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Ishii M, Nakagawa K, Yoshimi K, Okumura T, Hasegawa S, Yamaguchi K, Nakane A, Tamai T, Nagasawa Y, Yoshizawa A, Tohara H. Time Spent Away from Bed to Maintain Swallowing Function in Older Adults. Gerontology 2023; 69:37-46. [PMID: 35413713 DOI: 10.1159/000522499] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/05/2022] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the associations of time spent away from bed with whole-body muscle mass and swallowing function in older adults with low activities of daily living (ADL). METHODS This cross-sectional study was conducted at Tokyo Medical and Dental University and included adults over 65 years of age who underwent a medical intervention at their residence. Data regarding age, sex, body height and weight, activity status, medical history, time spent away from bed, and Functional Oral Intake Scale (FOIS) were collected. We calculated the body mass index, Charlson Comorbidity Index, whole-body muscle mass, the appendicular skeletal muscle mass index (ASMI), and the trunk muscle mass index (TMI). According to the time spent away from bed, the subjects were grouped as follows: <4 but ≥0 h (S), <6 but ≥4 h (M), and ≥6 h (L). These variables were analyzed using the one-way analysis of variance, the Kruskal-Wallis test, and the χ2 test, then differences among the three groups were examined. To adjust for confounding factors, we performed multiple regression analysis with ASMI and TMI as the dependent variables and ordinal logistic regression analysis with FOIS as the objective variable. RESULTS Ninety subjects (male: n = 42; female: n = 48; mean age = 82.9 ± 8.8 years, and groups S: n = 23; M: n = 30; L: n = 37) were analyzed. Group L had a significantly higher ASMI, TMI, and FOIS score than groups S and M, while group M had a significantly higher ASMI and FOIS score than group S. After adjusting for confounding factors, the significant explanatory factors for ASMI were sex, activity status, time spent away from bed, and TMI. The factors for TMI were activity status, time spent away from bed, ASMI, and FOIS. The factors for FOIS were time spent away from bed and TMI. CONCLUSION Spending 4 or more hours away from the bed is related to appendicular skeletal muscle mass and FOIS, while spending 6 or more hours is related to appendicular skeletal muscle mass, trunk muscle mass, and FOIS in this population. These findings highlight factors that can prevent a decline in swallowing function in the daily life of older adults with low ADL who have difficulty performing exercises to preserve swallowing function.
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Affiliation(s)
- Miki Ishii
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kazuharu Nakagawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kanako Yoshimi
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Takuma Okumura
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shohei Hasegawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kohei Yamaguchi
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Ayako Nakane
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tomoe Tamai
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuki Nagasawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akira Yoshizawa
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Haruka Tohara
- Division of Gerontology and Gerodontology, Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Abstract
Concern over social scientists' inability to reproduce empirical research has spawned a vast and rapidly growing literature. The size and growth of this literature make it difficult for newly interested academics to come up to speed. Here, we provide a formal text modeling approach to characterize the entirety of the field, which allows us to summarize the breadth of this literature and identify core themes. We construct and analyze text networks built from 1,947 articles to reveal differences across social science disciplines within the body of reproducibility publications and to discuss the diversity of subtopics addressed in the literature. This field-wide view suggests that reproducibility is a heterogeneous problem with multiple sources for errors and strategies for solutions, a finding that is somewhat at odds with calls for largely passive remedies reliant on open science. We propose an alternative rigor and reproducibility model that takes an active approach to rigor prior to publication, which may overcome some of the shortfalls of the postpublication model.
