Do post-stroke patients benefit from robotic verticalization? A pilot-study focusing on a novel neurophysiological approach

Background: Tilt-table equipped with the dynamic foot-support (ERIGO) and the functional electric stimulation could be a safe and suitable device for stabilization of vital signs, increasing patient's motivation for further recovery, decreasing the duration of hospitalization, and accelerating the adaptation to vertical posture in bedridden patients with brain-injury. Moreover, it is conceivable that verticalization may improve cognitive functions, and induce plastic changes at sensory motor and vestibular system level that may in turn facilitate motor functional recovery. Objective: To test the safety and effectiveness of ERIGO treatment on motor and cognitive functions, cortical plasticity within vestibular and sensory-motor systems in a bedridden post-stroke sample. Methods: 20 patients were randomly divided in two groups that performed ERIGO training (30 sessions) (G1) or physiotherapistassisted verticalization training (same duration) (G2), beyond conventional neurorehabilitation treatment. Motor and cognitive functions as well as sensory-motor and vestibular system plasticity were investigated either before (T0) or after (T1) the rehabilitative protocols. Results: Both the verticalization treatments were well-tolerated. Notably, the G1 patients had a significant improvement in cognitive function (p = 0.03), global motor function (p = 0.006), sensory-motor (p <0.001) and vestibular system plasticity (p = 0.02) as compared to G2. Conclusions: ERIGO training could be a valuable tool for the adaptation to the vertical position with a better global function improvement, as also suggested by the sensory-motor and vestibular system plasticity induction.