Article

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 Facilities-accredited, 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
Scale-Revised, 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, 6-204d). 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.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS