对康复感到困惑?针对处于困惑状态的脑损伤患者的多方面方法

Hospitals Pub Date : 2024-05-09 DOI:10.3390/hospitals1010005
Jesper Fabricius, Anna Birthe Andersen, Gitte Lindegård Munk, Hanne Kaae Kristensen
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引用次数: 0

摘要

伤后意识模糊是后天性脑损伤后的一种常见现象。建议采用多方面的方法来减少意识模糊,但与非药物治疗相关的研究却很少。本研究的主要目的是提出一种治疗精神错乱的多元方法的概念模型,其次是调查采用这些方法后的康复效果。研究环境是一个专门为后天性脑损伤后出现严重认知障碍的患者提供康复治疗的病房。概念模型包括神经行为策略、药物治疗、从事有意义的职业、近亲参与、组织要求、物理环境以及鉴别诊断。我们还提供了一些病例来说明每种方法的影响。在 281 名患者中,共有 141 名患者在入院时处于意识模糊状态。出院时,62%的患者已经摆脱了意识混乱状态。因创伤性脑损伤和蛛网膜下腔出血而处于意识模糊状态的患者,在根据概念模型进行康复治疗后,从入院到出院,其功能独立性指标的临床意义差异大于 22 分。而非蛛网膜下腔出血脑卒中患者和其他类型脑损伤患者则没有临床重要差异。所提出的概念模型应在复杂的干预研究中进一步评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Confused about Rehabilitation? Multi-Faceted Approaches for Brain Injured Patients in a Confusional State
Post-injury confusional state is a common phenomenon following acquired brain injury. A multi-faceted approach for decreasing confusion is recommended, but there is a paucity of research related to non-pharmacological management. The main objective was to present a conceptual model of multi-faceted approaches for confusion, and secondly to investigate the rehabilitation outcome following these approaches. The setting is a specialized ward for rehabilitation of patients with severe cognitive difficulties following acquired brain injury. The conceptual model encompasses neurobehavioral strategies, pharmacological treatment, engagement in meaningful occupations, next of kin involvement, organizational demands, the physical environment, along with differential diagnostics. Patient cases are provided to illustrate the impact of each approach. A total of 141 of 281 patients were in a confusional state at admission. At discharge, 62% had emerged from the confusional state. Patients in a confusional state due to traumatic brain injury and subarachnoid hemorrhage had clinically important differences of >22 points in the functional independence measure from admission to discharge, following rehabilitation efforts based on the conceptual model. No clinically important difference was seen in patients with non-SAH stroke and patients with other types of brain injuries. The proposed conceptual model should be further evaluated in complex intervention studies.
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