Rehabilitation interventions for vegetative and minimally conscious patients

Elliott, Louise; Walker, Louise

doi:10.1080/09602010443000506

Cited by 78 publications

(46 citation statements)

References 75 publications

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“…In comatose or vegetative patients, verticalization may improve the regaining of consciousness (reviewed in [18]). Whether the addition of stepping or FES to tilt-table exposure increases this effect, it is unknown.…”

Section: Discussionmentioning

confidence: 99%

Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Кузнецов

Rybalko

Даминов

et al. 2013

Stroke Research and Treatment

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Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age 58.3 ± 1.2 years, 4.6 ± 1.2 days after stroke) were assigned to 30 days of ROBO-FES (n = 38), ROBO (n = 35), or control (n = 31) in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped <10% during robot training. In 52% of controls mean arterial pressure decreased by ≥20%. ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than control (1.03 ± 0.61, P < 0.05). CBFV increased in both robotic groups more than in controls (P < 0.05). Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

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Section: Discussionmentioning

confidence: 99%

Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Кузнецов

Rybalko

Даминов

et al. 2013

Stroke Research and Treatment

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“…However, MCS patients show some inconsistent but reproducible behavioral signs, which are often long enough to be clearly distinguished from simple reflexes. The MCS clinical management and treatment is still a crucial issue [2] and is usually performed using an appropriate combination of both pharmacological intervention [3], [4] and psycho-physical rehabilitation therapy [5]. Focussing on such a psycho-physical treatment, mobilization and postural changes mainly characterize the current clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Quantitative EEG analysis in minimally conscious state patients during postural changes

Greco

Carboncini

Virgillito

et al. 2013

2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)

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Mobilization and postural changes of patients with cognitive impairment are standard clinical practices useful for both psychic and physical rehabilitation process. During this process, several physiological signals, such as Electroen-cephalogram (EEG), Electrocardiogram (ECG), Photopletysmography (PPG), Respiration activity (RESP), Electrodermal activity (EDA), are monitored and processed. In this paper we investigated how quantitative EEG (qEEG) changes with postural modifications in minimally conscious state patients. This study is quite novel and no similar experimental data can be found in the current literature, therefore, although results are very encouraging, a quantitative analysis of the cortical area activated in such postural changes still needs to be deeply investigated. More specifically, this paper shows EEG power spectra and brain symmetry index modifications during a verticalization procedure, from 0 to 60 degrees, of three patients in Minimally Consciousness State (MCS) with focused region of impairment. Experimental results show a significant increase of the power in β band (12 - 30 Hz), commonly associated to human alertness process, thus suggesting that mobilization and postural changes can have beneficial effects in MCS patients.

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“…There is a general lack of evidence for establishing the causal effect of early rehabilitation on promoting the recovery of a damaged brain (Zhu et al, 2007). Biochemical and anatomical plasticity of the brain and natural recovery provide the foundation for rehabilitation interventions to enhance the functional recovery in patients with brain injuries (Elliott and Walker, 2005). Experimental studies of animals (Oliff et al, 1998) and studies of patients with stroke (Liepert et al, 2000) demonstrated that brain plasticity is activity driven, and that the potential to enhance brain plasticity and improve functional recovery is greater in the early stages of recovery after injury (Zhu et al, 2007).…”

Section: Early Rehabilitation and Functional Outcomementioning

confidence: 99%

Does an Early Onset and Continuous Chain of Rehabilitation Improve the Long-Term Functional Outcome of Patients with Severe Traumatic Brain Injury?

Anđelić

Bautz‐Holter

Rønning

et al. 2012

Journal of Neurotrauma

199

129

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There are currently no international guidelines regarding treatment in the early rehabilitation phase for persons with severe traumatic brain injury (TBI), and only a few studies have investigated the effect of integrating rehabilitation into acute TBI care. The aim of the study was to evaluate whether a continuous chain of rehabilitation that begins with the acute phase could improve the functional outcome of severe TBI patients, compared to a broken chain of rehabilitation that starts in the sub-acute phase of TBI. A total of 61 surviving patients with severe TBI were included in a quasi-experimental study conducted at the Level I trauma center in Eastern Norway. In the study, 31 patients were in the early rehabilitation group (Group A) and 30 patients were in the delayed rehabilitation group (Group B). The functional outcomes were assessed 12 months post-injury with the Glasgow Outcome Scale Extended (GOSE) and the Disability Rating Scale (DRS). A favorable outcome (GOSE 6-8) occurred in 71 % of the patients from Group A versus 37 % in Group B ( p = 0.007). The DRS score was significantly better in Group A ( p = 0.03). The ordinal logistic regression analysis was used to quantify the relationship between the type of rehabilitation chain and the GOSE. A better GOSE outcome was found in patients from Group A (unadjusted OR 3.25 and adjusted OR 2.78, respectively). These results support the hypothesis that better functional outcome occurs in patients who receive early onset and a continuous chain of rehabilitation.

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Rehabilitation interventions for vegetative and minimally conscious patients

Cited by 78 publications

References 75 publications

Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Early Poststroke Rehabilitation Using a Robotic Tilt-Table Stepper and Functional Electrical Stimulation

Quantitative EEG analysis in minimally conscious state patients during postural changes

Does an Early Onset and Continuous Chain of Rehabilitation Improve the Long-Term Functional Outcome of Patients with Severe Traumatic Brain Injury?

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