Tracking neurophysiological, cardiovascular, and functional outcomes in an adult emerging from disorders of consciousness undergoing overground exoskeleton gait training

Research Objectives: To describe the neurophysiological, cardiovascular responses, and functional outcomes of an adult emerging from disorders of consciousness (DoC) who participated in overground exoskeleton gait training (OEGT) during inpatient rehabilitation.

Design: Individual Case Study

Setting: TBI Model Systems inpatient rehabilitation facility

Participants: A 21-year-old male with disorder of consciousness (DoC) following traumatic brain injury admitted to inpatient rehabilitation 24-days post-injury with Rancho Los Amigos Scale (RLA) level=2, Disability Rating Scale (DRS)=22, and Coma Recovery Scale-Revised (CRS-R)=5.

Interventions: Patient completed five sessions/week of OEGT using an Ekso as part of his therapy plan of care to promote arousal and upright tolerance.

Main Outcome Measures: Neurophysiological responses during OEGT were measured (initial session, after demonstrating clinical signs of emergence, and final session) utilizing a 24-channel mobile electroencephalograph (EEG) system with maximum 1000Hz sampling, 24-bit resolution, 500 ohm input impedance, 1 µV input referred noise and CMRR > 110 dB. Cardiovascular intensity data was collected each OEGT session using the Polar A 370 Fitness Watch. Functional outcomes (RLA score, DRS, and CRS-R) and OEGT session data were recorded.

Results: Patient completed 25 OEGT sessions [walk time 17.23±8.92 minutes; up time 20.51±8.2 minutes; step count 549.72±298.96] with cardiovascular intensity of Very Light 58.25±35.31%, Light 20.7±20.17%, Moderate 20.95±26.7%, Vigorous 0.1±0.31%, and Maximal 0%. Clinical changes in arousal were observed primarily during postural changes from sitting to upright standing and initiation of gait. Patient emerged 46 days into a 56 day inpatient rehabilitation stay (21 OEGT session pre-emergence, 4 sessions post-emergence). Patient discharged home classified as RLA=5, DRS=11, and CRS-R=23. EEG data are pending analysis and will be reported.

Conclusions: A patient emerging from DoC tolerated OEGT during inpatient rehabilitation with light-to-moderate cardiovascular intensity. Improvements were observed in functional outcomes and the patient was able to be discharged home. Future efforts may consider examining the contribution of OEGT to promote arousal after severe brain injury during inpatient rehabilitation.

Author(s) Disclosures: none