Effect of Vestibular Stimulation Exercises on Level of Consciousness in Patients With Intracerebral Hemorrhage

Introduction Intracerebral hemorrhage (ICH) is frequently associated with impaired consciousness due to disruption of cortical, subcortical, and brainstem arousal networks. Reduced consciousness limits participation in rehabilitation and highlights the need for safe early interventions to facilitate responsiveness. Conventional multisensory stimulation provides visual, auditory, tactile, and olfactory input to support arousal. Graded vestibular stimulation may offer additional benefit through head movements, positional changes, and visual-vestibular activities; however, its role in patients with ICH remains insufficiently explored. This study aimed to evaluate the effectiveness of adding graded vestibular stimulation exercises to conventional multisensory stimulation for improving the level of consciousness (LOC) in patients with ICH. Methods This randomized controlled parallel-group trial was conducted in the neuro-ICU of Krishna Vishwa Vidyapeeth (Deemed to be University), Karad. Thirty-six patients with ICH were randomly allocated to an experimental group or a control group (n = 18 each). Both groups received conventional multisensory stimulation. The experimental group additionally received a graded vestibular stimulation exercise protocol, modified according to the patient’s LOC, including head and head-trunk movements, head-end inclination and declination positioning, rocking-based vestibular stimulation, wheelchair mobilization, gaze stabilization, eye movement exercises, and optokinetic visual stimulation. Interventions were administered once daily for 14 consecutive days; total treatment exposure was greater in the experimental group because vestibular exercises were provided as an add-on intervention. LOC was assessed by a blinded assessor using the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness (FOUR) score at baseline (Day 1), Day 7, and Day 14. Statistical significance was set at p < 0.05. Results Both groups demonstrated significant improvement in level-of-consciousness scores from baseline to Day 14 (p < 0.001). Baseline GCS and FOUR scores did not differ significantly between groups. On Day 7, the experimental group demonstrated significantly higher GCS scores than the control group (9.2 ± 1.3 vs. 8.1 ± 1.2; p = 0.018) and significantly higher FOUR scores (11.0 ± 1.6 vs. 9.6 ± 1.5; p = 0.013). On Day 14, GCS scores remained significantly higher in the experimental group (11.3 ± 1.4 vs. 10.1 ± 1.3; p = 0.010), as did FOUR scores (13.4 ± 1.7 vs. 11.8 ± 1.6; p = 0.005). From Day 1 to Day 14, mean GCS and FOUR scores increased by 4.5 and 5.2 points, respectively, in the experimental group, compared with 3.4 and 3.7 points in the control group. Conclusions The addition of graded vestibular stimulation exercises to conventional multisensory stimulation was associated with significantly higher GCS and FOUR scores at Day 7 and Day 14 than conventional multisensory stimulation alone in patients with ICH. As total treatment exposure was greater in the experimental group, the findings reflect the effect of the add-on intervention rather than the isolated effect of vestibular stimulation alone.