Background: Severe traumatic brain injury (TBI) is a major cause of mortality, disability, and prolonged intensive care unit (ICU) stay. Sensory deprivation and prolonged immobilization may adversely affect neurological recovery and functional outcomes among critically ill patients. Aim: To evaluate the effect of early nursing-led sensory-motor activation on functional recovery among patients with severe traumatic brain injury. Design: A quasi-experimental pretest-posttest control group design was utilized. Setting: The study was conducted at the Surgical Intensive Care Units, Mansoura Hospital. Sample: A purposive sample of 76 adult patients with severe traumatic brain injury was recruited and assigned into an intervention group (n = 38) and a control group (n = 38). Tools: I- Patient Assessment Sheet, II-Full Outline of Unresponsiveness (FOUR) Score, IIISensory Modality Assessment and Rehabilitation Technique (SMART), IV-Disability Rating Scale (DRS), and V-Functional Recovery and Clinical Outcomes Assessment Sheet. Results: Patients who received early nursing-led sensory-motor activation demonstrated significantly better neurological responsiveness, sensory responsiveness, and functional recovery than those receiving routine care. The intervention group achieved significantly higher FOUR and SMART scores, significantly lower DRS scores, and greater improvements across all SMART domains. Furthermore, patients in the intervention group demonstrated greater physiological stability, Shorter ICU length of stay (7.53 ± 2.35 vs. 16.18 ± 5.70 days) and a higher extubation success rate (78.9% vs. 15%), lower reintubation rates, and better discharge outcomes compared with the control group. Conclusion: Early nursing-led sensory-motor activation effectively enhanced neurological responsiveness, sensory processing, functional recovery, physiological stability, and clinical outcomes among patients with severe traumatic brain injury. Recommendations: Incorporating structured sensory stimulation and graded motor activation into routine neurocritical care nursing practice may improve recovery trajectories and reduce disability in this patient population.