Why is Coma Arousal Therapy needed?
- Some patients wake spontaneously, some don’t
- These patients are (and need to be) designated as “rehab” but will not be a priority in a busy rehab unit where other patients are making daily gains
- People in comas have specific and different needs compared to other patients
- Need to be rehab because need OT/SLT/ PT/SW inputs
- AND they need a program that is intensive enough to give results BUT gentle enough to allow adequate time for rest which people with brain injuries need to recover.
How did we come up with what we want to do?
- Experience in acute neurosurgical settings including ICU/high care/ wards and in rehab units and head injury brain injury societies
- From the literature
- Intuition/understanding about what comatose people need and what makes their comas lighter
What do we actually want to do?
- Allow for lots of stimulus
- Allow for lots of rest
- Monitor individual patient’s responses
- Create a timetable that provides these things and works for this category of patient (It won’t necessarily fit in with the way we have done things before though)
- Obtain data on what happens
- Please use first names and talk to patients in their own language when possible.
- Patients will need to be doing different things during stimulation periods – someone might be listening to music, someone might be having physio or getting showered, someone else might be outside and/or doing the sensory program and the 4th person might be being seen by the doctor or having nursing interventions
- During stimulus periods staff should talk to each other and patients
- Rest periods should be silent with no TV/ no music/ no talking by staff/ no nursing or medical intervention unless they are critical for care/ no therapy/ no blood tests etc.
- Research suggests minimum of 2 weeks before any results in subacute/acute patients. (Ours are mostly chronic patients.)
- It also suggests 1 full month of the sensory program needed before there are any permanent changes.
- We will need to train families what to do to help
- Planning to have themed displays on walls so if patients are lying with eyes open there is something stimulating to look at (waiting for display boards to be put up)
- We’ll use the small display boards over each person’s bed to put the patients’1st names and favourite colours and other info
- Everyone should talk to patients during activity times and explain what they’re doing and why
- Regular suction is important for rest
- We want to use multi-modal sensory inputs (i.e. something for every sense at least once a day)
- Doctors: We often miss you in the ward and therefore can’t communicate verbally, but we will put queries/problems we identify in the notes, so please will you read them and respond in the same way where possible?