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Affiliation(s)
- James W Moody
- Department of Sociology, Duke University, Durham, North Carolina, USA
- Duke Network Analysis Center, Duke University, Durham, North Carolina, USA
| | - Lisa A Keister
- Department of Sociology, Duke University, Durham, North Carolina, USA
- Duke Network Analysis Center, Duke University, Durham, North Carolina, USA
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Maria C Ramos
- Interdisciplinary Social Science Program, Florida State University, Tallahassee, Florida, USA
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Riberholt CG, Olsen MH, Berg RMG, Møller K. Mobilising patients with severe acquired brain injury in intensive care (MAWERIC) - Protocol for a randomised cross-over trial. Contemp Clin Trials 2022; 116:106738. [PMID: 35331944 DOI: 10.1016/j.cct.2022.106738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/21/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In the early phase after severe brain injury, patients are often bedridden in an attempt to control intracranial homeostasis; however, prolonged immobilisation may trigger complications. There is limited knowledge about the physiological effects of mobilisation in this early phase. OBJECTIVE To investigate changes in brain tissue oxygen tension when patients are mobilised using a Sara Combilizer® in the early phase after severe brain injury, in a randomised cross-over design. METHODS Patients with traumatic brain injury, subarachnoid haemorrhage or intracranial haematoma, will be randomised to early mobilisation or rest (no mobilisation = control) on the first day that the patient is deemed to be fit for mobilisation, and the opposite on the next day. On both days, patients will undergo continuous multimodal monitoring measuring brain tissue oxygen tension (primary outcome), invasive blood pressure, heart rate, middle cerebral artery blood flow velocity by transcranial Doppler ultrasound, intracranial pressure, and microdialysis markers of cerebral oxidative metabolism. DISCUSSION Intensive care unit patients with acute brain injury are frequently immobilised in the early phase after the ictus. The optimal timing and intensity of mobilisation is unknown. The present study attempts to establish if early mobilisation is safe with respect to intracranial homeostasis. Protocol version 1.1. Date: 19.02.2022. Ethical registration: H-21002728; approved on August 11, 2021. GDPR registration: P-2021 - 105; approved on February 10, 2021. CLINICALTRIALS govidentifier:NCT05038930; approved on September 8, 2021. Electronic case report file: REDCap-database; created on August 13, 2021.
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Affiliation(s)
- Christian Gunge Riberholt
- Department of Neurorehabilitation, Traumatic Brain Injury, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Denmark.
| | - Markus Harboe Olsen
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ronan M G Berg
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark; Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Denmark; Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Kirsten Møller
- Department of Neuroanaesthesiology, The Neuroscience Centre, Copenhagen University Hospital - Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Overbeek BUH, Lavrijsen JCM, van Gaal S, Kondziella D, Eilander HJ, Koopmans RTCM. Towards consensus on visual pursuit and visual fixation in patients with disorders of consciousness. A Delphi study. J Neurol 2022; 269:3204-3215. [PMID: 35001197 DOI: 10.1007/s00415-021-10905-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this Delphi study was to reach consensus about definition, operationalization and assessment of visual pursuit (VP) and visual fixation (VF). METHODS In a three-round international Delphi study, clinical and research experts on disorders of consciousness indicated their level of agreement on 87 statements using a 5-point Likert scale. Consensus for agreement was defined by a median of 5, an interquartile range (IQR) ≤ 1, and ≥ 80% indicating moderate or strong agreement. RESULTS Forty-three experts from three continents participated, 32 completed all three rounds. For VP, the consensus statements with the highest levels of agreement were on the term 'pursuit of a visual stimulus', the description 'ability to follow visually in horizontal and/or vertical plane', a duration > 2 s, tracking in horizontal and vertical planes, and a frequency of more than 2 times per assessment. For VF, consensus statements with the highest levels of agreement were on the term 'sustained VF', the description 'sustained fixation in response to a salient stimulus', a duration of > 2 s and a frequency of 2 or more times per assessment. The assessment factors with the highest levels of agreement were personalized stimuli, the use of eye tracking technology, a patient dependent time of assessment, sufficient environmental light, upright posture, and the necessity to exclude ocular/oculomotor problems. CONCLUSION This first international Delphi study on VP and VF in patients with disorders of consciousness provides provisional operational definitions and an overview of the most relevant assessment factors.
