this pilot study, prescriptive interactive video game therapy in early rehabilitation was feasible and safe in the neurosciences critical care setting. Video game therapy may be a valuable complement to existing rehabilitation for critically ill neurologic patients and warrants validation in a larger patient sample., (©2025 American Association of Critical-Care Nurses.)