Early mobilization of a patient with acquired brain injury using a new standing aid, the Innowalk Pro. A single subject experimental design

Abstract

Background Early mobilization is regarded as important in patients with severe acquired brain injury. Objective To explore the feasibility, physical and physiological responses of using a new assistive, electric standing device, Innowalk Pro (IP), that passively moves the legs in an upright position. Design A single-subject experimental design. Methods A three-phase model (A1-B-A2) was chosen; A1: baseline using a standing frame, B: an intervention using IP and A2: withdrawal using a standing frame. Outcome measures: Patient’s and assistive personnel’s experiences with Likert scales, Modified Trunk Impairment Scale, Modified Ashworth Scale (MAS), Lidcombe Template (passive ankle dorsiflexion), duration of the training, blood pressure and heart rate. Results A 40-year-old female, with subarachnoid haemorrhage, perceived training in the IP as more physically exhausting than training in a standing frame, influencing the training time. However, she preferred the IP over the standing frame. Trunk control did not improve, until the withdrawal phase. A small MAS reduction in ankle plantar flexors was maintained in the A2-phase. The heart rate showed an ascending trend in A1, and a non-significant descending trend in B- and A2-phases. Blood pressure showed a flat trend line in A1 and B-phases, and a descending trend in A2. Conclusion The new IP was considered a feasible and motivating intervention. Heart rate tended to decrease during IP training, while the blood pressure remained stable. Further research is needed to evaluate whether the IP should be a preferable or a supplementary assistive device for early mobilization. Implications for rehabilitation A new electrical standing device, Innowalk Pro, which moves the legs in upright position, was found to be feasible in early mobilisation of a patient with severe brain injury. Trained physiotherapist and assistive personnel are recommended for safe training. Physiological responses like heart rate and blood pressure remained relatively stable when training in Innowalk Pro. We question whether the leg movements when standing in Innowalk Pro, may contribute to improvement in trunk control.