Neurorehabilitation after Traumatic Brain Injury with Special Reference to Vegetative State

Traumatske ozljede mozga jedan su od vodećih uzroka onesposobljenosti u suvremenom svijetu, što je velik javnozdravstveni problem, a i socioekonomski je važan. Heterogenost i nepredvidljivi klinički ishodi ozljeda mozga posljedica su kompleksnih uzoraka njegova oštećenja. Akutna (bolnička) rehabilitacija provodi se nakon stabilizacije stanja bolesnika i završenog akutnog liječenja. Kliničkim pregledom potrebno je odrediti područje oštećenja mozga, donijeti terapijski plan s ciljevima koje u određenom vremenu želimo postići i odabrati specifične terapijske intervencije radi njihova ostvarenja. Terapijski plan mora biti individualiziran, a provedba multidisciplinarna i interdisciplinarna. Među teškim posljedicama ozljede mozga izdvajaju se stanja s poremećajem svijesti. Vegetativno stanje klinički se prezentira kao stanje budnosti (s otvorenim očima), ali bez svjesnosti, s očuvanim ciklusom budnosti i sna te očuvanim funkcijama moždanog debla. Liječenje se sastoji od preventivnih mjera i liječenja komplikacija, uz mjere intenzivne medicinske njege. Rehabilitacija je usmjerena restauraciji stanja svijesti, prije svega senzomotoričkom stimulacijom.Traumatic brain injuries (TBIs) are one of the leading causes of disability in the contemporary world, which represents a major public health issue bearing considerable socio-economic relevance. Heterogeneity and unpredictable clinical outcomes of TBIs are the result of complex patterns of brain damage. Acute (hospital) rehabilitation is carried out after the patient’s condition is stabilized and acute treatment completed. Clinical examination should be conducted to determine the domains affected by brain damage, to devise a therapeutic plan that includes desirable goals to be attained within a specific timeframe, and to choose specific therapeutic interventions that help attain such goals. The therapeutic plan should be individualized, with both multi- and inter-disciplinary implementation. One of the identified severe consequences of TBI are disorders of consciousness. The vegetative state is clinically presented as a state of wakefulness (with eyes open) without regained awareness, in which patients demonstrate awake-sleep cycles and preserved brain stem functions. The treatment consists of preventive measures and treatment of complications, including the intensive care treatment. Rehabilitation is focused on restoring consciousness, primarily by sensorimotor stimulation