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Leckey Horizon Stander and KIT Seat used in recent Italian Independent Study

21st September 2016

A group of researchers in Italy recently completed a study called 'Comprehensive Treatment of Complex Postural Needs (CPN) in Spastic-Dystonic Tetraplegia Secondary to Traumatic Brain Injury (TBI): A Pilot Case Study'.



The study uses a formal single case study design to evaluate a comprehensive treatment approach including rehabilitation, botulinum toxin, orthopaedics, and postural devices. The postural devices used in this independent study were Leckey's Horizon Stander and KIT Seat. Below is a summary of the research.

Comprehensive Treatment of Complex Postural Needs (CPN) in Spastic-Dystonic Tetraplegia Secondary to Traumatic Brain Injury (TBI): A Pilot Case Study

Objective:

The aim of this interventional evaluation study was to assess the modification and amelioration of complex postural attitudes in a patient with functional disorders, related to a spastic-dystonic muscle pattern of trunk and limbs secondary of traumatic brain injury (TBI), by using a comprehensive treatment approach.

Methods and Main Outcomes:

A male, 37 years old, affected by TBI with a complex spastic-dystonic muscle pattern of trunk and limbs implicating a whole of dysfunctional postural attitudes never treated before and conditioning the quality of life and caregiver approach, was recovered in our Section from April to June 2013. 

Step 1: Baseline evaluation. After recovery in our Section of Neurological Rehabilitation, patient underwent to a clinical and functional evaluation in a resting bed position and in a noiseless milieu.

Step 2: Rehabilitative approach. Our patient underwent physiotherapy during the recovery and observational period, 6 days a week, in 2-hour sessions, in line with the GCS National Consensus Conference about the treatment protocol of patients affected by severe brain injury.

Step 3: Botulinum neurotoxin treatment. In line with our internal treatment protocol, BoNTX-A (Xeomin®) was injected after 15 days and 49 days of hospitalisation to reduce muscle over-activity and the pathological schema observed. Ultrasound guide to optimise the treatment technique was used for the multi-segmental botulinum toxin treatment of the neck, of the right shoulder and of the right lower limb.

Step 4: Functional orthopaedic approach. To realise a surgical correction of the unstable left ankle, completely intra-rotated and in varus dislocated, a comprehensive bone and joint stabilisation was made 25 days after hospitalisation. 

Step 5: Assistive postural device approach. To optimise patient's postural attitude and to increase his ergonomic sitting and standing out-of-bed positioning, an innovative disability assistive postural chair and an orthostatic aid device were used at the end of this multidisciplinary approach. 

Main Outcomes and Results:

Evaluation was made at time T0 (at the beginning of hospitalisation), T1 (15 days after hospitalisation), time T2 (30 days after hospitalisation), time T3 (45 days after hospitalisation) and time T4 (60 days after hospitalisation) using a. outcome measures (MAS of upper and lower limb; TCT) b. objective behavioural and cognitive aspects; c. objective postural attitudes in different conditions considered.

After our comprehensive treatment approach we observed:

  • a significant change of all complex postural limb and trunk attitudes and a significant change of multisegmental muscle hypertonus
  • an amelioration of the individual grade of space and environment exploration
  • a progressive vertical positioning using an innovative static aid
  • with the introduction of an innovative postural chair, the maintaining of an optimal and ergonomic sitting position

 

Conclusions:

This interventional case study suggests that a comprehensive clinical-functional and surgical (multidisciplinary) approach is needed for an appropriate and incisive change and amelioration of CPN secondary to TBI.

The research, published in the Jacobs Journal of Physical Rehabilitation Medicine in June 2016, can be accessed openly here.

Information on the Horizon Stander and KIT Seat can be found at www.leckey.com.