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A. Piene Wesche1, L.I. Strand2, V. Jørgensen3, A. Opheim4,5,6, E. Høyer7
1Sunnaas Rehabilitation Hospital HF, The Department of Brain Injury, Nesoddtangen, Norway, 2University of Bergen, Physiotherapy Research Group, Department of Global Public Health and Primary Care, Bergen, Norway, 3Sunnaas Rehabilitation Hospital HF, The Department of Research, Nesoddtangen, Norway, 4Sunnaas Rehabilitation Hospital, The Department of Research, Nesoddtangen, Norway, 5Region Västra Götaland, Habilitation & Health, Gothenburg, Sweden, 6University of Gothenburg, Institute for Neuroscience and Physiology, Rehabilitation Medicine, Gothenburg, Sweden, 7Sunnaas Rehabilitation Hospital HF, The Department of Competence, Nesoddtangen, Norway
Background: Mobilisation is considered important in the early phase after severe brain injury, to prevent negative consequences of immobilisation. One aspect in this approach is the gradually transition and habituation from lying to sitting and standing positions. Standing devices suitable to challenge the whole body in upright standing position have until recently been of static character, like a standing plinth and standing frame. In the later years standing devices, able to additionally move the lower limbs during standing, have been developed. One of these, Innowalk Pro (IP), is an assistive electric standing device, supporting the legs, hips, and trunk, while the legs are passively moved in circular patterns resembling walking movements (www.madeformovement.com). We questioned the feasibility of this device for patients with severe brain injury in a stable, subacute phase.
Purpose: This study aimed to investigate feasibility and explore physical and physiological responses during use of Innowalk Pro. The research questions were: 1) How feasible is standing training in Innowalk Pro? 2) Does standing in Innowalk Pro influence trunk control, muscle tone and ankle joint range of motion? 3) What is the impact on heart rate, blood pressure and endurance during training?
Methods: A Single-Subject Experimental Design was applied, using an A1-B-A2 model over a period of 12 weeks. The A1-phase represented baseline using traditional training including a standing frame. The B-phase represented the intervention, adding IP training. In the A2-phase the IP training was withdrawn, but was otherwise similar to A1. Patient's and assistive personnel’s experiences of using the IP were examined by questionnaires with Likert scales (1-5) after each session and at the end of the research period. Outcome measures included Trunk Impairment Scale, Modified Ashworth Scale and Lidcombe Template (ankle dorsiflexion), all repeated three times in each phase. Physiological measures were blood pressure, heart rate, and duration of training, elapsed distance and cadence, recorded during each training session. Visual analysis of graphs, with trends, levels and slopes, and descriptive statistics were used in data analysis.
Results: The patient, a 40 year old female, described IP-training as a motivating experience despite feeling more physically challenged, and standing a shorter time than in a standing frame. The assistants showed a positive attitude using IP, but did not feel comfortable in administering the device. Improved trunk control was seen in the A2-phase. Ankle dorsiflexion increased somewhat. Muscle tone decreased in ankle plantar-flexors, but fluctuated in knee-flexors and -extensors. The blood pressure was stable and within normal range during IP-training, while the heart rate decreased, probably due to medication.
Conclusion(s): Early mobilisation, adding the IP, was found to be a feasible and motivating intervention. The patient improved substantially in physical function during the A2-phase, while physiological measures remained rather stable in A1- and B-phases. Whether improvement in trunk control may have been positively influenced by dynamic leg movements in standing upright position, needs further investigation.
Implications: The new standing device, Innowalk Pro, was found to be feasible and motivating in early mobilisation after severe brain injury. Trained physiotherapist and assistive personnel are recommended for safe training.
Funding, acknowledgements: The South-Eastern Norway Regional Health Authority, Innovation Norway, and The Norwegian Fund for Post-Graduate Training in Physiotherapy provided financial support.
Keywords: Aquired brain injury, Early mobilisation, Assistive technology
Topic: Disability & rehabilitation
Did this work require ethics approval? Yes
Institution: Sunnaas Rehabilitation Hospital HF
Committee: The South-East Regional Committee for research ethics in Norway
Ethics number: 2013/2273/REK
All authors, affiliations and abstracts have been published as submitted.