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Affiliation(s)
- Berno U H Overbeek
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands. .,Kalorama, Beek Ubbergen, The Netherlands. .,Azora, Terborg, The Netherlands.
| | - Jan C M Lavrijsen
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simon van Gaal
- Faculty of Social and Behavioural Sciences, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henk J Eilander
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Center for Specialized Geriatric Care, Joachim en Anna, Nijmegen, The Netherlands
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Bohannon RW, Green MD. Neurologic and musculoskeletal effects of tilt-table standing on adults: a systematic review. J Phys Ther Sci 2021; 33:700-706. [PMID: 34539077 PMCID: PMC8436033 DOI: 10.1589/jpts.33.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/27/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Tilt table use is associated, most often, with the assessment of syncope. However, it also has applications for patients with neurologic and orthopedic problems. These applications do not appear to be widely applied. The purpose of this review, therefore, was to summarize the research literature addressing the use of tilt tables for treating specific musculoskeletal and neurologic impairments in adults. [Methods] Relevant literature was identified by searches of the PubMed, CINAHL, and Scopus databases and hand searches (December 2018 and October 2020). The methodological quality of the identified research articles was assessed using the PEDro scale. [Results] Of 482 unique articles identified, 20 matched the eligibility criteria of the review and were included. The studies varied widely in the populations studied, procedures used, and responses reported. The studies provide limited support for tilt table standing as an intervention. [Conclusion] However, evidence that some patients with neurologic conditions may respond positively to tilt-table standing is available. Among such individuals are those with decreased ankle range of motion, positive neurologic signs in the lower limbs, and decreased levels of consciousness.
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Sumioka H, Shiomi M, Honda M, Nakazawa A. Technical Challenges for Smooth Interaction With Seniors With Dementia: Lessons From Humanitude™. Front Robot AI 2021; 8:650906. [PMID: 34150858 PMCID: PMC8207295 DOI: 10.3389/frobt.2021.650906] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Due to cognitive and socio-emotional decline and mental diseases, senior citizens, especially people with dementia (PwD), struggle to interact smoothly with their caregivers. Therefore, various care techniques have been proposed to develop good relationships with seniors. Among them, Humanitude is one promising technique that provides caregivers with useful interaction skills to improve their relationships with PwD, from four perspectives: face-to-face interaction, verbal communication, touch interaction, and helping care receivers stand up (physical interaction). Regardless of advances in elderly care techniques, since current social robots interact with seniors in the same manner as they do with younger adults, they lack several important functions. For example, Humanitude emphasizes the importance of interaction at a relatively intimate distance to facilitate communication with seniors. Unfortunately, few studies have developed an interaction model for clinical care communication. In this paper, we discuss the current challenges to develop a social robot that can smoothly interact with PwDs and overview the interaction skills used in Humanitude as well as the existing technologies.
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Affiliation(s)
- Hidenobu Sumioka
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Masahiro Shiomi
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | - Miwako Honda
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Riberholt CG, Olsen MH, Søndergaard CB, Gluud C, Ovesen C, Jakobsen JC, Mehlsen J, Møller K. Early Orthostatic Exercise by Head-Up Tilt With Stepping vs. Standard Care After Severe Traumatic Brain Injury Is Feasible. Front Neurol 2021; 12:626014. [PMID: 33935935 PMCID: PMC8079637 DOI: 10.3389/fneur.2021.626014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Intensive rehabilitation of patients after severe traumatic brain injury aims to improve functional outcome. The effect of initiating rehabilitation in the early phase, in the form of head-up mobilization, is unclear. Objective: To assess whether early mobilization is feasible and safe in patients with traumatic brain injury admitted to a neurointensive care unit. Methods: This was a randomized parallel-group clinical trial, including patients with severe traumatic brain injury (Glasgow coma scale <11 and admission to the neurointensive care unit). The intervention consisted of daily mobilization on a tilt-table for 4 weeks. The control group received standard care. Outcomes were the number of included participants relative to all patients with traumatic brain injury who were approached for inclusion, the number of conducted mobilization sessions relative to all planned sessions, as well as adverse events and reactions. Information on clinical outcome was collected for exploratory purposes. Results: Thirty-eight participants were included (19 in each group), corresponding to 76% of all approached patients [95% confidence interval (CI) 63–86%]. In the intervention group, 74% [95% CI 52–89%] of planned sessions were carried out. There was no difference in the number of adverse events, serious adverse events, or adverse reactions between the groups. Conclusions: Early head-up mobilization is feasible in patients with severe traumatic brain injury. Larger randomized clinical trials are needed to explore potential benefits and harms of such an intervention. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT02924649]. Registered on 3rd October 2016.
