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The effect of positioning on the level of arousal and awareness in patients in the vegetative state or the minimally conscious state: a replication and extension of a previous finding
Wilson, B.A., Dhamapurkar, S., Tunnard, C., WATSON, P. & Florschutz, G.
Brain Impairment, 14(3), 475-479
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In 2005 Elliott et al published a paper entitled “Effect of posture on levels of arousal and awareness in vegetative and minimally conscious patients: a preliminary investigation” (p 298). Twelve patients, of whom 5 were in the vegetative state (VS ) and 7 in the minimally conscious state (MCS), were assessed with the Wessex Head Injury Matrix (Shiel et al 2000) when supine and when upright on a tilt table. The present study replicated and extended these findings by including a third position, sitting, in addition to supine and standing. We assessed 16 patients (8 in the VS and 8 in the MCS) with mixed aetiologies and compared the observed behaviours in three different positions (supine, sitting and standing) using the WHIM. Most patients, 75%, showed more behaviours when in the upright position, compared to lying down (p<0.003). Our findings are similar to those seen in the study reported by Elliott et al (2005). With regard to sitting, 62.5% of patients were more responsive when assessed sitting in a wheelchair (p<0.05) than in a supine position and almost 69% were better if assessed in an upright position compared to sitting. This was particularly true for patients in the MCS where 87.5 % did better if assessed on a tilt table or standing frame than sitting, suggesting that positional changes can have an effect on the level of arousal and awareness among patients in the VS and MCS.