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Titre : | Specialized Early Treatment for Persons With Disorders of Consciousness: Program Components and Outcomes (2013) |
Auteurs : | Ronald Seel ; Jennifer Douglas ; Andrew Dennison ; et al. |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (2013/10, 2013) |
Article en page(s) : | pp. 1908-1923 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Diagnostic ; Pronostic ; Rééducation et réadaptation |
Mots-clés: | Brain Injuries ; Lésions encéphaliques ; Diagnosis ; Prognosis ; Persistent Vegetative State ; État végétatif persistant |
Résumé : |
Objectives To describe a specialized early treatment program for persons with disorders of consciousness (DOC) that includes family education; to identify rates of secondary conditions, imaging used, and selected interventions; and to evaluate outcomes. Design A single-center, retrospective, pre-post design using electronic medical record data. Setting A Commission on Accreditation of Rehabilitation Facilitiesaccredited, long-term acute care hospital that provides acute medical and inpatient rehabilitation levels of care for people with catastrophic injuries. Participants Persons (N=210) aged 14 to 69 years with DOC of primarily traumatic etiology admitted at a mean + SD of 41.0+27.2 days postinjury; 2% were in coma, 41% were in the vegetative state, and 57% were in the minimally conscious state. Interventions An acute medical level of care with ≥90 minutes of daily interdisciplinary rehabilitation and didactic and hands-on caretaking education for families. Main Outcome Measures Coma Recovery ScaleRevised, Modified Ashworth Scale, and discharge disposition. Results Program admission medical acuity included dysautonomia (15%), airway modifications (79%), infections (eg, pneumonia, 16%; urinary tract infection, 14%; blood, 11%), deep vein thrombosis (17%), pressure ulcers (14%), and marked hypertonia (30% in each limb). There were 168 program interruptions (ie, 139 surgeries, 29 nonsurgical intensive care unit transfers). Mean length of stay + SD was 39.1+29.4 days (range, 6204d). Patients showed improved consciousness and respiratory function and reduced presence or severity of pressure ulcers and upper extremity hypertonia. At discharge, 54% showed sufficient emergence from a minimally conscious state to transition to mainstream inpatient rehabilitation, and 29% did not emerge but were discharged home to family with ongoing programmatic support; only 13% did not emerge and were institutionalized. Conclusions Persons with DOC resulting primarily from a traumatic etiology who receive specialized early treatment that includes acute medical care and ≥90 minutes of daily rehabilitation are likely to show improved consciousness and body function; more than half may transition to mainstream inpatient rehabilitation. Families who receive comprehensive education and hands-on training with ongoing follow-up support may be twice as likely to provide care for medically stable persons with DOC in their homes versus nursing facility placement. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/archives-of-physical-medicine-and-rehabilitation |