By Klaus R. H. von Wild (auth.), Univ-Prof. Dr. Klaus R. H. von Wild (eds.)
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Extra resources for Functional Rehabilitation in Neurosurgery and Neurotraumatology
So we try hard to begin coma stimulation therapies as early as possible after vital stabilization of the patient; success of early rehabilitation will also depend on the control of complications. Results Of the total of 252 patients 68% belonged to the initial GCS 3~8, 22% to GCS 9~12 and 10% to GCS 13~15. Mean duration ofICU treatment was 7,2 days, mean duration of early rehabilitation 51 days (range of 4~388 days). In this group we saw complications in 134 of the 252 patients. CNS/neurosurgical complications occurred in 27% of the patients, and 27% suffered also from one or more pulmonal complications.
In the group of the vegetative patients only 1 improved to GOS 3, 3 patients died and 11 patients remained unchanged. Fifty-one patients with a GOS score of 3 at the end of early rehabilitation improved to GOS 4 and 5, 16 of them deteriorated and died. In GOS 4 28 patients improved and 9 patients deteriorated, in GOS 5 also 14 patients showed a worse late medical outcome. Retrospectively we observed that none of the patients with <20 (of 24) points in the coma remission scale at day 40 of treatment reached GOS 4 or 5 in the final , Early rehab discharge Long time results GOS Number % GOS Number % 2 3 4 5 11 15 110 58 46 5 6 46 24 19 I 2 3 4 5 36 11 50 15 5 21 27 32 64 79 Fig.
These methods do not only help us recording vital stress but also may indicate reactions of the comatose patient to coma stimulation therapy even though this will be subject of subsequent investigations. The frequency and kind of neurosurgical secondary operations point out that this early phase of rehabilitation is an essential part of neurosurgical therapy to ensure continuity of treatment and to prevent transfers to other hospitals which will severely disturb reorganisation of the brain and reorientation of the patient returning from inconsciousness.