Neurorehabilitation for severe disorder of consciousness: the S. Anna – RAN operational model

Dolce, Giuliano; Lucca, Lucia Francesca; Quintieri, Maria; Leto, Elio; Rogano, Stefania; Riganello, Francesco; Pignolo, Loris

doi:10.2340/16501977-0968

Cited by 7 publications

(6 citation statements)

References 17 publications

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“…With the goal of reintroducing the patient to their home environment, the family is trained to care for them at home for brief periods of time when it is practical. It is also possible to extend the healthcare and neurorehabilitation at the patient’s home under remote control, thanks to a collaboration between our institute, the local government, and the healthcare organization [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, WHIM is generally simple to use in neurorehabilitation settings, requires less staff training, and although WHIM takes relatively more time to administer, it allows a regular or routine serial examination. These aspects could make WHIM useful to help therapists and relatives to identify which stimuli, in different environments (e.g., in the context of domiciliary care), work better for the patient [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

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Behavioral scales variability in patients with prolonged disorders of consciousness

et al. 2023

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Background The principal conditions differentiating disorders of consciousness (DOC) patients are the unresponsive wakefulness syndrome/vegetative state (UWS/VS) and the minimally conscious state (MCS). Many individuals who suffer from sudden-onset severe brain injury move through stages of UWS/VS and MCS before regaining full awareness. In some patients, the DOC condition is protracted for years (PDOC). In this study, we observed PDOC patients for 6 months to assess possible changes in their level of consciousness. Methods We enrolled 40 PDOC patients, 23 UWS/VS and 17 MCS hosted in a dedicated unit for long-term brain injury care. The time from injury was 472 ± 533 days for UWS/VS and 1090 ± 1079 days for MCS. The Wessex Head Injury Matrix (WHIM), Coma Recovery Scale-R (CRS-R), and Nociception Coma Scale were administered monthly for 6 months. Results During the period of assessment, the percentage of UWS/VS shifted from 58 to 45%, while for the MCS, from 42 to 55%. A positive correlation was found for the UWS/VS patients between the months of observation with the CRS-R total score and WHIM total numbers of behaviors (TNB). In the UWS/VS group, the CRS-R auditive and visual subscales correlated positively with the observation time. During the whole period of observation, 8 patients had constant CRS-R total scores while the WHIM TNB changed in 7 of them. Conclusion Our findings demonstrated that the monthly assessment of PDOC by means of the CRS-R and WHIM was able to detect also subtle changes in consciousness level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Behavioral scales variability in patients with prolonged disorders of consciousness

et al. 2023

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“…For example, the InterQual IRF admission guidelines require patients to be "Rancho Level III [roughly MCS] and evolving" to qualify. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Moreover, reimbursement to SNFs is typically insufficient to support multidisciplinary rehabilitation and specialty medical monitoring that were previously possible in the fee-for-service environment. Consequently, many patients who have DoC are discharged directly from acute care to health care settings lacking expertise to provide specialized care.…”

Section: Background and Rationalementioning

confidence: 99%

“…16 Evidence suggests that achieving and maintaining medical stability is the result of active management rather than the passage of time 17 and may decrease overall health care costs. 18 Complications and comorbidities associated with DoC are best managed by specialists in settings that routinely provide care for such patients.…”

Section: List Of Abbreviationsmentioning

confidence: 99%

Minimum Competency Recommendations for Programs That Provide Rehabilitation Services for Persons With Disorders of Consciousness: A Position Statement of the American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living and Rehabilitation Research Traumatic Brain Injury Model Systems

Giacino

Whyte

Nakase‐Richardson

et al. 2020

Archives of Physical Medicine and Rehabilitation

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Persons who have disorders of consciousness (DoC) require care from multidisciplinary teams with specialized training and expertise in management of the complex needs of this clinical population. The recent promulgation of practice guidelines for patients with prolonged DoC by the American Academy of Neurology, American Congress of Rehabilitation Medicine (ACRM), and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) represents a major advance in the development of care standards in this area of brain injury rehabilitation. Implementation of these practice guidelines requires explication of the minimum competencies of clinical programs providing services to persons who have DoC. The Brain Injury Interdisciplinary Special Interest Group of the ACRM, in collaboration with the Disorders of Consciousness Special Interest Group of the NIDILRR-Traumatic Brain Injury Model Systems convened a multidisciplinary panel of experts to address this need through the present position statement. Content area-specific workgroups reviewed relevant peer-reviewed literature and drafted recommendations which were then evaluated by the expert panel using a modified Delphi voting process. The process yielded 21 recommendations on the structure and process of essential services required for effective DoC-focused rehabilitation, organized into 4 categories: diagnostic and prognostic assessment (4 recommendations), treatment (11 recommendations), transitioning care/long-term care needs (5 recommendations), and management of ethical issues (1 recommendation). With few exceptions, these recommendations focus on infrastructure requirements and operating procedures for the provision of DoC-focused neurorehabilitation services across subacute and postacute settings.

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“…Professional commitment, logistics, and costs must be sustainable and hospitalization must be limited by time. The overall architecture of the Institute S. Anna-RAN has been originally designed [ 78 ] and upgraded in the following years in order to manage a sequence of activities to investigate residual brain function(s) in each subject with DOC and make use of any newly acquired knowledge to improve diagnosis and treatment in a circular, self-supporting process producing scientific, translational, and applicative research. In association with the turnover among units and home care under remote medical control of the eligible subjects, the approach has limited hospitalization to six months in almost the totality of cases.…”

Section: Commentmentioning

confidence: 99%

Care and Neurorehabilitation in the Disorder of Consciousness: A Model in Progress

Dolce

Arcuri

Carozzo

et al. 2015

The Scientific World Journal

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The operational model and strategies developed at the Institute S. Anna-RAN to be applied in the care and neurorehabilitation of subjects with disorders of consciousness (DOC) are described. The institute units are sequentially organized to guarantee appropriate care and provide rehabilitation programs adapted to the patients' clinical condition and individual's needs at each phase of evolution during treatment in a fast turnover rate. Patients eligible of home care are monitored remotely. Transferring advanced technology to a stage of regular operation is the main mission. Responsiveness and the time windows characterized by better residual responsiveness are identified and the spontaneous/induced changes in the autonomic system functional state and biological parameters are monitored both in dedicated sessions and by means of an ambient intelligence platform acquiring large databases from traditional and innovative sensors and interfaced with knowledge management and knowledge discovery systems. Diagnosis of vegetative state/unresponsive wakefulness syndrome or minimal conscious state and early prognosis are in accordance with the current criteria. Over one thousand patients with DOC have been admitted and treated in the years 1998–2013. The model application has progressively shortened the time of hospitalization and reduced costs at unchanged quality of services.

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Neurorehabilitation for severe disorder of consciousness: the S. Anna – RAN operational model

Cited by 7 publications

References 17 publications

Behavioral scales variability in patients with prolonged disorders of consciousness

Behavioral scales variability in patients with prolonged disorders of consciousness

Care and Neurorehabilitation in the Disorder of Consciousness: A Model in Progress

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