Children and young adults in a prolonged unconscious state due to severe brain injury: outcome after an early intensive neurorehabilitation programme.
OBJECTIVE
The Rehabilitation Centre Leijpark in The Netherlands provides an Early Intensive Neurorehabilitation Programme (EINP) to children and young adults in a prolonged unconscious state after severe brain injury. In an extensive research project the effects of EINP were studied. This part of the project focused on the outcome in terms of level of consciousness (LOC) in relation to the specific characteristics of a retrospectively studied cohort.


METHODS
This study was executed according to a one-group archived pre-test-post-test design.


METHODS
Subjects were all consecutively admitted patients (n=145, 72% male) between December 1987-January 2001. Inclusion criteria were: age 0-25 years, within 6 months after injury, LOC at admission vegetative state (VS) or minimally conscious state (MCS). One hundred and four patients (72%) suffered a traumatic injury and 41 patients (28%) a non-traumatic injury.


METHODS
All patients had received EINP until they reached consciousness or until it was concluded that no progress was achieved during 3 months after the start of EINP. Medical files were investigated to collect the patients' characteristics and injury data, to determine the LOC at admission and at discharge and to determine the discharge destination.


RESULTS
Almost two-thirds of the patients reached full consciousness. LOC at admission, aetiology and interval since injury were found to be significant prognostic factors. Traumatic patients had a much better outcome than non-traumatic patients. A comparison with earlier outcome studies showed a more favourable outcome than expected. It is argued that a multi-centre study is needed to confirm possible effects of EINP.
Eilander
H J
HJ
Rehabilitation Centre Leijpark, Division Research, Project VLB-NAH, Tilburg, The Netherlands. h.j.eilander@hccnet.nl
Wijnen
V J M
VJ
Scheirs
J G M
JG
de Kort
P L M
PL
Prevo
A J H
AJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003243:Consciousness; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018458:Persistent Vegetative State / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D012017:Referral and Consultation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014474:Unconsciousness / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*