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Affiliation(s)
- Christian Gunge Riberholt
- Traumatic Brain Injury Unit, Department of Neurorehabilitation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Markus Harboe Olsen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Gluud
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Ovesen
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.,Department of Regional Health Research, The Faculty of Heath Sciences, University of Southern Denmark, Odense, Denmark
| | - Jesper Mehlsen
- Surgical Pathophysiology Unit, Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Møller
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Lane TJ. The minimal self hypothesis. Conscious Cogn 2020; 85:103029. [PMID: 33091792 DOI: 10.1016/j.concog.2020.103029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/07/2020] [Accepted: 09/26/2020] [Indexed: 12/01/2022]
Abstract
For millennia self has been conjectured to be necessary for consciousness. But scant empirical evidence has been adduced to support this hypothesis. Inconsistent explications of "self" and failure to design apt experiments have impeded progress. Advocates of phenomenological psychiatry, however, have helped explicate "self," and employed it to explain some psychopathological symptoms. In those studies, "self" is understood in a minimalist sense, sheer "for-me-ness." Unfortunately, explication of the "minimal self" (MS) has relied on conceptual analysis, and applications to psychopathology have been hermeneutic, allowing for many degrees of interpretive latitude. The result is that MS's current scientific status is analogous to that of the "atom," at the time when "atom" was just beginning to undergo transformation from a philosophical to a scientific concept. Fortunately, there is now an opportunity to promote a similar transformation for "MS." Discovery of the brain's Default Mode Network (DMN) opened the door to neuroimaging investigations of self. Taking the DMN and other forms of intrinsic activity as a starting point, an empirical foothold can be established, one that spurs experimental research and that enables extension of research into multiple phenomena. New experimental protocols that posit "MS" can help explain phenomena hitherto not thought to be related to self, thereby hastening development of a mature science of self. In particular, targeting phenomena wherein consciousness is lost and recovered, as in some cases of Unresponsive Wakefulness Syndrome (UWS), allow for design of neuroimaging probes that enable detection of MS during non-conscious states. These probes, as well as other experimental protocols applied to NREM Sleep, General Anesthesia (GA), and the waking state, provide some evidence to suggest that not only can self and consciousness dissociate, MS might be a necessary precondition for conscious experience. Finally, these findings have implications for the science of consciousness: it has been suggested that "levels of consciousness" (LoC) is not a legitimate concept for the science of consciousness. But because we have the conceptual and methodological tools with which to refine investigations of MS, we have the means to identify a possible foundation-a bifurcation point-for consciousness, as well as the means by which to measure degrees of distance from that foundation. These neuroimaging investigations of MS position us to better assess whether LoC has a role to play in a mature science of consciousness.
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Affiliation(s)
- Timothy Joseph Lane
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan; Brain and Consciousness Research Centre, TMU Shuang-Ho Hospital, New Taipei City, Taiwan; Institute of European and American Studies, Academia Sinica, Taipei, Taiwan.
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Ng H, King A. A systematic review of head-up tilt to improve consciousness in people with a prolonged disorder of consciousness. Clin Rehabil 2020; 35:13-25. [PMID: 32734772 PMCID: PMC7814097 DOI: 10.1177/0269215520946696] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: This systematic review analysed the evidence for the effect of head-up tilt (passive-standing) on consciousness among persons in prolonged disorders of consciousness. Data sources: Articles were identified through primary database searching (Medline, CINAHL, AMED, The Cochrane Library) and post-citation searching (Scopus). Review methods: This review followed the PRISMA statement. The search strategy was created to find articles that combined any conceivable passive standing device, any measure of consciousness and disorders of consciousness of any origin. Inclusion criteria were any papers that evaluated the use of head-up tilt in adults in defined disorders of consciousness. Exclusion criteria included active stand studies, paediatric studies and animal studies. The search was completed independently by two researchers. Data collection and risk of bias assessment was completed using the Downs and Black tool. Results: 6867 titles were retrieved (last search completed 21/6/20). Ten papers met the inclusion criteria: five examined the effects of a single head-up tilt treatment, and five the effects of head-up tilt regimes. Eighty-seven participants were randomised in three randomised controlled trials. In the remaining preliminary studies or case series, 233 participants were analysed. Quality was low, with only two high-quality studies available. Four studies were suitable for effect size analysis, where medium to large effect sizes were found. The two high-quality studies found head-up tilt had a large effect on consciousness. Conclusion: Overall there is some evidence that repeated passive standing on a tilt-table can improve consciousness, but the relevant studies provoke further questions.
