Effectiveness of Mobilization to Sitting in Improving Arousal at Various Durations in Traumatic Brain Injury Patients

Background: Rehabilitation of motor function in Traumatic brain injury patients in the acute phase depends on their state of consciousness and arousal level. Upright positioning stimulates the ascending reticular activating system and is proved to have improvement in arousal level. Verticalization in the acute phase is not well tolerated due to orthostatic intolerance. Mobilization to sitting in the acute phase could reduce the negative effects and improve arousal but the effective duration of mobilization is not well studied which demands the need of the study.

Methodology: This interventional study was conducted in the Neurosurgery ICU with 24 patients in each group. Brain abnormalities were classified using Marshalls CT TBI classification and patients with Coma Recovery scale (CRS-R) of ≤ 7 were included and allocated to either ½ hour or 1 hour mobilization for 15 days. Changes in the arousal level were assessed with CRS-R after 15 days to measure their improvement.

Results: Both the groups showed statistically significant improvement in arousal with p value ≤0.01 in paired test and unpaired t test showed increased arousal in group 2 than group 1 with p value ≤ 0.01. Negative correlation was observed between onset of mobilisation and improvement in CRS-R in both the groups with Pearson correlation (p ≤ 0.01)

Conclusion: The study concludes that arousal in TBI patients is significantly improved by early onset of mobilization to sitting both for ½ and 1 hour duration without much orthostatic intolerance in the acute period which could be included into the standard care of rehabilitation of TBI patients.