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Samenvatting Coma & Ataxie
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Samenvatting van 7 pagina's voor het vak Neurological Physiotherapy 3 aan de UA (coma en ataxie)
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REHABILITATION IN COMA PATIENTS1 DEFINITION
Coma = toestand van diepe bewusteloosheid met het ontbreken van abnormale reacties op externe stimuli. Als
gevolg van een hersenletsel -> gebruikt als overkoepelende term voor verschillende stadia/ types
Awareness = the quality or state of being awake
Wakefulness = the state of being responsive (to external stimuli)
Minimally conscious state = awake and at times conscious/aware à gradual awareness is possible
(Persistent) vegetative state = awake but unaware à most of the times leads to death
Locked- in syndrome (exception): Damage to the lower brain and brain stem, but not the upper brain.
Brain death = irreversible coma <-> general anesthesia = reversible coma
Measuring instrument -> Glasgow coma scale : voor level van conciousness
Score = som van eye opening, verbal respons en motor respons
Altijd 1st gehoorsproblemen nagaan, gevolgd door observatie vd categoriën -> daarna stimuleren: verbaal
(roepen) en tactiel (druk geven aan vingertop, trapezius of supraorbitaal)
Elk half uur rating doen tot maximale score door de pt wordt behaald
2 STIMULATING PROGRAM
Doelen:
Verhoging van het bewustzijnsniveau / alertheid
- bevorderen van het ontwakingsproces van de comapatiënt
- Voorkomen van sensorische deprivatie en isolement
Bevorderen van gedragsreacties door gerichte stimulatie
- stimuleren van hersengebieden (vnl thalamus, frontale en parietale connectie) - aanspreken van
reservecapaciteit van de hersenen en het bevorderen van reorganisatie
Verbinding met patiënt maken
- zoeken naar een manier om te communiceren
- communicatie op gang brengen
Leefomgeving
- Aanpassingen van de omgeving -> om het aangenamer te doen aanvoelen (meer herkenbaar)
, Structuur:
Geïndividualiseerd -> gebruik maken van persoonlijke interesses
Multidisciplinair karakter
Verschillende elementen: Leefomgeving (elke dag stimuleren!), Specifiek zintuiglijk stimulerings-
programma, Intensieve begeleiding van de familie
PHYSIOTHERAPEUTIC REHABILITATION
1. SENSORY STIMULATION (SENSORY STIMULUS PROGRAM)
Concept: Basal stimulation (Andreas Fröhlich) -> difference between proprioceptive and exteroceptive stimuli
Base of concept = Patient isn’t aware of his own body -> stimulate perception: initiate communication
Use specific and strong stimuli !
Concept: Affolter (Andreas Fröhlich)
Perception of body + environment -> what and where -> check paramters: good positioning!
What and where question: must be answered
à what is my body doing and where is my body in the room?:
At the same time processed in the brain: but in different regions of the brain
à patient will relax and not build up some tension in the body.
Belangrijk = focus op comfort en relaxatie -> geen overload/ onaangename stimuli en focus op lichaamsbeleving
Guidelines:
15-30 min per stimulation session (4 X 15’/dag)
Alternating senses, separately (avoid other disturbing stimuli: hospital noise, radio in the room, …)
Intensity Bilateral Habituation!
Individual / person related (know your patient!)
Patient must be as awake as possible (influence medication, posture,…)
Tactile stimuli: touch (hugging), massage/ rubbing/ vibrations, naming stimuli in later stadium
Temperature stimuli: cold/ hot compress; dryer, ice cubes, fango (= compres van water en parafine -> heat therapy die
spierspanning doet afnemen)
Pain stimuli: pinching, pressing on nail, pricking, tapping cheek or pinching
Visual stimuli: Light in the eyes; Strob light (light flashes with high frequency); Move mirror just before patient’s eyes; TV
/ slides in a darkened room; View photos together; Color contrasts
Auditory stimuli: Intensity (variation: volume, low or high tone,…); Loud sound (2 boards against each other, …); Sharp
flute tone; Bicycle bell; Favorite music; Talking (name, memories, current events, …); Voice messages from family and/or
friends
Aroma stimuli (taste): Salt, sweet, … ; Herbs; Solid or semi-solid food; Caution with swallowing problems (alertness, cranial
nerves, head position !!); Smell stimuli; Mint, floral aromas, sharp scents, …
N Vagus en N Glossopharyngeus -> slik-proces -> oppassen voor verslikken wnr deze beschadigd zijn
Mogelijk reacties: ogen openen, knipperen, oogbewegingen, grimace, hand squeeze, terugtrekreflex (triple flexion LL)
2. POSITIONING & TRANSFERS
Geeft zowel proprioceptieve info als preventie van hoge spiertonus en decubitus
Kan ook sensorische info geven (door druk van kussens en matras)
Bij transfers is de pt altijd zo actief als mogelijk is
3. MOBILIZATION
Wervelkolom
Verbeteren respiratie, decompressie van neurovasculatuur, mobiliteitsverlies tegengaan
Ledematen:
Preventie van spierverkortingen, preventie van verminderde joint mobility, neurodynamische mobilisatie
Controleer de startpositie -> volledige ROM
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