(Research Hub Theater) From the Bed to the Tread: Mobility and Ambulation Potentials in Patients with Disorders of Consciousness After Receiving Intensive Rehabilitation

Objective: To assess the mobility and functional ambulation in patients with disorders of consciousness (DoC) after receiving specialized intensive inpatient rehabilitation.

Design: Retrospective chart view.

Setting: Acute inpatient rehabilitation.

Participants: 137 patients with DoC admitted between January 2014 and October 2018.

Interventions: Intensive physical, occupational, speech therapy with transdisciplinary management in a specialized program.

Main Outcome Measures: Locomotion on the Functional Independence Measure (FIM) by the end of Phase I inpatient rehabilitation; long-term functional ambulation, including walking distance and the ability to walk stairs.

Results: The cohort contained predominant male, diverse ethnicity backgrounds, with an average age of 35.8±15.0 years old. Among patients admitted at the acute, subacute, and chronic stages, 18/20 (90%), 52/84 (62%), and 6/33 (18.2%) emerged from minimally conscious state, respectively. Among those who emerged, by the end of Phase I inpatient rehabilitation, 10/18 (56%), 9/52 (17%), and 0/6 (0%) achieved locomotion either at a wheelchair or walking level with moderate assistance or less (FIM score ≥3), respectively. By the end of trackable inpatient rehabilitation stays, 9/18 (50%), 8/52 (16%), 0/6 (0%) achieved functional ambulation with mostly minimal assistance or less, respectively. The ambulation distance ranged from 150 to 1625 feet. Among the ambulatory DoC patients, 5/9 (56%) and 5/8 (63%) functionally walked stairs, respectively.

Conclusions: Mobility constitutes a significant component of general health and health-related quality of life. The results demonstrated the significance of specialized intensive inpatient rehabilitation in promoting mobility and functional ambulation in patients with DoC, who are traditionally deemed to have no potential of recovery. This could be a time-sensitive matter. As the chronicity of the patients’ condition evolved, the chance of achieving functional ambulation may decline due to neuromuscular complications. In summary, patients with DoC have potential to recover in mobility and ambulation; early and intensive rehabilitation are indicated.