Locomotor therapy in unweighted conditions in patients with chronic disorders of consciousness. A prospective non-randomized single-center study

BACKGROUND: It is known that regular physical activity stimulates synaptic plasticity in the central nervous system. Neurons involved in movement and sensory integration form new connections, contributing to the restoration of lost functions (angiogenesis, neurogenesis, changes in cortical pathways). Based on this, it was hypothesized that KRISAF device (locomotor therapy in unweighted conditions) in patients with chronic disorders of consciousness, due to the presence of passive stereotyped motor cycles mimicking crawling/swimming/walking, may modulate the recovery of cerebral hemisphere functions and subsequently affect the level of consciousness through the mechanism of afferent ontogenetic “recollection.” AIM: To assess the changes in cerebral hemisphere function recovery based on the scores of the CRS-R, Behavioral Pain Scale, Ashworth Scale, and Glasgow Outcome Scale Extended (GOS-E) in patients with chronic disorders of consciousness undergoing locomotor therapy in unweighted conditions. MATERIALS AND METHODS: A descriptive prospective comparative cohort study included 74 patients from 2019 to 2024. They were divided into two groups: intervention group (n=44) and control group (n=30). Patients in the intervention group, in addition to the main course of rehabilitation treatment, received 5 sessions of locomotor therapy in unweighted conditions. RESULTS: The median level of consciousness score according to the CRS-R scale in the intervention group increased from 6 (5.4–6.6) to 9 (8.1–9.9) points (p=0.0006), while in the control group, it increased from 5.5 (4.7–6.3) to 7 (6–8) points (p=0.0609), indicating a statistically significant difference (p 0.00001). CONCLUSION: The significant improvement in the CRS-R score at discharge among patients undergoing locomotor therapy indicates that this treatment method has a positive effect on the level of consciousness.