A patient in Persistent Vegetative State and his Rehabilitation

Czech version

Authors: M. Lippert-Grüner ^1,2; Y. Angerová ²; M. Hralová ³; O. Švestková ²
Authors‘ workplace: Universität zu Köln, Kolín nad Rýnem, Německo ¹; Klinika rehabilitačního lékařství 1. LF UK a VFN v Praze ²; Fyziologický ústav 1. LF UK v Praze ³
Published in: Cesk Slov Neurol N 2011; 74/107(3): 279-284
Category: Review Article

Overview

The aim of this article is to introduce the possibility of rehabilitation for vegetative patients, something that is far from common in the Czech Republic. We maintain that it is very important to draw attention to the matter, particularly today, when the comprehensive system of care for patients with cerebrovascular disease is at its very beginning. The vegetative state (term used in Anglophone countries), or “apalic syndrome” (translation of the term used in German-speaking contries) refers to subacute or chronic failure of brain cortex functions leading to a dissociation between awareness and optical vigilance (capacity for visual pursuit), assuming that the activating system of the formatiae reticularis is functioning. Some patients remain vigilant despite vegetative functions but communication with them is impossible.

In spite of a great deal of diagnostic and therapeutic progress, the prognosis for those in whom a vegetative state lasts longer that four weeks remains doubtful. For the majority of patients, complete remission not achieveable. In certain cases, however, remission over a period of years is still possible. Having established an improvement in vigilance and inceptive capacity for perception, the primary aims of rehabilitation in the early stages of remission are to extend vigilance and facilitate its enhancement. However, patients have very limited endurance and therefore rehabilitation should be individually targeted, preferably taking place in an optimally-adapted environment, especially without intrusive impacts. During the following stages of remission it is possible gradually to enhance the complexity of individual rehabilitation, still with the aim of alleviating the functional deficiency based on the actual abilities of the patient at any given point.

Key words:
vegetative state – apalic syndrome – rehabilitation – remission

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