AI Article Synopsis
- Advances in medical care have led to more survivors of severe brain injuries experiencing prolonged disorders of consciousness (PDOC), and early intensive neurorehabilitation (EIN) is recommended for better recovery outcomes.
- A study evaluated the effectiveness of a nationwide EIN program in the Netherlands, finding that 68% of participants improved to at least a minimal conscious state, with 44% fully regaining consciousness, although 6% died during the program.
- Despite frequent medical complications (with 30% requiring hospital readmission), most participants experienced little to no pain, and there was a reduction in cardiovascular medication and analgesics by 15%.
Article Abstract
Background: Advances in medical care have increased survival in people with severe brain injuries and with that the number of survivors with prolonged disorders of consciousness (PDOC) has increased. In the literature, early intensive neurorehabilitation (EIN) for people with PDOC is recommended to achieve the best possible outcomes.
Objectives: To evaluate the frequency and extent of recovery of consciousness, mortality, complications, pain and discomfort, and medication during a nationwide EIN programme in people with PDOC after acquired brain injury. We hypothesized that level of consciousness would improve in half of people with PDOC.
Methods: Prospective cohort study. People with PDOC aged 16 years and older admitted to the EIN department centralized in a single rehabilitation centre in the Netherlands (Libra Rehabilitation & Audiology) were included. The EIN delivers a subacute medical level of care and rehabilitation for a maximum duration of 14 weeks. The outcome measures were level of consciousness (CRS-R), mortality, number of complications, medication and pain/discomfort (NCS-R).
Results: Of the 104 people included, 68 % emerged to a minimal conscious state with command-following or higher during EIN and 44 % regained consciousness. Mortality during EIN was 6 %, and 50 % of deaths followed a non-treatment decision or withdrawal of life-sustaining treatment. Almost all participants had at least 1 medical complication, leading to hospital readmission for 30 %. 73 % showed no pain or discomfort. During EIN, cardiovascular medication and analgesics were reduced by 15 %.
Conclusions: During the EIN programme, a large percentage of people with PDOC regained at least a minimal conscious state or even consciousness. These outcomes and the frequent medical complications in these people suggest that intensive specialized care should be offered to all people with PDOC. The outcomes of this study might help health professionals to better inform the families of people with PDOC about the short-term prognosis of PDOC.
Protocol Registration Number: The Dutch Trial Register, NL 8138.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.rehab.2024.101838 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Local Neuronal Activity and the Hippocampal Functional Network Can Predict the Recovery of Consciousness in Individuals With Acute Disorders of Consciousness Caused by Neurological Injury.
CNS Neurosci Ther
November 2024
Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Aims: There is limited research on predicting the recovery of consciousness in patients with acute disorders of consciousness (aDOC). The purpose of this study is to investigate the altered characteristics of the local neuronal activity indicated by the amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC) of the hippocampus network in patients with aDOC caused by neurological injury and to explore whether these characteristics can predict the recovery of consciousness.
Methods: Thirty-seven patients with aDOC were included, all of whom completed resting-state functional magnetic resonance imaging (rsfMRI) scans.
Longitudinal transcriptional changes reveal genes from the natural killer cell-mediated cytotoxicity pathway as critical players underlying COVID-19 progression.
Elife
October 2024
Facultad de Medicina y Ciencia, Universidad San Sebastián, Puerto Montt, Chile.
Patients present a wide range of clinical severities in response severe acute respiratory syndrome coronavirus 2 infection, but the underlying molecular and cellular reasons why clinical outcomes vary so greatly within the population remains unknown. Here, we report that negative clinical outcomes in severely ill patients were associated with divergent RNA transcriptome profiles in peripheral immune cells compared with mild cases during the first weeks after disease onset. Protein-protein interaction analysis indicated that early-responding cytotoxic natural killer cells were associated with an effective clearance of the virus and a less severe outcome.
View Article and Find Full Text PDFExploration of resting-state brain functional connectivity as preclinical markers for arousal prediction in prolonged disorders of consciousness: A pilot study based on functional near-infrared spectroscopy.
Brain Behav
August 2024
Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Background: There is no diagnostic assessment procedure with moderate or strong evidence of use, and evidence for current means of treating prolonged disorders of consciousness (pDOC) is sparse. This may be related to the fact that the mechanisms of pDOC have not been studied deeply enough and are not clear enough. Therefore, the aim of this study was to explore the mechanism of pDOC using functional near-infrared spectroscopy (fNIRS) to provide a basis for the treatment of pDOC, as well as to explore preclinical markers for determining the arousal of pDOC patients.
View Article and Find Full Text PDFPrognosis of patients with prolonged disorders of consciousness after brain injury: a longitudinal cohort study.
Front Public Health
August 2024
Department of Rehabilitation Medicine, Hospital of Zhejiang People's Armed Police, Hangzhou, China.
Background: The findings regarding the prognosis of prolonged disorders of consciousness (PDOC) vary widely among different studies. This study aims to investigate the mortality, consciousness recovery and disabilities of patients with PDOC after brain injury.
Methods: A total of 204 patients with PDOC were included in a longitudinal cohort study, including 129 males and 75 females.
Short-term outcomes of early intensive neurorehabilitation for prolonged disorders of consciousness: A prospective cohort study.
Ann Phys Rehabil Med
June 2024
Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, PO Box 2040, 3000 CA, Rotterdam, the Netherlands; Rijndam Rehabilitation, PO Box 23181, 3001 KD, Rotterdam, the Netherlands.
Article Synopsis
- Advances in medical care have led to more survivors of severe brain injuries experiencing prolonged disorders of consciousness (PDOC), and early intensive neurorehabilitation (EIN) is recommended for better recovery outcomes.
- A study evaluated the effectiveness of a nationwide EIN program in the Netherlands, finding that 68% of participants improved to at least a minimal conscious state, with 44% fully regaining consciousness, although 6% died during the program.
- Despite frequent medical complications (with 30% requiring hospital readmission), most participants experienced little to no pain, and there was a reduction in cardiovascular medication and analgesics by 15%.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!