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Affiliation(s)
- Harriet Ng
- Centre for Sport, Exercise and Life Sciences (CSELS), Coventry University, Coventry, Warwickshire, UK
| | - Andrew King
- Coventry University, Coventry, Warwickshire, UK
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Ancona E, Quarenghi A, Simonini M, Saggini R, Mazzoleni S, De Tanti A, Saviola D, Salvi GP. Effect of verticalization with Erigo® in the acute rehabilitation of severe acquired brain injury. Neurol Sci 2019; 40:2073-2080. [PMID: 31129775 DOI: 10.1007/s10072-019-03917-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 04/26/2019] [Indexed: 11/28/2022]
Abstract
The recovery of the orthostatism after a severe acquired brain injury (sABI) is an essential objective to pursue in order to avoid the occurrence of secondary complications resulting from prolonged immobilization to which the patient is subjected during the acute phase. This randomized controlled trial aims to evaluate the effect of verticalization with the lower limb robot-assisted training system Erigo® versus conventional neurorehabilitation in 44 adult subjects affected by sequelae of sABI in the acute rehabilitation phase, related to cardiorespiratory signs and measures of impairment and activity. At the end of the study (20 treatment sessions, 5 sessions per week), in both groups of patients, there were no dropouts nor adverse events. In subject verticalized with Erigo®, there were no episodes of (pre)syncope from orthostatic hypotension nor postural orthostatic tachycardia and cardiorespiratory signs remained stable; moreover, there were no increase in muscle tone nor reduction in range of motion at lower limbs. Results obtained show improved outcomes on the whole and in a similar way in both groups; however, the improvement in scores of the National Institutes of Health Stroke Scale, the Tinetti scale, and the Functional Independence Measure from the enrollment to the end of the treatment cycle being equal, the evaluation performed at the 10th session allows to establish that the improvement appears earlier in the intervention group and later in the control group. The more rapid recovery of impairments and some activities in subjects treated with Erigo® could allow a "time-saver" to devote to the rehabilitation of sensory-motor functions which are more complex and subordinated to the preliminary reacquisition of elementary postures and motor strategies.
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Affiliation(s)
- Emilio Ancona
- Neurorehabilitation Unit, "Quarenghi" Clinical Institute, Via San Carlo 70, 24016 San Pellegrino Terme, Bergamo, Italy
| | - Annamaria Quarenghi
- Neurorehabilitation Unit, "Quarenghi" Clinical Institute, Via San Carlo 70, 24016 San Pellegrino Terme, Bergamo, Italy
| | - Marcello Simonini
- Neurorehabilitation Unit, "Quarenghi" Clinical Institute, Via San Carlo 70, 24016 San Pellegrino Terme, Bergamo, Italy
| | - Raoul Saggini
- School of Specialty in Physical and Rehabilitation Medicine, "Gabriele d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore "Sant'Anna", Pontedera, Pisa, Italy
| | - Antonio De Tanti
- "Cardinal Ferrari" Rehabilitation Centre, "Santo Stefano" Riabilitazione, Fontanellato, Parma, Italy
| | - Donatella Saviola
- "Cardinal Ferrari" Rehabilitation Centre, "Santo Stefano" Riabilitazione, Fontanellato, Parma, Italy
| | - Giovanni Pietro Salvi
- Neurorehabilitation Unit, "Quarenghi" Clinical Institute, Via San Carlo 70, 24016 San Pellegrino Terme, Bergamo, Italy.
