Abstract
Background and ObjectiveVerticalization was reported to improve the level of arousal and awareness in patients with severe acquired brain injury (ABI) and to be safe in ICU. We evaluated the effectiveness of a very early stepping verticalization protocol on their functional and neurological outcome.MethodsConsecutive patients with Vegetative State or Minimally Conscious State were enrolled in ICU on the third day after an ABI. They were randomized to undergo conventional physiotherapy alone or associated to fifteen 30-minute sessions of verticalization, using a tilt table with robotic stepping device. Once stabilized, patients were transferred to our Neurorehabilitation unit for an individualized treatment. Outcome measures (Glasgow Coma Scale, Coma Recovery Scale revised -CRSr-, Disability Rating Scale–DRS- and Levels of Cognitive Functioning) were assessed on the third day from the injury (T0), at ICU discharge (T1) and at Rehab discharge (T2). Between- and within-group comparisons were performed by the Mann-Whitney U test and Wilcoxon signed-rank test, respectively.ResultsOf the 40 patients enrolled, 31 completed the study without adverse events (15 in the verticalization group and 16 in the conventional physiotherapy). Early verticalization started 12.4±7.3 (mean±SD) days after ABI. The length of stay in ICU was longer for the verticalization group (38.8 ± 15.7 vs 25.1 ± 11.2 days, p = 0.01), while the total length of stay (ICU+Neurorehabilitation) was not significantly different (153.2 ± 59.6 vs 134.0 ± 61.0 days, p = 0.41). All outcome measures significantly improved in both groups after the overall period (T2 vs T0, p<0.001 all), as well as after ICU stay (T1 vs T0, p<0.004 all) and after Neurorehabilitation (T2 vs T1, p<0.004 all). The improvement was significantly better in the experimental group for CRSr (T2-T0 p = 0.033, T1-T0 p = 0.006) and (borderline) for DRS (T2-T0 p = 0.040, T1-T0 p = 0.058).ConclusionsA stepping verticalization protocol, started since the acute stages, improves the short-term and long-term functional and neurological outcome of ABI patients.Trial Registrationclinicaltrials.gov NCT02828371
Highlights
Acquired brain injuries (ABIs) result from traumatic and non-traumatic cerebral events and may lead to coma state in the acute phase
Verticalization was reported to improve the level of arousal and awareness in patients with severe acquired brain injury (ABI) and to be safe in ICU
Consecutive patients with Vegetative State or Minimally Conscious State were enrolled in ICU on the third day after an ABI
Summary
Acquired brain injuries (ABIs) result from traumatic and non-traumatic (mostly hemorrhagic, hypoxic, ischemic, infective and toxic) cerebral events and may lead to coma state in the acute phase. The AVERT (A Very Early Rehabilitation Trial) investigators stated that a very early in-bed and out-of-bed mobilization of ischemic and hemorrhagic stroke patients in Stroke Unit leads to a less favorable outcome. Their very early rehabilitation was carried out in the first 24 hours from the event (in the acute unstable phase of the brain injury) and only five hours before the physiotherapy timing of the controls [19]. We evaluated the effectiveness of a very early stepping verticalization protocol on their functional and neurological outcome
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