[Local Medical]Multidisciplinary neurorehabilitation treatment assessment awareness…

Text◆Zeng Yongtai

Due to the lack of care guidelines for disorders of consciousness, many family members in our country will place patients with severe brain injuries in general community nursing homes, or find a maid to take care of him at home, because the family members do not know that there is a correct care path that meets the needs of this type of patient. .

(Kuala Lumpur News) Recovery from severe brain injury may be a long journey, but these patients with cognitive disorders still need to receive appropriate care, including complete multidisciplinary neurorehabilitation treatment, because they still have the potential to improve. .

Can be divided into traumatic and non-traumatic

Associate Professor Lydia Abdul Latif, specialist consultant in rehabilitation medicine, pointed out that disorder of consciousness refers to a state of consciousness that falls into after the brain is seriously injured, mainly including coma, vegetative state and so on. ) and Minimally Conscious State.

“Coma” refers to a completely unconscious state that cannot be awakened (Arouse),

The eyes remain closed, not awakening (Awake), not aware (Aware).

“Vegetative state or ‘unresponsive arousal syndrome’

(Unresponsive Wakefulness Syndrome),

It means that the patient is in a state of awakening and may open his eyes spontaneously.

However, the patient showed no behavioral signs that he was aware of his environment.

“Mildly conscious state” means that the patient has clear behavioral signs that he is aware of his own environment. Usually these behaviors may not be obvious or come and go. “

She noted that the causes of severe brain damage can be divided into traumatic and non-traumatic. Traumatic severe brain injury refers to head trauma caused by accidents, such as falls, car accidents, or during sports. Non-traumatic severe brain injuries are caused by diseases that can cause a lack of oxygen in the brain, such as heart attacks, strokes, brain infections, and brain tumors. The most common serious brain injuries are caused by strokes and brain tumors. “

Provide treatment options based on state of consciousness

“First of all, we need to assess the patient’s level of consciousness (Level of Consciousness). Is he in a coma, vegetative state or minimally conscious state? Because different states of consciousness require different treatment plans and management conditions.”

She emphasized that assessment methods include clinical behavioral assessment, as well as monitoring through various neuroimaging and neurophysiological modalities. Among them, the Glasgow Coma Score is the most basic and commonly used method to assess the degree of coma of a patient. It is a common “language” for health care workers around the world. It uses the patient’s eye opening reaction, speaking reaction and motor reaction. to evaluate.

“The degree of coma is assessed by the sum of the three scores, which can be divided into three levels of coma: severe, moderate and mild. In addition, the Coma Recovery Scale can also help evaluate the patient’s clinical behavior.”

“Simply put, the first thing is to see if the patient can be aroused. If so, then see if he can be aware of his environment. If so, then look at his ability to communicate, whether verbal or non-verbal.”

The longer you stay in the ICU

The greater the economic burden and cost

Assessing the patient’s state of consciousness is to predict the possible development of the disease and also to assist doctors in evaluating which interventional treatment or rehabilitation program should be provided to the patient.

Lydia gave an example. If the patient is in the Persistent Vegetative State, let him participate more in the Arousal Program. If the patient has awakened to a minimally conscious state, let the patient participate more in reminding him. Awareness treatment programs, if the patient is already aware of his or her environment, can try to strengthen his or her communication skills.

“Recovery from a severe brain injury can be a long journey, and its management is complex and challenging, but these patients still need to receive appropriate care, which includes complete multidisciplinary neurorehabilitation therapy. Neurological Rehabilitation), because they still have the potential to be improved. Just like the United States or the United Kingdom, they even have clear guidelines on what kind of medical setting and care plan patients with consciousness disorders should be treated after leaving the intensive care unit. Care, that’s what our country is lacking right now.”

“In contrast, in China, due to the uncertainty of prognosis, most family members will place patients with mental disorders in general community nursing homes, or find a maid to take care of them at home, because they do not know whether there is a correct and suitable nursing care for this type of patients. You can choose the route, and they don’t know when the patient will wake up. The longer the patient stays in the ICU, the greater the financial burden will be on the family.”

Payo will not fall into a coma

Question 1. Is there any rehabilitation treatment that can be performed while in a coma?

Answer 1.Yes, Early Mobilization and Neurological Rehabilitation should be started as early as in the intensive care unit and must be led by doctors who have experience in managing disorders of consciousness. This can prevent complications and avoid Delay the patient’s recovery time.

Question 2. In movies or TV series, we often see characters who have been comatose for many years suddenly awaken. Is this possible in real life?

Answer 2.This is possible if the patient is in a minimally conscious state. Unless a patient is in a coma for more than 12 months, we know they don’t have much potential. But we have also seen patients awaken from coma to a vegetative state, then to a minimally conscious state, and even finally fully regained their consciousness and communication abilities.

Therefore, any person with a disorder of consciousness still needs to receive appropriate care.

Question 3. It is often heard that the personality of patients after awakening will be different from before. Why is this?

Answer 3.It depends on the patient’s brain injury and the severity of the disease, but there are many factors that can affect a patient’s ability to return to their premorbid function.

Whether it is a mild or severe injury, there will definitely be a certain degree of compromise. No matter what form of brain injury it is, behavioral issues (Behavior Issues) are known and inevitable complications. They may be aggressive or depressed. They generally do not occur in the early stages. They may occur. Much later.

Question 4. Can Parkinson’s disease or dementia cause severe brain injury and enter a coma?

Answer 4.Won’t. Both can be physically intact but cognitively impaired. Although both are progressive brain injuries, they will not cause the patient to enter a coma. Comatose states can only be caused by severe brain injuries, traumatic or non-traumatic, as mentioned above.

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