The specificities of restoration of mental activity in patients after severe traumatic brain injury at the stage of confusion syndromes

Kulyk O. V. The specificities of restoration of mental activity in patients after severe traumatic brain injury at the stage of confusion syndromes. Актуальні проблеми транспортної медицини / Actual problems of transport medicine / 2018;4(54):32-43. ISSN 1818-9385

DOI http://dx.doi.org/10.5281/zenodo.2525598

http://aptm.org.ua

The specificities of restoration of mental activity in patients after severe traumatic brain injury at the stage of confusion syndromes

O. V. Kulyk

Scientific and practical center of neuro-rehabilitation "Nodus"

Abstract

The scientific work is based on the results of diagnostics, rehabilitation and restorative treatment of 220 patients with post-coma long-term consciousness disorders after severe traumatic brain injury.

Having considered separately each stage of confusion syndromes and analyzed the individual rehabilitation programs (IRP), process and rehabilitation of patients on these stages, it became apparent that the real difference and fundamentally new problems in terms of physical medical rehabilitation (including ergotherapy) among patients at stages 6A, 6B, 6C were not determined. The main attention is paid to the actual topic of mental activity restoration at the stage of confusion in line with the stages of classification according to Dobrokhotova T. A. in the course of the rehabilitation route. These are the features of the reintegration of reactions and psychopathological manifestations at each of the stages (6A, 6B, 6C). The differences identified during the studies that separated the stage from the stage during the rehabilitation route concerned only the methods of speech therapy and psycho-neurological correction. Even analysis of those cases (66 patients remained at the stages of confusion and during the study period did not pass to the seventh stage of post-coma consciousness transition syndromes) indicates that patients in their groups at stages 6A, 6B, 6C had almost identical (with individual fluctuations) physical capabilities, social skills, similar in basic features neurological status, but differed in the results of mental (intellectual-mnestic) functions restoration. Although further, during migration from stage to stage of syndromes of consciousness reintegration the emergence of new physical skills was observed and the consolidation of previous achievements occurred, but nevertheless, the tasks and methods introduced by us aimed at improving the language and higher cortical functions, through which the social activity of patients grew, came to the fore.

Neuropsychiatric correction had an integrated approach: the reintegration of basic reflexes and basic perinatal senses had a significant impact on the process of consciousness recovery, neuro-sensory correction, including neuro-sensory stimulation, was aimed at restoring the perception zone, differentiation of stimuli, differentiation of responses to sensory impact, introduction of kinesthetic praxis exercises, psycho-gymnastics, passive neurodynamic correction, etc. allowed to improve internally hemispheric and interhemispheric integration. For the first time it was recorded that the restoration of mental activity occurred faster than obtaining some new kinetic or locomotor skills. The patient was already reaching the stage of amnestic confusion (6C-ACC), but he continued to work in the apparatus of functional therapy of the hand over problems established at the stage of confusion with aspontaneity (6A-ATP with A). It was determined the importance of using adequate psychopharmacocorrection at each of the stages of consciousness restoration depending on the clinical manifestations, the main syndromes and the dynamics of psycho-emotional reactions.

Keywords: psychotherapy, cognitive-behavioral therapy, traumatic brain injury, post-coma disturbance of consciousness, psychopharmacocorrection, psycho-rehabilitation, neuropsychiatry, neuropsychological rehabilitation, reintegration of consciousness, higher mental functions, sensory neural correction, psychostimulotherapy, neurodynamic correction, neurointegration.