Verticalization for Refractory Intracranial Hypertension: A Case Series

Lachance, Brittany Bolduc; Chang, Wan‐Tsu W.; Motta, Melissa; Parikh, Gunjan; Podell, Jamie; Badjatia, Neeraj; Simard, J. Marc; Schwartzbauer, Gary; Morris, Nicholas

doi:10.1007/s12028-021-01323-z

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…Moreover, verticalization may also improve brain and CSF hemodynamics. Indeed, the device could also improve muscle activation, through a better muscle pump function, and venous return ultimately resulting in improved cardiovascular stability and brain circulation [18,[44][45][46].…”

Section: Discussionmentioning

confidence: 99%

Improving Neuroplasticity through Robotic Verticalization Training in Patients with Minimally Conscious State: A Retrospective Study

De Luca,

Gangemi,

Bonanno

et al. 2024

Brain Sciences

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In disorders of consciousness, verticalization is considered an effective type of treatment to improve motor and cognitive recovery. Our purpose is to investigate neurophysiological effects of robotic verticalization training (RVT) in patients with minimally conscious state (MCS). Thirty subjects affected by MCS due to traumatic or vascular brain injury, attending the intensive Neurorehabilitation Unit of the IRCCS Neurolesi (Messina, Italy), were included in this retrospective study. They were equally divided into two groups: the control group (CG) received traditional verticalization with a static bed and the experimental group (EG) received advanced robotic verticalization using the Erigo device. Each patient was evaluated using both clinical scales, including Levels of Cognitive Functioning (LCF) and Functional Independence Measure (FIM), and quantitative EEG pre (T0) and post each treatment (T1). The treatment lasted for eight consecutive weeks, and sessions were held three times a week, in addition to standard neurorehabilitation. In addition to a notable improvement in clinical parameters, such as functional (FIM) (p < 0.01) and cognitive (LCF) (p < 0.01) outcomes, our findings showed a significant modification in alpha and beta bands post-intervention, underscoring the promising effect of the Erigo device to influence neural plasticity and indicating a noteworthy difference between pre-post intervention. This was not observed in the CG. The observed changes in alpha and beta bands underscore the potential of the Erigo device to induce neural plasticity. The device’s custom features and programming, tailored to individual patient needs, may contribute to its unique impact on brain responses.

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Section: Discussionmentioning

confidence: 99%

Improving Neuroplasticity through Robotic Verticalization Training in Patients with Minimally Conscious State: A Retrospective Study

De Luca,

Gangemi,

Bonanno

et al. 2024

Brain Sciences

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“…Given the potential risk for position-related pressure sores or more severe complications such as inadvertent decannulation or extubation, alternatives to PP could be a useful therapeutic option for intensivists caring for ARDS patients [3]. Verticalization for other disease processes, such as refractory intracranial hypertension, has been reported [8]. VT as a ventilation strategy for ARDS patients not receiving ECMO therapy has also been studied.…”

Section: Discussionmentioning

confidence: 99%

Verticalization Therapy for Acute Respiratory Distress Syndrome Patients Receiving Veno-Venous Extracorporeal Membrane Oxygenation

Shayan¹,

DeLeon²,

McGregor³

et al. 2023

Cureus

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Persistent hypoxemia during veno-venous extracorporeal membrane oxygenation (VV-ECMO) for supporting acute respiratory distress syndrome (ARDS) patients is a clinical challenge for intensive care medical providers. Prone positioning is an effective strategy to treat persistent hypoxemia; however, placing a patient in a prone position is resource intensive with significant risks to the patient. We present a patient with severe ARDS receiving VV-ECMO who underwent verticalization therapy and subsequently recovered pulmonary function.

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“…Similarly, moderate hypothermia to 35°C to 36°C (95.0°F to 96.8°F) effectively lowers ICP, but does not improve outcomes 43,44 . Finally, a small case series suggests verticalization therapy, or securing a patient in a standing position, may improve refractory intracranial hypertension again without evidence for improved outcomes 45 . case 7-1 illustrates that even patients requiring all three tiers of management for intracranial hypertension can achieve favorable functional outcomes.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Traumatic Brain Injury and Traumatic Spinal Cord Injury

Podell,

Morris

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article reviews the mechanisms of primary traumatic injury to the brain and spinal cord, with an emphasis on grading severity, identifying surgical indications, anticipating complications, and managing secondary injury. LATEST DEVELOPMENTS Serum biomarkers have emerged for clinical decision making and prognosis after traumatic injury. Cortical spreading depolarization has been identified as a potentially modifiable mechanism of secondary injury after traumatic brain injury. Innovative methods to detect covert consciousness may inform prognosis and enrich future studies of coma recovery. The time-sensitive nature of spinal decompression is being elucidated. ESSENTIAL POINTS Proven management strategies for patients with severe neurotrauma in the intensive care unit include surgical decompression when appropriate, the optimization of perfusion, and the anticipation and treatment of complications. Despite validated models, predicting outcomes after traumatic brain injury remains challenging, requiring prognostic humility and a model of shared decision making with surrogate decision makers to establish care goals. Penetrating injuries, especially gunshot wounds, are often devastating and require public health and policy approaches that target prevention.

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Verticalization for Refractory Intracranial Hypertension: A Case Series

Cited by 4 publications

References 36 publications

Improving Neuroplasticity through Robotic Verticalization Training in Patients with Minimally Conscious State: A Retrospective Study

Improving Neuroplasticity through Robotic Verticalization Training in Patients with Minimally Conscious State: A Retrospective Study

Verticalization Therapy for Acute Respiratory Distress Syndrome Patients Receiving Veno-Venous Extracorporeal Membrane Oxygenation

Traumatic Brain Injury and Traumatic Spinal Cord Injury

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