The post-traumatic vegetative state / [edited by] Giuliano Dolce, Leon Sazbon ; with contributions by M. Gil ... [and others].

Format:

Book

Contributor:

Dolce, Giuliano.

Sazbon, Leon.

Language:

English

Subjects (All):

Persistent vegetative state.

Persistent Vegetative State.

Medical Subjects:

Persistent Vegetative State.

Physical Description:

x, 158 pages : illustrations ; 25 cm

Place of Publication:

Stuttgart ; New York : Thieme, [2002]

Summary:

While mortality rates resulting from traumatic brain injury have been greatly reduced over the years, the result has been more and more patients ending up in a vegetative state -- lasting anywhere from a few days to several months. In this practical book, the authors summarize nearly thirty years of clinical experience to give you valuable information on the diagnosis, treatment, and management of patients with this condition. In addition to the partial or complete recovery of mental and neurological functions, the book also addresses treatment options for those suffering from the relatively new phenomenon of minimal responder syndrome.

Contents:

History of the Concept of Vegetative State 1

Etiology 3

Epidemiology 4

Age and Gender 4

Season and Time of Day 5

Circumstances of VS 5

Recovery 5

Neuropathological Basis of the Vegetative State 6

3 Neurophysiopathology / Giuliano Dolce, Leon Sazbon 11

Relationship with the Outer World 11

Relationship with the Inner World 15

Working Hypothesis on the Brain's Functional Organization in the Vegetative State 16

4 Clinical Picture / Leon Sazbon, Giuliano Dolce 18

General Considerations 18

Medical Aspects and Complications 18

Cardiovascular Effects 18

Respiratory Complications 19

Urinary Complications 19

Gastrointestinal Complications 19

Motor Problems 20

Periarticular New Bone Formation 21

Seizures 21

Ventricular Enlargement 22

Undernutrition 22

Water and Electrolyte Balance 22

Hematological Alterations 23

Hormonal Disorders 23

Immunologic Disorders 24

Infections 24

Deep Vein Thrombosis 24

Autonomic Disturbances 25

Dermatological Changes and Bedsores 26

Complications of Medications 26

Other 26

Neurological Aspects 26

Neurological Examination 26

Posture 27

Spontaneous and Pathological Movements 27

Passive Movements and Muscular Tone 27

Behavioral Responses 28

Ocular Motility 28

Otal Reflexes and Automatism 29

Oculocephalic Reflex 29

Trunk and Limbs 29

Reflexes 30

Recovery of Conscious Activity 30

Prognostic Value of Neurological Signs / Giuliano Dolce, Leon Sazbon 32

Basic Glossary and Definitions of Relevant Signs 33

Ditterential Diagnosis / Frich Schmutzhard 35

Locked in Syndrome 36

Akinetic Mutism 38

Patamedian Diencephalic Syndrome (Hypersomnia) 39

Prognosis and Outcome / Leon Sazbon, Giuliano Dolce 41

Survival 41

Recovery of Consciousness 42

Recovery of Function 44

Assessment of the Vegetative State / Cecha Koren, Mali Gil, Leon Sazbon 46

The Glasgow Coma Scale 47

The Rancho Los Amigos Levels of Cognitive Functioning Scale 47

The Disability Rating Scale 47

The Western Neuro-Sensory Stimulation Profile 48

The Coma/Near Coma Scale 48

The Coma Recovery Scale 48

The Sensory Stimulation Assessment Measure 49

Prognostic Model of Emergence from Vegetative States 49

The Coma Exit Chart 50

The Sensory Modality Assessment and Rehabilitation Technique 51

The Preliminary Neuropsychological Battery 51

Loewenstein Communication Scale for the Minimally Responsive Patient 51

5 Ancillary Examination / Leon Sazbon 60

Laboratory Findings 60

Neuroimaging in the Vegetative State / Hans Hacker 61

Neurophysiological Assessment of Brain Function in the Persistent Vegetative State / Alessandro Pincherle, Walter G. Sannita 65

Electroencephalography 66

Sleep EEG 67

Stimulus-Related Evoked Potentials 67

6 Therapy / Leon Sazbon, Giuliano Dolce 76

Medical Therapy 76

Types of Drug Used in the Vegetative State 76

Deep Brain Electrical Stimulation 78

Surgical Therapy 79

Incidence of Hydrocephalus 80

Diagnosis and Treatment 80

Outcome of Surgery 81

Stimulation Techniques 81

Types and Techniques of Sensory Stimulation 82

Assessment and Outcome 83

Other Potential Advantages 84

7 Practical Guide to the Management of Patients in the Vegetative State / Maria Quintieri, Sebastiano Serra 89

General Considerations 89

Observation of the General State 90

Survey of Vital Parameters 90

Pharmacological Therapy and Drug Administration Modes 90

Procedure: before Drug Administration 90

Treatment Program 91

Hygiene 91

Evaluation of Nutritional Aspects and Methods 93

Procedure for Body Weight Monitoring 94

Feeding: Routes of Administration 94

Treatment in the Gym 94

Respiratory Treatment 96

Verticalization 97

Hydrotherapy 98

Positioning the Patient on the Wheelchair 100

Treatment of Swallowing Disturbances 102

Evaluation and Treatment of Spasticity 104

Management of Tracheostomy Patients in the Vegetative State / Paolo Scola 107

Countercannula Disinfection 107

Inhalation 107

Swallowing 108

Fibrotracheal Bronchoscopy 108

Complications 108

Cannula Removal 108

8 Minimal Response Syndrome / Ofer Keren, Jacqueline Resnik 110

What is Minimal Response Syndrome? 110

Significance of the Syndrome 110

Implications for Health Policy 110

Diagnosis and Assessment Tools 111

Incidence and Prevalence 112

Practical Management Recommendations 113

Clinical Management 113

Objectives of Treatment 113

Treatment Aimed at "Care" 113

Treatment Aimed at "Therapy" 114

Clinical Treatment Providers 115

Policy and Ethics Related to the Minimally Responsive Patient 116

9 Ethical Aspects / Giuliano Dolce, Leon Sazbon 120

10 Treating Families of Patients in Vegetative State: Adjustment and Interaction with Hospital Staff / Anat Shilansky, Rosemarie Weitz 124

Focusing on the Families 124

Family Assessment 125

Typical Psychological Reactions of the Family Members 125

Focusing on the Staff: Emotional Stress and Sources of Tension 127

Recommendations and Suggested Strategies 128

11 Covert Cognitive Abilities of a Person with Altered Consciousness / Levy Rahmani 131

12 Intensive-Care Unit for Vegetative State: Management Guidelines / M. Rachele Zylberman 141

General Organizing Criteria 141

Admission Criteria 142

Discharge Criteria 143

The Department 143

Structural Organization 144

Building Materials 145

Equipment and Biotechnology 145

Lying-in Period 145

Gymnasium 146

Sanitary Rooms 146

Human Resources 146.

Notes:

Includes bibliographical references and index.

ISBN:

1588901165

313130071X

OCLC:

49527076