The Effectiveness of physiotherapy and coma duration in patients with severe traumatic brain injury in acute and post acute rehabilitation

Abstract

Objectives: to evaluate the effectiveness of physiotherapy depending on the duration of coma in patients with severe traumatic brain injury. Methods: We assess 52 TBI patients with the level of consciousness according to the Glasgow Coma Scale (GOS) ranging from 3 to 8 scores, a mean age of 44.4 (years SD, 11.9) in acute rehabilitation 14 days (Neurosurgery department) and post acute rehabilitation 54 days (Neurorehabilitation department). The patients were divided into 2 groups according to duration of coma: the 1group of patients who were in coma up to 1 week, the 2 group - patients who were in coma for more than 2 weeks. The recovery of patients' mobility was evaluated according to the Motor Assessment Scale, and the recovery of mental status, according to the Mini-Mental State Examination. Results: Mobility: supine to side lying, supine to sitting over side of bed, balanced sitting, sitting to standing, walking, upper arm function, hand movements, advanced hand activities, and general muscle tone in patients who were in coma up to 1week recovered significantly better after physiotherapy than those who were in coma for longer than 2weeks (P<0.05). The evaluation of the recovery of mental status showed that the patients who were in coma up to 1week the tasks associated with orientation in time and place, attention, naming a pencil and a watch, and repetition of some words performed significantly better n than those who were in coma for longer than 2weeks (P<0.05). Conclusions: Recovery of motor and mental status of the patients in the acute rehabilitation was significantly better for those who were in coma for the shorter period. We did not find correlations associations between coma duration and recovery during post-acute rehabilitation.