The Effect of Positioning on the Level of Arousal and Awareness in Patients in the Vegetative State or the Minimally Conscious State: A Replication and Extension of a Previous Finding

Wilson, Barbara A.; Dhamapurkar, Samira Kashinath; Tunnard, Catherine; Watson, Peter; Florschutz, Gerhard

doi:10.1017/brimp.2013.34

Cited by 28 publications

(29 citation statements)

References 5 publications

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“…Both studies found that 75% of patients showed more behaviors when assessed in a standing position. The amount of difference found, however, was not as large in the Wilson et al (2013) study as that seen in the Elliott et al (2005) study. This may be because the patients in the Wilson et al study were in the chronic stage, with most sustaining their brain injury many months (in one case, 36 years) earlier.…”

Section: The Effects Of Posture On Awarenesscontrasting

confidence: 58%

Assessment and treatment of people with a disorder of consciousness: An account of some recent studies.

Wilson¹,

Dhamapurkar²,

Rose³

2016

Psychology & Neuroscience

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This paper describes a number of studies looking at the assessment and treatment of people with disorders of consciousness (DOCs). These include patients in a coma, patients in a vegetative state (VS), and patients in a minimally conscious state (MCS). It is important to distinguish between these latter 2 states, as referral decisions may well be different for the 2 groups. A new version of a measure to assess patients with DOCs is described. The effects of posture on awareness are then considered. Provided that medical conditions do not contraindicate this, assessments should be carried out when the patient is in an upright position, as the majority of patients with DOCs show more behaviors when assessed on a tilt table or a standing frame. The third study looks at the effect of modafinil, an agent that maintains wakefulness and promotes attention and concentration, on levels of consciousness. Those with a traumatic brain injury (TBI) would appear to respond more to this than those whose DOC is caused by hypoxia. The fourth study compares the delayed recovery of 2 groups of patients, those with a TBI and those with hypoxic brain damage. Not surprisingly, those who showed delayed recovery of consciousness were far more likely to have sustained a TBI than hypoxic brain damage. The paper concludes with a case study of a man who had a DOC for 19 months before regaining consciousness and proceeding to regain skills so that he is now leading a reasonably normal life.

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Section: The Effects Of Posture On Awarenesscontrasting

confidence: 58%

Assessment and treatment of people with a disorder of consciousness: An account of some recent studies.

Wilson¹,

Dhamapurkar²,

Rose³

2016

Psychology & Neuroscience

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“…This device made it possible to mobilize the patients into a standing position earlier and for a longer time during the course of rehabilitation. Assuming that the vertical position influences the state of arousal and alertness [ 14 , 15 ], an extension of verticality duration potentially enhances arousal and therewith the alertness and responsiveness of the patient.…”

Section: Introductionmentioning

confidence: 99%

Tilt Table Therapies for Patients with Severe Disorders of Consciousness: A Randomized, Controlled Trial

et al. 2015

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One major aim of the neurological rehabilitation of patients with severe disorders of consciousness (DOC) is to enhance patients’ arousal and ability to communicate. Mobilization into a standing position by means of a tilt table has been shown to improve their arousal and awareness. However, due to the frequent occurrence of syncopes on a tilt table, it is easier to accomplish verticalization using a tilt table with an integrated stepping device. The objective of this randomized controlled clinical trial was to evaluate the effectiveness of a tilt table therapy with or without an integrated stepping device on the level of consciousness. A total of 50 participants in vegetative or minimally conscious states 4 weeks to 6 month after injury were treated with verticalization during this randomized controlled trial. Interventions involved ten 1-hour sessions of the specific treatment over a 3-week period. Blinded assessors made measurements before and after the intervention period, as well as after a 3-week follow-up period. The coma recovery scale-revised (CRS-R) showed an improvement by a median of 2 points for the group receiving tilt table with integrated stepping (Erigo). The rate of recovery of the group receiving the conventional tilt table therapy significantly increased by 5 points during treatment and by an additional 2 points during the 3-week follow-up period. Changes in spasticity did not significantly differ between the two intervention groups. Compared to the conventional tilt table, the tilt table with integrated stepping device failed to have any additional benefit for DOC patients. Verticalization itself seems to be beneficial though and should be administered to patients in DOC in early rehabilitation. Trial Registration: Current Controlled Trials Ltd (www.controlled-trials.com), identifier number ISRCTN72853718

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“…Mobilizat ion into a standing position, e.g., with a tilt table, has been shown to imp rove arousal and awareness in small groups of vegetative state and min imally conscious state patients (Elliot L et al, 2005, Wilson BA et al, 2013, Riberholt CG et al, 2013.…”

Section: Discussion:-mentioning

confidence: 99%

Effect of Robotic Tilt Table Vers Us Conventional Exercis Es on Rehabilitation Outcome in Stroke Patients: A Follow Up Study.

Kumar¹,

Yadav²,

Aafreen³

2018

IJAR

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Background: Stro ke is the main cause of long term disability among adults, living survivors with deficits, and one third remain dependant in activities of daily liv ing thus necessitates early mobilization. Purpose: To determine the efficacy of exercises by Robotic tilt table versus the conventional physiotherapy treatment program in rehabilitation of patients with hemip legia following stroke. Methods: A total of 80 hemiplegic patients (age 50.36 ±8.36 years, 8.43±4.76 days after stroke) were assigned randomly into two groups for 30 days of Conventional physiotherapy or Robotic tilt-table rehabilitation. The National Institutes of Health Stroke Scale (NIHSS), Mini Mental Scale Examination (MMSE), Modified Ashworth Scale, Quality of Life (QOL) and muscle strength of affected upper and lower limb) outcomes were assessed before (day 0), after (day 30) of the rehabilitative protocols and on 90 th day of follow up. Results: The Robotic tilt table group imp roved with time in 0-90 days in QOL=26.6, NIHSS= 9.38, Ashworth= 0.18, MMSE =8.10, muscle strength upper limb =2.08 and lower limb =2.40.Whereas conventional physiotherapy group improved with time within 0-90 days QOL=14.18, NIHSS= 8.30, Ashworth= 0.45, MMSE =8.25, muscle strength upper limb =2.10 and lo wer limb =2.07. Conclusion: Robotic tilt table group has shown higher improvement than conventional physiotherapy group.

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The Effect of Positioning on the Level of Arousal and Awareness in Patients in the Vegetative State or the Minimally Conscious State: A Replication and Extension of a Previous Finding

Cited by 28 publications

References 5 publications

Assessment and treatment of people with a disorder of consciousness: An account of some recent studies.

Assessment and treatment of people with a disorder of consciousness: An account of some recent studies.

Tilt Table Therapies for Patients with Severe Disorders of Consciousness: A Randomized, Controlled Trial

Effect of Robotic Tilt Table Vers Us Conventional Exercis Es on Rehabilitation Outcome in Stroke Patients: A Follow Up Study.

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