The effects of aquatic therapy during post-acute neurorehabilitation in patients with severe traumatic brain injury: a preliminary randomized controlled trial

Abstract

Objective: The primary aim is to verify the effectiveness of an aquatic training (AT) in inpatients with severe Traumatic Brain Injury (sTBI) on balance. The secondary aims are to explore the effects on gait, activities of daily living, and quality of life, comparing to a land-based conventional protocol. Methods: Two-arm, randomized controlled trial. Twenty inpatients with sTBI, Glasgow Coma Scale score ≤8, and Level of Cognitive Functioning ≥7 were recruited and randomly assigned to the aquatic therapy group (ATG) or to the Conventional Training Group (CTG). Patients underwent 12 individual rehabilitation sessions (3 days/week, 4 weeks), in a rehabilitation pool during the post-acute intensive neurorehabilitation. The primary outcome measure was the Berg Balance Scale (BBS). Secondary outcome measures were the Modified Barthel Index (MBI), Disability Rating Scale (DRS), Tinetti Gait Balance Scale (TBG) and Quality of Life After Brain Injury (QOLIBRI). All the evaluations were performed at the baseline and after 4 weeks of training. Results: The within-subjects analysis showed a significant improvement both in ATG and CTG in MBI, BBS, TBG, and QOLIBRI. Conclusion: Our results may support the use of AT during post-acute phase to improve motor functions and quality of life in patients with sTBI.

The effect of physical activity on health outcomes in people with moderate-to-severe traumatic brain injury: a rapid systematic review with meta-analysis

“…Aim was to complete 100 sit-to-stand repetitions and 60 step-ups daily, 5*days/week. Curcio et al 2020 [ 41 ] Structured Gait/ Balance/ Functional Exercise Aquatic therapy targeting enhanced postural stability and gait exercises Yes (Physiotherapist) NR 45-min, 3*/week, 4 weeks NR Hydro pool, Neurorehabilitation hospital NR Cuthbert et al 2014 [ 42 ] Structured Gait/ Balance/ Functional Exercise VR-based balance therapy (Nintendo Wii) Yes (Physiotherapist) NR 15-min, 4*/week, 4 weeks No Hospital Gym NR Freivogel et al 2009 [ 47 ] Structured Gait/ Balance/ Functional Exercise Robotic Body-Weight Supported Treadmill Training (LokoHelp) Yes (Physiotherapist) Maximal treadmill speed tolerable by participant 30-min, 3–5*/week, 6 weeks No Inpatient Hospital gym Initial BWS ranged from 10-30% and was reduced as soon as possible Wilson et al 2006 [ 58 ] Structured Gait/ Balance/ Functional Exercise Partial Body-Weight Supported gait training Yes (Physiotherapists and assistants) NR Max 60-min, 2*/week, 8 weeks No Hospital gym % BWS reduced when participant showed no sign of discomfort with walking pace. Treadmill speed also increased when no assistance was needed, and participant showed no signs of discomfort or discoordination due to walking pace.…”

“…The remaining outcomes (i.e., global function, other mobility, muscle strength, cognition, physical activity, and participation) were not pooled due to too many single study outcomes, the absence of data reported for the outcome, and the considerable heterogeneity among the included studies. In studies that measured global function [34,41,58], muscle strength, [43,52], cognition [54][55][56], and physical activity [36,37], there was no clear effect of physical activity on these outcomes (Appendix 4).…”

“…Balance We pooled the immediate effect of intervention Berg Balance Scale data (range 0 to 56, higher score indicates better mobility) from two studies [41,42]. The standard error data reported in one study were converted into SD for comparison analysis [61].…”

Revisão sistemática de ensaios clínicos randomizados para reabilitação funcional do traumatismo cranioencefálico

“…Estes estudos observaram que nenhuma abordagem diferenciada foi superior ao treino de marcha convencional. No entanto, a hidroterapia tem se mostrado tão eficiente quanto a terapia em solo para essa população na fase aguda da lesão 12 .…”

Vestibular Rehabilitation Improves Gait Quality and Activities of Daily Living in People with Severe Traumatic Brain Injury: A Randomized Clinical Trial

“…A physiotherapist supported them in keeping the right position. Afterwards, they had to maintain balance in a standing position on a Freeman board for 5 min and transfer their body weight in a standing position using parallel bars for 10 min [ 35 ].…”