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Approaches to assessment and rehabilitation of people in states of reduced awareness
Shiel, A., WILSON, B.A., Elliot, L.E., Foley, J., Menon, D., Pickard, J.D
Brain Impairment, 5(1), 101
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Admission to many rehabilitation units is dependent on the patient's ability to engage and participate in rehabilitation programmes. Yet, this may exclude those patients who are slow to recover full consciousness and/or remain in states of reduced awareness. In addition, even for those who recover more readily, the window of opportunity to address impairments caused by brain injury may be reduced. Rehabilitation after brain injury should begin immediately. Even patients in the very early stages of recovery for example, those who are still dependent on ventilators benefit. Accurate and regular assessment is central to provision of appropriate intervention, Accurate and regular assessment is central to provision of appropriate intervention. If appropriate assessment is not carried out, it may appear that progress has ceased whereas subtle gains are being made over weeks, months, or even years. Assessment should also be carried out at different times of the day and in different environments as meaningful behaviours may occur at infrequent and unpredictable intervals and responses are rarely is ever consistent. When such gains and/or behaviours are correctly identified they can be consolidated with some patients when treated in an appropriate environment by a multidisciplinary team. Approaches to rehabilitation of people in states of reduced awareness may be restorative, compensatory or adaptive. Regardless of the approach, many of the techniques and methods employed are similar. These include provision of a stimulating environment, the interaction of people in the environment with the patients and postural changes. A series of single case studies including coma, the vegetative state and the minimally conscious state will be used to illustrate how appropriate assessment and treatment methods can be applied regardless of location.