Intervention
non-communicating, dysphagia, Coma, pain, coma, knee flexion, RTT
DYSPHAGIA, COMA, CONTRACTIONS, AIDS, COMA, -20
Therapeutic intervention was performed over a period of four weeks. A final follow-up study visit was conducted at 6 months after inclusion. Four therapy sessions were performed per week and each therapy session took 45 min for all study groups. This led to a total therapy time of at least 12 h in four weeks (45 min × 4 days × 4 weeks).In the two intervention groups (RTT + F, RTT-F), the ErigoPro® system (Hocoma AG, Volketswil, Switzerland, Fig. Erigo®Pro (Hocoma AG, Volketswil, Switzerland) robotic tilt table system with cyclic leg movement function with a) 75° and b) 90° tilt, respectivelyIn the RTT+F group, FES was performed with eight channels: M. quadriceps femoris (knee extension; large rectangle electrodes), M. biceps femoris (knee flexion; large rectangle electrodes), M. tibialis anterior (foot elevation; small oval electrodes), M. gastrocnemius (foot flexion; large rectangle electrodes) on both sides. The stimulation parameters of the FES were selected for all electrodes in such a way that stimulation is initially performed with a low current of 10 mA, a pulse width of 250 µs and a frequency of 25 Hz. Then the intensity was increased until contractions of the stimulated muscles became visible (i.e., motor threshold + 20% amplitude). A stimulation maximum of 130 mA was not exceeded. To prevent painful stimulation in non-communicating patients, a special pain grading scale for coma patients was collected before and during stimulation (Nociception Coma Scale- Revised, NCS-R).In the RTT-F group, concurrent to the verticalization a sham stimulation was applied with a minimum current intensity. This stimulation merely produced an electrifying sensation of the skin without being able to excite muscles (visual and palpatory control of the target muscles; settings: motor threshold -20% of amplitude).In the control condition (CPT), patients received 45 min of physiotherapy according to standard clinic procedures. Physiotherapists in the CPT setting were given the aim to mobilize and verticalize patients as much as possible. Patients were mobilized to the edge of the bed or to a standing position using aids (e.g., splints and conventional standing devices). Verticalization was then defined as a position with the patient’s upper body being verticalized to more than 60° to the best upright position possible. The interventions took place in the morning in a time slot between 8 and 11 a.m. in all groups.The study intervention was administered as part of a comprehensive early neurological rehabilitation program with an average of 300 min of therapy per inpatient day. Standard rehabilitation program consisted of occupational therapy, speech and language therapy, neuropsychological therapy, music therapy, and dysphagia therapy, in an individual composition depending on weekly rehabilitation goals. Patients of all three study groups received this rehabilitation program.