A systematised review of assisted standing for persons in a prolonged disorder of consciousness

Student thesis: Master's ThesisMaster of Science by Research


Background: Persons in disorders of consciousness after brain injury pose a highly complex philosophical and scientific issue. With medical advances, more people now survive previously fatal brain injuries but can be left in prolonged disorders of consciousness. The mechanisms for regaining consciousness after brain injury are still poorly understood. Treatment to remediate consciousness is an important rehabilitative issue. Passive standing using equipment such as a tilt table is a therapeutic method used with the intention to aid the recovery of consciousness. This is a commonly used treatment method but, it is not known if it is effective.

Research objective: The intention of this systematised review is to analyse the evidence for passive standing’s effect on consciousness for those in a prolonged disorder of consciousness.

Methods: This review followed a PRISMA-P protocol for comprehensive reporting. The use of this ensured structured searching, selection and presentation of articles. The search was completed independently by two separate researchers. The search strategy was created to retrieve all possible causes of disorders of consciousness, combined with all conceivable passive standing devices and assessments of consciousness. Papers were identified through primary database searching (in Medline, CINAHL, AMED, PEDro and The Cochrane Library) and post-citation searching (via Scopus). A search for relevant grey literature was performed in profession-specific magazines, theses, conference proceedings and clinical trial registries. Inclusion criteria were any papers that evaluated passive standing on adults who were in defined disorders of consciousness. Exclusion criteria included active stand studies, paediatric studies and animal studies, as these are inappropriate to answer the research question. A consensus was reached through discussion between the two separate researchers.

Results: Ten papers were appropriate for inclusion through adherence to the inclusion and exclusion criteria. Data collection from the papers was completed using the Cochrane data collection form (2014). For all articles assessment of study quality and bias was completed using the Cochrane risk of bias tool (2014), additionally, the Downs and Black tool (1998) was used to assess the quality of observational studies. The majority of studies reviewed were of low to medium quality. The results of these did not provide conclusive recommendations as to the effectiveness of supportive standing. This systematised review has created recommendations for future research to assess if standing is a therapeutically effective treatment of consciousness.
Date of Award2018
Original languageEnglish
Awarding Institution
  • Coventry University
SupervisorAnn Green (Supervisor), Jackie Shanley (Supervisor) & Andrew King (Supervisor)

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