Verticalization with Erigo® in early rehabilitation in patients with severe acquired brain injury: evidence from a pilot study.
Valentina Colombo, Bledi Shehaj, Francesca Cesira Cava and 6 others
Robotic verticalization was safe and well-tolerated in 22 patients with severe brain injury.
Consciousness and disability scores improved, spasticity stayed stable — but all were in the 1–4 month window of fastest natural recovery with full concurrent therapy, so gains cannot be credited to the device.
Key findings
1Consciousness (CRS-R), cognitive functioning (LCF), and disability (DRS) scores all improved significantly after 10 Erigo sessions, but the paper states these gains are consistent with the natural recovery window and concurrent multidisciplinary therapy and cannot be attributed to the device.
2Spasticity (MAS), nerve excitability (H-reflex, Hmax/Mmax ratio), muscle ultrasound quality (Heckmatt scale), and ankle joint range of motion all remained stable across the 10 sessions, with one exception: right hip adductor spasticity worsened mildly (p = 0.04).
3No patient experienced a serious adverse event; 14% had minor complications (one case of orthostatic hypotension, two of pain).
Still to come
How it was doneWhat they foundWhat it means for PTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
No control group: every patient received full concurrent multidisciplinary rehabilitation (daily physiotherapy, 2–3×/week speech therapy, neuropsychology, and occupational therapy), so the functional improvements cannot be separated from the overall programme or from the 1–4 month window of fastest spontaneous neurological recovery. Small sample: 22 completers out of 28 enrolled; the a priori power calculation required 28, so the study was underpowered for the neurophysiological and spasticity outcomes. Only 10 treatment sessions, which the authors acknowledge may have been too few to detect changes in muscle structure or spinal excitability. Single centre, single device, single protocol; generalisability to other settings, devices, or patient mixes is limited. The Modified Ashworth Scale is a semi-quantitative ordinal measure with known inter-rater variability; the one significant spasticity finding (right hip adductor, p = 0.04) may reflect measurement noise or natural progression rather than an effect of the intervention. Respiratory outcomes were monitored for safety but not analysed as treatment outcomes. No objective neurophysiological biomarkers (EEG, sensor-based monitoring) were included, so subtle cortical or network changes were not captured. Five of the six non-completers withdrew because they had recovered active standing, meaning the analysed sample is enriched for patients who were still severely impaired at the end of the study period.
Declared interests
The authors declared that no financial support was received for the work or its publication. The Erigo device is a commercial product manufactured by Hocoma AG (Volketswil, Switzerland), but no conflict of interest with the manufacturer is declared in the text provided.
The easy way to misread this
Do not read the significant improvements in consciousness, cognitive, and disability scores as evidence that Erigo caused them. All 22 patients were in the 1–4 month window of fastest spontaneous neurological recovery and received full concurrent multidisciplinary therapy (daily physiotherapy, speech therapy, neuropsychology, occupational therapy); the paper states explicitly that the gains cannot be attributed to the device. The one significant spasticity worsening (right hip adductor, p = 0.04) is equally unlikely to be caused by Erigo — the authors note it may reflect measurement variability on a semi-quantitative scale, asymmetric neurological involvement, or natural progression in a muscle group prone to spasticity.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →