Comparison of orthostatic reactions of patients still unconscious within the first three months of brain injury on a tilt table with and without integrated stepping. A prospective, randomized crossover pilot trial

Objective: To determine whether passive leg movement during tilt table mobilization reduces the incidence of orthostatic dysfunction in mobilization of patients being comatose or semi-comatose early after brain injury. Design: Randomized crossover pilot trial using sequential testing. Setting: Neurorehabilitation hospital. Subjects: Nine patients still unconscious within the first three months of brain injury (5 men, 4 women; age 51 +/- 20 years). Intervention: Patients were subjected once to a conventional tilt table and once to a tilt table with an integrated stepping device. Main outcome measure: The number of syncopes/presyncopes (orthostatic hypotension, tachypnoea, increased sweating) during interventions. Results: One patient had presyncopes on both devices, six patients had presyncopes on the conventional tilt table but not on the tilt table with integrated stepping, and two patients did not exhibit presyncopal symptoms on either device. There were significantly more incidents on the tilt table without than on the one with an integrated stepping device (P<0.05) at tilts of 50 or 70 degrees respectively. Conclusion: Patients tolerate greater degrees of head-up tilt better with simultaneous leg movement.