Awakening from coma : assessment and stimulation in a Post-Critical Care Rehabilitation Units (PCCRU)
Prof Jacques LUAUTÉa
a CHU de Lyon
Brain injured patients who have suffered a coma require important medical supervision with a coordinated program of rehabilitation and are most likely to benefit from Post-Critical Care Rehabilitation Units (PCCRU). For these patients, an important challenge is to recognize signs of awareness beyond wakefulness. This evaluation is necessary to establish a diagnosis of the disorder of consciousness: vegetative state (VS) or unresponsive wakefulness syndrome versus minimally conscious state (MCS). Daily clinical observations of patients by trained care-givers confer to these particular environments an expertise in this field. The use of specific scales such as the Coma Recovery Scale Revised (CRS-R) allows the standardization of practices and provides quantitative data that are useful to follow patients, to assess the beneficial effect of a treatment or to compare patients. Neurophysiology and functional imagery can be used to search for markers of high level brain activity. These tools are mostly used in research areas but can provide information complementary to the clinical evaluation, which involves a degree of subjectivity. Detecting awareness requires that patients are comfortable and because of the fluctuation of awareness, a sufficient time of observation is essential. A favorable atmosphere to promote the emergence of awareness comprises personalized stimulations such as sensory regulation programs. Music, noninvasive brain stimulations and several drugs can also boost awareness detection. A program integrating these practices is proposed to patients awakening from coma or for a specific assessment before the admission in dedicated units for patients in VS/MCS.
Keywords : VS, URW, PCCRU