The use of assisted technologies in early aggressive mobilization with an individual in a minimally conscious state: a case report

Abstract

Introduction Early neurorehabilitation and passive, upright mobilization strategies have been shown to be beneficial for individuals with disorders of consciousness (DOC). However, literature is limited in illustrating the use of an early, aggressive program with an added focus on dynamic and active upright mobilization. The purpose of this case report is to describe a two-week aggressive, upright standing and walking program with an individual with traumatic brain injury in an acute inpatient rehabilitation setting. The case investigates the association between aggressive mobilization with changes in level of consciousness and daily cognitive, motor and communicative behaviours. Case description A 30-year-old male classified in DOC as minimally conscious state (MCS) participated in an early upright mobilization program. The two-week intervention consisted of aggressive static/passive and dynamic/active upright mobilization activities, involving a multidisciplinary rehabilitation team. Expressive communication, motor responses and current level of consciousness were monitored and assessed twice a day. Additionally, the patient’s activation and arousal were subjectively monitored during daily therapy sessions. Results Following the dynamic/active mobilization activities, the patient demonstrated improved expressive communication, motor scores and increased activation and arousal during the mobilizations. After the two-week intervention, he emerged from DOC. Conclusion This case report illustrates intense, more active/dynamic upright mobilization with the use of assisted technologies provides promise as an effective intervention for improving communication, motor responses, arousal and level of consciousness in a patient in MCS. Initiating upright, active activity sooner in the recovery process, may lead to improved outcomes and quicker emergence. IMPLICATIONS FOR REHABILITATION Aggressive upright mobilization may be delivered safely to patients in DOC early in their rehabilitative care. Aggressive upright mobilization may be beneficial for patients in DOC. Higher intensity, more active/dynamic upright mobilization such as the use of Erigo®Pro + stepping and locomotor training on a treadmill with body weight support demonstrated positive outcomes with expressive communication, motor responses and arousal. Earlier initiation of aggressive mobilization may promote recovery.