Robotic Verticalization plus Music Therapy in Chronic Disorders of Consciousness: Promising Results from a Pilot Study

Abstract

Background: Music stimulation is considered a valuable form of intervention in disorders of consciousness (DoC); for instance, verticalization may improve motor and cognitive recovery. Our purpose is to investigate the effects of a novel rehabilitative approach combining robotic verticalization training (RVT) with personalized music stimulation in people with DoC. Methods: Sixteen subjects affected by minimally conscious state due to traumatic brain lesions who attended our Intensive Neuro-Rehabilitation Unit were enrolled in this randomized trial. They received either music robotic verticalization (MRV) using the Erigo device plus a personalized music playlist or only RVT without music stimuli. Each treatment was performed 2 times a week for 8 consecutive weeks in addition to standard neurorehabilitation. Results: We found significant improvements in all patients’ outcomes in the experimental group (who received MRV): Coma Recovery Scale-Revised (CRS-R) (p < 0.01), Level of Cognitive Functioning (LCF) (p < 0.02), Functional Independence Measure (FIM)(p < 0.03), Functional Communication Scale (FCS) (p < 0.007), Trunk Control Test (TCT) (p = 0.05). Significant differences between the two groups were also found in the main outcome measure CRS-R (p < 0.01) but not for TCT and FIM. Conclusions: Our study supports the safety and effectiveness of RVT with the Erigo device in chronic MCS, and the achievement of better outcomes when RVT is combined with music stimulation.

Innovative Technologies in the Neurorehabilitation of Traumatic Brain Injury: A Systematic Review

“…Among the 26 articles included in this review, we found only 2 articles [ 12 , 24 ] on the use of robotic verticalization with the Erigo device in sTBI patients. Specifically, De Luca et al [ 12 ] administered autobiographical music stimulation plus robotic verticalization to the experimental group with a better improvement in the level of awareness and consciousness.…”

“…Among the 26 articles included in this review, we found only 2 articles [ 12 , 24 ] on the use of robotic verticalization with the Erigo device in sTBI patients. Specifically, De Luca et al [ 12 ] administered autobiographical music stimulation plus robotic verticalization to the experimental group with a better improvement in the level of awareness and consciousness. Taveggia et al [ 24 ] found that the use of the Erigo device may reduce orthostatic hypotension in vs. and MCS patients, thanks to its gradual verticalization and stepping, with constant and non-invasive monitoring of vitals parameters.…”

“…In addition, patients affected by TBI (or at least their caregivers) should be familiar with technical issues to not yield the training more challenging [ 42 ], especially when they have to use virtual reality, computer-based approaches and telerehabilitation. In detail: Patients with a diagnosis of DoC or sTBI need to achieve an early and gradual verticalization in order to avoid deterioration of the autonomic nervous system and bedridden complications [ 12 , 24 ]. For these reasons, the Erigo device could be a useful tool in clinical practice to meet patient necessities.…”

“…Patients with a diagnosis of DoC or sTBI need to achieve an early and gradual verticalization in order to avoid deterioration of the autonomic nervous system and bedridden complications [ 12 , 24 ]. For these reasons, the Erigo device could be a useful tool in clinical practice to meet patient necessities.…”

“…In addition, in patients with severe TBI (sTBI), walking training and specific cognitive programs make rehabilitation difficult or even impossible due to a lack of physical and psychiatric patient compliance [ 11 ]. These patients, especially when affected by disorder consciousness, could benefit from early robotic verticalization through tilt tables to avoid episodes of orthostatic hypotension and bedridden complications [ 12 ]. This is why robotics and VR may be a complementary treatment to further improve functional recovery in TBI.…”