Rehabilitation outcome in a patient awakened from prolonged coma.
BACKGROUND
This article describes the rehabilitation of a patient recovering from a prolonged coma (defined as lasting longer than 4 weeks). The case is noteworthy because it exemplifies the possibilities and difficulties entailed in treating these patients, who are often regarded as too severely impaired to justify intensive rehabilitation efforts.


METHODS
The patient is a 28-year old Polish male, unmarried, who suffered serious closed head injuries in an automobile accident in April of 1999. He was in a comatose state for more than two months, with a GCS score of 5. When admitted for rehabilitation he was bedridden, with global aphasia, agraphia, limb apraxia, and executive dysfunction. The rehabilitation program developed for him is described in detail.


RESULTS
Over the course of rehabilitation, which began in December 1999 and continues to this writing, the patient has regained locomotion capabilities (though with impairments), and his speech has improved considerably. The apraxia has largely resolved, and he is able to write his name and copy words. He is now capable of performing many activities of daily living.


CONCLUSIONS
A comprehensive program of rehabilitation characterized by a strategic, heuristic approach is capable of achieving a good outcome even in very difficult cases, such as prolonged coma.
Talar
Jan
J
Department and Clinic of Rehabilitation, Medical University, Bydgoszcz, Poland. klreh@amb.bydgoszcz.pl
D000063:Accidents, Traffic; D000203:Activities of Daily Living; D000328:Adult; D001072:Apraxias / Q000209:etiology / Q000534:rehabilitation; D001925:Brain Damage, Chronic / Q000209:etiology / Q000534:rehabilitation; D001930:Brain Injuries / Q000534:rehabilitation*; D002557:Cerebrospinal Fluid Shunts; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation; D020207:Coma, Post-Head Injury / Q000150:complications / Q000534:rehabilitation*; D005625:Frontal Lobe / Q000473:pathology; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery; D007806:Language Disorders / Q000209:etiology / Q000534:rehabilitation; D008297:Male; D009069:Movement Disorders / Q000209:etiology / Q000534:rehabilitation; D009483:Neuropsychological Tests; D026741:Physical Therapy Modalities; D012720:Severity of Illness Index; D013064:Speech Disorders / Q000209:etiology / Q000534:rehabilitation