A prospective case series to investigate current practice in the physical management of people in low awareness states (LAS)

Advances in medical sciences and technology have allowed more severely impaired people to survive in LAS. The main role of rehabilitation for this patient group is to maximise potential for recovery and to prevent deterioration. Soft tissue shortening, following prolonged periods of immobility and sustained posturing, can hinder effective seating and provision of hygiene and ADL needs.

Management of LAS patients is multi disciplinary in which physiotherapy has a significant role. Posture management is a 24-hour approach carried out mainly by physiotherapists, occupational therapists and nurses. Regular changes in posture may prevent many secondary complications (e.g. contractures, pressure sores) and improve comfort and safety. However, robust evidence supporting these claims is limited and clinical practice has substantial variability.

This prospective case series aims to

• Explore the pattern of deformities observed in people in LAS
• Document the type, duration and frequency of physical (spasticity and posture) management interventions provided to patients in LAS
• Monitor the time course of development of contractures longitudinally