Severe Traumatic Brain Injury, Traumatic Brain Injury
Conditions
Brief summary
Traumatic brain injury (TBI) is an acquired insult to the brain from an external mechanical force. It is considered a major cause of mortality and of long-term disabilities in young adults, especially considering high-income countries. The TBI can cause a wide range of temporary and/or permanent brain's dysfunctions that can involve physical, cognitive, behavioural and emotional functioning limiting everyday life and social activities and leading to a lowers quality of life. a sequential preparatory approach (SPA), performed in aquatic environment, based on increasing difficulty and following a specific sequence of preparatory exercises (from the simplest to the most complex) could be an effective complementary training during post-acute intensive rehabilitation in patients with severe traumatic brain injury (sTBI).
Interventions
OTHERAquatic Training
Aquatic Training training consists of a sequential and a preparatory approach aimed at enhancing dynamic postural stability. The exercises follow a specific sequence starting from a kneeling position, proceeding to a sitting position and ending with a supine position. Step exercises preparatory for gait were performed using a step and two floating aids. Gait exercises were performed first with the upper limbs placed on two floating aids and then during a dual motor task (i.e. catching a ball thrown by the therapist). Subjects performed three sessions a week for four weeks and each session lasting 45 minutes. The training was carried out by a physiotherapist who had at least 5 years of experience in aquatic neurorehabilitation.
OTHERConventional Training
Conventional land-based therapy consists of customized exercises focused on static and dynamic postural stability improvement. The exercises included the active-assisted mobilization, the muscle stretching the postural transition, the balance and the gait training. The control approach was carried out three times a week for four weeks and each session lasted 45 minutes.
Sponsors
I.R.C.C.S. Fondazione Santa Lucia
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
15 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* age between 15 and 65 years; * Glasgow coma scale (GCS) score ≤ 8 (used to objectively describe the severity of impaired consciousness at the time of injury) * level of cognitive functioning (LCF) ≥7; * ability to understand verbal commands. * acclimatization to water.
Exclusion criteria
* Cognitive deficits affecting the ability to understand task instructions (Mini-Mental State Examination \> 24); * Severe unilateral spatial neglect (diagnosed with a test battery that included the Letter Cancellation test, Barrage test, Sentence Reading test and the Wundt-Jastrow Area Illusion Test); * Severe aphasia (diagnosed by means of neuropsychological assessment); * Presence of other neurological diseases; * Presence of cutaneous and mycosis infections; * Presence of open wounds, eczema, skin ulcers, decubitus lesions, severe burns; * Presence of PEG (Percutaneous endoscopic gastrostomy); * Presence of tracheostomy; * Urinary incontinence; * Presence of otitis * Presence of orthopedic or cardiac comorbidities that would limit participation in the experimental and conventional training (all of which were clinically evaluated).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Berg Balance Scale (BBS) at 1month | 1 month | Change of Berg Balance Scale (BBS) from baseline at 1 month. BBS values ranging from 0 to 56, where 0 means the lowest level of function and 56 the highest |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Tinetti Balance and Gait Scale (TBG) | baseline and after 4 weeks of training | Change of Tinetti Balance and Gait Scale (TBG) from baseline at 4 weeks of training and at 4 weeks after the end of the training. TBG values ranging from 0 to 28, where 0 means the worse outcome and 28 the best one. |
| Modified Barthel Index (MBI) | baseline and after 4 weeks of training | Change of Modified Barthel Index (MBI) from baseline at 4 weeks of training and at 4 weeks after the end of the training. MBI values ranging from 0 to 105, where 0 means the worse outcome and 105 the best one. |
| Modified Ashworth Scale (MAS) | baseline and after 4 weeks of training | Change of Modified Ashworth Scale (MAS) from baseline at 4 weeks of the training and at 4 weeks after the end of the training. MAS values ranging from 0 to 5, where 0 means the best outcome and 5 the worse one. |
| Change in quality of life assessed by the proxy version of the Quality of Life after Brain Injury (Proxy-QOLIBRI) | baseline and after 4 weeks of training | Change of proxy version of the Quality of Life after Brain Injury (Proxy-QOLIBRI) from baseline at 4 weeks of training and at 4 weeks after the end of the training. (Proxy-QOLIBRI) values ranging from 0 to 100, where 0 means the worse outcome and 100 the best one. |
| Disability Rating Scale (DRS) | baseline and after 4 weeks of training | Measure of function after TBI intended to measure function from coma to community. Minimum score= 0; Maximum score= 29 (High scores are indicative of greater degree of disability). |
Countries
Italy
Outcome results
None listed