Verticalization with Erigo® in early rehabilitation in patients with severe acquired brain injury: evidence from a pilot study.

INTRODUCTION: Following severe acquired brain injury (sABI), the inability to maintain orthostatism and prolonged bed rest triggers neurovegetative, haemodynamic, respiratory and osteo-myo-articular adaptations that may significantly affect rehabilitation. Restoring orthostatic tolerance is a key rehabilitation goal to prevent secondary complications. Although the safety of early verticalization with Erigo device has been established, evidence on its effects on muscle hyperactivity, trophism, and consciousness level in the subacute sABI remains limited. This pilot study aimed to monitor lower-limbs hyperactivity in patients with sABI of any aetiology, 1-4 months after the acute event, undergoing verticalization with the Erigo device in addition to conventional rehabilitation. Secondary aims were to evaluate muscle ultrasound characteristics, ankle mobility, disability, arousal level and device tolerability.

METHODS: All patients with early-stage sABI, admitted to the Critical Care Area of the Montecatone Rehabilitation Institute from March 2022 to April 2024, were included. Each patient underwent 10 sessions of approximately 30 min, once a day, 3-5 times per week. Assessments before and after treatment included electroneurography of the lower limbs, muscle ultrasound measurement of the tibialis anterior and medial twin muscles, bilaterally, and rating scales evaluating disability and arousal (Disability Rating Scale - DRS, Levels of Cognitive Functioning - LCF, Coma Recovery Scale Revised - CRS-R). Adverse events related to device were monitored daily.

RESULTS: The study includes 22 patients with sABI. Neurophysiologically, there was a reduction or invariance in the H max/M max ratio compared to the initial assessments; the Heckmatt scale scores remained unchanged in all patients. All the mobility measures, the H-reflex amplitude, the Hmax/Mmax ratio and the MAS scores remained stable. The functional measures improved significantly: CRS-R (p = 0.005), LCF (p = 0.002) and DRS (p < 0.001).

DISCUSSION: This pilot study suggests that early verticalization with Erigo is a feasible and well-tolerated intervention in patients with sABI in the subacute phase of rehabilitation. No worsening of muscle hyperactivity or muscle ultrasound characteristics was observed during the intervention period. A significant improvement in cognitive function was observed. Controlled studies are required to determine whether these findings are attributable to the Erigo intervention.