Frazzitta et al. (2016)

Italy & Austria

RCT

PEDro=5

N_initial=40  N_Final=31

Population: Severe ABI; Early verticalization (n=15): Mean Age=53 yr; Gender: Male=9, Female=6. Controls (n=16): Mean Age=69 yr; Gender: Male=11, Female=5.

Intervention: Patients with severe ABI underwent fifteen 30 min sessions of verticalization using a tilt table with a robotic stepping device in addition to conventional physiotherapy. Controls received conventional physiotherapy alone.

Outcome Measures: Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), Coma Recovery Scale-Revised (CRSr), Level of Cognitive Functioning (LCF).

1.         All outcome measures improved significantly over the treatment period (p<0.001).

2.         The early verticalization group showed significantly more improvement in the CRSr test compared with controls (p=0.006).

3.         No other outcome measures were significantly different between groups.

Rocca et al. (2016)

Switzerland

RCT

PEDro=3

N=30

Population: ABI; Mean Age=54.2 yr; Gender: Male=17, Female=13.

Intervention: Patients were randomized into 1 of 3 groups. The MOTOmed Letto group utilized an automatic system for leg mobilization in a supine position. The Erigo group utilized a tilting table with an integrated leg movement system, which allows progressive verticalization of the patient. The 3^rd group received standard care. Between day(s) 1-7 patient were mobilized in bed, while post day 7 patients were mobilized out of bed, or as soon as able. From the time of admission patients were mobilized every day in bed. Patients were mobilized out of bed after a minimum of 7 days.

Outcome Measures: Production of Catecholamines, cardio-respiratory parameters.

1.        There were no significant intra or inter group changes in blood pressure throughout the trial.

2.        Significant within and between group differences were found for increased epinephrine rate both after MOTOmed (both p=0.023) and standard mobilization (both p=0.046). Epinephrine increased more in the MOTOmed group compared to the standard mobilization group.

3.         Plasmametanephrine concentration significantly increased after MOTOmed treatment (p=0.023).

4.        Overall, plasmanormetanephrine concentration significantly increased after standad physiotherapy (p=0.046).

Roth et al. (2014)

Germany

Case Series

N=29

Population: SAH=15, TBI=8, ICH=5, Stroke=1; Mean Age=57 yr; Gender: Male=9, Female=20.

Intervention: Participants were examined in the supine and prone positions.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Mean Arterial Pressure (MAP).

1.        Mean ICP significantly increased from 9.5 to15.4 mmHg in prone position (p<0.0001).

2.        Mean CPP decreased from 82-80 mmHg in prone position, but the difference was not significant (p=0.0591).

3.        Mean MAP significantly decreased from 72.6-64.7 mmHg in prone position (p<0.001).

4.        ICP>20 mmHg rates were significantly higher in prone position (18% versus 4%, p<0.0001).

5.        CPP<70 mmHg rates were significantly higher in prone position (24% versus 18%, p=0.0022).

Nekludov et al. (2006)

Sweden

Case Series

N=8

Population: TBI; Mean Age=53.63 yr; Gender: Male=6, Female=2; GCS Range≤8

Intervention: Participants were examined in the supine and prone positions.

Outcome Measures: Arterial Oxygenation (AO₂), Intracranial Pressure (ICP), Mean Arterial Pressure (MAP), Cerebral Perfusion Pressure (CPP).

1.        There was a significant improvement in AO₂ in the prone position (p=0.02).

2.        There were significant increases in ICP (p=0.03), MAP (p=0.05), and CPP (p=0.03) in the prone position.

Thelandersson et al. (2006)

Sweden

Case Series

N=11

Population: TBI=6, ICH=2, SAH=3; Mean Age=51 yr; Gender: Male=7, Female=4.

Intervention: Participants were examined in the supine and prone positions.

Outcome Measures: Intracranial Pressure (ICP), Cerebral Perfusion Pressure (CPP), Mean Arterial Pressure (MAP), Partial Pressure of Oxygen (PaO₂), Oxygen Saturation (SaO₂).

1.        No significant changes were demonstrated in ICP, CPP or MAP in the prone position.

2.        PaO₂ and SaO₂ were significantly increased in the prone position and after 10min in the supine post-prone position (p<0.05).

Tillet et al. (1993)

USA

Case Series

N=58

Population: TBI; Mean Age=33.2 yr; Gender: Male=44, Female=14; Time Post Injury=24 hr; Mean GCS=6.

Intervention: Patients underwent continuous rotational therapy with side-to-side rotation maintained at 40º.

Outcome Measure: Intracranial Pressure (ICP).

1.        No significant differences in ICP were demonstrated during rotation compared to non-rotation during any of the time periods (2-5d post admission).

2.        Findings showed a statistically significant difference in ICP when patients were rotated to the side of the lesion (p=0.025).

Lee (1989)

China

Case Series

N=30

Population: ABI; GCS Range<8.

Intervention: Participants were placed into four different positions: supine; supine with head down 30º; 75% supine; and 75% prone.  Outcomes were assessed at each position.

Outcome Measure: Intracranial Pressure (ICP).