Acquired Brain Injury, Critical Illness Polyneuropathy
Conditions
Brief summary
Background: Intensive Care Unit (ICU) survivors often develop an acquired weakness due to a Critical Illness Polyneuropathy (CIP). Early mobilization in ICU, by reducing the bed rest and decreasing the oxidative stress, was shown to represent a valid preventive option. Purpose: To evaluate whether ICU sessions of stepping verticalization associated with Functional Electrical Stimulation (FES) of the lower limbs are able to reduce the occurrence of CIP in Acquired Brain Injured (ABI) patients. Methods: all the ABI patients admitted in our Neurorehabilitation Unit from our ICU were retrospectively evaluated. Patients affected by previous peripheral neuropathy, diabetes, cancer, alcoholism, viral hepatitis, AIDS and autoimmune diseases were excluded. They were divided into 3 groups according to the rehabilitation strategy received in ICU: group 1 received conventional physiotherapy + stepping verticalization sessions with Erigo® (Hocoma, Switzerland); group 2 received conventional physiotherapy + stepping verticalization sessions with FES using ErigoPro®; group 3 received only conventional physiotherapy. As for internal protocol, all patients started rehabilitation in the first week from the ABI and performed 60 minutes/day of rehabilitation, 5 days/week. Primary outcome was the evidence of CIP at Neurorehabilitation admission (=ICU discharge), according to neurophysiological criteria. Secondary outcomes were the strength impairment at Neurorehabilitation discharge, measured by the total Motricity Index score and the Functional Ambulation Classification (FAC) score, assessing quality of gait.
Interventions
DEVICEstepping verticalization plus functional electrical stimulation
patients hospitalized in ICU are rehabilitated using 30 minutes/day of conventional physiotherapy + 30 minutes/day of verticalization using a tilt table with an integrated robotic stepping device synchronized with an electrical stimulation of the lower limbs muscles
DEVICEstepping verticalization
patients receive 30 minutes/day of conventional physiotherapy + 30 minutes7day of verticalization using a tilt table with a robotic stepping device
OTHERconventional physiotherapy
patients are treated only with 60 minutes/day of conventional physiotherapy
Sponsors
Ospedale Generale Di Zona Moriggia-Pelascini
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* arriving directly from our acute care facility * hospitalized in ICU due to an acute brain injury
Exclusion criteria
* previous peripheral neuropathies * diabetes * cancer * alcoholism * viral hepatitis * AIDS * autoimmune diseases * absence of clinical or neurophysiological informations at data collection
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| CIP occurrence | at enrollment | Presence of critical illness polyneuropathy at the end of ICU stay |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| motricity index | at enrollment | total motricity index score (4 limbs) at neurorehabilitation discharge. Score goes from 0 (no movement in any limb) to 400 (full strength in alla limbs) |
| Functional Ambulation Classification (FAC) | at enrollment | Functional Ambulation Classification score at neurorehabilitation discharge. Scale goes from 0 (no ambulation) to 5 (independent ambulation) |
Countries
Italy
Outcome results
None listed