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Riberholt CG, Lindschou J, Gluud C, Mehlsen J, Møller K. Early mobilisation by head-up tilt with stepping versus standard care after severe traumatic brain injury - Protocol for a randomised clinical feasibility trial. Trials 2018; 19:612. [PMID: 30409170 PMCID: PMC6225708 DOI: 10.1186/s13063-018-3004-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/19/2018] [Indexed: 11/15/2022] Open
Abstract
Background Intensive rehabilitation of patients with severe traumatic brain injury is generally applied in the subacute stages of the hospital stay. Few studies have assessed the association between early and intensive physical rehabilitation and functional outcomes. The aim of this trial is to assess the feasibility of an intensive physical rehabilitation intervention focusing on mobilisation to the upright position, starting as early as clinically possible versus standard care in the intensive care unit. The feasibility study is intended to inform a subsequent randomised clinical trial that will investigate benefits and harms of the intervention. Methods This randomised clinical feasibility trial with a follow-up period of 1 year will use blinded outcome assessors for the Coma Recovery Scale–Revised. A maximum of 60 patients admitted to the neurointensive care unit at Rigshospitalet, Denmark, with traumatic brain injury (age of at least 18 years), a low level of consciousness, and stable intracranial pressure will be included in the trial. Patients will be randomly assigned to experimental intervention versus standard care (1:1) stratified according to their Glasgow Coma Score. The intervention group will receive daily mobilisation in a tilt table with an integrated stepping device (ERIGO®). Feasibility is declared if more than 60% (the lower 95% confidence interval of the proportion) of eligible patients are included in the trial and more than 52% (the lower 95% confidence interval of the proportion) of patients in the intervention group receive more than 60% of the planned interventions. Safety is assessed by the occurrence of adverse events and adverse reactions. Exploratory clinical outcomes consist of cerebral haemodynamics (blood flow velocity and pressure autoregulation) and baroreceptor sensitivity in the early phase as well as functional outcomes (Coma Recovery Scale–Revised, Early Functional Ability scale, and Functional Independence Measure). Discussion Our findings will inform a future, larger-scale randomised clinical trial on early mobilisation using a tilt table early after severe traumatic brain injury. Trial registration ClinicalTrials.gov identifier: NCT02924649. Registered on 3 October 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-3004-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Gunge Riberholt
- Department of Neurorehabilitation/TBI unit, Rigshospitalet, University of Copenhagen, Kettegard Alle 30, 2650, Hvidovre, Denmark.
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Jesper Mehlsen
- Syncope Centre, Department of Cardiology, Bispebjerg & Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Kirsten Møller
- Department of Neuroanaesthesiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, København Ø, Denmark
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Pistarini C, Maggioni G. Early rehabilitation of Disorders of Consciousness (DOC): management, neuropsychological evaluation and treatment. Neuropsychol Rehabil 2018; 28:1319-1330. [PMID: 30033818 DOI: 10.1080/09602011.2018.1500920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In order to ensure the best possible rehabilitation plan and best outcome for patients with Disorders of Consciousness (DOC), optimal management of the early phase of rehabilitation is fundamental. This includes a correct diagnosis, accurate assessment of the patient's state of alertness and the main comorbidities, appropriate neurophysiological and neuroradiology examinations, and education of the caregiver and family so that they can provide the best assistance. Thirty years ago, specialists first began applying a systematic approach to the rehabilitation of patients with DOC, but still today many problems remain unsolved: the rate of misdiagnosis is still high, and recommendations about the most appropriate mode of rehabilitation are lacking, both as regards the timing of interventions and what the best techniques to use are. In a medical sector where nosography has changed over the last decade and where the documented evidence, though increasing, still remains insufficient, we discuss in this brief review the main assessment tools and disability scales to use and the key issues that need to be considered when a patient with DOC is admitted to the rehabilitation unit and decisions about the early rehabilitation plan are made.
