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Up to 80% of cirrhosis patients report poor sleep quality, as evidenced by Pittsburgh Sleep Quality Index (PSQI) scores exceeding 5 (ChildTurcottePugh [CTP] A: 16.9%, CTP B: 26.5%, and CTP C: 56.6%), and around 16 to 52% suffer from excessive daytime sleepiness (EDS), reflected by Epworth Sleepiness Scale (ESS) scores over 10 (CTP A: 17.6%, CTP B: 29.7%, CTP C: 52.8%) (31)

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Surprisingly, simple exercises using hand and forearm strengthening devices (handgrip) have shown their capacity to reduce blood pressure by approximately ten points and can be easily integrated into daily concussion therapy routines