Vegetative state
introduction
The so-called vegetative state is a condition in which there is a failure of the cerebral functions while the functions of the brain stem, spinal cord, cerebellum and some diencephalic functions are preserved. This is usually the result of severe brain damage, for example as part of an accident. In medicine, the vegetative state is also called apallic syndrome designated. The affected patients appear alert to the outside world, but can hardly come into contact with their surroundings at all. Every year around 3,000 to 5,000 people in Germany are newly affected.
definition
In medicine, various criteria have been established that the Uniformly define the state of the coma should.
Loss of the ability to come into contact with the environment or to actively perceive the environment as well as loss of awareness of oneself
Loss of normal sleep-wake rhythm
Loss of speech understanding and production (Aphasia)
Loss of the ability to specifically react to external stimuli with one's own behavior
Loss of control over bowel and bladder function (Incontinence)
Extensive preservation of the reflexes
causes
As The cause of the decline into a vegetative state very different factors come into consideration. What they all have in common, however, is that they are one severe brain damage cause. That happens most often apallic syndrome caused by a traumatic brain injury in an accident (e.g. traffic accident, fall from a great height). At severe injuries with extensive blood loss The apallic syndrome can also be called Result of the temporary lack of oxygen in the brain occur.
Finally, many other diseases that affect the brain can lead to a vegetative state. These include, for example, brain tumors, strokes, meninges or encephalitis or neurodegenerative diseases, such as various Parkinson's syndromes or Alzheimer's disease.
Find out everything about Parkinson's Syndrome here: Parkinson's Syndrome
Ultimately, massive metabolic imbalances can also trigger a vegetative state, for example massive and long-lasting low blood sugar (hypoglycemia).
Symptoms
Patients who are in a vegetative state appear awake at first glance, but are unable to communicate with their environment. It is impossible for them to do everyday activities, eat or drink independently.
Are typical automated movements, bowel and bladder incontinence, spasms in arms and legs as well received reflexes. One often shows up after a few weeks Disorder of the autonomic nervous systemwho are going through Sudden high blood pressure, excessive sweating, racing heart and sometimes muscle twitching can express. This condition usually stabilizes again soon. At the beginning of the coma, the patient is usually up artificial respiration reliant.
After a few weeks in the intensive care unit, artificial ventilation can usually be stopped when the patient is breathing again on his own. This is an expression of the recovery of the brain stem.
diagnosis
To the diagnosis of a coma awake is especially the intense observation of the patient via a longer period (Weeks to months) of vital importance. By identifying the typical clinical symptoms, the suspicion of a vegetative state can already fall. But that is important Differentiation from similar states of consciousnesssuch as the Locked-in Syndrome or that comabecause these patients have to be treated differently.
That is also important imaging diagnostics (especially the Magnetic resonance imaging/MRI). in the EEG let the Brain waves derive and check whether the patient perceives stimuli from the environment. They work similarly evoked potentials (acoustic and somatic evoked potentials)in which the brain's reaction to various stimuli presented is analyzed. Unfortunately, it is not always easy to differentiate the various forms of unconsciousness and the numerous differential diagnoses from the actual vegetative state. Hence are Misdiagnoses are not all that rare.
therapy
The therapy of vegetative coma patients takes place in several stages depending on the current condition of the patient.
In the early phase, when the patient cannot yet breathe or swallow himself, he is artificially ventilated and fed through the abdominal wall via a gastric tube.
The urine is also artificially drained. In this way the body functions are preserved. Physiotherapeutic exercises that start early should prevent cramps and shortening of the muscles. It is also important that the patient is sufficiently mobilized so that he does not suffer from pneumonia while receiving artificial ventilation. Physiotherapy also works on the act of swallowing. After the patient has stabilized and his condition has improved, the next stage of therapy can be continued.
The principle of basal stimulation is followed. The patient is offered stimuli of different quality that are intended to improve his perception, psychological and motor functions.
Examples of such therapy offers are music therapy, massages with different oils or materials, work with different colored lights and petting animals. This phase of therapy is crucial, as it is the most likely to show the patient's progress and thus create important cornerstones for his future. If there is a clear improvement in his condition, he can be guided further towards independence through further rehabilitative measures; if he does not improve, the care and addressing is continued through various stimulus concepts.
forecast
The forecast for a patient with vegetative state is bad overall. Significantly less than half of the patients recover from this condition, as most of them have been preceded by severe brain damage. Nevertheless, there are various parameters that speak for a better prognosis. This includes a young age of the patient, less than 24 hours coma Before entering a vegetative state and a traumatic event as the cause of the condition, while awake coma patients have poorer prognoses due to a lack of oxygen or insufficient blood flow.
Factors that speak for a poor prognosis for the patient are the absence of the brain stem reflexes after more than 24 hours, severe changes in the EEG, massive brain swelling, failure of the pupillary reaction after 72 hours, as well as bilateral damage to the Brain stem. As a rule, there is no complete recovery from the vegetative state - patients need lifelong help in their everyday lives. If there is no improvement in the condition of the coma patient after a traumatic brain injury within 12 months, this is usually no longer to be expected after this period.
prophylaxis
There is no direct prophylaxis to avoid a vegetative state. The vegetative state is mostly the result of severe brain damage in the context of an accident or other not necessarily foreseeable events. A forward-thinking lifestyle is therefore a basic requirement to avoid such conditions. In order not to develop diseases that could one day lead to a vegetative state, such as strokes, is one healthy lifestyle the basis. Adequate exercise and a healthy diet are the basic requirements for maintaining good health, but cannot target a person before apallic syndrome preserve.
maintenance
The care of patients in a vegetative state is very individual differently and requires a lot of time and experience.
Every patient is slightly different in their needs. The Care concept is therefore depending on the individual case individually adapted.
The measures to be taken also differ depending on the stage of the coma. The patient not only needs to be physically cared for in his basic needs, but also needs motor and mental support.
A vegetative coma patient is therefore often cared for by a team of various staff. This includes trained nurses and doctors on the one hand, speech therapists, physiotherapists and occupational therapists on the other, and of course the relatives, who should definitely be included in the care of the patient. Targeted addressing of the patient and the repeated presentation of various stimuli, for example music, tactile stimulation of the skin, the use of animals, lights or colors, the patient's brain regions can be addressed and activated. Some vegetative coma patients experience one as a result improvement their condition.
The intensive care and support of the patient is therefore Basic requirement for its possible rehabilitation.