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Affiliation(s)
- Caterina Pistarini
- a Head of Severe Brain Injury Rehabilitation Unit , I.R.C.C.S. I. Clinici Maugeri , Genova , Italy
| | - Giorgio Maggioni
- b Rehabilitation Unit , I.R.C.C.S. I. Clinici Maugeri , Veruno , Italy
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Morrissey AM, Gill-Thwaites H, Wilson B, Leonard R, McLellan L, Pundole A, Shiel A. The role of the SMART and WHIM in behavioural assessment of disorders of consciousness: clinical utility and scope for a symbiotic relationship. Neuropsychol Rehabil 2017; 28:1254-1265. [PMID: 28762872 DOI: 10.1080/09602011.2017.1354769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
As the prevalence and incidence of disorders of consciousness (DoC) increase, researchers and clinicians are tasked with developing best practice assessment techniques. Neurobehavioural assessment remains the most clinically available method of measuring consciousness. Neuroimaging and other physiological measurements are demonstrating promise in supporting this assessment but many of these techniques require further research and are not widely available in sub-acute and long-term care settings. No study to date has explored in-depth complementary use of multiple neurobehavioural assessments in aiding beside assessment of consciousness. This paper describes and proposes complementary use of two commonly used standardised neurobehavioural assessments. The Sensory Modality Assessment and Rehabilitation Technique (SMART) and the Wessex Head Injury Matrix (WHIM) both have specific aims and play an important role in behavioural assessment across the care continuum. This paper proposes that when used together appropriately these two assessments promote best practice and strengthen behavioural assessment of consciousness by providing increased opportunities to capture awareness. Further research into use of more than one neurobehavioural tool is highlighted as an important area of inquiry for this heterogeneous population not only in clinical practice but also in research.
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Affiliation(s)
- Ann-Marie Morrissey
- a Discipline of Occupational Therapy , Trinity College Dublin, The University of Dublin , Dublin, Ireland.,b College of Medicine, Nursing and Health Sciences , National University of Ireland Galway , Galway , Ireland
| | | | - Barbara Wilson
- d Department of Neuropsychology, Raphael Medical Centre , Tonbridge , Kent , UK.,e Department of Neuropsychology, Oliver Zangwill Centre , Ely , Cambridgeshire , UK
| | - Rachel Leonard
- f Department of Speech and Language Therapy , Mayo General Hospital , Castlebar, Mayo , Ireland
| | - Lindsay McLellan
- g Rehabilitation Research Unit , University of Southampton , Southampton , UK
| | - Amy Pundole
- c Royal Hospital for Neuro-Disability Putney , London , UK
| | - Agnes Shiel
- b College of Medicine, Nursing and Health Sciences , National University of Ireland Galway , Galway , Ireland
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Dhamapurkar SK, Rose A, Florschutz G, Wilson BA. The natural history of continuing improvement in an individual after a long period of impaired consciousness: The story of I.J. Brain Inj 2015; 30:230-6. [PMID: 26680113 DOI: 10.3109/02699052.2015.1094132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Recovery of consciousness and recovery of function among patients with prolonged disorders of consciousness rarely occur. Those patients who do regain consciousness typically remain with severe disability. The aim of this retrospective study is to suggest that continuing improvement is possible in a survivor of catastrophic brain injury after being in a prolonged state of disordered consciousness. CASE STUDY This retrospective single case study follows the progress of a 29 year old man, I.J, who sustained a severe traumatic brain injury following an assault in October 2011. He was in a vegetative state for 15 months and in a minimally conscious state for a further 4 months. This was followed by a slow and steady recovery of motor and cognitive functions. At 3 years post-injury I.J is considered to be moderately disabled. He is now living in the community with continuing outpatient support. On the disability rating scale his level of functioning is rated as mildly dependent. CONCLUSION This study shows that continuing recovery to a level of moderate disability is possible, even after a prolonged disorder of consciousness. Intense multi-disciplinary long-term rehabilitation and cranioplasty may be contributing factors for such an unexpected recovery.
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Affiliation(s)
| | - Anita Rose
- a The Raphael Medical Centre , Kent , UK
| | | | - Barbara A Wilson
- a The Raphael Medical Centre , Kent , UK.,b Oliver Zangwill Centre , Cambridgeshire , UK
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Krewer C, Luther M, Koenig E, Müller F. Tilt Table Therapies for Patients with Severe Disorders of Consciousness: A Randomized, Controlled Trial. PLoS One 2015; 10:e0143180. [PMID: 26623651 PMCID: PMC4666666 DOI: 10.1371/journal.pone.0143180] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/30/2015] [Indexed: 01/28/2023] Open
Abstract
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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Affiliation(s)
- Carmen Krewer
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
- * E-mail:
| | - Marianne Luther
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
| | - Eberhard Koenig
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
| | - Friedemann Müller
- Schoen Klinik Bad Aibling, Motor Research Department, Bad Aibling, Germany
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