Changes in rest-activity cycles in patients with severe acquired brain injury during early rehabilitation

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Abstract

Question: There is little knowledge on rest-activity cycles (RAC) in patients with severe acquired brain injury (sABI) during early in-hospital rehabilitation. Consolidated RACs have been linked to improvements in consciousness and function in TBI. This study aims to investigate if patients with sABI displayed unconsolidated RACs at the beginning of rehabilitation, and how these cycles changed over time. Methods: This study was an observational cohort study. All patients admitted to one ward at a rehabilitation hospital were screened consecutively. Patients with a consciousness level < Rancho Los Amigos Scale score III and reduced motor activity due to locked in syndrome or brain injury with comparable motor deficits were excluded. Motor activity were registered using an Actigraph wGTX3-BT device (ACC), starting as early after admission as possible and continuing for 20 days. From the raw vector magnitude, the ratio (Daytime Activity Ratio (DAR)) of activity between daytime (7-22), and the total 24hr activity were calculated per day. Previous research has defined a DAR of ≥ 80% as a consolidated RAC (Duclos, 2014). Prevalence of consolidated RAC in this study was based on the mean DAR of day 1 and 2. In order to describe development over time, the mean DAR of day 19 and 20 was calculated. Change in DAR over time was analyzed using paired t-test. Results: 55 patients were screened and 20 patients could be included for data acquisition. ACC recording started on average (SD) on day 5 (2). In 18 patients there was no missing data in day 1 one and 2 of ACC recording. 56% of 18 patients had a consolidated RAC at the beginning of rehabilitation. At follow up, complete data could be obtained from 15 patients, 80% of 15 patients displayed consolidation of RAC. 9 patients improved their DAR over time while 5 patients had deteriorated DAR. One patient showed no DAR change. When comparing first and last two days a significant mean 5.8% (0.52;11.01, 95% CI) increase in DAR was found p<0.05. Conclusion: Approximately half of the patients exhibited consolidated RACs within the first days after arrival. After approximately 3 weeks 80% of the same subjects exhibited consolidated RACs. On a group level, the DAR changed significantly in a positive direction in the first 3 weeks.
Original languageEnglish
Publication date2 Aug 2021
Publication statusPublished - 2 Aug 2021
Event11th World Congress of Neurorehabilitation - Online
Duration: 6 Oct 2020 → …
https://wcnr-digital.org/

Conference

Conference11th World Congress of Neurorehabilitation
LocationOnline
Period06/10/2020 → …
Internet address

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