Abstract
Patients with motor dysfunction accompanied with disturbance of consciousness are often encountered among those with central nervous diseases.
Patients with disturbance of consciousness usually lack the will to recover, spontaneity and the ability to communicate. Particularly in those with severely disturbed consciousness (consciousness level of two or three digits according to the Japan Coma Scale established by the Japan Neurosurgical Society), self-directed movements also disappear and prognosis is poor in many cases.
In such patients, life-saving treatment including the following procedures are required: intubation feeding, tracheotomy, oxygen inhalation, intravenous drip, balloon insertion, use of diaper, etc. When too much time are required for the treatment, irretrievable secondary complications may occur, possibly leading to delayted rehabilitation including maintenance therapy.
We performed rehabilitation in patients with dyskinesia as a main complaint accompanied with disturbance of consciousness using not only conventional maintenance therapy but also providing assistance to the patient in getting up and sitting, maintaining a sitting position, balancing, transferring to a wheel chair, standing up, etc. Multiple sensory stimulation was also applied to induce reflex movements. We performed such rehabilitation in 21 patients (14 males and 7 females, mean age 54 years) with encephalitic central nervous diseases for 4 years.
The following results were obtained: (1) Twelve patients (57%) had severe degree of disturbance of consciousness (two or three digit level of consciousness) when rehabilitation was started, but the level returned to zero in all cases. (2) All patients were eventually able to leave their sickbed. (3) According to the stage established by the 2nd Tokyo National Hospital, all patients showed severe disturbance of under 2 at the initiation of rehabilitation, but 11 (52%) showed a recovery to over 7, the level at which it was possible for patients to walk, by the end of rehabilitation.
Early rehabilitation seemed to induce more favorable results.
