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The effects of Different Postures on Levels of Arousal in Patients in Coma and in the Vegetative State
SHIEL, A., O'Connell, R., Elliot, L., Hooper, L., WILSON, B., Menon, D.K., & Pickard, J.D.
Journal of the International Neuropsychological Society, 9(4), 581
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Posture is known to affect levels of arousal in people without brain injury. For example, sleep-deprived subjects' ability to remain awake was shown to be best while standing and changes in EEG activity caused by sleep loss were attenuated when subjects stood. Patients in coma and in a vegetative are usually assessed lying in bed and the effects of posture and position on levels of arousal have not been investigated. A series of single case studies was carried out on patients defined as being in coma or in a minimally conscious state. Levels of arousal were assessed using the Wessex Head Injury Matrix (WHIM) lying in bed, standing upright in a frame and afterwards. All patients showed increased arousal in standing and this effect was most marked with those in coma. Two patients in a chronic vegetative state were also studied. Of these, one showed a slight effect and the other remained unchanged. While standing upright, patients who are in coma or minimally conscious showed significant improvement in objective tests of arousal and cognition and motor function. Furthermore these effects have been observed to last for some hours. This finding has enormous implications not only for the immediate benefits of standing but also for patients' potential response to other therapies carried out immediately afterwards.