"Now that he has been able to wash his own clothes, sweep the floor, fold the quilt and follow the stairs, thanks to the rehabilitation department, he has regained his ability to take care of himself and return to family and social life." The family of Xiao Xu, a brother of Ningxiang Express, sent a message to the medical staff in the rehabilitation ward.
Last summer, 35-year-old Xiao Xu suddenly suffered from heat stroke, suffered from multi-organ failure, and finally saved a life after active rescue, but he never woke up and became a chronic impaired consciousness patient, which is commonly referred to as "vegetative person".
Xiao Xu, who was usually full of vitality, lay unconscious on the hospital bed, the top beam and pillar fell, and the whole family felt that the sky had collapsed. After many inquiries, I learned that the Rehabilitation Medicine Department of Hunan Provincial People's Hospital has opened a coma and awakening clinic, which has treated many "vegetative people", so I came to the clinic and was admitted to the coma and awakening ward.
Xiao Xu is doing an assessment test related to coma and awakening.
The awakening of vegetative people has always been a worldwide problem, and the accurate assessment of consciousness disorders is difficult, the treatment methods are relatively scarce, and the treatment cost is high and the effect is slow. In September 2019, the first rehabilitation ward of Hunan Provincial People's Hospital opened a coma and awakening promotion ward, which is the first coma and awakening promotion ward specially opened by the first third-class hospital in the province. In September 2021, led by Academic Director Song Tao, the multidisciplinary collaboration team of coma and awakening promotion was established in conjunction with neurology, neurosurgery, imaging, electrophysiology and other multidisciplinary collaboration teams, formulated and continuously improved the coma and awakening rehabilitation process, promoted exchanges in provincial and even national academic conferences, and had independent brain function detection and non-invasive neuromodulation rooms in the ward, and had a complete and standardized evaluation and standardized treatment process for patients with chronic consciousness disorder, which greatly improved the success rate of patients promoting awakening.
After Xiao Xu was admitted to the hospital, the coma and awakening team intensively evaluated him, and on the basis of the systematic physical examination, the FOUR and CRS-R scales were selected for the assessment of the state of consciousness, and it was found that Xiao Xu was in a state of micro-consciousness; through the examination of event-related potentials (P300, N100, MMN, etc.), EEG nonlinear dynamics, etc., the electrophysiological evaluation of the brain was consistent with the results of the clinical assessment; further imaging tests such as fMRI, DTI, SWI and other imaging tests clarified the location and extent of brain injury.
The Coma-Induced Awakening Multidisciplinary Assistance (MDT) team discusses Xiao Xu's situation.
After full evaluation, the MDT team discussed that Xiao Xu was in a state of micro-consciousness, the probability of awakening was large, and a detailed treatment plan was formulated, and on the basis of drugs, hyperbaric oxygen, acupuncture and other treatments, the international advanced awakening stimulation methods such as transcranial direct current stimulation, repeated transcranial magnetic stimulation, median nerve electrical stimulation, and a variety of sensory stimulation were added.
While actively promoting awakening, the team carried out all-round rehabilitation treatment for Xiao Xu's cardiopulmonary rehabilitation, swallowing training, language training, limb function training, etc. With the development of treatment, Xiao Xu gradually removed the tracheal cannula, gastric tube, and urinary tube, and finally became conscious after two months of admission, and the family was pleasantly surprised.
Xiao Xu, who woke up, became the patient with the strongest initiative in rehabilitation training, and finally in the third month of hospitalization, he realized that he could walk independently on the ground and communicate with people with a loud voice and clear thinking.
Xiao Xu was treated and was able to walk independently on the ground.
Xiao Xu is just one of tens of millions of patients with chronic impairment of consciousness, and according to conservative estimates, there are at least 500,000 "vegetative people" on the mainland. Rehabilitation area is a member unit of the China Association of Physicians with Impaired Consciousness, a member unit of the China Coma Rehabilitation Alliance, a chairman unit of the Hunan Neurological Rehabilitation Alliance, and a chairman unit of the Hunan Provincial Coma Rehabilitation Specialist Alliance, from clinical to scientific research, in the past three years, the department has treated 212 patients with chronic consciousness disorder, successfully awakened 136, and the awakening rate reached 64.15%, so that more vegetative people no longer sleep.
Text: Rehabilitation area Huang Lei, Qin Liang, Xiao Chunhua
Editor: Wu Jing
Review: Zhou Jinrong
Hunan Provincial People's Hospital Health Medical Line