The system of differentiated medical neurorehabilitation in the traumatic post-coma conditions of long-term disorders of consciousness

The study focuses on achieving the proper degree of daily patient activation, the minimization of the manifestations, the consequences of post-coma immobilization syndrome, especially the syndromes of repressed consciousness, highlighting the key importance of the type of individual rehabilitation programs’ content. The main aim of this study was to develop and justify a system of differentiated medical (physical) rehabilitation of patients with post-traumatic post-coma long-term disorders of consciousness, identify key principles for the functioning of this system, and highlight the basic guidelines for specialized rehabilitation medical institutions. The work is based on the results of diagnosis, rehabilitation and restorative treatment of 220 patients with traumatic post-coma disorders of consciousness, who were examined and underwent neurorehabilitation (NR) treatment at the State Institution Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine and the "Nodus" Practical Center for Neuro Rehabilitation from January 2007 to July 2018 inclusive. All patients after courses of rehabilitation treatment were discharged for outpatient monitoring or continued treatment of somatic complications of the underlying disease at their place of residence. During the rehabilitation treatment conducted over the study period, none of the patients died. The conclusion as to the applied effectiveness of the established system of rehabilitation is made after comparing the expected results of the rehabilitation and rehabilitation with the real achievements, carrying out a detailed analysis of the implemented individual programs at each stage of the restoration of consciousness, as well as clarifying the design of daily exercises and the principles of the distribution of loads in order to solve the set clinical problems, and both general and current goals